Experts in global health and infectious diseases say transparency
with data is critical to learning more about the virus, which until
two years ago had never been seen in humans but has now killed more
than 300 people worldwide.
And while an announcement on Tuesday that a historical review of the
outbreak had revealed 113 previously unreported cases, including 92
deaths, suggested greater openness, some scientists said
international health authorities may have been kept in the dark.
"It really calls into question why these cases weren't reported
before - particularly those that are at least two or more months
back in time," said Michael Osterholm, director of the Center for
Infectious Diseases Research and Policy at the University of
"From the information we have available I don't think we can tell
why (they weren't reported before). But it's one of two reasons -
one, it was incompetent surveillance that was not properly set up to
be able to detect and confirm these cases, or two, it was an
intentional effort not to report some cases, particularly the more
severely ill and fatal cases."
Tariq Madani, head of the scientific advisory board in the Saudi
Health Ministry's command and control center, said he did not
believe the under-reporting had been deliberate, and was due to a
range of factors.
"We don't think this was intentionally done, intentionally under
reported. This can happen anywhere in the world, that 20 percent of
patients may not be reported. This is within the limit. It's
actually less than 20 percent," he said.
The Middle East Respiratory Syndrome (MERS) virus, which can cause
fever, coughing, shortness of breath and pneumonia, is thought to be
transmitting into humans from camels, although scientists say
human-to-human spread is also taking place.
The Saudi agriculture minister was reported on Thursday as saying
the kingdom's camels would be tested.
Saudi Arabia has already been criticized for its handling of the
outbreak, which public health experts say could have been under
control by now if officials and scientists there had been more
willing to collaborate on studies into how the virus operates and
where it is coming from..
In response, the health ministry says it has put in place new
measures for better data gathering, reporting and transparency,
including standardization of testing and improved guidelines for
labeling and storing samples.
On Monday, acting health minister Adel Fakieh announced he had
dismissed deputy health minister Ziad Memish from his post. Fakieh
was appointed in April after King Abdullah sacked his predecessor
Abdullah al-Rabeeah following a surge in MERS cases.
On Tuesday the ministry revealed a jump of nearly 50 percent in MERS
deaths in a data review that also showed the number of cases since
2012 was a fifth higher than previously reported.
Latest Saudi figures show a total of 691 MERS cases in people there,
of which 284 have been fatal.
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The European Centre for Disease Prevention and Control (ECDC) said
it was not clear whether the new cases met the World Health
Organisation's definition of confirmed cases and noted that they had
been reported without key details.
"Information about age, gender, residence, probable place of
infection, whether the case is sporadic/primary or part of a cluster
of secondary transmission, health care associated transmission or
not, and whether the case is a healthcare worker, is missing," the
The health ministry's Madani said that although only limited data
was published on the ministry's website, more detailed data was
available to scientists and healthcare professionals who contacted
the ministry directly.
Ian MacKay, an associate professor of clinical virology at
Australia's University of Queensland who has been tracking the MERS
outbreak since the virus was first identified almost two years ago,
told Reuters he remained skeptical about how transparent the new
officials would be.
"I'm fairly doubtful about the whole process," he said in a
telephone interview. "We're seeing all this under a banner of
increased transparency, and yet there's no information about what
these 113 cases are, about where or how they were tested, or what
age they are. There's really very little information, so I'm very
dubious about what this is supposed to tell us."
The United Nations' public health arm, the World Health
Organization, said its experts were in Saudi Arabia providing
"The recent appointment of a new Minister of Health has resulted in
renewed energies and greater government commitments to address the
challenges linked to MERS. WHO welcomes all efforts to gather and
verify information and support the sharing of information about MERS,"
Osterholm said international scientists and health authorities
should encourage Saudi Arabia to stick to its word.
"MERS is not a Kingdom of Saudi Arabia problem, and it's not a
Middle East problem, it's an international problem - and it takes an
international response to deal with it," he said, noting that people
infected with the virus have already imported cases from the region
into Europe, Asia and the United States.
"Imagine if tomorrow one of these air passengers turned out to be a
super shedder of the virus and ends up in London or New York or Hong
Kong or Toronto. The world would change overnight."
(Additional reporting by Angus McDowall in Riyadh, editing by
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