Thursday, 24 April 2014

And then that happened....

Noting to see here. Ignore the blip.
These are not the data you were looking for.
Click on image to enlarge.
I had a big post written about the lack of cases and how that was unlikely to be real and how hypothesis, hand-waving and guesswork rush in to fill a vacuum because nature abhors a vacuum and humans resent a void of information when they think there should be some..blahblahblah. 

So that's deleted. 

We have this instead. 

What seemed to start as a healthcare cluster
in late March in Jeddah hospitals and among
Abu Dhabi paramedics, seems to have shifted towards
cases appearing across a wider area than had been occurring
immediately before the clusters. Weather? Festivals with
camels? MERS-CoV variant 2.0 with altered transmissibility
characteristics? Multiple things? We don't know.
Click to enlarge.
MERS-CoV is a faster moving beast than a variant of the Zaire ebolavirus right now, and for something only acquired through "close contact", MERS-CoV seems to be punching well above its weight in April when talking about transmitting. I think MERS-CoV now needs to come with the ebolavirus tag of "numbers are subject to change". Right now, that change is all upwards and at a pretty rapid daily rate. April alone has nearly seen more cases than all those reported for all of 2013 (n=171). 

April certainly contains the biggest number of MERS case announcements ever. Apologies to the Buzzfeed article that came out overnight; numbers have moved a bit even since then. 2014 has already equaled all of 2012's and 2013's detections added together. Another interesting number, 23-Apr, it is the biggest single day of MERS-CoV case reporting ever.
Click on image to enlarge.

So let's all agree that the pattern of MERS-CoV detections has changed this month compared to any other month you want to point at.

But why? 

I have two main thoughts on that.

  • Option 1: MERS-CoV v2.0 spreads better than v1.0. We need sequences to address this. If the virus has changed then this may be the percolation of a virus with pandemic potential, and a sizable clicnial impact among a particular portion of the community, happening in  real-time. Or not. Suffice to say we need hose sequences yesterday to stay in front of that possibility and its global implications.
  • Option 2. Massive breakdown in infection prevention and control in some healthcare facilities, which has spread. The question I have about this option is why has it occurred in 2 geographically distinct places at once (Jeddah, Kingdom of Saudi Arabia [KSA] & Abu Dhabi, United Arab Emirates)? The fact that healthcare workers were intimately involved at both sites adds weight to close-contact, but also to their role as sentinels for emerging viruses, including v2.0 variants. And this much close contact? 
It's impossible to say which option, or if both, have contributed to the uncharacteristic and ongoing spike in cases. But we need to keep watching this closely for some answers since this is the most rapid development for MERS epidemiology since its discovery.

If the KSA Ministry of Health experts are serious about accepting ideas from outside, I have a few quickies:

  1. Please tell us what you're doing to control the cluster in Jeddah
  2. Please  tell us if testing methods or approaches have changed lately (more testing overall, different tests, testing instead of simply observing contacts..)
  3. Please tell us what you're doing to understand MERS-CoV, the virus, in 2014 (hint; sequence the Spike gene of as many viruses as you can get you hands on, do genomes later and release those data quickly; social media, WHO, Eurosurveillance or some other super-rapid journal for example)
  4. Please give us a reason, or a best guess, for why April is different from every other month since MERS-CoV was identified in 2012
  5. Please provide the WHO scrubbed case data more quickly and include sex/age/date of illness/animal contact[Y/N]/comorbidity[Y/N]/date of hospitalisation/region of KSA
  6. Please screen samples by PCR from the community, looking at asymptomatic, mild and moderate acute respiratory disease.
  7. Please publish some data on what other respiratory viruses do among older males with comorbidities (e.g. diabetes) in the KSA so we have a comparator for MERS-CoV

So let's all agree that the 1-day blip in case reporting was in response to changes in the Ministry and move on with hypothesis, hand-waving and guesswork. The void still exists of course, and we're all still living in it. Welcome to it fellow information seekers. Let's hope we get thrown a line soon. Because the daily double-digit case numbers now have me at "don't want to look away".

Click on image to enlarge.
I won't post a new sex chart as many of the April cases have no sex information attached to them. Here's the rolling average age per week based the 357/360 cases with data, including the influence of negative weeks. No obvious trend towards young cases?

Today saw 2 case releases in a single day (probably just catch up?) and the case load for MERS continues its ascent apparently unabated.


  1. A Deadly Virus Is Spreading Around Saudi Arabia And It Might Be About To Go Global