Monday, 12 May 2014

MERS-CoV detections and deaths: is the war on MERS making headway?

For a few days now its felt as though we are seeing a more deaths in each Kingdom of Saudi Arabia (KSA) Ministry of Health (MOH) report, than we had been for a while. All very precise language there.

Currently there are about 161 fatalities among the 571 MERS-CoV detection. According to those numbers, 28.2% of people testing positive for MERS-CoV have died.



NOTE: Specific dates for some deaths are missing; date of reporting has been used instead.
The chart use 151 of approximately 161 deaths.
Click on image to enlarge.

Earlier in April, when the case numbers exploded thanks to a healthcare-associated outbreak, I wondered on Twitter if we'd see deaths "catch-up" to announcements as cases struggling for life in hospital, eventually succumbed to the damage started by their MERS-CoV infection. This is a virus with an apparently determined ability to wreak havoc in the lungs and kidneys of those who often already have an associated underlying disease of these tissues, and/or the cardiovascular system.

From the chart above, it looks like that catch-up is happening as the number of fatal outcomes (red dots) among the total of laboratory-confirmed MERS-CoV detections (green mountain) has been rising from mid-April onward. 

Most notable to me is that the proportion of fatal cases (PFC) is now also rising as the number of new detections no longer outstrips the number of deaths being reported. 

This is the first rise (rise >1% in PFC at least) since the beginning of March and reverses a trend of relatively stable PFC which dated back to late Aug-2013. 

This bears watching both at face value but also in light of the recent concerns about extra testing and its impact on straining the KSA healthcare system. It might be more prudent to discuss the significant strain being placed on the KSA healthcare system by filled hospital beds and intensive care units and the supportive management of severely ill people detected as result of that testing. 

The testing  should be telling the MOH (even if it no longer tells us) in which hospitals the problems lie. At this stage, 21-days after the KSA Health Minster was replaced (21-April-2014), we'd expect to see the case numbers dropping as (hopefully) changes have been implemented that (hopefully) focused a stern gaze toward (hopefully) improving healthcare worker safety and (hopefully) infection prevention and control (IPC). 

21-days into the new Health Minister's watch lies well outside the upper limit of the known MERS-CoV incubation period. If changes were sufficiently sweeping and if the war on MERS was entering a phase, detection numbers should be dropping as steeply as H7N9 cases do after a wet market closure. But they are not. Not yet anyway. 

The accumulating MERS-CoV detections (green mountain) are looking to be slowing a little, which is good news. But of course with that slowing, I expect we'll see those red and back lines rise in the weeks ahead as deaths keep occurring. Which is not, and will not be reported as, good news. About the only thing to stop that numerical marker from rising would be a new outbreak of cases. Not something we want to see. And of course, it would only be a smoke-screen for the fact that MERS-CoV positive people are still dying from MERS-CoV infection and the complications that ensue.

Last point for this post. Recent KSA MOH reports are more up-to-date than they have been for a while so we can see that MERS-CoV infected people are still being admitted to hospital, even in recent days (e.g. 7-May), and MERS-CoV infected people are dying relatively recently too (e.g. 10-May).