Friday, 9 May 2014

Snapdate: MERS-CoV by date 20-Apr:08-May [UPDATED]

With the addition of a new country, Lebanon, the 18th to host an imported or locally acquired laboratory confirmed MERS-CoV-positive, I've updated the world map below. 
Click on map to enlarge. It needs it!
I've also had a quick look at cases per day for some (but not all) recent detections of the MERS-CoV, based on the dates we have to work with. 

It certainly looks like case numbers are dropping slowly


Click on image to enlarge.
Having more dates of onset has helped to re-assign when people actually became ill, an important piece of the transmission puzzle for tracking the Jeddah-based outbreak. Onset is my date of choice - when it's available. 

We no longer know, or can't calculate using public data;

  1. When a death/recovered person is first identified. The Kingdom of Saudi Arabia (KSA) Ministry of Health (MOH) reports do not include any deliberate link between age/location of death/recovery they now note, and date the case was originally reported/became ill/was hospitalized. Any of those would be a Rosetta stone to decode the link. Apart from a "total dead/recovered" tally, having only partial information on death/recovery is another missed opportunity to be clear.
  2. Profession of the infected person. Just in broad categories, as we saw from China for H7N9 earlier on (not so much now). Healthcare worker detail has disappeared with no communication about whether this is due to an actual drop in such cases or not. Some assume it means we're just no longer being told this information. But a recent Filipino HCW (h/t @lisaschnirring) was reported back home as having died, yet HCW does not seem to have been listed on relevant KSA MOH report supporting the worries of the some.
  3. Homeland.  Is the infected person a KSA citizen, expatriate worker, pilgrim for umrah (or hajj later this year) a traveler for business or for pleasure?
  4. Links for contacts. We get told of contacts with previous cases but no linkage detail is provided.
  5. Respiratory symptoms may be mentioned as a reason for hospitalization (which is dated) but the date of onset (DOO) of these symptoms is sometimes not provided. DOO is the currency of good basic epidemiology in my opinion. Its gold, diamonds and platinum. It's chocolate (okay, that's just my currency). This data will occur for some cases but not for others, even within a single MOH announcement.
  6. Animal contact. No longer to we get mentions about exposure (be that to airborne or ingested virus) to camels/animals/farms. Add festivals to that.
  7. Date of laboratory testing. This isn't available for prodromal/asymptomatic people. They would be best identified using the date of testing - but since the MOH doesn't tell us the date of testing, I use the date of reporting. That might be anywhere from 1-day to 2-weeks after actual testing. 
  8. Nosocomial (hospital-acquired) MERS-CoV infection. Reliable dates would help identify these. This is available sometimes, but inconsistently. Relates to both #5 and #7 This is also confounded by the recent removal of hospital names, presumably to avoid panic and save face by not broadcasting the names of facilities with continued poor control of MERS-CoV spread.
I know that by saying "providing half-baked data is tantamount to providing no data at all", the intent could be changed and instead used to say "okay, then lets provide no data at all". Hopefully charts like mine and others and our commentaries do not serve to focus the MOH gaze on what to remove from the data that have draw our ire, but instead provide a service to help hone the message by stopping up data gaps and oversights

Endemic communication timidity and inconsistencies have been a hallmark of the emergence of MERS and the MERS-CoV. They only serve to promote anxiety and attempts by talking heads (like myself) to fill such information voids with guesses, the overuse of CAPITAL LETTERS and just plain vacuous garbage.

As ProMED put it in an email to its membership today in relation to Polio (and in seeking some funds to keep running which you can help with by donating here)..
"...the notion that gathering data and sharing it freely is in the best interests of everyone's health. Vigilant surveillance remains the best strategy for rapid response.."
'Nuff said.

Thanks to @HelenBranswell for further additions.