A crack in the wall of MERS-CoV case information: new MERS cases, a key, a family cluster with 2 news cases from 1 [AMENDED]

Thanks to Prof Andrew Rambaut for pointing out my incorrect usage of R₀

In a strong piece by Maryn McKenna on Wired a bit over a week ago, she posited that "Censorship Doesn’t Just Stifle Speech — It Can Spread Disease".

Today we see a possible turn of events. In an post on ProMED today, Prof Memish, Deputy Minister for Public Health in the Kingdom of Saudi Arabia (KSA), penned his own update on case details from yesterday's announcement, and added information (including dates of illness onset) on 2 new, asymptomatic MERS-CoV cases!

This is a great sign that more information is starting to flow from the KSA. It was also extremely encouraging to see the appearance of a KSA key for these cases - SA83-the 55-year old male (55M); SA84-38M etc. I will add this numbering to my list in anticipation of this becoming a regular thing. This really does help track and confirm cases and information with much more precision. 

If you take requests Prof Memish - I have a few data gaps I would love to have filled (you can eMail me below)!!

We learned that SA83 (55M) was probably in contact with the recent Qatari patient diagnosed in Qatar. We should be looking a little more closely to Qatar as a source for recent cases - and applying that list from my last post, to there as well.

The new cases are both children who were asymptomatic family member contacts of 38M, who we learn was diabetic, showing signs of disease 8th of August and dying of acute respiratory distress syndrome on the 17th of August.

1. 16M (VDU #107; SA85)
2. 7F (VDU #108; SA86)

This is yet another case of 1 case infecting more than 1 new cases - 2 new cases in fact. Should that be the norm rather than the exception, we would see the basic reproduction number (R₀) creep upwards. We saw this also happen in the United Arab Emirates cluster (4 from 1) - see my earlier post on that.

The potential for transmission is certainly there but the level of contact requires "close" in its description (family). Further, the second passage of virus (from the initial case to the next people) seems to mostly result in milder/no disease - or is that simply a reflection of the odds favouring transmission to a person without comorbidity? In other words, MERS-CoV is an opportunistic pathogen but a bit of a wimp in "normal" healthy younger people.

This brings the case tally to 108 by my tally, with 49 deaths and a PFC of 46.7%.

Congratulations to Prof Memish and the KSA Ministry of Health for taking this new path. Long may it last.