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Paradigm Shift Intervention Monitoring
Coronavirus Reporting Delays
The above comments from the latest WHO update on coronavirus infections reflect reporting delays which continue to increase concerns that only a small fraction of the infections are being reported. The novel coronavirus produces a wild range of clinical presentations including mild cases, but only fatal cases have been reported in 2013 from the Kingdom of Saudi Arabia (KSA).
The track record of reports from WHO and the KSA Ministry of Health has lacked transparency, which also suggests that human to human (H2H) transmission is significantly higher than the reported confirmed cases. The three 2013 cases reported by the KSA MoH have been fatal and information on symptomatic contacts has been absent.
Unlike the initial cases in the SARS outbreak of 2002/2003, only lab confirmed cases are being reported for novel coronavirus (nCoV) cases and testing remains highly suspect. Although WHO acknowledges probable cases in the ICU cluster in Jordan last April, as well as the Riyadh familial cluster in late 2012, detail on the probable cases, including age, disease onset date, and relationships has been withheld.
The undercount of the confirmed cases has been linked in part to testing issues. An additional death was cited in initial reports of the first confirmed case, who was a Bisha resident who died at a hospital in Jeddah. The second death was not confirmed, and media reports suggested that samples were not collected from that case. More recent reports have also been delayed. The first case from Riyadh (45M) was reported on the date of discharge. The report on the Riyadh cluster cited the surviving confirmed case (31M) and failed to cited the death of the father (70M) and brother (39M) of the surviving case (or hospitalization of the 4th family member).
The first case in 2013 (61F) was said to have developed symptoms overseas, but no country or location was cited. Minimal information has been released on the two most recent 2013 cases (69M and 39M), and as noted above, the most recent case was announced 10 days after his death.
The limited information from KSA is similar to initial reports from Guangdong Province in 2003, when a “mysterious” disease was said to have cause 100 pneumonia deaths. Details on the cases were released after the SARS CoV spread internationally, and the vast majority of cases were reported between mid-March and mid-May.
Similarities between SARS-CoV and nCoV testing (which is heavily dependent on samples from the lower respiratory tract) and incomplete reporting continue to increase.