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Paradigm Shift Intervention Monitoring
Jeddah MERS Contact Testing
Before, tests were done on patients who had pneumonia and required [intensive care]. But now people are being tested not because they are sick, but because they had contact with a patient. Some of these tested positive, but many of them don’t really get sick.
The Saudi Arabian Ministry of Health routinely screens all close contacts of patients in whom MERS-CoV infection has been diagnosed, and more than 3000 people have been screened to date. We recently identified seven health care workers with MERS-CoV infection (two of whom were asymptomatic and five of whom had mild upper respiratory tract symptoms) through screening of single sample nasopharyngeal swabs by means of a real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) amplification test, with amplification targeting both the upstream E protein gene (upE) and open reading frame 1a (ORF1a) for confirmation.
The above comments (in red) are from the Science Insider story “MERS: A Virologist's View From Saudi Arabia” which claims that the recent spike in Jeddah MERS PCR confirmed cases was due to a March, 2014 change in the case definition, leading to increased testing.
However, the comments (in blue) from a NEJM paper entitled “Middle East Respiratory Syndrome Coronavirus Infections in Health Care Workers” which was published in August of 2013, cited more than 3000 tests on contacts on MERS confirmed cases. This testing identified seven health care workers who either had mild symptoms or were asymptomatic, confirming that there was no change in the case definition in KSA in 2014.
It is well known that there has been an increase in beta coronavirus cases in the spring. In 2003 there was an explosion of SARS-CoV cases and international spread almost exactly 11 years prior to the explosion of MERS-CoV cases in Jeddah. Similarly, the nosocomial outbreak in the ICU in Zarka, Jordan was in the spring of 2012, while a larger nosocomial outbreak in Al Hasa in eastern KSA was reported in the spring of 2013.
Thus, the increase in MERS cases in Jeddah hospitals the spring of 2014 lead to increased testing of contacts, which was due to more PCR confirmed cases, not a change in the case definition.
The claim that the testing caused the spike in cases because the case definition changed is clearly false and Science should retract the statement.
Moreover, the misrepresentation of the Jeddah case spike also raises concerns regarding the comment that the recent MERS sequences from Jeddah and Mecca, like the first three sequences released from early April Jeddah cases (Jeddah_C7569, Jeddah_C7149, Jeddah_C7770), "all look completely normal." This statement should be supported by release of the recent sequences at the Drosten website, as pledged in the ProMED letter published on April 26.
The failure to release the sequences, or answer the most basic questions regarding the relationship between the first three sequences and the subsequent three sequences, strongly suggests that all or most of these sequences form the same novel sub-clade with unique polymorphisms, as noted.
The Drosten lab has exclusive access to these critical samples, and sequences should be made public immediately.