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Paradigm Shift Intervention Monitoring
Hospital Linked MERS-CoV
Since 14 April 2013, 13 new cases of infection have been confirmed and reported in Saudi Arabia (10 males and 3 females, median age 58 years). Seven of these have died, four remain critically ill in intensive care and two are hospitalized but clinically improved. All patients were reported to have at least one comorbid medical condition and most had more than one. Most of the cases were patients at a single health care facility. Two were family members of two patients from that facility;
The above comments are from a WHO update on MERS-CoV, which begins to acknowledge the large number of clusters as well as linkage to health care settings. Although the Jordan ICU cluster happened over a year ago, the above comments are the first acknowledgement by WHO of the number of probable novel coronavirus cases. Prior updates had noted that there were probably cases, which included likely examples of human to human (H2H) transmission from health care workers to family members, disease onset dates, age/gender, and the number of probable cases was withheld (and other than the number of probable cases are still withheld).
The above comments coupled with statements noting that the human sequences were distinct from bat sequences may help shift the emphasis from animal sources, which are frequently cited in media reports largely due to efforts by the ECDC and ProMED, which ignore that evolutionary distance between the bat and human sequences, as well as the absence of any animal contact in the vast majority of cases, including the large ICU cluster in Jordan. In the recent cluster linked to contaminated dialysis equipment in eastern Saudi Arabia, ProMED continues to float wild speculation on linkages to bats because the region grows dates.
The latest WHO update may focus media attention on the growing number of clusters ans well as the large number of cases cited in local media which are not included in the lab confirmed totals. Recent media reports have cited deaths in adolescents (ages of 9, 10, 11,18) as well as an infant (11 months) who was from eastern KSA and travel to Riyadh for heart surgery on a congenital defect and was found to be MERS-CoV positive (see map for detail).
Although these recent cases are not cited in WHO reports, the above comments do cite two clusters linked to the confirmed dialysis cases.
In addition the case exported from the UAE to France (see map) has been cited, and the symptoms in three contacts (patient, doctor, and nurse) serves as a reminder of the similarities between MERS-CoV and SARS-CoV, and raises concerns that more MERS-CoV cases will be identified in travelers from the Saudi Arabian Peninsula.