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Paradigm Shift Intervention Monitoring
Asir Mild MERS
Cluster Raises Pandemic Concerns
The above description from the Kingdom of Saudi Arabia Ministry of Health (KSA-MoH) website cites the two most recent confirmed MERS-CoV cases, a contact of a confirmed case and an associated health care worker (HCW). Both cases are mild and recovered or are recovering without treatment of hospitalization. These cases extend a recent trend in KSA of confirmation of mild or asymptomatic contacts (which frequently included HCWs) of confirmed cases which have been reported throughout KSA (see map).
This latest cluster began with a confirmed case (66M) in a military hospital in Asir (see map). Media reports noted that there were three additional suspect cases in the area, and the above report confirms MERS-CoV in two. These two confirmed cases raise the official KSA numbers to 68 confirmed and 38 fatal cases, but these numbers are largely meaningless and are used to put out press reports for media stories which grossly misrepresent the true MERS-CoV distribution in the Middle East. MERES-CoV has attainedsustain community transmission throughout the region, which strong parallels with the SARS outbreak in 2003.
An announcement by a MERS emergency committee is expected today, to attempt to restore some credibility to WHO comments on the situation (and move beyond "seemingly sporadic"). Recently WHO has acknowledged the obvious (possible sustained community transmission), but has not formally confirmed community transmission.
The latest cases support community transmission since almost all confirmed cases are associated with onward transmission, which largely involves mild symptoms in contacts. KSA acknowledged these mild cases indirectly in the spring, when they noted that most of the mild cases were in Jeddah, when the only confirmed case was the first confirmed case, who was a resident of Bisha who was diagnosed and died in Jeddah in July of 2012. The only confirmed Jeddah case since the mild cases were announced was a child (2M) in a military hospital who also died. Thus, to date there have been no confirmed mild cases in Jeddah, although the KSA-MoH was well aware of the mild cases in the spring.
The recent mild and asymptomatic cases signal earlier gaming of the system, and invalidate WHO claims of no sustained community transmission.
It will be interesting to see if the emergency committee acknowledges the sustained transmission, or merely extends the WHO fairy tale on community transmission.