On his VDU's blog, Dr. Ian Mackay has a new post well worth reading and pondering: And then that happened.... He points out that this month alone has seen almost as many MERS cases as all of 2013. And April 23 "is the biggest single day of MERS-CoV case reporting ever." Then he goes on to say:
So let's all agree that the pattern of MERS-CoV detections has changed this month compared to any other month you want to point at.
I have two main thoughts on that.
Option 1: MERS-CoV v2.0 spreads better than v1.0. We need sequences to address this. If the virus has changed then this may be the percolation of a virus with pandemic potential, and a sizable clinical impact among a particular portion of the community, happening in real-time. Or not. Suffice to say we need those sequences yesterday to stay in front of that possibility and its global implications.
Option 2. Massive breakdown in infection prevention and control in some healthcare facilities, which has spread. The question I have about this option is why has it occurred in 2 geographically distinct places at once (Jeddah, Kingdom of Saudi Arabia [KSA] & Abu Dhabi, United Arab Emirates)? The fact that healthcare workers were intimately involved at both sites adds weight to close-contact, but also to their role as sentinels for emerging viruses, including v2.0 variants. And this much close contact?
It's impossible to say which option, or if both, have contributed to the uncharacteristic and ongoing spike in cases. But we need to keep watching this closely for some answers since this is the most rapid development for MERS epidemiology since its discovery.
If the KSA Ministry of Health experts are serious about accepting ideas from outside, I have a few quickies:
1. Please tell us what you're doing to control the cluster in Jeddah.
2. Please tell us if testing methods or approaches have changed lately (more testing overall, different tests, testing instead of simply observing contacts..).
3. Please tell us what you're doing to understand MERS-CoV, the virus, in 2014 (hint: sequence the Spike gene of as many viruses as you can get you hands on, do genomes later and release those data quickly; social media, WHO, Eurosurveillance or some other super-rapid journal, for example)
4. Please give us a reason, or a best guess, for why April is different from every other month since MERS-CoV was identified in 2012.
5. Please provide the WHO scrubbed case data more quickly and include sex/age/date of illness/animal contact[Y/N]/comorbidity[Y/N]/date of hospitalisation/region of KSA.
6. Please screen samples by PCR from the community, looking at asymptomatic, mild and moderate acute respiratory disease.
7. Please publish some data on what other respiratory viruses do among older males with comorbidities (e.g. diabetes) in the KSA so we have a comparator for MERS-CoV.