The longer the KSA MOH MERS page stays offline, the higher the hopes that it will return as a cornucopia of data. But it also gives us time to reflect on how Middle East reticence syndrome has raced through the Middle East health bureaucracies, evidently with a 100% attack rate and leaving precious few survivors able to talk about their experience.
The symptoms are obvious even to laypersons: the sudden onset leaves the vocal cords semiparalyzed. The patient is barely able to croak out a few words: "transparency," "camels," "citizen," "underlying health condition." Facial paralysis causes a fixed grin, as if the patient were trying to reassure us that everything is OK and under control. The syndrome often progresses to involuntary arm-waving, thumb-lifting, or the clamping of hands over the mouth. Case fatality rates among health ministers range from zero to 50%, but so far none have been officially listed as recovered.
Middle East reticence syndrome is an almost exclusively nosocomial infection, but outside health experts suspect that index cases may have been exposed to monarchs. It has been impossible, however, to obtain samples from monarchs that would confirm or refute this theory. Those monarchs recently observed from a distance appear asymptomatic, and their keepers ridicule the whole idea. Some even kiss their monarchs to show how safe they are.
Such outside experts are aware of the irony that reticence-syndrome cases are the chief source of information about this mysterious condition, yet seem unable to describe it in sufficient detail (or any detail at all). As the World Health Organization observed in today's update on MERS in the United Arab Emirates, "There is an ongoing need to share experiences and knowledge from all countries that have cases of MERS-CoV to better understand this emerging disease..."
Until that experience is indeed shared, we can only speculate as to the causes of Middle East reticence syndrome.
As for the longterm consequences of the syndrome, they don't bear thinking about.