Thanks to Reuters' Ben Hirschler for tweeting the link to this excellent report: Saudi MERS response hobbled by institutional failings. Excerpt (but read the whole piece):
Tariq Madani, head of the scientific advisory board at the health ministry, said 58 of the 113 cases added last week had been confirmed as positive in government hospitals and laboratories, but the results had simply not been passed by those institutions to the ministry.
Another 22 cases tested positive at the King Faisal Specialist Hospital in Jeddah, but duplicate samples were not sent to government laboratories and the institution did not communicate the results to the health ministry, he said.
A spokesman for King Faisal Specialist Hospital declined to comment further and referred all queries back to the health ministry.
The remaining 33 cases had tested positive in private laboratories but showed as negative in government ones, Madani said.
Madani said he did not believe the under-reporting had been deliberate and he thought a 20 percent shortfall in reported cases was not unusual in a disease outbreak.
"This can happen anywhere in the world, that 20 percent of patients may not be reported. This is within the limit. It's actually less than 20 percent," he said.
However, Ian MacKay, an associate professor of clinical virology at Australia's University of Queensland who has been tracking the MERS outbreak since the virus was first identified in 2012, is skeptical about the notion that it is normal for 20 percent of cases to go unreported.
"I know of no global scientific norms that define a threshold below which it is normal to under-report cases of any viral cluster, outbreak or epidemic," he said.
Madani said in some cases patients intermittently shed the virus, so it is not caught in a test. The ministry's policy, he said, had been to say that if there was a discrepancy between test results, only government laboratory results should stand.
The new acting health minister Adel Fakieh has changed that policy, Madani said, and from now on positive tests from any laboratory accredited by the health ministry will count as confirmed cases.
The appointment of Fakieh has also led to other changes, he said. Authorities have brought in tighter infection procedures in hospitals and are trying to be more transparent about how they are tackling MERS.
"After the change of minister they involved people more in preventative methods. There were text messages on hand washing, the public has been more involved," said a Saudi public health expert who was critical of the ministry earlier this year. He, like some others interviewed for this article, spoke on condition of anonymity because he was not authorized to comment.
But some international scientists still complain that data published online by Saudi authorities, which includes daily updates on confirmed new infections and deaths in different cities, is not comprehensive enough to allow them to research the disease.