The World Health Organization (WHO) today reported a MERS-CoV (Middle East respiratory syndrome coronavirus) case in a 14-year-old Saudi girl, while Saudi Arabia announced another death in a previously reported case.
The WHO said the 14-year-old, who has underlying medical conditions, became ill with a MERS-CoV infection on May 29 and is in stable condition. She is from the country's Eastern region, but not from Al-Ahsa, the site of a recent hospital-based cluster that included 22 cases and 10 deaths.
From the WHO's short description, the case appears to be the same one announced by the Saudi Arabian Ministry of Health (MOH) on Jun 2. The extremely brief MOH announcement said the patient is a female who lives in the Eastern region and has chronic cardiac disease. It described her condition as "reassuring."
Today's Saudi MOH announcement came in a translated statement posted by ProMED, the disease tracking service of the International Society for Infectious Diseases. It said only that the MOH "has announced the death of one patient among the previously infected cases by MERS-CoV in Al-Ahsa Governorate." It didn't list the patient's age, gender, location, or other details. The MOH had not posted an English translation of the announcement as of this writing.
The WHO statement listed the total MERS-CoV tally at 54 cases and 30 deaths. Today's Saudi announcement would increase the death toll to 31.
But the true numbers of MERS-CoV cases and deaths are somewhat unclear, since another case and three other deaths reported by the Saudi MOH in recent days have not yet been mentioned by the WHO. Yesterday the MOH reported a case in an 83-year-old man in Al-Ahsa, and on Jun 1 the ministry reported the deaths of three patients whose cases had been announced earlier.
Meanwhile, the US Centers for Disease Control and Prevention (CDC), on its MERS-CoV page, lists a global count of 55 cases—one more than the WHO number—and 30 deaths. Both the CDC and the Saudi MOH put Saudi Arabia's numbers at 40 cases and 24 deaths.By now it's pretty clear that the Saudis are not telling us all they know, and they seem to know remarkably little—otherwise they wouldn't be toting vials of MERS onto airplanes and hanging out unmasked and ungloved around MERS patients.
When the Chinese played dumb about SARS, the game was up as soon as cases appeared outside the country, while Chinese and foreign-resident bloggers managed to report on their local situations. In the recent H7N9 outbreak, the Chinese showed they'd learned their lesson. While MERS has also been exported from the Middle East, cases in Germany, Britain, France and Italy have been few and not always originating in Saudi Arabia.
The Saudis therefore seem to have decided on a stonewall strategy: Say as little as possible, give thanks to God for every negative MERS test, and hope the deaths can be at least partly blamed on patients' underlying medical conditions.
As far as I can tell, WHO has neither the resources nor the will to get tough with the Saudis. The most they could do would be to issue a travel advisory, preferably just before the Hajj this coming fall. But they can't do that over a handful of cases and very little sign of human-to-human transmission. Nor would western health agencies like PHE in Britain and CDC in the US, at least until their own nationals were coming home sick.
So the Saudis can play politics with MERS, and everyone else, at least for now, has to play along. It may be politically correct to do so, but it's damn poor public health.
