By: Helen Branswell, The Canadian Press
May 30, 2013
Despite the complaints about the kingdom's lack of transparency, Memish insisted he has been forthcoming.
"People say we're not
transparent. People say we're not giving information. But as we spoke to
the DG" — the director general — "and WHO we said everything that we
are learning," Memish said.
He clearly chafes at the suggestion that the virus is coming from his country, or region.
In fact, in an article Memish
published this week in the New England Journal of Medicine, he said an
earlier iteration of the WHO's advice for how to find cases probably led
to an underestimation of the scope of the problem, because it linked
infections only to countries on and around the Arabian Peninsula. The
most recent version of the guidance talks about the Middle East.
"If you ask why we're picking
up more cases in Saudi recently, it's because we're just looking harder
and harder. We're processing hundreds of samples a day from different
parts of the country. So far we sampled 1,500 or 1,700 samples in the
whole of Saudi," he said.
"I don't think any country in this world is doing that much testing. And I guess the more you look the more you'll find."
If other countries — even
countries outside the Middle East — conducted similar testing, they too
would find MERS cases, he said. "I would not be surprised if it's in
every other country in the globe."
He supported that argument
with the fact that in many cases of pneumonia, the bacterial or viral
cause is never found. Still, Memish's suggestion that those could be
undetected MERS cases met with skepticism from infectious diseases
"To suggest that cases of
MERS-CoV" — CoV stands for coronavirus — "infections are being missed
all over the world carries no epidemiologic or virologic credibility
among those of us who have spent our careers tracking down global
emerging infections," said Michael Osterholm, director of the Center for
Infectious Diseases Research and Policy at the University of Minnesota.
"Such a statement merely
blames the rest of the world for the continued problems with
transparency by the Kingdom of Saudi Arabia in responding to this public
Osterholm said if undiagnosed
MERS cases were in hospitals in other parts of the world, health-care
workers would be contracting the disease as they did SARS in 2003. (MERS
is from the same virus family as the SARS coronavirus.) "They would
become the sentinel canaries. We're not seeing those."
Gregory Hartl, a spokesperson
for the WHO, said if there were clusters of MERS cases elsewhere, they
would be garnering attention, testing or no testing. "The outbreaks that
we're seeing now would not likely be overlooked even if a country
weren't looking very hard."
As well, he noted that some
countries have been testing stored blood samples looking for evidence of
antibodies to the virus, a finding that would suggest people in those
countries had been exposed to MERS in the past. So far there have been
no positive findings, he said.
One of the issues that has
plagued efforts to find cases, particularly previous cases that were
undiagnosed at the time of the infection, is the lack of validated MERS
Several laboratories in
Europe have developed tests. But in order to be certain that a test is
working — that it is picking up true positive cases and is not
generating false positives — developers need to test it on blood from
people who have survived the infection. The only country with
significant numbers of MERS survivors at this point is Saudi Arabia,
which has reportedly not responded to requests from some European
academic labs that have developed MERS blood tests.
Asked about that, Memish said
Saudi Arabia is collaborating on the development of MERS blood tests.
He said the country is working with scientists at Columbia University in
New York, and with the U.S. Centers for Disease Control.
"We're working with CDC. We're just trying to finalize the agreement," he said.