Friday, May 31, 2013

#Coronavirus: An interview with Dr Ziad Memish: MERS Cases Likely Around Globe...

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 experts.
"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 health crisis."
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 blood tests.
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.

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