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Commentary
More WHO Novel
Beta Coronavirus Reporting Issues
Recombinomics
Commentary 20:30
December 1, 2012
The two Qatari patients are not linked. Both had severe pneumonia and acute renal failure. Both are now recovering.
The above comments from the updated WHO novel betacornavirus surveillance recommendations posted Friday morning (in red) and the betacoronavirus update posted Friday afternoon (in blue) are inconsistent with the recent publication on the second confirmed Saudi Arabia case (45M), who also developed renal failure prior to recovery and discharge on November 1, when the case was announced by the Kingdom of Saudi Arabia (KSA) Ministry of Health (MoH).
The above WHO comments note that all three fatal cases had renal failure, as did two additional confirmed cases who survived. The above statement, in blue, notes that both cases from Qatar had renal failure and survived.
However, the case (45M) described in the publication (Saudi Medical Journal) survived and had renal failure indicating six (three fatal and three surviving) of the seven confirmed cases in the Arabia Peninsula, developed renal failure.
The inconsistency in the Friday morning version of the surveillance update followed a more dramatic set of inconsistencies in the Thursday morning version, which claimed that only 4 of the 7 confirmed cases had renal failure and only one died, which was published after the November 23 update which noted that two of the confirmed cases had died, while a suspect case had also died.
The Nov 23 report did announce four additional confirmed cases, but three had already been announced by others. However, the Nov 23 reported that two of the new cases (one confirmed and one suspect) had died and were from the same family with two other symptomatic cases, including one who was also lab confirmed. Thus, the cluster was of considerable concern, but WHOI withheld age, gender, and dates of onset, hospitalization, and death.
The earlier reports by others suggested the WHO Nov 23 announcement was 1-2 months after the fact and the missing information was well known to WHO. Media reports on the day of the report noted that the unconfirmed fatal case was 70 years of age and the father of the other fatal case, who was his son. Moreover, the son was hospitalized after the father died, suggesting a gap in the disease onset dates, signaling human to human transmission.
The publication on the third case confirmed the WHO delays. The paper noted that the third case was a 45 year old male gym teacher with a disease onset of October 9. Thus, WHO reported the case 6 weeks after disease onset. The paper also noted the case was hospitalized October 12, developed renal failure and was placed on dialysis. However, the patient recovered and was discharged on November 4, the date the KSA MoH announced the confirmation.
In addition to the failure to provide key data points for the confirmed cases and cluster from the Arabian Peninsula, WHO also failed to provide detail on the two confirmed fatal cases in Jordan. The April outbreak was described in local media reports as well as multiple ECDC reports, which noted a cluster consisting of 7 nurses, 1 doctor, and 3 additional cases, linked to an ICU in Zarpa. The reports noted the death of a nurse (40F), while the media reports included the date and the fact that the fatal case’s son was symptomatic. Moreover, a doctor at the hospital also died after the others recovered, but the linkage of the doctor to the earlier cluster was denied.
Thus, WHO has reported two fatal confirmed cases, but has withheld age, gender, dates as well as relationships between the two fatal cases and the other cluster members.
The withholding of this key data allows WHO to make “no evidence of” statements to deny the obvious human to human transmission and similarities with the SARS CoV outbreak in 2003.
WHO should end the charade and release the key information of the confirmed and contact cases immediately.
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