In continuation of the efforts exerted by the Ministry of Health (MOH) to combat Coronavirus and curb its spread and out of the MOH’s desire to keep all members of the society and media aware of the latest developments of the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) in light of the increased number of registered cases in the past weeks and with the aim of shedding more light on the MOH's preparations for this year's Hajj season concerning this matter, the MOH's Command and Control Center (CCC) would like to clarify that since Sunday’s statement, additional 7 confirmed cases of Coronavirus have been reported at the National Guard's King Abdulaziz Medical City, bringing the total number to 78 confirmed cases in our laboratories.
In confirmation of what we have mentioned before, the cases reported in this week are not new but they acquired the infection previously, therefore the continuing announcement of cases doesn't mean that the infection is still prevailing in the hospital, but such cases have acquired the infection recently, and due to the prolonged incubation period of the virus, they did not show symptoms until recently, then their infection was confirmed after laboratory tests.
Meanwhile, the rapid response teams at the CCC's Infection Control Platform continued its activities of assessing commitment of health facilities to the prevention measures, as they visited 34 hospitals and medical centers in the past week and issued reports and timetables on how to deal with violations, if any. Also, a team of the Field Epidemiology Program of the MOH and a team of the US Centers for Disease Control and Prevention (CDC) are available at King Abdulaziz Medical City at the National Guard to provide support in regard to study of ceases and ways of infection transmission. The two teams’ reports are discussed during meetings of the CCC before taking the necessary measures upon them.
Additionally, the MOH continues its preparations for the Hajj season to prevent emergence of any cases of Coronavirus or any other infectious diseases during Hajj. The Ministry also is applying precautionary measures to maintain public health by officially issuing health requirements for Hajj and sending them to all Islamic countries and other countries with Islamic communities to abide by them. The requirements are also published in the Bulletin of the World Health Organization (WHO).
In addition to that, the air, sea and land crossing points were placed on alert to check on pilgrims’ commitment to these requirements, and until this date the number of pilgrims who have been medically examined amounted to 458,942, and preventive treatment against meningitis was given to 108,534 pilgrims of the so-called African meningitis belt. Also, Oral Polio Vaccine (OPV) was given to 147,334 pilgrims coming from countries affected by polio or from countries in which the spread of the disease was over but they are still placed under observation.
On preparations for the infectious respiratory diseases, including Coronavirus, seasonal flu and others, the MOH is working on several axes, most importantly prevention of the primary Coronavirus cases resulting from close contact with camels, as the Ministry sought to prevent the presence of camels at pilgrimage areas for any purpose whatsoever, and the authorities concerned have welcomed this decision. It also sought to prevent the secondary cases, whose infection may be transmitted amongst humans by means of identifying those in contact with the confirmed cases and not allowing them to perform Hajj until their follow-up period is over.
The Ministry has also been eager to apply active surveillance of respiratory infections, promote the procedures for identifying, sorting and isolating suspected cases and transferring the confirmed cases outside the Holy Sites' hospitals; that’s to be added to provision of laboratory diagnosis in Mina, Arafat, the Holy City of Makkah and Madinah, vaccination of pilgrims against seasonal flu, raise of immunization coverage to the highest possible level, and forcible vaccination of health workers against seasonal flu and meningitis to protect them and pilgrims as well.
The rapid response teams tasked with controlling infection at health facilities represent the most important responsive procedure that the Ministry depends on for the inspection of the mechanism of dealing with the infectious diseases at the health facilities. Such teams were formed last year in the context of responding to the outbreaks of Coronavirus. They received intensified training courses and gained vast experiences in dealing with the disease. The teams are managed by the command and control centers in health regions and are working around the clock, seven days a week.
The response activities are divided into three types, depending on the number of reported cases and the facility's readiness to deal with them. The team may need to repeat the visit and sometimes remain at the said facility for a period of up to a week. In the context of responding to the current outbreak in the city of Riyadh, a number of the response team members from inside and outside Riyadh reported that they had paid 351 visits to the hospitals of the MOH, government sectors outside the MOH and the private sector.
The Assistant Deputy Minister of Health for Preventive Health, Dr. Abdullah Assiri, explained that there is no connection between the atmosphere and transmission of the virus among people, noting that there is no any outbreak in the meantime. “The Ministry deals with any person with pneumonia as a suspected case,” he said, adding that the Ministry has formulated an idea about any suspected case or outbreaks, as there are two types of the disease: Contracting the disease from known sources outside the hospital, while the other type is the transmission of the disease among people in hospitals. He noted that the ratio of viral transmission among people is not more than 2%, pointing out that the virus is still weak. The World Health Organization (WHO), he said, has held more than 10 meetings that came up with similar recommendations that the virus is limited to a certain geographical area and no actions need to be taken right now.
Dr. Assiri confirmed that the virus is geographically limited and its source is known, however this does not eliminate that possibility and any observations will be considered and confirmed. Answering a question on the probability of closing schools or any other gathering places, he stressed that such actions are taken upon the WHO recommendations, but the Organization believes that the disease is still limited.
Speaking about this year's Hajj season, Dr. Assiri confirmed that recommendations were made to prevent specific age groups, who are more prone to get infected with infectious or epidemic diseases such as: the elderly, children and those with chronic diseases, adding that the MOH has listed all those who died of Coronavirus to compensate their families, as per the royal decree, with SR 500,000 regardless of their nationality or profession. “Upon the completion of the administrative procedures, the payment will be made,” he said, adding that a committee was formed from several parties, including the MOH and Finance Ministry, to that effect.
He said that the studies conducted by US and Saudi researchers have proved that the virus was just spreading among camels in the Kingdom for more than 30 years, without being transmitted to humans. “During the past four years,” he said, “the virus started to be transmitted from camels to humans,” adding that it has been discovered that 74% of camels carry anti-virus (Corona), meaning that they have been infected with the virus at some stages of their life.
The researchers confirmed that the finding of the virus in camels on a large scale gives important indices that the spread of the virus could be controlled. In addition, the researchers discovered that the virus is mainly living in the respiratory tract not in the stool, thus providing an important base to study pathways of transmission between humans and animals. In this regard, Dr. Assiri pointed out that there are new studies in the Kingdom to confirm camels' relation with transmission of the infection to humans, including a special study about the blood of camels to confirm the presence of anti-virus and another study to confirm the role of camels in transmitting the virus to humans.
“The problem,” according to Dr. Assiri, “lies in the fact that the symptoms don't inevitably appear on camels, but some respiratory symptoms may or not appear on them. Therefore, further studies will confirm all hypotheses.” He underlined that in all cases, a number of health requirements were recommended for dealing with livestock at barns in general, the most important of them are wearing protective masks and staying away from animals which show symptoms of the disease.
To sum up, the bats may be the first incubator of the virus, while the other domesticated animals, particularly camels, are the second incubator transmitting the infection to humans. Speaking about alternatives to sacrificial camels, Dr. Assiri explained that the Saudi Grand Mufti has issued a Fatwa (religious opinion) authorizing the sacrifice of cows, sheep and goats instead of camels, which were prevented from entering the Holy Sites for this year's Hajj season, as a precautionary measure to limit the spread of the virus.
On his part, Dr. Ali Al-Barak, the Director-General of the National Center for Disease Control and Prevention and Member of the Advisory Scientific Board, in a response to a question whether Coronavirus is a biological weapon against the Kingdom, he said, "In case of the outbreak of diseases at unusual places and times, this possibility is taken into consideration and discussed in detail to prove whether it is correct or not."
Dr. Al-Barak added, "The underway procedures and type of Coronavirus outbreak rule out what was mentioned in the question, however this possibility is always probable". He pointed out that precautionary measures to prevent the spread of the disease are done on a regular basis, through documentation and review of available scientific and medical information in every stage during the last three years, in other words, since our knowledge of the disease. “Such accumulated medical information,” he said, “confirmed transmission of the virus from camels to humans and from humans to humans inside the health facilities.”
He went on saying, "As a result, the Command and Control Center (CCC) has taken some procedures to contain and prevent the spread of the virus inside the health facilities and issued recommendations for the public concerning their ways of contact with camels.” Dr. Al-Barak noted that during the last period, efforts have been exerted to disseminate the information and make it available to health workers and community as a whole, so they get acquainted with the disease and methods of its transmission in a correct manner in order to take medical and social precautions to distance themselves from its sources.