Saudi Arabia announced the removal of its health minister today as its count of Middle East respiratory syndrome coronavirus (MERS-CoV) cases surged by 17, following 20 new cases over the weekend, for a total of 37 cases and 6 deaths in 3 days.

Twenty-one of the cases reported were in Jeddah, site of a growing healthcare-related outbreak.

Meanwhile, sketchy reports from the United Arab Emirates (UAE), where 14 MERS cases were recently linked to one paramedic, cited a dozen new cases there.

The latest cases in Saudi Arabia raised the country's MERS count to 261, including 81 deaths. More than a third of those cases have been announced just this month. Most of the April cases have been in the Red Sea port of Jeddah, many of them in healthcare workers (HCWs).

Health minister's removal

Multiple media reports today said Saudi Health Minister Abdullah al-Rabeeah was removed from his post and appointed as an advisor to the Royal Court. Labor Minister Adel bin Mohammad Faqih was assigned to act as minister of health while continuing his labor duties. No reasons were given for Rabeeah's removal.

Worries among the staff at King Fahd Hospital in Jeddah forced the temporary closure of the emergency department there earlier this month. As noted in a Gulf News report today, Rabeeah visited the hospital last week in an effort to reassure the public, but on Apr 16 four doctors there reportedly resigned after refusing to treat MERS patients.

At a press conference yesterday, Rabeeah attributed the recent spate of cases to improved testing rather than faster spread of the virus, according to Gulf News. He said more than 20,000 people have been screened for MERS over the past few weeks. He also said the MERS case-fatality rate has been dropping.

A newspaper columnist quoted by the news service Al Arabiya today said the MERS outbreak was "the last straw" that led to Rabeeah's removal.

Mohammad Assaaed, columnist for the daily al-Hayat, said Rabeeah has been dogged by successive failures, especially concerning "the comprehensive medical insurance which people have been waiting for over the past 15 years," according to the story.

He said Rabeeah, a surgeon who is known for operations to separate conjoined twins, failed to take serious and urgent action when the coronavirus first surfaced in 2012.

"He is undoubtedly an excellent surgeon, but as a manager he was less qualified in my opinion. His medical body, which is his right arm, was also not satisfied with him," Assaaed told Al Arabiya.

Latest Saudi cases

The Saudi Ministry of Health (MOH) announced 7 new cases on Apr 19, 13 more on Apr 20, and 17 today, for a total of 37. Twenty-one of those were in Jeddah. There were six deaths among the new cases, and one previously reported case-patient, a 54-year-old Jeddah man, also died.

All seven of the cases reported Apr 19 were in Jeddah, according to a machine translation of a Saudi Ministry of Health statement, posted on FluTrackers, an infectious disease message board. There were two deaths among those patients, in non-Saudis who were 64 and 44 years old. Two others, both 54-year-old HCWs, had no symptoms, the statement said.

Of the 13 cases announced on Apr 20, 7 were in Jeddah, 4 were in Riyadh, 1 was in Najran, and 1 in Medina. One of the Jeddah patients died, as did the two in Najran and Medina, the MOH said. The Jeddah and Riyadh patients each included one HCW.

The 17 cases reported today included 7 in Jeddah, 6 in Riyadh, 3 in Medina, and 1 in Tabuk, according to a computer translation of the MOH announcement posted on Avian Flu Diary, an infectious disease blog. One patient, a 73-year-old in Riyadh, succumbed to the disease.

Today's cases include only one HCW, a 45-year-old Jeddah resident who is being treated in an intensive care unit (ICU), the MOH said. Several other patients also were in ICUs, while six, ranging in age from 11 to 42, have no symptoms.

Past CIDRAP News stories indicate that Saudi Arabia's MERS count stood at 163 cases and 64 deaths at the beginning of this month. Unofficially, the present MOH count of 261 cases and 81 deaths marks an increase of 98 cases and 17 deaths since the month began.

More UAE cases

Meanwhile, on Apr 20 The National, a news service in the UAE, reported 12 new MERS-CoV infections in that country. Citing the UAE's state news agency, the story said the cases were all identified through routine screening and that the patients were isolated in hospitals.

The patients were expected to clear the virus within 10 to 14 days without treatment, the state news agency was quoted as saying.

Computer translations of other press reports from the UAE on Apr 19 indicated that none of the 12 patients had any symptoms. The translations were posted by Avian Flu Diary. The reports gave no other details about the patients.

Last week the World Health Organization (WHO) noted 14 MERS cases in UAE HCWs, all of them linked to a patient in Abu Dhabi who died on Apr 10. One of the 14 was a male nurse whose asymptomatic infection was reported after he returned home to the Philippines.

Details on case in Greece

In other developments, the WHO's Regional Office for Europe on Apr 20 confirmed Greece's first MERS-CoV case, which was first reported by the media on Apr 18.

The agency confirmed that the case involved a 69-year-old man who is a Greek citizen who lives in Jeddah. He fell ill with a fever and diarrhea on Apr 8 and sought treatment at a hospital, the agency he said. Initially he was diagnosed as having typhoid fever and was treated accordingly because his wife had been hospitalized with that disease and he had visited her regularly.

The man traveled to Greece on Apr 17 and sought treatment on his arrival, the WHO said. He was found to have bilateral pneumonia caused by MERS-CoV, and was in stable condition on Apr 18.

The WHO said health authorities had identified the man's close contacts and that none of them were sick.

See also:

Saudi MOH page with MERS case count

Apr 21 Gulf News story

Apr 21 Al Arabiya story

Apr 19 FluTrackers post with translated Saudi statement

Apr 20 Saudi statement (in English) on 13 cases

Apr 21 Avian Flu Diary post with Saudi statement on 17 new cases

Apr 20 The National story on 12 cases in UAE

Apr 19 Avian Flu Diary post on 12 cases in UAE

Apr 20 WHO statement on case in Greece