Public response to MERS-CoV in the Middle East: iPhone survey in six countries

Abstract

Gulf Cooperation Council (GCC) countries bear the heaviest brunt of MERS-CoV. This study aims to compare public awareness and practice around MERS-CoV across GCC countries. A cross-sectional survey was conducted using the Gulf Indicators (GI) smartphone app among people in the six GCC countries, namely Saudi Arabia, Kuwait, the United Arab Emirates, Qatar, Bahrain, and Oman. A total of 1812 participants recruited. All were aware of MERS-CoV, yet the perception and practice around MERS-CoV varied widely between countries. Over two thirds were either "not concerned" or "slightly concerned" about contracting MERS-CoV; believing that they were under Allah's (God's) protection (40%) was the most cited reason. While 79% were aware that the disease can transmit through droplet from infected person, only 12% stated that MERS-CoV transmits via camels; people in Saudi Arabia were better aware of the transmission. Nevertheless, only 22% of respondents believed that camels are the zoonotic reservoir of MERS-CoV. Those who were concerned about contracting MERS-CoV (aOR: 1.6, 95% CI: 1.2-2.1, p<0.01) and those who thought MERS-CoV to be a severe disease only for those with high-risk conditions (aOR: 1.5, 95% CI: 1.1-2.1, p<0.01) were more likely to believe that camels are the zoonotic source. However, residents of KSA (aOR: 0.03, 95% CI: 0.01-0.07, p<0.01), UAE (aOR: 0.01, 95% CI: 0.004-0.02, p<0.01) and Kuwait (aOR: 0.03, 95% CI: 0.01-0.07, p<0.01) were less likely to believe that camels are the main zoonotic source compared to respondents from the other countries. Hygienic measures were more commonly adopted than avoidance of camels or their raw products, yet there was a discrepancy between the countries. This study highlights that despite being aware of the ongoing MERS-CoV epidemic; many people lack accurate understanding about MERS-CoV transmission, prevention, and are not fully compliant with preventive measures.

Diagnostic delays in 537 symptomatic cases of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

“…271-2.380). This may be attributed to several factors: (1) access to healthcare facilities could be an issue for non-healthcare workers, and thus warrants further investigation, (2) the symptoms of MERS may not be clearly obvious to non-healthcare workers, as there are gaps in knowledge about the virus and symptoms in this group (Assiri et al, 2013b;Alqahtani et al, 2017). An interventional study may target the level of knowledge in the non-healthcare worker group to improve their understanding of the virus and symptoms, and the importance of the early notification of symptoms.…”

A Comparative Analysis of Factors Influencing Two Outbreaks of Middle Eastern Respiratory Syndrome (MERS) in Saudi Arabia and South Korea

“…This is due to better universal health coverage, and flexibility to choose health care professionals compared to Saudi Arabia, where the government has more restrictions and involvement in healthcare decisions [56,57]. From the beginning of the outbreak, South Korean patients who were MERS-positive sought and embraced medical attention much faster than did Saudi Arabian patients [58]. However, this brings about the previously discussed problem of visiting a variety of healthcare environments prior to diagnosis, exacerbating spread.…”

“…While Saudi Arabian officials did put in place a Rapid Response Team (RRT) to combat the outbreak, a 2017 study found that, even several years after implementation, many interviewed Health Care Workers, nurses, and other hospital support staff were not fully compliant with these guidelines, putting themselves and patients at risk for MERS-CoV infections [58]. The general feeling of Saudi Arabian workers and citizens was largely that MERS was not a substantial problem, and holes in primary care practices in addition to spread by dromedaries and humans alike in the population contributed to the continuing epidemic in the Saudi Arabian region.…”

“…Another contributing factor falls into the category of cultural belief systems. In a 6-country iPhone survey done in the Middle East (including hotspots of MERS-CoV outbreaks), investigators found that two-thirds of the nearly 2000 participants responded as "not concerned" or "slightly concerned" about contracting MERS [58]. Approximately 40% of those participants cited religious convictions as their reason for lack of concern.…”

Where we missed? Middle East Respiratory Syndrome (MERS-CoV) epidemiology in Saudi Arabia; 2012–2019

“…This incident acted as epicentre spreading first in neighbouring countries then globally. ( Alqahtani et al, 2017 ), alike Ebola or swine flu it became an alarming threat to global health security. The Middle East respiratory syndrome (MERS) is acute respiratory viral infection caused by novel extremely pathogenic coronavirus ( Ahmadzadeh et al, 2020 ; Alosaimi et al, 2020 ).…”