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SAN FRANCISCO -- The fog of war affects those fighting disease outbreaks as well as those in combat, according to the man in charge of battling the outbreak of Middle East coronavirus (MERS-CoV).
Although much is known about the virus, "unfortunately some issues are still unresolved," according to Ziad Memish, MD, Saudi Arabia's Deputy Minister for Public Health.
Those knowledge gaps are the "biggest challenge," he said, in communicating what's happening with the outbreak, which has caused most of them in Saudi Arabia.
"There's a lot of stuff we don't know," Memish said in the opening plenary session of the here, "and that's the part that is difficult to explain to news media and reporters."
Saudi officials were recently publicly chided for not being forthcoming about all the details of the outbreak. In an interview, Larry Anderson, MD, of Emory University in Atlanta, called the state of knowledge about the virus "concerning and sad."
"We knew more in two to three weeks with SARS than we probably even know now (about MERS),"
Anderson, who now teaches in the medical school at Emory University in Atlanta, led the CDC's response to the 2002-2003 SARS outbreak, which infected about 8,000 people worldwide and killed about 700.
In an earlier presentation in the same session, , of ABC News, said he had found the Saudis less "transparent" than he would have liked about the outbreak.
Besser, a former acting director of the CDC, compared the Saudis with the Chinese during last spring's H7N9 avian flu outbreak.
Chinese officials "opened the doors," Besser said, "but the doors weren't opened so wide" when he tried to get inside the MERS outbreak.
The issue is important, Besser argued, because "without total transparency, you're not going to have trust."
Memish replied bluntly that he disagreed: "There's a lot of data being shared."
Later, Memish told MedPage Today "we have been transparent with reporting cases (and) we're testing aggressively."
"We're testing, we're reporting, and we're doing the best that we can," he said.
The MERS outbreak was first noticed about a year ago, when Saudi Arabia reported the first cases of a mystery ailment. Later investigation found evidence of a cluster of cases a few months earlier in Jordan.
But recent studies -- conducted by a team led by Memish -- have suggested the virus has a longer and more complicated history, with at least three different types circulating for several months before the first cases were noticed.
Although no cases have been seen so far in the U.S., the CDC has created tools to cope with MERS -- from a "patient under investigation" form for doctors to use to pamphlets in both English and Arabic aimed at travellers to the Middle East, according to , of the CDC.
Swerdlow, speaking via video from Atlanta, said the agency also has a four-tier surveillance plan as well as detailed guidance for physicians when and if the virus hits the U.S.
Like Memish, however, he noted that major gaps remain in scientific understanding of MERS, including where it comes from and how it can be treated.
Memish told MedPage Today -- based on social media and news reports -- that the Saudi public is well aware of the outbreak. He said websites, newspapers, and TV all report both news and the health ministry's guidance on how to respond to the virus.
The IDWeek meeting comes just days before the annual Hajj pilgrimage to the holy sites of Islam in Saudi Arabia, which draws millions to the country every year.
Memish said his government has urged those , including the elderly and those with underlying medical conditions.
But the "ministry of health does not control the global community," he said, and most of the pilgrims will probably fall into one or more of the vulnerable groups.
But, he said, the country attracted some 5 million people for the Umrah pilgrimage, usually taken during the month of Ramadan.
"And five million people went back to their countries with no problem," he said.