Evaluation of visual triage for screening of Middle East respiratory syndrome coronavirus patients

Alfaraj, S.H.; Al-Tawfiq, J.A.; Gautret, P.; Alenazi, M.G.; Asiri, A.Y.; Memish, Z.A.

We retrospectively evaluated the proposed Saudi MoH triage scoring system for the screening of MERS-CoV patients. During the outbreak of severe acute respiratory syndrome, one hospital expanded the isolation criteria to include all patients with undifferentiated fever with or without respiratory symptoms or chest X-ray changes [21] . Differentiating patients with MERS-CoV from other non-MERS-CoV patients has been a challenge for the healthcare workers in Saudi Arabia. There are no signs, symptoms, physical findings, specific laboratory or radiologic findings that can help healthcare workers identify MERS-CoV patients [17] [18] [19] . This was made clear from recent MoH data, which showed that every year more than 50,000 patients suspected to be infected with MERS-CoV were tested kingdomwide, with a yield of 0.7% positivity [22] . This calls for regular review of MERS-CoV case definition and a reevaluation of the visual triage scoring to ensure its accuracy and to avoid clogging isolation rooms and exhausting MoH financial resources by excessive testing of suspected MERS-CoV cases. In addition, it is important to have healthcare organizations ready to identify and isolate patients with suspected MERS-CoV. In a recent study evaluating the readiness of hospitals in the United States, 42 specific drills for patients with possible MERS-CoV infection were conducted in New York City [23] . The drills revealed variable identification of potentially infectious patients and implementation of appropriate infection control measures [23] .