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.

The first case of Middle East respiratory syndrome coronavirus (MERS-CoV) was described in 2012 from a hospitalized patient in a private hospital in the Kingdom of Saudi Arabia [1] . The disease has attracted the attention of the global heath community because it carries a high fatality rate of 40% to 60% [2] [3] [4] [5] . The high case fatality rate could be an overestimate because the exact numbers of asymptomatic and mild cases were not well defined. Recent estimates indicate an overall fatality rate of 35%. Over the 4 years since the virus's discovery, there have been multiple healthcare-associated outbreaks [2, 3, [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] . The main reason for these outbreaks was the difficulties in early identification of MERS-CoV confirmed cases from influenza-like illness cases, leading to inappropriate application of infection control standards and quarantine. In an effort to facilitate this task, differentiation between MERS-CoV and non-MERS-CoV cases based on epidemiologic and clinical indicators was evaluated in few studies, but with no helpful findings [16] [17] [18] . A case-control analysis identified some significant predictors in univariate but not in multivariate analysis [16] . In other studies, presenting symptoms were not specific for MERS-CoV infection [17, 18] .