Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems

Background: Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors. Methods: The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017 -May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis. Results: In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3-8 days), 4 days (IQR range: 2-7 days), and 2 days (IQR range: 1-2 days), respectively. Both patient delay (r = 0.894, P= 0.001) and health-system delay (r = 0.163, P= 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004-1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006-1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003-1.476) were significantly longer in patients who died. Conclusion: Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and healthsystem delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system. (C) 2019 Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons,org/ licenses/by-nc-nd/4.0/).