Table 1.

First phase of the epidemic (23 September–19 November).

Date	Epidemic Events and Other Key Public Health Actions	Executed SCH Communication Activities and Key Messages	Al-Raya Newspaper Reports and Key Messages	Assessment Remarks Based on Crisis Emergency Risk Communication (CERC)
23 September 2012	The first laboratory confirmed case is declared in Britain			A novel and virus with great deal of uncertainty. A typical situation at the outset of an emerging virus.
24 September 2012	Surveillance system was reinforced. Technical Consultations with WHO & HPA in the UK were initiated	Press conference: Supreme Council of Health (SCH) confirmed the first case admitting lack of knowledge on how to best clinically manage the case. No need to “Panic”, as no further cases were detected.		Despite the scarce information and the overwhelming uncertainty, the SCH managed to timely announce the case and explain the undertaken measures, in line with the CERC which calls for admitting the limitations while telling what actions are being done to bring answers (consultations with the WHO). This constitutes the ‘initial phase’ as described by the CERC. However, empathy was hardly expressed to the patient and his family - it was a little early to generate behavioral messages that conveyed a paternalistic approach (without reality check). These were largely not in accordance with the CERC.
25 September 2012	National Outbreak Control Taskforce (NOCT) was activated		Reports on the information shared during the press conference, adding facts about Middle East Respiratory Syndrome Coronavirus (MERS) as sourced from the WHO website. The SCH was blamed for not providing sufficient follow up to the patient.	The Qatari early preparedness based on the previous experience with the SARS and H1N1 helped activate the national response in relatively short time (stakeholder communication and coordination). While CERC stated that people and media would eagerly seek for other sources of information during emergency situations, the SCH seemed not to have considered this behavior as it did not provide a sustained flow of information, allowing for the local media to blame the sluggish response.
26–27 September 2012	SCH Maintains close communication with the UK hospital where the patient was transferred to be abreast of the clinical developments of the patient		Reports on patient status and transfer to the UK: Family members were interviewed. SCH response was described as “late” and that the authorities only come to know about the case from the international media and the WHO. Reports on the potential risk of greater spread during the approaching Hajj, and Reports on similarities between MERS and Severe Acute Respiratory Syndrome (SARS).	Despite initiating reasonable public health measures, the SCH still seemed not to cope with the urgency of the situation. SCH should have publicized the ongoing efforts at the different levels including the persistent follow up of the patient.
29 September 2012	Development of the risk assessment plan and roadmap to response with (with support from WHO and FAO)	Press Release: The patient is improving and the SCH was engaged with the UK authorities to closely monitor the patient. This is in response to the rumor that the Qatari authorities are not providing the care to the case.	Reports on patient status and transfer to the UK: Family members are interviewed. They suggested that a medical specialist should have been sent to UK to accompany the patient.	Although it has come a little late, the SCH reacted to the rumor with a press release but it should have further displayed the progression on the technical efforts with the WHO and FAO to guide the public health response.
1 October 2012	Health preparations for Hajj season were initiated: Seasonal flu vaccine is available			The approaching Hajj season heightened the fears of the public that MERS might spread widely during the big gathering event. This constituted another test to the readiness and the nature of coordination of the authorities at the local and the regional levels. The displayed aspects included: provision of the Flu vaccine (the preventive role of which is yet to be confirmed), besides the pre-travel medical screening and education.
2 October 2012	Coordination with stakeholders was maintained	Press Release: As a new virus, it was hard even for an advanced country like the UK to discover the nature of the novel virus until late.		Again the messages were not developed according to CERC recommendations. It could have better explain the progression on the preparedness efforts and help shift the public focus to things to do.
3 October 2012	Healthcare Workers training implemented	SCH spoke-person is interviewed. Hajj preparations considered Flu and the risk of MERS.	The media reported on the interview which emphasized that: Seasonal flu immunization is mandatory, as per KSA health regulations for pilgrims, and that the health situation was being monitored through information sharing with the KSA and WHO.	The spokesperson seemed to have answered some of the key current questions. While the media focused on Hajj preparations, SCH should have bring the attention to the reinforcement of the preparations (training of the healthcare workers).
4 October 2012		Press conference of the Medical Committee of the Qatar Hajj Commission. Various epidemic scenarios were considered.	The media reported on the press conference which addressed the clinical and preventive measures including the risk of MERS. Reports on first MERS case being cured.	The fact that other authorities counted for the new virus in their preparation package to the Hajj season indicated the level of coordination among stakeholders.
5 October–19 November 2012	Coordination between the KSA and Qatar authorities during Hajj. Close monitoring of the situation with support from WHO	Focus on Hajj preventive measures.	Reports focused on Hajj seasons: public concern of the potential spread of the disease during the season.	Here the authorities indicated their international level of coordination for Hajj with the relevant authorities.
Pilgrimage Season—in 2012 the end of the Hajj season was on 24–29 October. However, pilgrims start to travel to Saudi Arabia 8–10 weeks prior to that. Therefore since the inception of the first case, Qatar was experiencing pilgrimage season.

CERC: Crisis Emergency Risk Communication; SCH: Supreme Council of Health; MERS: Middle East Respiratory Syndrome Coronavirus.