Table 3.

Third phase of the epidemic (20 August 2013–17 March 2014).

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 CERC
20 August 2013	Third case confirmed Hajj season pilgrimage begins Communication with major stakeholders is maintained including neighboring countries	Press release focused on: (1) Third case confirmed (2) Surveillance in place (3) Webpage and helpline being available Public awareness campaign launched	Reports on concerns related to forthcoming Hajj season. Local media reports a British study tells that camels might have a role in MERS transmission Media reported on the press release, stating that diagnostic capacity was made available.	This phase largely corresponds to the ‘maintenance phase of CERC’. After a 9 months pause, a new MERS case was reported in Qatar. Despite no cases, in contrary to the initial expectations pertaining the virus behavior, the media fairly occupied the vacuum by reporting on the disease cases and deaths reported by the other neighboring countries in the region. Having no cases might indicate either there were no cases for real or the surveillance system was poor (unable to detect cases). The SCH refuted the latter emphasizing the alertness of the surveillance system. The public need for access to further information seemed to be appreciated as a specific webpage was introduced. This action came as a response to the public demands. Yet, it is unclear whether the awareness campaign has just coincided with the new case or it was launched as an upbringing of the national response.
22 August 2013	SCH launches an awareness campaign including helpline services		The media reported on the awareness campaign and helpline service.	The campaign seemed to have helped the public get better understanding of the virus threat as more information now was made accessible. The campaign also created a good chance to provide facts, refute rumors and correct misperceptions. But it is unclear whether the campaign was designed based on CERC principles and whether it was followed by assessment.
27 August 2013	Fourth case confirmed as contact of previous case	Press release announcing the fourth case (patient with comorbidities)		The prime event is the death of a MERS confirmed case. The SCH decided to declare this death coupled with the cure of another recently confirmed case.
7 September 2013	Fourth case dies and third case is cured	Press release announcing the death of the fourth case and recovery of the third case		This press release seemed to have conveyed two messages; while it acknowledged the death of an infected person, it declared the other was free of the infection and discharged home, indirectly reassuring the public that not all of those who contract the infection will eventually end up dead. The local healthcare system could be still be trusted.
29 September 2013		Interview with SCH spoke-person focused on: Preventive measures for Hajj season Recommendations for Qatari pilgrims Updated information on MERS		The second Hajj season since the start of the epidemic. Despite the previous season passed uneventful in terms of virus spread, concerns remained high that it can still affect Pilgrims. This seemed to have necessitated the SCH sharing of the preparedness measures and coordination between Health and other sectors besides coordination between Qatar and KSA authorities.
18 October 2013	Fifth case confirmed End of Hajj season	Press release announcing the fifth case	Reports on absence of causes related to the Hajj season based on a statement from KSA authorities.	While declaring Hajj season is over, the fifth case was proclaimed, in line with the SCH policy of transparency. As part of the heightened media and public attention, MERS news continued to be newsworthy. Nevertheless, epidemiologists were unable to explain why the virus did not spread in the Hajj big gathering.
27 October 2013	Sixth case confirmed The Sultanate of Omar announces the first case KSA continues to report cases	Press release announcing the sixth case (contact of previous case), fifth case cured.	Some of the recently reported cases and deaths were from the eastern part of KSA (sharing borders with Qatar). KSA was the biggest affected country so far.	More facts were being shared to help establish a realistic understanding of the virus. The press release explained that human-to-human transmission was possible but it also consolidated that it could be treated (locally).
3 November 2013	Seventh case confirmed	Press release announcing the seventh case.		There were concerns now as to why after 9 months of zero cases people begin to hear about new 5 cases being reported in less than 2 months. This created more pressure on the SCH professionals to bring about reasonable explanations.
13 November 2013	The Sultanate of Omar announces that the first case died Kuwait reports two cases KSA reports the virus was detected in camels		Media kept reporting the spread of MERS in the Gulf Countries.	Reporting of new MERS cases from countries across the region seemed to have helped the public accept the virus risk as a fairly distributed one. But the virus detection in camels was a key turning point of the epidemic course. Camels are involved in peoples' lives (socioeconomically) across the Arab Peninsula, making it seriously challenging to investigation efforts.
19–21 November 2013	Death of 2 cases (two days apart) KSA—55 deaths and 130 reported cases	Press release announcing the death of two cases on 19 and 21 November respectively (total 3 deaths in the country).	Those who died were either suffering a chronic illness already or had an immunosuppressing condition.	Reporting more deaths related to MERS and acknowledging the fatality nature of the virus. However, a simple comparison with KSA was reassuring to the local community in Qatar.
25 November 2013	Special debriefing from the Qatari national senate focused on prevention and control measures	The senate recommendation acknowledged the ongoing investigation and control efforts but demanded these to be reinforced in terms of: disease monitoring domestically and abroad; expansion of isolation capacity in the healthcare facilities; screening of humans and animals.	Reports focused on senators’ demand for reinforced preventive measures. The senate demands were somehow portrayed as a response to the media outcry to step up the national response.	Since the break out of the first MERS case, this is considered the second remarkable call on SCH and its partners to boost the national preparedness and response to the virus threat. Despite the situation in the country was not as bad as it was in other neighboring countries, but having the subject discussed in the senate could indicate to serious public concerns about the quality of the SCH response. Further, it might indicate the need to make the ongoing investigation and control efforts (besides the available competencies) more visible. Nonetheless, the senate session seemed to have helped secure more resources and support to the ongoing control efforts.
28 November 2013	MERS virus was isolated from camels in Qatar	Press release: SCH announced the virus was isolated from two camels.	Reports on interviews with camel owners criticizing the Ministry of Environment (MOE) for the lack of proactive measures and for withholding information.	This epidemiological breakthrough helped proof that SCH was not waiting passively for the big technical institutions to reveal the virus characteristic but rather was really engaged with them in the efforts to understand the disease characteristic and risk. Yet, this discovery also implied that the investigation efforts would not be easy. It would not be easy to convince the camel owners (with the majority involved in the camel race business) to accept the notion that their camels might play a role in the disease transmission.
2–6 December 2013		SCH and MOE joint press conference to address the concern of the public and camel owners focused on: (1) The status of the outbreak (2) Efforts to contain the epidemic (3) The recent discovery (the virus isolation from the camels) as a possible progression towards the control of the epidemic (4) Screening of camels will be initiated soon (5) No plans to impose restrictions on trade as of now	The print media neutrally reported the messages which were communicated during the press conference.	SCH and its main partner (Animal Health Department) decided to hold a press conference as a form of communicating the new updates related to MERS, instead of issuing press release. For the second time, one of the spokespersons reassured that "the situation is stable" while yet more is to be known about the virus risk and behavior. This was not in accordance with the CERC recommendations. It seems that the press conference was a mean to prepare the public to collaborate with the intended national screening surveys. The grounds on which the selection of the communication method was unclear.
6 December 2013–17 March 2014	Animal Health Department announced control of the epidemic in camels as no new human case reported.		Qatar Animal resources are secured from the “leak” of coronavirus. Camels will be subjected to laboratory screening.	While the first key message seemed to have looked over-reassuring as the future of the virus was impossible to predict, the second one, however, was consistent with the official message indicating that the involved authorities were in agreement.