The outbreak of Middle East Respiratory Syndrome (Mers) in South Korea has become the biggest outside of Saudi Arabia, where the virus was first discovered in 2012.

All the cases so far have been confined to medical institutions. As the government scrambles to contain the spread of the Mers virus, it has also come under fire for its flawed response to the outbreak, especially in the initial weeks.

Here are some of the key criticisms from experts:

1. Delay in diagnosis

The first Mers patient - a 68-year-old man who fell sick after a business trip to the Middle East last month- coughed and wheezed his way through four hospitals from May 11 to 20 before officials figured out, nine days later, that he had something far more serious and contagious.

The Korea Centres for Disease Control and Prevention said it initially held off from testing the patient for Mers because he had told medical workers that his only stop in the Middle East was outbreak-free Bahrain, and he reported having no contact with sick people or camels, a common carrier for the virus. But, in fact, he had also visited the United Arab Emirates and Saudi Arabia, where many infections have been reported. His wife attributed the gaps in his travel history to confusion from high fever.

The World Health Organisation (WHO) has also said Mers is not an easy virus to identify early because its symptoms, including fever and runny nose, are similar to that of other respiratory infections like a common cold.

2. Hospital hopping, over-crowding at medical facilities

The index case apparently transmitted the virus to at least 30 people, including medical staff, fellow patients and hospital visitors, during his visits to various hospitals.

Local doctors said South Korean patients tend to visit different hospitals frequently until a diagnosis can be ascertained, which can spread disease. Patients who were in contact with the first patient and later moved to other hospitals started separate chains of infection in Seoul and Daejeon, south of the capital.

Peculiarities in the local culture have also helped spread the virus. Family members and caregivers tend to mingle with the sick in crowded emergency wards. They often stay with the patients in their rooms and do much of the nursing work - wiping sweat, emptying bedpans, changing sheets and exposing themselves to infections.

In addition, many patients seek medical care at large hospitals. The two hospitals - Pyeongtaek St Mary's Hospital in Gyeonggi province and Samsung Medical Centre in Seoul - where the vast majority of Mers cases have occurred were among the biggest in the country.

"In big hospitals, we see bottlenecks. This is a very Korean thing, and I think this is not a good situation when we have a new contagious virus breaking out," said Kim Woo Joo, head of the Korean Society of Infectious Diseases who is leading the government's epidemiological study of the Mers outbreak.

Professor of epidemiology Cho Sung Il from the Graduate School of Public Health at Seoul National University said: "Our crowded hospital environment is a weakness."

"Chances of close contact are higher in a South Korean hospital emergency room, for example, where seats and beds are usually arranged close together."

3. Lax quarantine

The lax quarantine of those infected and people who had contact with them inflated the scale of the outbreak, say experts. Soon after the first case of Mers was confirmed on May 20, a man under voluntary quarantine flew to Hong Kong and travelled by bus to Huizhou in southern China. He was later hospitalised and confirmed by Chinese health authorities as having Mers. Some 38 people in China who had been in close contact with him did not develop any symptom. In Hong Kong, health authorities had to quarantine 18 people who were seated within two rows of the man. Another 17 people were placed under medical surveillance.

In another case, a South Korean woman under quarantine could not be found at home in Seoul and authorities tracked her via her mobile phone to a golf course hundreds of kilometres away.

But authorities have since tightened quarantine, including sealing off a village of about 100 people in the south of the country after a resident was diagnosed with Mers.

4. Slow information dissemination

The South Korean government has been criticised widely for inadequate information disclosure in the initial stage of the outbreak. For more than two weeks, the government refused to make public the names of hospitals that had treated Mers patients because it was concerned about public panic.

As a result, fear and confusion mounted over news of the first two deaths from the Mers outbreak. Some people stayed away from clinics and hospitals, while shoppers snapped up face masks and hand sanitisers.

On June 7, the government changed its strategy and revealed the names of all 24 Mers-affected hospitals. Acting Prime Minister Choi Kyung Hwan said the government will be "as open as possible" in releasing information.

Officials also issued more advisories on how to guard against Mers and to counter rumours about its spread.

SOURCE: WALL STREET JOURNAL, NEW YORK TIMES, REUTERS, AFP