Managing the Double Burden: A Comprehensive Framework for the Concurrent Management of Middle East Respiratory Syndrome Coronavirus and COVID-19 in Saudi Arabia’s Healthcare System

Abstract Background: Saudi Arabia faces a unique dual challenge: managing Middle East respiratory syndrome coronavirus (MERS-CoV), endemic since 2012, and COVID-19 concurrently. Despite their distinct epidemiological profiles, transmission patterns and seasonal variations, both pathogens strain healthcare resources. This study aimed to develop, implement and evaluate a comprehensive integrated management framework. The goal was to optimise the concurrent management of both diseases across Saudi Arabia’s healthcare system. Methodology: Using a mixed-methods implementation science approach across 24 healthcare facilities nationwide, we developed a framework encompassing six domains: dual-pathogen surveillance, seasonal resource allocation, clinical management pathways, infection prevention and control, risk communication and healthcare worker protection. Implementation spanned January 2023–December 2024, with continuous monitoring of clinical outcomes, resource utilisation and economic impacts. Results: The framework led to major improvements. For MERS-CoV, the detection time dropped by 68.4%, length of stay by 29.7%, intensive care unit (ICU) admissions by 28.9% and fatality rates by 11.8%. For COVID-19, the detection time dropped by 65.4%, stay by 29.2%, ICU admissions by 26.7% and fatality rates by 26.1%. Resource use efficiency improved by 21.1%–26.7%, and cost-effectiveness was achieved by Q2 2024. Conclusions: The integrated framework significantly improved outcomes and resource use. Key barriers included resistance to change and coordination issues. Strong leadership and MERS experience were identified as facilitators. This model can inform global responses to concurrent respiratory threats.