Public health officials in the Gulf states are playing down fears about an outbreak of the deadly MERS coronavirus among pilgrims travelling to the Hajj in Saudi Arabia this month, though doctors are advising the elderly, people with existing health conditions, pregnant women and young children to stay away.
As of 4 October, according to the World Health Organization (also known as the WHO), laboratories in the region had confirmed 136 cases of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), including 58 deaths since April 2012.
Most cases and deaths have been in Saudi Arabia, where two million Muslims are expected to converge in mid-October for the annual Hajj pilgrimage to the holy cities of Mecca and Madinah.
The virus is seen as a cousin of Severe Acute Respiratory Syndrome (SARS), which swept through Asia in 2002-3, killing over 700 people.
MERS-CoV can cause breathing difficulties, diarrhoea, kidney failure, and in extreme cases, death.
Saudi Arabia’s Health Minister Abdullah Al Rabia says his country is ready for an outbreak, but stressed that he was confident there would be no problem, given there were no recorded cases during either July’s Umrah pilgrimage or last year’s Hajj.
The country, which has had 120 cases and 49 deaths since September 2012, has assigned two laboratories for MERS-CoV-specific testing. It will also use existing health surveillance points at borders (set up to ensure pilgrims are vaccinated against Meningococcal Meningitis and Yellow Fever) to be on the look-out for cases.
Health authorities around the Middle East, many of whom already send large health support teams to the Hajj, will also be raising awareness of the virus among pilgrims, with a focus on reminding people what they should do if they return from Saudi Arabia and feel unwell.
The risks of MERS-CoV transmission were discussed at length during a week-long meeting of the International Mass Gathering Medicine Conference held last month in Saudi Arabia, home to the Global Center for Mass Gathering Medicine run by the Saudi government.
Over 1,000 health officials from WHO, the US government’s Centers for Disease Control and Prevention (CDC) and various governments from around the world attended the event, which focused on MERS-CoV.
One of the difficulties with the virus is that the early symptoms can be easily confused with the common cold. Unless doctors are specifically screening for the virus, it can be hard to pick up.
Another challenge is that despite more than one year of research, scientists remain unsure about the source of the virus and how it is transmitted.
“Until we have a definitive source of infection, it is hard to give targeted advice,” explained Richard Brown, a medical doctor and regional adviser for communicable disease surveillance and epidemiology for WHO’s South East Asia Regional Office.
Brown, who is also focal point for WHO’s International Health Regulations, told IRIN: “There is an assumption that the source is animals, and we have seen some very interesting studies about bats and camels, but if they are a possible source of infection, we don’t really know how it’s getting from those animals to humans, or whether perhaps even these animals are being infected from yet another, undiscovered source.”
He added: “People need to be careful in a very generic way, such as ensuring good hand hygiene. We would normally tell people to avoid very crowded situations, but obviously in this case, with the Hajj, that is unrealistic.”
Anthony Mounts, a medical doctor and technical lead for the MERS-CoV response with WHO in Geneva, stressed the importance of global awareness about MERS-CoV, not just among countries in the Middle East, or those sending pilgrims to the Hajj.
“The Hajj could possibly be an issue, but actually there are pilgrims that go to sites in Saudi Arabia all through the year. When you look back at our data, we have not seen cases emanating from these people,” he explained.
“However”, he added, “the concern extends beyond the countries in the immediate region. If you look at the way people travel in the region, in particular the workforce, they come from a lot of poor countries, from places like Pakistan, India and the Philippines, all of which are places which don’t perhaps have the best infrastructure to respond to a virus or even to detect it.”
Experts find some comfort in two things: the pace of the disease has not accelerated, nor has the disease mutated.
“Although we have seen human to human transmissions occur in healthcare facilities, between patients, from patients to doctors, among healthcare staff and close family members, we haven’t yet seen that third or fourth level of community transmission,” Mounts said, meaning when the disease is spread more randomly among strangers.
“There have been quite a lot of investigations looking for this [community transmission], they just haven’t found it yet. What’s more, the clusters that we have seen seem to extinguish themselves with relatively modest interventions, which was not the case with SARS.”