Travel to Mecca and Medina is simply cancelled this year by Saudi Arabia over fears that the coronavirus will spread. Millions of Muslims make the pilgrimage every year. Cancelling foreigners from travelling to the holiest sites in Islam is considered an extraordinary decision, and not one we have ever seen before, even during MERS, Ebola fears at Hajj, a SARS breakouts and alarm and the occasional stampede.

In fact more people have been killed at Hajj during a stampede that all of the people affected by coronavirus so far. The latest deadliest stampede killed more than 2000 people in 2015:

Saudi Arabia does not want an outbreak like Iran so the oil-rich monarchy cancelled Hajj last week. The center of the western East breakout is Iran in the Shia city of Qom where the faithful kiss and touch a shrine every year.

Watch Video of the shrine lick in Qom:

https://youtube.com/watch?v=wadsf-1x4LU%3Fwmode%3Dopaque%26start%3D0

“Saudi Arabia renews its support for all international measures to limit the spread of this virus and urges its citizens to exercise caution before travelling to countries experiencing coronavirus outbreaks,” the Saudi foreign ministry said in a statement announcing the decision.

“We ask God Almighty to spare all humanity from all harm.”

Previous epidemics during Hajj

Disease outbreaks have been a concern in the past and we have covered the SARS and MERS outbreaks as they spread, offering tips to stay out of harm’s way.

Hajj, the journey to Mecca and Medina is required of all Muslims once in their life, if they are able. Al Jazeera reported that in 632 pilgrims fought of malaria; then there was cholera in 1821 killing 20,000 pilgrims. Cholera again in 1865 killed 15,000 and then spread viciously around the world.

The virus that causes the illness named COVID-19 has infected more than 80,000 people globally, mainly in China. In the Middle East, the hardest hit nation is Israel.

Israel has clamped down on travel into Israel and people returning from European countries, China, Japan, are sent to self-isolate or quarantine. Events for the upcoming holiday of Purim are cancelled, like the annual parade in Holon.

In Bahrain, which confirmed 33 cases as of Thursday last week, the authorities stopped all flights to Iraq and Lebanon.

Iranian President Hassan Rouhani said there were no immediate plans to quarantine Iranian cities but acknowledged it may take “one, two or three weeks” to get control of the virus.

Related: Why Muslims don’t drink alcohol

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About 500 people have died from the Middle East Respiratory Syndrome (MERS) believed to be transmitted by camels. And now Saudi Arabia is issuing a warning to camel handlers. This warning should go into effect for tourists who seek out the thrill of a camel ride as well.

Saudi Arabia is saying that anyone coming into contact with camels should wear both masks and gloves. They believe the MERS coronavirus, similar to SARS, is being spread by camel.

SARS skilled 800 people worldwide and there is no vaccine or anti-viral treatment to fight it.

The focus point of the MERS outbreak has been Saudi Arabia. Of the 500 that have died from the disease, 480 were in Saudi Arabia. Social media sites are percolating with news that the Saudi government isn’t handling the disease in an appropriate way.

Muslim pilgrims are expected to flock to Saudi Arabia in July, spreading fears among those making the journey to Mecca as part of Hajj.

Camels have a special place in the heart of Saudi society. While scientists worldwide are debating MERS and the link to camels, Saudi Arabia has remained quite hush hush.

There is a link between consuming camel meat and milk and the virus may be transmitted by consuming these items. Saudis whose livelihood depends on camel milk and meat are denying the link, according to Arab News. We hope readers who use these products be vigilant in at least making sure they are pasteurized or cooked well.

Image of camel and MERS from Shutterstock

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Deadly and debilitating viruses are no strangers to the Middle East; especially following the discovery of a SARS-like mystery virus in Saudi Arabia back in 2012.  This virus, which since then has become known as the Corona or MERS virus (see photo above) has been said to be spreading fast in the Arabian Peninsula by bats and camels.

But Saudi doesn’t seem to be able to cope with the problem.

The focus of the MERS virus, or Middle East Respiratory Syndrome, has until now been centered in Saudi Arabia, where 261 confirmed cases of the virus have resulted in 81 deaths.

The spread of the virus in the Kingdom has raised such concern that the Saudi Health Minister, Abdullah al Rabeeah, was sacked recently by Saudi by King Abdullah after saying in a news conference that he “had no idea why Middle East Respiratory Syndrome-Coronavirus, or MERS, was surging,” in his country.

The outcry and fear in this desert nation over the deadly disease, for which there is presently no vaccine and which kills an estimated one in three who contract the disease, is now causing great concern for the health of the millions of visitors who will come there during the annual Hajj pilgrimage; causing it to spread to developing countries in Africa and Asia.

A number of victims to the disease have been health workers who have had to deal with the increasing cases of the disease, now said to be passed from person to person. This has caused doctors and nurses to  doctors and nurses to express their concerns on Twitter and other social media sites; and accuse the health ministry of trying to minimize the outbreak.

To add to the above fears, the word is out that the MERS virus has now spread to Egypt.

Local reports from Al Jazeera say that the deadly virus was reported recently in Cairo from a person who had returned from visiting Saudi Arabia.  Al Jazeera went on to say that the “virus has been extraordinarily common” in camels for at least 20 years, and may have been passed directly from the animals to humans”.

This factor involving camels transmitting the disease was also reported by Green Prophet.

The SARS virus, which caused great concern almost a decade ago, resulted in 8,273 persons being infected, of which 9 per cent died.

Dr Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and an expert on pandemics and biosecurity, was quoted saying that the Saudi government needs to cooperate more with international health officials, such as those connected with the World Health Organization:

“They really need to bring in the global public health community. A senior WHO-supported team needs to get in there and help out. They need people with expertise,” says Dr. Osterholm.

More articles on the MERS virus, now on  the rise in the Middle East:

Bats blamed for Deady Middle East MERS Respiratory Virus

Deadly Middle East Corona Virus may come from Camels

SARS Like Mystery Virus Appears in Saudi Arabia, Alerting Haj Pilgrims

Photo of actual Corona shaped MERS virus by Reuters/AlJazeera

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MERS, a SARS-like virus believed to be transmitted by either camels or bats has claimed another life in the Middle East. This time a mother of a newborn and an eight year old boy from Jordan.

The family came into a hospital for a regular check up when the MERS virus was detected, according to local reports.

“They had no travel history, no contact with a known confirmed case and no history of contact with animals,” WHO said in a statement. The eight year old boy from Jordan, his dad and newborn are all being monitored. None of the family had been in contact with animals or other suspected cases of MERS.

To date the World Health Organization has found 163 laboratory-detected cases on infection and 70 deaths. The latest death in Abu Dhabi was preceded by two deaths in Qatar in November. 

Human cases of MERS, which can cause pneumonia and flu-like symptoms such as coughing and fever, have been reported in France, Germany, Spain, Italy, Britain, Saudi Arabia, Qatar, Kuwait, Jordan, United Arab Emirates, Oman, and Tunisia.

The Qatari health council warn people with underlying health conditions such as heart disease, diabetes and respiratory illnesses to avoid any close animal contact when visiting farms and markets.

The coronavirus MERS emerged in the Middle East last year, killing nearly 40 percent of the people so far infected.  It’s related to Severe Acute Respiratory Syndrome (SARS), and fears that the virus would explode amongst this year’s Hajj pilgrims have so far proved unfounded.

Image of virus under microscope from Shutterstock

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The deadly Middle East Respiratory Syndrome (MERS) virus has been detected in three camels linked to two new human cases of the disease in Qatar, fuelling speculation that camels might be the animal link that passes the virus to people.

British researchers who conducted some of the earliest genetic analyses on MERS said the virus was also related to a strain found in bats.

The three camels come from a single herd, according to the Supreme Council of Health and the Ministry of Environment.  The associated pair of human cases have already been cured. Qatar’s Supreme Council of Health said in a statement, “The three camels were investigated among a herd of 14 camels, and the samples were collected as part of the epidemiological investigation.”

World Health Organization spokesman Gregory Hartl said there was still insufficient evidence to say for sure what the source of the human MERS infections was. “Neither camels nor bats can yet be said to be reservoir of MERS,” he posted on the Twitter.

Last summer, Dutch scientists found strong evidence that the MERS virus is widespread among one-humped dromedary camels in the Middle East, suggesting people may become infected from camels used for meat, milk (read about camel milk here), transport and racing.

Human cases of MERS, which can cause pneumonia and flu-like symptoms such as coughing and fever, have been reported in France, Germany, Spain, Italy, Britain, Saudi Arabia, Qatar, Kuwait, Jordan, United Arab Emirates, Oman, and Tunisia.

The Qatari health council warn people with underlying health conditions such as heart disease, diabetes and respiratory illnesses to avoid any close animal contact when visiting farms and markets.

The coronavirus MERS emerged in the Middle East last year, killing nearly 40 percent of the approximately 176 people so far infected.  It’s related to Severe Acute Respiratory Syndrome (SARS), and fears that the virus would explode amongst this year’s Hajj pilgrims have so far proved unfounded.

Image of camels from Shutterstock

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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.

Global threat?

“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.”

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Over a year has passed since the first case emerged of Middle East Respiratory Syndrome (MERS).  MERS has since infected 135 and killed 58, yet questions on the origin and transmission patterns of the disease remain.

Hajj (here’s how you can make it green) is an Islamic pilgrimage to Mecca, in the Kingdom of Saudi Arabia (KSA), and the largest annual gathering of Muslims in the world. One of the five pillars of Islam, it is a religious duty which must be performed by all able-bodied Muslims who can afford to do so at least once in their lifetime.

Medical experts are concerned that large scale international travel might accelerate virus spread.

Many opt for gruelling bus travel (drive time from Amman, Jordan to Mecca exceeds 12 hours). Once there, a strenuous series of rituals begin to symbolize the lives of the Prophet Ibrahim and his wife Hajar. Consider desert climate and rough accommodations, and see why the pilgrimage is difficult.

This year, KSA announced new limits to religious tourist visas, emphasizing ongoing construction at the Holy Mosque as the constraining factor.  Belgium’s National Flu Commissioner, virologist Dr. Marc Van Ranst, advised Belgian Muslims to pass on the pilgrimage. Margaret Chan, secretary-general of the World Health Organization (WHO), pulled no punches with her proclamation that MERS posed a “threat to the entire world.”

KSA medical experts have suggested that the elderly, young children, pregnant women and people with compromised health do not make the pilgrimage. Particular caution is aimed at those with suppressed immune systems. But, regulation-wise, the bottom line is that people are free to travel to Mecca as per usual: WHO has issued no travel warnings to the Middle East relative to MERS.

While not believed to be easily transmitted in the general population, the MERS coronavirus can spread between people in prolonged close contact, hence the risk to pilgrims living and traveling in crowded conditions. The American Center for Disease Control (CDC) website offers some guidelines (link here).

Epidemiology aside, mass gatherings have always been linked with unique health risks.  The Saudi Ministry of Health mitigates some by requiring all pilgrims to be vaccinated for meningococcal in order to receive Hajj visas. The CDC recommends polio boosters and vaccination against hepatitis A, B, and typhoid for travel to KSA, in addition to routine vaccines (such as measles, pertussis, and flu).

Stomach flu and diarrhea are common during Hajj, partly due to unfamiliar food prep and unreliable refrigeration. After Hajj, men are required to shave their heads: unclean blades can transmit disease, so men are urged to use officially designated centers where licensed barbers use disposable, single-use blades.

Autumn temperatures in Mecca can exceed 100°F, putting heat exhaustion, sunburn and heatstroke on the menu of maladies.

Finally, human stampede is a major risk in any gathering, exponentially worsened by the millions of assembled hajjis. Stampedes at previous Hajj events have injured or killed hundreds, inciting the KSA government to invest over $25 billion to help control crowds and minimize risk.

This year, Hajj is expected to occur from October 13 through 18; the exact duration is dependent on moon sightings. As a non-Muslim, it’s improbable I’ll ever experience it. Instead, I watch my friends glow at the prospect of participating in this mind-blowing celebration and I wish that, Insha’Allah, they return rejuvenated in spirit, mind and body.

If you want to make the Hajj more green, read our green guide to Hajj here. And here are four steps to a greener Hajj. Share these with all pilgrims everywhere.

Image of pilgrims at the Kaaba from Shutterstock

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To date, Middle East Respiratory Syndrome (MERS) has affected at least 94 people, 46 of whom died, but researchers have yet to pinpoint the source of this deadly virus.

New research published in the journal Lancet Infections Diseases suggests that dromedary camels may be responsible.

In order to investigate how people are picking up the coronavirus, which is not yet considered a global threat, researchers tested animals in several countries to determine if they had ever been infected with the disease.

Professor Marion Koopmans, from the National Institute of Public Health and the Environment and Erasmus University in The Netherlands, told the BBC:

“We did find antibodies that we think are specific for the Mers coronavirus or a virus that looks very similar to the Mers coronavirus in dromedary camels.”

Animals that test positive for these antibodies have been exposed to the disease at one time or another, Prof Koopmans adds.

It turns out that in the Canary Islands, 15 out of 105 dromedary camels tested positive for the antibodies, while all 50 of the camels in Oman have also been exposed to the disease at one time during their lifespan. But neither of the two countries have reported any cases of humans contracting the disease.

Prof Koopmans said: “It is a smoking gun, but it is not definitive proof.”

Professor Paul Kellam from the Wellcome Trust Sanger Institute in Cambridge and University College London told the paper that there is only one way to know for certain that the camels are spreading the disease to humans.

“The definitive proof would be to isolate the virus from an infected animal or to be able to sequence and characterise the genome from an infected animal,” he told BBC. The next step is to take samples from camels in Saudi Arabia, where the first man contracted the disease and died.

Although BBC News reports that there is no concern for alarm, last year Margaret Chan, WHO secretary-general, said otherwise.

Chan announced that Mers is a “threat to the entire world.”

“We understand too little about this virus when viewed against the magnitude of its potential threat,” said Chan.

“Any new disease that is emerging faster than our understanding is never under control. These are alarm bells and we must respond. The novel coronavirus is not a problem that any single country can manage by itself.”

:: BBC News

Image of dromedary camels in Egypt, Trip Advisor

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These statistics were published by WHO on June 14. On June 15th, three new cases and another death were advised, rendering daily WHO updates instantly out of date. By the time this story is published, numbers will rise.

By June 17, Saudi Arabia has confirmed four more deaths.

The bug is a variant of Severe Acute Respiratory Syndrome (SARS), a virus that emerged in Asia over a decade ago.  That disease spread rapidly, infecting over 8,000 people and killing nearly 800 before mysteriously disappearing.

Last year, the first case of this new virus was recorded when a Saudi man developed the infection and died. It was several months before a second man was stricken. Concerns arose that transmission would exponentially increase during the 2012 Hajj, when millions of Muslims made pilgrimage to the Saudi holy city of Mecca, but no outbreak occurred and alarm over the unnamed virus (simply called “SARS-like”) quieted.

But it’s back in the news with two known cases of Mecca pilgrims falling fatally ill this year. In February, a British pilgrim died after infecting two family members.  In late May, a 66-year-old Tunisian man died after returning from a pilgrimage, and two of his children tested positive for the virus.

Last month two new cases were reported in France. Patient #1 had traveled to Dubai, became ill and was hospitalized in France, where his hospital roommate picked up the bug. Cases have since been reported in Tunisia, Qatar, the United Kingdom, Germany, Jordan, and the United Arab Emirates.

Tough talk and decisive action can be effective tools when dealing with public health.  So Margaret Chan, WHO secretary-general, grabbed a microphone and boldly announced that the coronavirus circulating mostly in the Middle East posed a “threat to the entire world.”

And the news media took the bait.  Is she overstating the threat?

Chan from WHO was directly involved with the Asian SARS outbreak. She’s experienced in corralling world attention to scary epidemics. A case of “the girl who cried wolf”? Or a prudent early warning system to incite sober attention to an unpredictable new virus with far-reaching influence?

She said, “We understand too little about this virus when viewed against the magnitude of its potential threat. Any new disease that is emerging faster than our understanding is never under control. These are alarm bells and we must respond. The novel coronavirus is not a problem that any single country can manage by itself.”

The virus continues to spread into new countries, raising concern ahead of the Islamic pilgrimage periods which will occur this summer and autumn.

Most of the victims suffered from underlying medical conditions. The WHO says the virus spreads by means including interpersonal contact, and possibly via airborne transmission between people in closed quarters.  It doesn’t appear to spread easily in communities at large, but what about transmission between travelers in airports and planes?

Authorities believe initial transmission of the virus was from animal to human, but the animal source remains unidentified.

The European Center for Disease Prevention and Control noted the many unanswered questions about the Middle East-based virus, issuing a statement saying, “It is unusual to have such a degree of uncertainty at this stage in an outbreak.”

Image of man in oxygen mask from Shutterstock

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