New MERS virus + Hajj: Maybe not a recipe for disaster

Muslim pilgrims circle the Kaaba as they pray inside the Grand Mosque in the Muslim holy city of Mecca, Saudi Arabia
Muslim pilgrims circle the Kaaba as they pray inside the Grand Mosque in the Muslim holy city of Mecca, Saudi Arabia. Amr Nabil

It seems like the perfect storm — millions of people from all over the world, descending on a few cities all in the space of a few weeks, just as a deadly and mysterious new virus is spreading.

But global health officials say they are not especially worried that the annual Hajj pilgrimage in Saudi Arabia will help spread the MERS coronavirus when it starts next week. That’s even though this virus has demonstrated that it’s only a single flight away from any city in the world, and even though it’s an especially deadly virus.

Why not? MERS hasn’t yet acquired the ability to spread easily from one person to another.

And while U.S. health officials are keeping an eye out for it, they’re not especially concerned, either. “We think the risk is low,” says Dr. David Trump, state epidemiologist for Virginia.

Watching out for the virus across the United States this year may fall mostly on the shoulders of state health officials such as Trump, as the government shutdown has closed most activities of the Centers for Disease Control and Prevention.

The Middle East respiratory syndrome (MERS) virus emerged in Saudi Arabia about a year ago. It’s a coronavirus, in the same family as the severe acute respiratory syndrome (SARS) virus that caused an epidemic in 2003 and infected around 8,000 people and killed more than 700 of them before it was stopped.

So far, MERS has been confirmed in 136 people and it’s killed 58 — making it a highly deadly virus. Most, but not all, victims have been old or weak or sick in some way — many with kidney disease or diabetes. But healthy people have been killed, too.

The World Health Organization says it has the potential to cause a pandemic. It’s been seen mostly in Saudi Arabia, centered around Riyadh, but has spread to France, Germany, Britain, Jordan, Qatar and other countries.

And now an estimated 3 million people are about to descend on Saudi Arabia for the Hajj – the mass pilgrimage to the city of Mecca that devout Muslims try to undertake at least once in their lives. The Centers for Disease Control and Prevention estimates that 11,000 Americans make the trip every year.

This year, it takes place Oct. 13-18.

For a new virus or other microbe to cause a pandemic, it has to spread easily and efficiently from one person to another. MERS doesn’t do that. Some people have infected others, but most new infections are still a bit mysterious – and at least one study suggests people are being infected directly by animals.

Saudi health officials are taking precautions, however. The Saudi Ministry of Health has suggested that people over 65, children under 12, pregnant women and people with chronic conditions such as diabetes and kidney failure stay home this year.

Because millions of people are crowded into close quarters, the Saudi Ministry of Health requires all pilgrims to be vaccinated against meningitis. CDC recommends that people make sure other vaccines are up to date -- the Hajj comes at the beginning of flu season, also.

“CDC also recommends vaccination against hepatitis A and B and typhoid for travel to Saudi Arabia, and all travelers, regardless of destination, should be up-to-date on routine vaccines (such as measles and pertussis),” the agency advises.

CDC also advises travelers to the Hajj to take other precautions, like washing their hands a lot, to protect against all sorts of infectious diseases.

State health officials say they’re already watching for signs anyone traveling from the Middle East might have MERS. Trump says there have been several false alarms in Virginia, which has a large population of people who travel frequently to the Middle East.

“We certainly have worked to make sure physicians know what to think about and who to call if they feel they have someone who has an illness compatible with the MERS coronavirus,” Trump said.

The same goes for Maryland, another state with a large international airport and frequent travel to the Middle East.

“We have alerted physicians and hospital infection prevention and control practitioners to be vigilant for persons who meet the Centers for Disease Control and Prevention's criteria for a MERS ‘patient under investigation’ or PUI, and advised them to immediately report all possible cases,” said Karen Black, a spokesperson for Maryland’s health department.

“We have also provided information about isolation and specimens to be collected for diagnostic testing.”

WHO does not advise special screening at airports for travelers coming back from the Hajj and doesn’t recommend any travel or trade restrictions.

Virus experts say they’ve linked MERS to bats, but say it’s unlikely bats are directly infecting people. Another animal may be involved. SARS was eventually traced to an animal called a civet, sold in wild animal markets in China.