The pilgrimage to Makkah has become an all year round activity, with large crowds of believers converging on the holy city every month – thus making the city a perfect environment for spreading new diseases. SARS, which originated from China, quickly spread to two-dozen countries, including Saudi Arabia, killing 800 people. Severe Acute Respiratory Syndrome, or SARS, is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). Since its 2003 outbreak, there has been no known cases of SARS reported anywhere in the world. In September 2012, Saudi Arabia reported two cases of a mysterious SARS-like virus, which resulted in one death. This unknown virus was found to be similar to SARS, thus raising concerns ahead of the Hajj pilgrimage of a possible epidemic. Later in 2012 the virus was identified as a new coronavirus and the disease was named the Middle Eastern Respiratory Syndrome (MERS). In early 2014, the rate of infection in Saudi Arabia surged and an outbreak of associated illnesses in hospitals in Jeddah and Riyadh was reported, however Saudi Arabia seemed to be successful in controlling the disease during 2014 haj ceremony. The number of people infected by the virus in 2015 Haj ceremony is otherwise so hard to estimate. Hospitalisation of Mina injured pilgrims has significantly increased the risk of virus transmission. On the other hand the long incubation period of the virus which can take to 14 days also elevates the risk of spreading the virus among the people when pilgrims get back to their countries.
Although the main source of the virus is not known, it is thought that mammals play an important role in the transmission of the virus, especially bats and camels. MERS-CoV (the corona virus which causes MERS) has been identified in camels in Qatar, Egypt and Saudi Arabia, and in bats in Saudi Arabia. It is very likely that the virus infected humans by air or after the consumption of infected camel milk or meat. All cases have been linked to countries neighbouring the Arabian Peninsula including Bahrain, Iraq, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, United Arab Emirates (UAE), the West Bank and Yemen. Cases reported in other countries are mostly travel-related.
The number of people infected by the virus in 2015 Haj ceremony is otherwise so hard to estimate. Hospitalisation of Mina injured pilgrims has significantly increased the risk of virus transmission. On the other hand the long incubation period of the virus which can take to 14 days also elevates the risk of spreading the virus among the people when pilgrims get back to their countries.
MERS is a pneumonia-like disease, and the symptoms are very close to SARS. The main difference between SARS and MERS is the renal failure associated with the MERS-CoV. The most common symptoms of MERS include a 100.4° F – 38° C fever, cough, breathing difficulties, chills, chest pain, body aches, sore throat, malaise (a general feeling of being unwell), headache, diarrhoea, nausea/vomiting, runny nose, renal (kidney) failure and pneumonia. Most sufferers develop severely acute symptoms, while a few show mild symptoms and a minority have no symptoms at all. Those in contact with MERS patients arriving from Hajj were examined for MERSCoV, and only after examination they showed symptoms of this illness. The virus has incubation period of 2-14 days and it is important to know that even in this period the virus can be transmitted.
Close contact with an infected person should be avoided as MERS is an air-borne influenza, or flu- like disease; the spreading process happens through small droplets of infected water and is disseminated through sneezing or coughing. Wearing masks or keeping a distance of at least three feet should be considered when near an infected patient. Touching a surface that has been touched by an infected patient can also transmit the disease, so washing hands regularly is essential for both the infected person and the healthy person. Health care providers and family members should take these warning seriously. Other high risk groups are patients with chronic diseases, such as diabetes, chronic lung disease and heart conditions, the elderly, organ transplant recipients who are on immuno -suppressive medications, and cancer patients undergoing treatment. Pneumonia – the most common complication – is the number one cause of death in affected patients. The respiratory problems can become so severe that the patient needs a mechanical respirator. Organ failures, like kidney failure and septic shock, occur in a significant number of patients, but people with chronic diseases like diabetes are more vulnerable to complications.
There are two peak periods for visits to the holy sites in Saudi Arabia – one towards the end of Ramadhan, and the other during hajj. Authorities have requested pilgrims to wear masks as a precaution against the MERS virus, while elderly and patients with chronic diseases are advised to postpone their pilgrimage. Pilgrims have also been asked to be extra careful with hygiene, to use paper tissues when sneezing or coughing, and to make sure that they are up-to-date with all their vaccinations. Hands should be washed with soap and water for at least 20 seconds. Touching the eyes, nose, and mouth with unwashed hands should be avoided, as they are common ways for contracting a virus. Regular disinfecting of surfaces like door-knobs and tables with an antibacterial cleanser is also a good precaution. Undercooked meats (especially camel’s meat), or unsafe water can be avenues for transmitting the disease and should be avoided. Raw fruits and vegetables should be peeled or boiled.
According to WHO, there is no specific treatment for MERS, but supportive medical care can be provided by doctors to help relieve symptoms. If any case of pneumonia-like symptoms in travellers to Saudi Arabia or neighbouring regions is observed, it is better to directly refer them to a hospital where diagnostic tools and supportive cares, such as mechanical respirators are more readily available. Supportive care does not improve or treat the illness, but may help in controlling complications and side effects, as well as providing comfort for the patient. Fever should be controlled by effective anti-fever drugs like Ibuprofen. Headache and body pains can be decreased by painkillers. The most important thing to do is to check and sustain the functions of vital organs, such as the liver, kidneys and heart. It should be noted that antibiotics are completely useless in the case of MERS, as well as any other viral disease.