SALON

Monday, Jun 10, 2013 6:32 PM UTC

Surgical masks for Ramadan? New virus has pandemic potential

World health experts worry pilgrimage will spark global health crisis if Saudi Arabia stays mum about MERS virus

By

Topics: Scientific American, World Health Organization, MERS, SARS, umrah, Ramadan,

Surgical masks for Ramadan? New virus has pandemic potential
This article originally appeared on Scientific American.

Scientific American
Over the next few weeks officials at the World Health Organization (WHO) face a tough and politically charged call. The Muslim month of fasting, Ramadan, begins July 9 and could draw as many as two million people from around the globe to the holy sites of Saudi Arabia in a pilgrimage called umrah. But a new disease, called Middle Eastern respiratory syndrome, or MERS, could threaten them.

Infectious disease control at mass gatherings is always a challenge, but this year even more so. Saudi Arabia is currently waging battle with MERS, yet it has released only the barest of details that scientists or public health officials could use to try to prevent its spread within Saudi Arabia or around the globe. In early May Saudi officials startled the world by announcing 13 new cases over the course of a few days. Since the start of May there have been 38 new cases worldwide—31 of them in Saudi Arabia—and 20 of the victims have died. With virtually no clues to draw on about where the virus lives in nature and how people contract it, WHO is trying to figure out what guidance to give those pilgrims, and the countries they will return to, about how to avoid infection and the international dissemination of a devastating new illness.

MERS triggers severe pneumonia and kidney failure in some cases. It is a cousin of SARS, severe acute respiratory syndrome, which broke out in mainland China in late 2002, spread from there to Hong Kong in 2003, and was then transported in the lungs of international travelers to Singapore, Hanoi, Toronto and other cities. Health officials do not want to pull out the big hammers used during the SARS outbreak, such as WHO travel advisories that urged the world’s citizens to avoid infected hubs such as Hong Kong and Toronto. On the other hand, no one wants umrah and the even larger hajj pilgrimage that will follow in October to trigger a pandemic.

The new virus was first isolated in June 2012. But its existence came to the world’s attention only weeks before last October’s hajj, when an Egyptian infectious diseases specialist who had been working in Saudi Arabia’s second largest city, Jeddah, reported that he had treated a man who died from an infection caused by a new coronavirus. Whether MERS has or can gain the capacity for sustained person-to-person spread is unknown. Kamran Khan, an infectious diseases physician who researches global flight patterns as a means of predicting disease spread, has had a worried eye on the Muslim religious calendar for some time. “We still don’t have a good idea where this (virus) is coming from, so taking measures to mitigate risks are constrained,” says Khan, who works at the Saint Michael’s Hospital Keenan Research Center in Toronto.

Coronaviruses such as MERS, SARS and numerous others are named for the hallmark halo, or crown, they appear to sport in their outer shells. Many infect bats; the few that infect people cause illnesses ranging from the common cold to the severe lung devastation seen with many MERS cases, forcing patients to undergo mechanical ventilation. MERS has not yet evolved to spread as well as SARS can. And SARS, which was no wimp, killed about 11 percent of cases before it disappeared in 2004.

Last fall and in the early part of 2013 MERS infections popped up sporadically in a variety of places. Testing of samples from an April 2012 outbreak in Jordan revealed the virus had killed two nurses there. Three men in a family in the Saudi capital, Riyadh, appeared to have passed the virus to one another. Sick people from Qatar and the United Arab Emirates were medivacked to the U.K. and Germany. And more recently tourists have taken the infection to the U.K., France, Tunisia and Italy.

The affected Arabian Peninsula countries have not been particularly forthcoming with information, and global health experts have yet to hit on the right strategy for persuading officials to get serious about finding the source of the infections or the scope of the illness in people. An outbreak of H7N9 bird flu virus in China at the beginning of April also distracted attention from MERS.

The latter virus, however, would not be ignored for long. The 13 new infections in early May were linked, arising in dialysis patients treated in Al Moosa Hospital at the Al-Ahsa oasis in the kingdom’s Eastern Province. Infection in hospitals is how SARS took off, so word that an institution—or as sources suggest, several institutions—were epicenters of the outbreak raises the level of concern.

Donald Low, a microbiologist at Mount Sinai Hospital in Toronto who became a SARS expert in 2003, expressed hope that the Al-Ahsa outbreak would “put their feet to the fire to get serious about this.” Low has been worried about the possibility that superspreaders will emerge, as they did during SARS. Most people who contracted SARS passed the virus to at most one other person. But some SARS patients infected large numbers of people. One patient in Singapore infected 62 others; a woman who fell ill in the early days of the Toronto outbreak infected 44. With SARS, superspreaders turned a virus that likely would have burned itself out into a global outbreak that claimed 916 lives.

Has there been a superspreader in Saudi Arabia? If so, Saudi authorities have not revealed it. But it is evident that infections are being detected at a more rapid pace. At WHO’s annual meeting—the World Health Assembly—in late May, the Saudi delegation was given what amounts to a diplomatic dressing down, with Director General Margaret Chan lauding China for its handling of the H7N9 outbreak and demanding that countries with MERS cases act as good global citizens and share information in a timely, complete manner. The next day Saudi Arabia announced five more cases in a three-line statement, which revealed only that victims ranged in age from 73 and 85; all had chronic diseases and lived in the Eastern Province.

Infectious disease experts are aghast that this late into MERS’s spread the world still has no idea what puts people at risk of infection, how long the incubation period is, when people are contagious or whether there are mild cases that are being missed because surveillance is focused on finding sick people in hospitals. They put the problem squarely at the feet of the Kingdom of Saudi Arabia (KSA), which accounts for 41 of the 55 infections to date. Says Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota: “The European countries have largely done an exemplary job of investigating and following up on the cases [that have been exported there]. Now, either the Middle Eastern countries, particularly KSA, have not, or they’re just withholding information, for whatever reason. And in a situation where this represents a potential global pandemic, that is inexcusable.”

Scientists also have no sense of whether the virus has changed over time. Genetic sequences of only four viral isolates have been placed in GenBank, the open-access sequence database run by the National Institutes of Health’s National Center for Biotechnology Information. The most recent of the genetic blueprints dates to an infection that occurred in February. No sequences from the flurry of recent cases have been released. In fact, except for the sequence of the first spotted case—the man from Jeddah—no Saudi sequences have been placed in the public domain. The kingdom’s deputy minister of health, Ziad Memish, has promised that sequences will be shared.

This week an international team of experts convened by WHO has gathered in Saudi Arabia to make headway in prying information out of the country. With the clock counting down to Ramadan, they have little time in which to answer key questions about the disease—answers needed to help safeguard the umrah pilgrims, and the rest of the world.

Helen Branswell

More Helen Branswell.

You Might Also Like

More Related Stories

Featured Slide Shows

7 motorist-friendly camping sites

close X
  • Share on Twitter
  • Share on Facebook
  • Thumbnails
  • Fullscreen
  • 1 of 9

Sponsored Post

  • White River National Forest via Lower Crystal Lake, Colorado
    For those OK with the mainstream, White River Forest welcomes more than 10 million visitors a year, making it the most-visited recreation forest in the nation. But don’t hate it for being beautiful; it’s got substance, too. The forest boasts 8 wilderness areas, 2,500 miles of trail, 1,900 miles of winding service system roads, and 12 ski resorts (should your snow shredders fit the trunk space). If ice isn’t your thing: take the tire-friendly Flat Tops Trail Scenic Byway — 82 miles connecting the towns of Meeker and Yampa, half of which is unpaved for you road rebels.
    fs.usda.gov/whiteriveryou


    Image credit: Getty

  • Chattahoochee-Oconee National Forest via Noontootla Creek, Georgia
    Boasting 10 wildernesses, 430 miles of trail and 1,367 miles of trout-filled stream, this Georgia forest is hailed as a camper’s paradise. Try driving the Ridge and Valley Scenic Byway, which saw Civil War battles fought. If the tall peaks make your engine tremble, opt for the relatively flat Oconee National Forest, which offers smaller hills and an easy trail to the ghost town of Scull Shoals. Scaredy-cats can opt for John’s Mountain Overlook, which leads to twin waterfalls for the sensitive sightseer in you.
    fs.usda.gov/conf


    Image credit: flickr/chattoconeenf

  • Nordhouse Dunes Wilderness Area via Green Road, Michigan
    The only national forest in Lower Michigan, the Huron-Mainstee spans nearly 1 million acres of public land. Outside the requisite lush habitat for fish and wildlife on display, the Nordhouse Dunes Wilderness Area is among the biggest hooks for visitors: offering beach camping with shores pounded by big, cerulean surf. Splash in some rum and you just might think you were in the Caribbean.
    fs.usda.gov/hmnf


    Image credit: umich.edu

  • Canaan Mountain via Backcountry Canaan Loop Road, West Virginia
    A favorite hailed by outdoorsman and author Johnny Molloy as some of the best high-country car camping sites anywhere in the country, you don’t have to go far to get away. Travel 20 miles west of Dolly Sods (among the busiest in the East) to find the Canaan Backcountry (for more quiet and peace). Those willing to leave the car for a bit and foot it would be remiss to neglect day-hiking the White Rim Rocks, Table Rock Overlook, or the rim at Blackwater River Gorge.
    fs.usda.gov/mnf


    Image credit: Getty

  • Mt. Rogers NRA via Hurricane Creek Road, North Carolina
    Most know it as the highest country they’ll see from North Carolina to New Hampshire. What they may not know? Car campers can get the same grand experience for less hassle. Drop the 50-pound backpacks and take the highway to the high country by stopping anywhere on the twisting (hence the name) Hurricane Road for access to a 15-mile loop that boasts the best of the grassy balds. It’s the road less travelled, and the high one, at that.
    fs.usda.gov/gwj


    Image credit: wikipedia.org

  • Long Key State Park via the Overseas Highway, Florida
    Hiking can get old; sometimes you’d rather paddle. For a weekend getaway of the coastal variety and quieter version of the Florida Keys that’s no less luxe, stick your head in the sand (and ocean, if snorkeling’s your thing) at any of Long Key’s 60 sites. Canoes and kayaks are aplenty, as are the hot showers and electric power source amenities. Think of it as the getaway from the typical getaway.
    floridastateparks.org/longkey/default.cfm


    Image credit: floridastateparks.org

  • Grand Canyon National Park via Crazy Jug Point, Arizona
    You didn’t think we’d neglect one of the world’s most famous national parks, did you? Nor would we dare lead you astray with one of the busiest parts of the park. With the Colorado River still within view of this cliff-edge site, Crazy Jug is a carside camper’s refuge from the troops of tourists. Find easy access to the Bill Hall Trail less than a mile from camp, and descend to get a peek at the volcanic Mt. Trumbull. (Fear not: It’s about as active as your typical lazy Sunday in front of the tube, if not more peaceful.)
    fs.usda.gov/kaibab


    Image credit: flickr/Irish Typepad

  • As the go-to (weekend) getaway car for fiscally conscious field trips with friends, the 2013 MINI Convertible is your campground racer of choice, allowing you and up to three of your co-pilots to take in all the beauty of nature high and low. And with a fuel efficiency that won’t leave you in the latter, you won’t have to worry about being left stranded (or awkwardly asking to go halfsies on gas expenses).


    Image credit: miniusa.com

  • Recent Slide Shows

  • Share on Twitter
  • Share on Facebook
  • Thumbnails
  • Fullscreen
  • 1 of 9

Related Videos

Comments

 4 Comments

Comment Preview

Your name will appear as username ( settings | log out )

You may use these HTML tags and attributes: <a href=""> <b> <em> <strong> <i> <blockquote>

Salon is proud to feature content from Scientific American, the longest continuously published magazine in the United States and the leading popular source and authority on science, technology and innovation. With a worldwide print and digital audience of more than five million people, fourteen local language editions, and a major new

blog network, Scientific American engages, educates and inspires current and future generations of science-interested citizens and public and private sector leaders.

Continue Reading

follow salon

Most Read

Popular on Reddit

links from salon.com

vote
James Clapper is still lying to America
106 points107 points | comment
vote
Let's Stop Screwing Around and Impeach James Clapper: After lying to Congress about all the different ways the NSA's spying on us, Director of National Intelligence James Clapper lies about how he lied. Call the White House at 202 456-1111 and Tell Obama to Get Rid of Clapper
90 points91 points | 4 comments
vote
Machiavelli doesn’t belong to the 1 percent | "The Prince" is oft-quoted on Wall Street, but its author was a hero of the working class who despised elites
62 points63 points | 13 comments
vote
We must hate our children
63 points64 points | 11 comments
vote
Machiavelli doesn’t belong to the 1 percent | "The Prince" is oft-quoted on Wall Street, but its author was a hero of the working class who despised elites
53 points54 points | 16 comments

From Around the Web

Presented by Scribol
listener_new_rect The Listener: "The Joker": Laughing at life's deepest sorrows