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Global health experts have stepped up warnings to the more than a million foreign pilgrims on their way to Saudi Arabia of the risks there from a deadly Sars-like virus that has killed more than 30 people worldwide.
As vast numbers of Saudi and non-Saudi Muslims prepare to travel to Mecca next month for the peak of the Umrah pilgrimage, public health officials fear the virus may be circulating more widely than thought.
The influx of visitors to Saudi Arabia increases the chances of both domestic and international transmission of the coronavirus dubbed Middle East Respiratory Syndrome, which has killed more than 20 people in the kingdom.
“The risk [to pilgrims] is there,” said Salman Rawaf, professor of public health at Imperial College, London.
Health officials have called on countries to look out for signs of infection from the virus ahead of the Muslim holy month of Ramadan, which is an especially popular time for pilgrimages and is due to start around July 8.
Anthony Mounts, technical lead on MERS at the WHO, said information was being prepared for distribution to many thousands of Muslims travelling to Mecca, amid signs that some infections by the virus may not have been picked up.
One concern is that surveillance and diagnosis so far had focused on severe cases and thus had likely missed many milder cases, Mr Mounts said.
Another is that confirmed cases had been reported by travellers returning from the Middle East to European countries, yet none had been identified in the Gulf states where they had travelled. Nor have any cases been reported in Asian countries such as Pakistan, Indonesia and the Philippines, the home to many migrant workers in Saudi Arabia who travel back and forth.
While Mr Mounts said the Saudi Arabian authorities had developed strong systems to diagnose the virus, he warned that there were still gaps in understanding both its origin – currently thought to be bats– and means of transmission.
“They are sending more information than before,” he said. “But some things are just not available.”
The cases in Saudi Arabia have so far been confined to an area close to the town of Hofuf in the al-Ahsa region in the east of the country, more than 1,000km away from Mecca in the west. But the large movement of Saudi pilgrims living in proximity during Ramadan, when the government forecasts more than 1m people will spend one or two days performing Umrah, could enable the disease to spread inside the country.
An al-Ahsa region resident said there was no sense of panic, as many people appeared to accept the official line that the virus was under control and was deadly only to those with pre-existing health problems.
“At this point it seems that people are taking the government’s word,” he said. “No one is wearing masks in gatherings or mosques, for example.”
The Saudi government has played down the seriousness of the virus and pointed to deaths from it in other states, such as Qatar, France and the UK. But Saudi Arabia accounts for a large majority of the fatal cases, while those who died in Europe had either been transferred there for treatment or had just visited the Middle East.
Riyadh has also deflected attention from the outbreak – and won some public support – by criticising the Egyptian doctor who sent a sample of the virus out of the Kingdom last year, allegedly giving foreign researchers the chance to privately develop and patent a treatment.
The Dutch and UK institutions that have been studying the virus contest this claim, saying they have shared their findings with public health officials from more than 40 countries.
The World Health Organisation does not advise the use of masks or any particular restrictions on travellers in relation to coronavirus
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