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SARS-Like Virus a threat to Muslim Pilgrims

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By John Butler

In the movie “World War Z,” Brad Pitt travels the globe trying to determine how to stop the spread of a virus that is turning people into zombies. We aren’t facing a zombie epidemic, thankfully, but a new virus from the same family as SARS has been described by the director general of the World Health Organization as a threat to the entire world.

The Middle Eastern respiratory syndrome coronavirus (MERS-CoV) may not have the catchiest name, but with 90 cases to date and 45 deaths in eight countries, public health experts, including WHO Director General Margaret Chan, are worried. Saudi Arabia is the epicenter of the disease with 70 cases and 38 deaths recorded.

Transmission of the virus isn’t fully understood, but it is known to spread between humans. Wary of the threat, Saudi Arabia’s Ministry of Health has issued a warning ahead of the annual hajj pilgrimage in October, when millions of Muslims travel to Mecca.

The ministry says people with chronic diseases, the elderly, pregnant women and children under 12 should postpone their hajj this year. Last year, a record 3.16 million people took part in the pilgrimage, according to the Saudi Arabian government. It is a journey that every able-bodied Muslim is encouraged to make at least once in their lifetime.

Ataur Rahman, chief executive of the Haj Committee of India, says around 125,000 people from India will travel to Mecca for the hajj this year, down from 170,000 last year. The quota has been cut because of ongoing construction work on the Haram Mosque in Mecca.

A challenge for the Indian government is to ensure that pilgrims are aware of the virus and its symptoms without creating a panic. The symptoms of MERS-CoV include fever, severe pneumonia and kidney failure.

A recent study in the Lancet found that for every person infected, the ongoing transmission is between 0.6 and 0.69. With infection below one, MERS-CoV isn’t in a position to become a global health pandemic, however authors of the Lancet study have said the disease could still change due to factors like season change or events like the hajj.

There is no vaccine for MERS-CoV, which is a coronavirus. Coronaviruses are common in both animal and humans. Most humans will, at some point in their life, get a coronavirus that causes mild to moderate illness.

“Vaccines for coronaviruses in general are very difficult. There’s no vaccine against the common cold, which is caused by a coronavirus,” said Gregory Hartl, a spokesperson for the WHO. There is still no vaccine for SARS, 10 years after an outbreak of the virus infected over 8,000 people and led to 774 deaths, predominantly in Southeast Asia. SARS was ultimately phased out by keeping patients isolated and quarantining all suspected contacts.

The mortality rate for MERS-CoV is 50%, whereas for SARS it was approximately 8%. Only in acute cases did SARS cause all systems to collapse; for most people it was a pulmonary problem. MERS-CoV is also a respiratory disease but the virus goes on to attack the dialysis centers, causing kidney failure and full system collapse. This is the reason for the high mortality rate in the recorded cases.

“It’s very important that India not only think about being on alert to watch for returning pilgrims with pneumonia but more importantly that they get information now to the Muslim community across the nation,” said Laurie Garrett, a senior fellow for Global Health at the U.S.-based Council on Foreign Relations.

This will give pilgrims going to Saudi Arabia for the hajj, or for umrah – another pilgrimage that happens throughout the year – a sense of being prepared. They should know who to call if they develop symptoms, rather than sitting in public clinics and infecting others, Ms. Garrett said.

The Indian government has issued an advisory, said Sujeet Kumar Singh, deputy director general at the Ministry of Health. “We sensitized all health institutes about the epidemiology and the transmission of the MERS coronavirus, particularly with regard to the pilgrims who are traveling to the hajj,” he said.

“Lab facilities available for detection and diagnosis of these illnesses at various levels have also been made aware,” he added.

Saudi Arabia’s experience highlights how hospitals can stop the spread of the virus, said Allison McGeer, head of infection control at Toronto’s Mount Sinai Hospital. Ms. McGeer visited Saudi Arabia and analyzed an MERS-CoV outbreak in Al-Hasa, where a cluster of 25 cases led to the deaths of 19 patients. The cluster was stopped by isolating suspected MERS-CoV patients and health workers taking precautions such as wearing gloves and facial masks.

“Saudi Arabia did this very nicely, it had an ugly outbreak, it’s not what anyone wanted but they stopped it at the first hospital,” Ms. McGeer said. “I don’t think that’s an impossible ask for many health care systems in India,” she added.

Important information about the virus remains unknown. “We know that the virus can spread from human to human, but critically we do not know the host of the virus or how it is transmitted to humans,” Ms. McGeer said.

Bats, horses, and camels have been considered as hosts or bridges linking the disease to humans. But there’s no certainty yet.

A new killer virus with unknown hosts and means of transmission presents a threat. It’s not zombies, but it is worrying.

(Courtesy: The Wall Street Journal)

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