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    How the Deadly MERS Coronavirus Could Be Spread Around the World by Pilgrims

    Written by

    Mat McDermott


    Photo: Al Jazeera English/Flickr


    This is a story about deadly disease flying on the wings of modern, globalized air travel. A new study published in PLoS Currents: Outbreaks outlines the route by which the deadly new MERS coronavirus could be spread around the world. It comes down to two important Muslim pilgrimages in Saudi Arabia and where the majority of those people flying into the region are coming from. 


    MERS stands for Middle East Respiratory Syndrome. Caused by a coronavirus, it emerged early in 2012 and spread to several countries in Europe and North Africa. In total, 80 cases have been confirmed globally. That doesn't sound too bad, until you realize that half of those cases have proven fatal.


    The good news is that, so far, the virus has only spread through close contact with an infected person, and has not, the CDC notes, been shown to spread in a sustained way in communities. Symptoms of the illness include severe acute respiratory illness with fever, cough, and shortness of breath. After SARS, also a coronavirus, killed some 800 people a decade ago, public health officials are looking to cut off MERS at the pass.


    Dr. Kamran Khan's team at St Michael's Hospital in Ontario looked at data from flight itineraries from last year and historic data for the Hajj and Umrah pilgrimages to Mecca—the former takes place in October this year, the latter is not tied to a specific date but participation peaks during Ramadan, which this year ends in early August. 


    The researchers tallied up the 16.8 million people who traveled on commercial flights to Saudi Arabia, Jordan, Qatar, and the UAE–the countries the MERS virus has been traced back to– during the period starting one month before Ramadan began last year and ending one month after the Hajj. Of these air travelers, slightly over half went to just eight nations: India (16.3%), Egypt (10.4%), Pakistan (7.8%), Britain (4.3%), Kuwait (3.6%), Bangladesh (3.1%), Iran (3.1%), and Bahrain (2.9%). Of the 1.74 million foreign pilgrims who performed the Hajj last year, 65.1 percent came from low- and lower-middle income countries. 


    It is in this that a main difference lies between the potential spread of MERS and the SARS virus. Dr. Khan notes that South Asian nations in particular, where roughly 25 percent of all Hajj pilgrims originate, could be key:

    Given that these countries have limited resources, they may have difficulty quickly identifying imported MERS cases, implementing rigorous infection control precautions and responding effectively to newly introduced cases.

    In contrast, SARS was spread via air travel, but largely to high-income nations, where available resources for screening are greater. 


    To help prevent the spread of MERS, Dr. Khan recommends screening passengers as they leave these four source nations, rather than waiting until these passengers arrive at their final destination, which has smacks of Ellis Island.


    As a precaution against the spread of MERS, Saudi Arabia has already restricted issuing visas to the elderly, pregnant women, and children for both the Hajj and Umrah pilgrimages.