10.12.12

Hajj Health Scare: Could a New Virus Spread?

A worrisome virus has popped up in the Middle East, just as millions of Muslims prepare for their annual pilgrimage. Kent Sepkowitz on why health professionals are taking extra precautions.

It’s been a busy autumn for microbes. We’ve had bacterial meningitis in gay men in New York, fungal meningitis in more than 100 recipients of tainted shots across the East Coast, the last gasps of a brutal West Nile season in the South, and the final countdown from a six-week quarantine for the hantavirus that shook the California camping world in late summer.

Well, there’s no rest for the weary—we now have officially been served that we might be facing a viral infection that initially seemed to have the makings of SARS Junior.

The story is this: in June of this year, a 60-year-old Saudi man died in Saudi Arabia of an overwhelming respiratory infection. His doctors found a new virus in his respiratory secretions—a coronavirus, of the same family of viruses that causes SARS. The plot thickened last month when a 49-year-old man from Qatar who had traveled recently to Saudi Arabia developed a similar overwhelming respiratory problem. He initially was hospitalized locally, then sent to England for treatment and remains critically ill. And he too was subsequently found to have coronavirus—in fact the same strain as the first patient. 

(Friendly suggestion to all you governments and airlines and hospitals worldwide: if someone is really sick from a possibly infectious illness, maybe it’s not such a great idea to pack the person up, drive him to an airport, fly him around, land him in another airport, drive him to a new hospital and resume his care. This seems a lot like a plan to leave a wide, preventable Trail of Potential Tears behind. Just a thought).  

Always on high alert for new and scary viruses, the involved scientists were able to recover the viruses in weeks—warp speed compared with our pre-SARS world. And relax, a little at least—though they share a viral strain, the two men seem never to have crossed paths. Plus there’s no evidence of any person-to-person spread.

Tellingly, none of the hospital workers for either case developed so much as a sniffle; and chances are that, early in the hospitalization for each patient, extra precautions, such as isolation and masks and gowns, were not taken. After all, people with coughs and pneumonia fill hospital beds worldwide, year-round, and most are not isolated. It is only after a few days of worsening despite increasing amounts of antibiotic that the treating team will start to smell trouble and ask for oddball tests, consider isolation, and begin to feel sorry about their own frightened necks.

In a few weeks, millions of people from all over the world will gather in deliberately tight quarters.

Since the first ripple of worry, no new cases have been found in the last month. So what is the CDC doing issuing guidelines just last week about the infection—aren’t they busy enough dealing with fungal meningitis? Yes, but they also are worried about the Hajj, which starts later this month. This solemn religious pilgrimage is essential to observant Muslims but creates a frightening set of possibilities to public-health types, who, after all, are prone to worry (it’s their job). CDC and WHO have been joined by another group of professional worrywarts, the self-styled Global Virus Network (GVN), not a new cable TV station in Uzbekistan but rather a collection of high-end virologists always on the hunt for one calamity or another.  

Right now, one and all are confronted with the reality that in a few weeks, millions of people from all over the world will gather in deliberately tight quarters to circle around the Kaaba, that enormous black cube that is the physical center of worship. They will spend hours together, inches apart. The thought that one of them (perhaps from Saudi Arabia where cases to date have occurred) might, maybe, could have coronavirus and in such close, sustained proximity could somehow spread it to the next guy where a small alteration in molecular structure might occur to make it a little more transmissible and enable him to pass it to the next guy in whose respiratory tract another small mutation could occur, and the next, and then follow them onto the airplane or bus back to their home town—it’s enough to send anyone over the edge. Where they should be. 

The problem is that we are following them over the edge. Our blind desire for more transparency has met up with our natural paranoia and love of a ripping good Hollywood-like plot—wow, not just an outbreak but Outbreak!! With all of this information, we may become confused between the real outbreak (fungal meningitis) and the one that, as a matter of routine, the CDC is preparing for but is very unlikely to occur (SARS Junior). The rub is this—transparency works when an outbreak is ongoing and daily dispatches are essential to keep doctors and patients focused and on terra firma. But the sausage factory we now all seem to live in, where every routine corner of everyone’s work is necessarily filleted on the table for constant perusal—yikes. Can’t we try a little opacity once in a while?