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The coronavirus in the Middle East: will Hajj pilgrims bring it home?

Source: Potential for the International Spread of Middle East Respiratory Syndrome in Association with Mass Gatherings in Saudi Arabia/PLOS Currents Outbreaks

On Wednesday, the World Health Organization announced that MERS -- the new coronavirus in the Middle East -- is not yet considered a public health emergency.

But emergency or not, the situation is a serious one. To date, MERS has infected 88 people and killed 45 people -- some of whom have brought the virus to Europe and Africa.

Thus far, all confirmed cases can be traced back to one of four Middle Eastern countries: Jordan, Qatar, the United Arab Emirates, and Saudi Arabia. But the majority of cases have occurred in Saudi Arabia -- the same country millions of pilgrims are now flocking to for Hajj and Umrah.

As Mecca enters its peak season for pilgrimages, there is a growing worry that visitors could get infected and scatter back to their home countries, bringing the virus with them.

But which countries are most at risk? This is the question a team of researchers -- led by Dr. Kamran Khan, a St. Michael's Hospital doctor and founder of BioDiaspora -- wanted to answer with their new study, published Wednesday in PLOS Currents Outbreaks.

The team used a web-based technology that analyzes global air traffic patterns to predict the spread of infectious diseases.

And their results are not exactly reassuring. According to a press release about the study, MERS "could spread faster and wider during two international mass gatherings involving millions of people in the next few months."

Analyzing 2012 data, the researchers found that 16.8 million travelers flew on commercial airlines out of Saudi Arabia, Jordan, Qatar and the United Arab Emirates between June (one month pre-Ramadan) and November (one month post-Hajj).

During SARS, which killed some 800 people worldwide, the majority of infected travelers turned up in high-income countries, including Canada. But with Hajj, there were 1.74 million pilgrims last year and an estimated 65.1 per cent flew home to low or low-middle income countries, according to the study.

Nearly one in four Hajj pilgrims flew to India, Pakistan, Bangladesh, Afghanistan and Nepal -- countries that spend $59, $30, $56 and $33 US per capita on health care, respectively. For comparison's sake, Canada's health expenditures per capita is $5,630 US, or $5,837 CAD.

"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," Khan said in the press release.

Khan and his team also found that eight countries supply the majority (51.6 per cent) of Mecca's pilgrims: India (16.3 per cent), Egypt (10.4), Pakistan (7.8), Britain (4.3), Kuwait (3.6), Bangladesh (3.1), Iran (3.1) and Bahrain (2.9). Twelve cities also received more than 350,000 commercial air travelers from the four Middle Eastern countries affected by MERS (Cairo, Kuwait City, London, Bahrain, Beirut, Mumbai, Dhaka, Karachi, Manila, Kozhikode (India), Istanbul and Jakarta).

In the press release, Khan and his team urge health care providers to learn from SARS; we should anticipate a wider MERS outbreak, they say, rather than react to one after it happens.

Sounds like good advice.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar


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That map looks just like the one in the Android game "Plague"

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