Hofuf, a run-down desert oasis town in eastern Saudi Arabia, is home to some of the world’s richest oil fields. It’s also the source of a more worrisome export: a deadly coronavirus.
The city is at the epicenter of an outbreak of a previously unknown virus that has killed 38 people in the Middle East and Europe, recently prompting Margaret Chan, the World Health Organization’s director general, to call it her “greatest concern.”
Now more voices are chiming in. The European Centre for Disease Prevention and Control said yesterday that a dearth of information about the outbreak from Saudi Arabia means it could evolve into a crisis similar to the SARS epidemic in China a decade ago. And researchers in the New England Journal of Medicine said in a study released yesterday that the infection is easily transmitted in hospitals, posing a “serious risk.”
“There’s ongoing transmission,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy in Minneapolis. “That’s what really poses the ongoing threat to the world.”
The virus, dubbed Middle East respiratory syndrome coronavirus, or MERS-CoV, has spread to the U.K., Germany, France and Italy, stoking concern it may spark a pandemic. And like SARS, it’s striking first in a nation unaccustomed to being at the forefront of a global health emergency.
Worldwide, 64 people have been confirmed with the virus since September, according to the WHO. Forty-nine of the cases and 32 of the deaths have been in Saudi Arabia. Other cases have been identified in Jordan, Qatar, the United Arab Emirates and Tunisia.
Basic information about the disease, such as how patients are exposed to it, is still missing for most cases, despite Saudi Arabia’s obligations to share such details under international health regulations, the ECDC said in a report yesterday. That’s making it impossible to estimate accurately the threat posed by the bug, the Stockholm-based agency said.
“At this stage, it is not possible to exclude a future SARS-like scenario,” the agency said. “It is unusual to have such a degree of uncertainty at this stage in an outbreak.”
There haven’t been any reported cases in the U.S. or among Americans traveling abroad, according to the Centers for Disease Control and Prevention, which hasn’t recommended any health warnings or precautions for those going to the Arabian Peninsula or elsewhere.
The deputy director of the U.S. CDC’s influenza division, Dan Jernigan, who joined a WHO trip to Saudi Arabia this month, was “not at liberty” to discuss it, according to Jason McDonald, a CDC spokesman.
Discussions are under way about developing an inoculation, the CDC has said. Novavax Inc. (NVAX:US), a Rockville, Maryland-based vaccine developer, said June 6 that it has produced a vaccine candidate against the virus.
Still, it will probably take at least a year to produce a vaccine, said Albert Osterhaus, the virologist at Erasmus Medical Center in the Netherlands whose team first identified the new virus in a sample it received from a doctor in Saudi Arabia.
Global health officials and scientists, including some from Saudi Arabia, are meeting in Cairo this week in an effort to get to the bottom of the outbreak and devise a plan for tackling it.
At King Fahd Hospital, where most of Saudi Arabia’s cases have been treated, officials including spokesman Ibrahim al-Hajji declined to provide information during a June 16 visit to the hospital, referring questions to the country’s health ministry.
Though Ziad Memish, the Saudi deputy minister of public health, didn’t respond to an e-mail seeking comment, he led the study released yesterday by the the New England Journal of Medicine on the risk of hospital transmission.
No one knows where the virus came from or how it’s spreading, though theories abound. While MERS-CoV belongs to the same family of viruses as the one responsible for SARS, it appears far less transmissible than the earlier pathogen, the WHO has said. Most cases so far have occurred in men with underlying medical conditions, and many family members who’ve had close contact with the sick haven’t been infected, according to statements from the Saudi health ministry.
Still, the statements don’t specify what those conditions are or how the patients may have been exposed to the virus, information that global health officials need as they try to pinpoint the bug’s origin.
Clues are coming from scientific reports on the handful of patients identified in Europe. A man from the U.A.E. who was flown to Munich for treatment in March owned camels and had tended to a sick animal shortly before showing symptoms of disease, researchers from the University of Bonn Medical Center in Germany wrote in The Lancet Infectious Diseases journal on June 17, citing the dead man’s relatives. No animal samples could be retrieved, they said.
The virus most likely has its origin in bats, which are known carriers of coronaviruses, said Erasmus’s Osterhaus.
Contact between people and bats in the Middle East is uncommon, making it likely the virus has an intermediate host. Camels, goats and domestic animals are being investigated as potential sources of infection, said Gregory Hartl, a WHO spokesman. Another theory is that dates may be to blame. Bats live in date palm trees, which are plentiful in Hofuf, and may contaminate the fruit by defecating or urinating on it. No samples from animals or dates have yet tested positive, Hartl said.
The Geneva-based WHO has said Saudi Arabia is doing an “excellent job” investigating and controlling the outbreak after about 15 international researchers traveled to Saudi Arabia this month to meet with local health officials and assess the situation.
Still, WHO’s Chan, who fought Severe Acute Respiratory Syndrome as director of health in Hong Kong a decade ago, has expressed frustration that her agency isn’t getting all the information it needs to assess the threat. She repeatedly reminded countries of their obligations under international health regulations at the World Health Assembly last month.
“The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself,” Chan said in a speech last month at the annual meeting of the WHO’s 194 member states. “The novel coronavirus is a threat to the entire world. Any new disease that is emerging faster than our understanding is never under control.”
That level of consternation isn’t evident in Hofuf, a way station for travelers moving between Saudi Arabia and neighbors Qatar and the United Arab Emirates. The area is near Ghawar, the oil field owned by Saudi Arabian Oil Co. that produces an average of 5 million barrels a day, making it the world’s largest.
After learning of the virus, Ahmed al-Hamada, a Saudi mechanical engineering student in Kansas, returned home from the U.S. as planned for his summer break.
“I got back eight days ago,” Hamada, 25, said June 16 at the largest shopping center in Hofuf. “I don’t know much about the virus, but I haven’t changed my behavior. I still go out and still walk around.”
Bader Abdullah, a 26-year-old electrician from the town of Qatif, north along the Persian Gulf, also said there was little concern among his friends and family.
“In the beginning, people were nervous,” he said. “They aren’t anymore. The people getting the virus are coming from villages, where there are no sewer systems.”
While most cases have been reported in Saudi Arabia’s eastern region, the nation’s health ministry last week reported two cases in Taif, a city about 90 kilometers (56 miles) from Mecca, and another in a 2-year-old in Jeddah, about the same distance west of Mecca. Millions of visitors are expected in Mecca for the annual Hajj pilgrimage in October. The Saudi government this week asked visitors to postpone traveling to the country for Hajj, citing construction at the city’s Grand Mosque, according to Arab News.
The Hajj is one of the five pillars of Islam and every able-bodied practicing Muslim is obliged to make the journey at least once in their lives, performing rituals such as circling the cube-shaped Kaaba, one of the religion’s most sacred sites. A record 3.16 million pilgrims traveled to Mecca to perform the Hajj in 2012, according to the Saudi Arabian government.
“Anytime you have massive numbers of people coming together in a crowded way, there’s always a risk,” said Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. “The lesson from SARS is that awareness and good infection control methods essentially put a stop to SARS, even prior to having any vaccine or having any drugs.”
To contact the reporters on this story: Simeon Bennett in Geneva at firstname.lastname@example.org; Glen Carey in Riyadh at email@example.com
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