Scientists are still working to find out more about the virus and how it spreads
Health officials in Saudi Arabia say they are doing all they can to avoid an outbreak of the deadly Middle East Respiratory Syndrome (Mers) coronavirus at the annual Hajj pilgrimage next month. The BBC's Global Health Correspondent Tulip Mazumdar has been given rare access to the kingdom.
Out in the humid golden desert on the outskirts of Jeddah we witness a loving scene. A large, strong, beautiful camel is stroked and kissed by one of its herders, Abdel Salam Youssof.
"I wake up each morning with my children and the first thing we do is bring him food and water," he says.
These impressive animals are the source of millions of dollars' worth of trade, as well as entertainment, food, drink - and status in Saudi Arabia. But they are also believed to be a source of one of the world's newest killer viruses, known as Mers.
In camels Mers mainly causes a mild cold. In humans it can be deadly.
Middle East Respiratory Syndrome
Situation as of 21 August 2014
855
cases
333
deaths
- 723 cases in Saudi Arabia
- 73 cases in the UAE
- 59 cases across the rest of the world
- 40% death rate
The virus has killed 302 people in Saudi Arabia since it first emerged in 2012. More than 723 people have been infected.
At its peak in April and May, the World Health Organization (WHO) was considering declaring Mers a public health emergency.
Symptoms include fever, coughing and shortness in breath. It can also cause pneumonia and kidney failure. Nearly 40% of those infected have died. Most already had an underlying medical problem.
It is unclear exactly how it passes from camels to people. Scientists say it is probably via secretions from the nose and mouth of infected animals. Raw camel milk could also carry the virus.
The WHO says anyone working closely with camels should wear protective gear like masks and gloves. It also says people should avoid drinking raw camel milk.
We didn't see anyone at the market following that advice.
"I've drunk raw camel milk every day for the last 17 years and I am fine. Everything is safe here," said Mr Youssof.
JIt is still unclear whether the key source of the virus is camels, or whether it could be another animal like bats. Mers is believed to spread between humans through droplets when infected people cough or sneeze
Although there have been sporadic cases outside Saudi Arabia, the vast majority of victims have been from the kingdom.
Although there have been sporadic cases outside Saudi Arabia, the vast majority of victims have been from the kingdom.
Now, with around two million pilgrims getting ready for the annual Hajj pilgrimage in Mecca, there are concerns there could be a significant outbreak.
"We've done a lot of work to ensure Hajj goes smooth without any [Mers] cases," said Prof Tariq Madani, the government's scientific advisor on Mers.
"Being a virus transmissible from human to human is a big concern for Hajj. We have overcrowding and this is an excellent medium for a respiratory infection to spread."
But officials say they have now got this outbreak under control.
Most of the victims who caught Mers, however, didn't pick it up from animals in the desert - they caught it in hospitals.
Hygiene issue
Poor infection control measures on wards meant people who came to hospital with Mers were able to spread it quickly to other patients and health workers.
Staff weren't taking basic steps, such as washing their hands between patients and wearing masks properly, so they were picking up the virus and passing it on.
Dr Hani Jokhdar said a third of those infected with Mers at King Fahd Hospital in Jeddah in the spring were health workers.
"When [so many] health care workers were becoming victims of the virus - that made an alert that there's something wrong, this is not a joke. [We realised] we need to stand up and put very strong infection control measures in".
It was after this spike in cases, 18 months into the outbreak, that the King sacked his health minister and other health officials and brought in a new team.
It was only then that things started to improve and the number of cases started to fall.
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Saudi Arabia says it is now putting stricter measures in place to prevent infection in hospitals
Now the health ministry says thousands of health care workers have been given strict infection control training.
Now the health ministry says thousands of health care workers have been given strict infection control training.
Whilst we were in the kingdom, more than 20 patients were being treated for Mers. We were unable to interview any of them, nor were we given access to affected families.
The government has been accused by some international scientists of a lack of transparency over the outbreak and taking too long to carry out the studies needed to find out more about the virus and where it came from.
"Given that we are two years on from first identifying MERS-CoV, it is disappointing that there are still have so many knowledge gaps." The European Centre for Disease Prevention and Control said.
The health ministry said it is working openly with international organisations including the WHO and the Centers for Disease Control in the US to figure out how Mers spreads, and where it actually came from.
Many unknowns
Saudi health officials say they have beefed up their response to the outbreak, with better infection control in hospitals and improved surveillance systems such as a new Command and Control Centre in Jeddah, which can coordinate swift isolation and treatment of new cases to prevent spread.
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Tulip Mazumdar takes a look inside the Mers Central Command and Control Centre
Tulip Mazumdar takes a look inside the Mers Central Command and Control Centre
"Mers is not an issue in Saudi anymore. We will do our best to ensure we continue doing all we can to have a safe Hajj for all our guests," said the Acting Health Minister Adel bin Muhammad Fakeih.
Mers
- Mers is a coronavirus from the same family of viruses as Sars which killed almost 800 people in China in 2003
- However, it is not as contagious as Sars
- No known cure or vaccine
- More than 800 cases worldwide including more than 300 deaths
- Has spread to 20 other countries, including the US and UK
Source: The European Centre for Disease Prevention and Control
The WHO says it still considers Mers a "public health concern".
"There are lot of "unknowns" in our understanding of the origin of the virus causing the disease, transmission mode of the virus as well as the behavioural risk factors that may result in infection," said WHO spokesperson Rana Sidani.
In the run-up to Hajj, it warned: "The virus will re-emerge if people won't adhere to behaviours that will protect themselves - such as proper way of coughing, good personal hygiene, avoiding close contact with camels as well as close contact with people who have been diagnosed with Mers."
It says pilgrims are advised to consult a health care provider before travelling to review the risk and assess whether making the pilgrimage is advisable.
In Jeddah's busy souks some hadn't heard of the virus, while other younger shoppers said they were aware of the disease from government campaigns on social media and YouTube.
Some shoppers in Jeddah's markets had not heard of the virus
One man buying camel skin shoes said: "I am very worried, especially when I am in crowded places. I don't know why people here don't take precautions."
One man buying camel skin shoes said: "I am very worried, especially when I am in crowded places. I don't know why people here don't take precautions."
Maissam's mother in law is currently being treated with a neurological condition in hospital and said: "I am very worried, I heard there are Mers patients being treated there as well."
"I am scared she will catch the virus, or I will when I go and visit her. The nurses were trying to give us masks and gloves for protection - but really the protection is from God only."
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