Officials in Saudi Arabia are raising alarm that the kingdom is not doing enough to prevent Mecca from becoming a route for exporting an often deadly respiratory virus as millions of Muslims from around the world converge on the city to perform pilgrimage at Islam's holiest site.
The calls have taken on greater urgency as Saudi Arabia struggles to contain a surge in infections from the Middle East respiratory syndrome, or MERS. The country has seen the most infections worldwide by far—more than 500 since 2012—and in past weeks the numbers have accelerated with several deaths reported nearly every day and new infections often numbering in the double digits.
So far Mecca, near the western Red Sea coast, has seen fewer cases than other parts of Saudi Arabia. Since the coronavirus was first discovered in 2012, there have been two annual hajj pilgrimages to the city, and neither saw instances of pilgrims being infected. Most of the cases that have appeared outside Saudi Arabia, including two in the United States, have been from foreigners returning home from work in the kingdom or from Saudis traveling abroad.
But as the number of cases rises in the kingdom, the concern is that there are not enough precautions being taken in Mecca, an obvious potential hotspot for spreading the disease.
Experts say the Saudi Health Ministry needs to move faster to create more public awareness, promote more aggressive testing in hospitals and take better precautions among medical staff—who have made up a significant proportion of those infected because of improper conditions.
Mecca sees a constant stream of pilgrims throughout the year from around the world, and their numbers swell during the holy month of Ramadan, which begins in late June. The hajj pilgrimage—which Islam says is a duty of all able-bodied Muslims to perform once in their lives —brings even more gigantic crowds: Some 2 million pilgrims from all over the world, packed into the close quarters as they visit the Kaaba, Islam's holiest site, and other locations in and around Mecca for a period of around five days. This year, hajj starts in early October.
Also, most of the international pilgrims travel to Mecca through the closest international airport, in the coastal city of Jiddah, which has seen far more cases.
Notably, no posters warning of the virus or giving visitors information on how to prevent its spread were visible during a recent visit by an Associated Press reporter through Jiddah airport or at the Grand Mosque in Mecca, where pilgrims circumambulate the Kaaba.
The Hajj Ministry's website, which many international pilgrims refer to for information, makes no mention of MERS or special precautions. The Health Ministry's website, however, advises people over 65, children under 12 and those who are ill to delay their pilgrimage.
"Mecca is a location for people from all over the world with all kinds of problems that could be spread all over," said Adnan al-Bar, a member of Saudi Arabia's top consultative body, the Shura Council, at a recent summit in Jiddah on development in the holy city.
Since the beginning of April, Mecca has seen 21 new confirmed cases—including one Turkish pilgrim—and four deaths. Over the same time period, there have been 114 new infections in Jiddah and 23 deaths. Asia saw its first MERS death last month, when a Malaysian man who went on pilgrimage to Mecca and passed through Jiddah in March returned home and was found to have been infected.
King Abdullah last month replaced the health minister in a sign of displeasure over efforts to control the virus' spread. The new minister, Adel Faqih, visited health workers in Jiddah on Wednesday and told them the coronavirus was spreading in part because hospitals are not taking anti-infection measures.
Only one medical facility in Mecca—the King Abdullah Medical City—is equipped to handle MERS cases, according to Ismail Mohammed, the director-general of another hospital in the city, Umm Al Qura.
"Mecca is almost considered to be free" of the virus, he told AP. But he warned steps have to be taken to ensure it remains so. Government policies have largely only been reactive; greater patient education is needed; and there is still no "overall orientation (of anti-MERS policy) toward the pilgrims."
Preparations, he said, are only on "an ad hoc basis."
Al-Bar, who served for years as Mecca's general health director, said the Health Ministry should be overhauled to become less bureaucratic and that Mecca's medical infrastructure needs a rapid transformation. Already, it does not have enough facilities to provide primary care for pilgrims.
"The current health care system in the Mecca does not cover half of the needed services," he said.
Fortunately, MERS is not highly contagious—person-to-person spread has been seen only in close contacts, like family members or health care workers who care for an infected person.
The World Health Organization said Wednesday the virus does not yet constitute a global health emergency. Worldwide, WHO has confirmations of at least 572 cases, including 173 deaths. The vast majority has been in Saudi Arabia—160 dead and 514 confirmed cases since 2012, according to government figures.
MERS often starts with flu-like symptoms but can lead to pneumonia, breathing problems and in severe cases, kidney failure and death. Scientists are unsure exactly how people are catching MERS but suspect the disease is linked to camels.
Pilgrims are largely undaunted.
Sharihan Abdel-Mofty, a 61 year-old Egyptian pilgrim, wore a blue surgical mask around the Grand Mosque that houses the Kaaba, a cube-shaped structure draped in black cloth.
It is her first time to visit Mecca and she wanted to be careful, but she says the chance to pray at the base of the Kaaba supersedes any concerns about the virus.
"Is there anything more beautiful after this?" she said. "I hope to come every year."