Fears are growing across the Middle East that coronavirus has infiltrated a main pilgrimage route, which could lead the deadly pathogen to vulnerable refugee populations, causing perhaps unprecedented public health crises across the region.
Concern is centred on the Iranian shrine city of Qom, which is thought to be a hub of the disease and the likely source of its spread elsewhere in the country and in neighbouring states, where infected travellers have been diagnosed in recent days.
The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the Wuhan coronavirus, for which there is no specific cure or vaccine.
The UN agency advises people to:
- Frequently wash their hands with an alcohol-based hand rub or warm water and soap
- Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing
- Avoid close contact with anyone who has a fever or cough
- Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers
- Avoid direct, unprotected contact with live animals and surfaces in contact with animals when visiting live markets in affected areas
- Avoid eating raw or undercooked animal products and exercise care when handling raw meat, milk or animal organs to avoid cross-contamination with uncooked foods.
Despite a surge in sales of face masks in the aftermath of the outbreak of the coronavirus outbreak, experts are divided over whether they can prevent transmission and infection. There is some evidence to suggest that masks can help prevent hand-to-mouth transmissions, given the large number of times people touch their faces. The consensus appears to be that wearing a mask can limit – but not eliminate – the risks, provided they are used correctly.
The Foreign and Commonwealth Office has advised UK nationals to leave China where possible. It is also warning that travellers from Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan and Thailand who develop symptoms of cough or fever or shortness of breath within 14 days of returning the UK should contact the NHS by phone.
Shia Muslim pilgrims who travelled to Qom are thought to make up the majority of the so far small numbers of those infected, in Kuwait, Bahrain, Iraq and Lebanon.
Adding to the fears that pilgrimage routes may have spread the disease was the diagnosis on Monday of an infected worshipper in Najaf, Iraq. Local health officials closed and disinfected the Imam Ali mosque after the case was confirmed, and public health experts warned of a pending emergency if the virus was not contained quickly .
“In Iraq, [coronavirus] poses a major public health threat because the Iraqi health system is very weak,” said Dr Adam Coutts, a specialist on public health in the Middle East at Cambridge University.
“It potentially could wipe out thousands of people. And there’s no way of tracking it once it gets into a refugee population, given the mobility. These viruses or diseases expose the politics and fragility of public health systems.”
Refugees and internally displaced populations across Iraq and Syria have been identified as the most vulnerable groups in the region, should the spread of the virus become a pandemic. Health officials in both countries remain under-equipped to deal with such a a reality that seems more possible with each passing day.
Coutts said: “The major issue we have been worrying about is coronavirus getting into the Syrian and Iraqi refugee population, given the conditions in which they live. Overcrowded with no sanitation, plus a lack of access to healthcare.”
Iraq, Turkey and Afghanistan have closed their borders with Iran, where officials scrambled on Monday to deny that 50 people had died of the virus in Qom.
“In the whole country, 47 have been diagnosed with Covid-19. Unfortunately, 12 of them have died of the disease so far,” said the spokesman for the Iranian parliament, Assadollah Abbasi, contradicting the reports out of Qom.
Panic buying and lockdowns spread through the city after local news reports citing regional health officials circulated on Monday morning. The local governor, Barham Sarmast, said enough was being done to stop the virus.
“Quarantining Qom is not an effective way to contain the coronavirus – we have to look for more effective ways,” he said. “Qom is geographically located in the crossroads of 17 provinces of the country and a pilgrimage centre. So if we could adopt a quarantine strategy, we would have adopted it already.”
A local news agency in the city tweeted: “The situation in Qom is very bad. Don’t come to Qom and no one should get out of Qom. Qom should be closed. We need a lot of medical help here. We don’t think we have enough medical staff in the city.”
Amid increasing alarm that officials had been slow to realise that coronavirus had taken root in parts of Iran, and could now no longer stop its spread, schools and universities were closed in several cities and Tehran’s public transport system disinfected.
Religious pilgrimages to Iraq have been suspended. Theatre sessions have also been cancelled and football matches are to be played without spectators, Iranian media reported.
Elsewhere, officials were attempting to track those who had returned from Iran in recent weeks and summons them for urgent screenings. Particular attention was being paid to Shia pilgrims who may have unwittingly carried the virus with them on their journeys home.
Iraq, Syria, Lebanon and Turkey are home to at least 12 million refugees and internally displaced people, many of whom live closely together in conditions of poor hygiene and with already compromised immunity systems. All three factors are considered ideal conditions for the spread of the disease, which health officials worldwide believe could survive on surfaces for up to nine hours.