Credit CDC Yellow Book.
# 7799
Despite reassuring statements from the Saudi government (see Middle East Online Hajj pilgrimage without MERS outbreaks: Saudi Arabia remains optimistic), mass gatherings like the Hajj have the potential to spark disease outbreaks, and the emergence of the MERS coronavirus on the Arabian peninsula this year only serves to accent those concerns.
Earlier this summer, during Ramadan, the KSA MOH Updated Health Protection Advice For Umrah & Hajj, where they urged thee elderly, those with chronic illnesses, immune dysfunctions, as well as pregnant women and children not to make a pilgrimage this year. This, however, was only a suggestion – not a mandate.
The KSA’s document Hajj and Umrah requirements for the year 1434 AH, issued September 04, 1434 (July 12th, 2013), also contains this advice:
It also included requirements set of tips and guidance health awareness for citizens, residents and pilgrims of them; pollutants to wash your hands thoroughly with soap and water or disinfectant other allocated to it, especially after coughing and sneezing, as well as the use of tissue when coughing or sneezing and dispose of the waste basket, in addition to not touch eyes, nose and mouth by hand, and the reduction of direct contact with the injured and non-participation tools personal, as well as the wearing of masks in crowded locations, and maintaining personal hygiene as a whole.
The advice to wear a facemask is not exactly new, as ARIs (Acute Respiratory Infections) have been common health complaints during the Hajj and Umrah, and calls for wearing masks have been made often over the years.
Last year, in The Hajj: communicable and non-communicable health hazards and current guidance for pilgrims masks were recommended to reduce the spread of TB and other respiratory illnesses, and similar calls have been made in the past, including in 2009 during the H1N1 pandemic.
The wearing masks is mentioned repeatedly on the KSA MOH web page on Health Tips to Be Followed During Hajj.
Which brings us to a (machine translated) report today from El Watan, in Algeria (h/t Pathfinder on FluTrackers) indicating that the Algerian government is providing 50 facemasks for each pilgrim as they depart for the Hajj.
Protective masks for Algerian Hajjis
the 09.22.13 | 10:00
Each of the 28,800 Algerian pilgrims received 50 masks in anticipation of risks related to the development, Saudi Arabia, severe respiratory syndrome in the Middle East (coronavirus), said the Ministry of Health, Population and Hospital Reform in a statement.
"Before their departure, pilgrims each received 50 masks in anticipation of risks related to the development, Saudi Arabia, severe respiratory syndrome in the Middle East by the novel coronavirus," says do we. A first group of 200 Hajis left Wednesday afternoon at Houari Boumediene International Airport (Algiers) to the two holy places of Islam, while the deadline for the submission of the visa for pilgrimage set by the Ministry of the Interior and Local Government in September 23. "A pilgrim's guide with important guidelines and health recommendations was presented to each of them," Does it said.
While the distribution of nearly 1.5 million masks would be cheap insurance if they prevented the spread of the MERS virus back to Algeria, compliance may be spotty, as Islam teaches that women may not `cover their face’ while in Ihram (a sacred state which a Muslim must enter in order to perform the Hajj or Umrah).
During the 2009 Pandemic the Grand Mufti of Saudi Arabia permitted the use of masks while performing the Umrah, stating that it was not the same as `covering the face’, but stated `that it should not be used unless needed.’
In the November 2009 edition of the EID Journal, a report entitled Hajj Pilgrims’ Knowledge about Acute Respiratory Infections, noted that:
National Health Service for England does not advise the use of masks, considering compliance with this advice unlikely because many Muslims believe that covering the face during the Hajj is prohibited and because masks need to be of high quality and changed at least every 6 hours to remain effective (7).
There are also concerns that masks could give the wearer a false sense of security, and that might lead to more risky behavior, or a failure to maintain hand hygiene.
The best use of surgical or procedure masks is undoubtedly having the person who is sick and symptomatic wear one.
Those contemplating using masks for personal protection should be aware that there’s considerable debate over how effective surgical or procedure masks are at preventing respiratory virus transmission. Topics we’ve explored before, including:
Survival Of The Fit Tested
Why Size Matters
Study: Aerosolized Transmission Of Influenza
NPI’s and Influenza
NEJM Perspective: Respiratory Protection For HCWs
