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All able bodied Muslims are required to make at least one major pilgrimage to Mecca during their lifetime, but over the past 5 years pandemic and size restrictions have prevented millions from doing so. The faithful may also make `lesser pilgrimages’, called omra (or Umrah), at other times of the year.
These minor pilgrimages don’t absolve the faithful of making the hajj journey unless they take place during Ramadan.
This week Saudi Arabia will host the annual Hajj (expected to run from June 4th-9th), with upwards of 2 million devout expected to make this sacred pilgrimage.
It can, however, be a dangerous journey.
Last year, reportedly more than 1,300 pilgrims died - mostly from heat-related illnesses - many of whom were unauthorized, and making a desperate trek across the desert. In years past we've also seen fires and stampedes that have cost many lives (see Hajj Tragedy: 450 Killed, 700+ Injured In Stampede).
As with all mass gathering events, the Hajj also has the potential to amplify and disperse emerging and existing infectious diseases - sometimes on a global scale (see J, Epi & Global Health: Al-Tawfiq & Memish On Hajj Health Concerns).
While COVID, MERS-CoV, and Avian Flu are often the first threats that come to mind, most infectious illnesses acquired during these mass gathering/migration events are far more common; seasonal flu, pneumonia, measles, meningococcal disease, norovirus, and vector borne infections (Zika, CHKV, Dengue, Malaria, Yellow Fever, etc.) (see CDC's Traveler's Health Saudi Arabia).
Earlier this month, we also saw reports of a recent surge in MERS-CoV cases in KSA (see WHO: Saudi Arabia Reports 9 New MERS-CoV Cases). Admittedly, MERS cases are far less commonly reported today than they were in the last decade, but it still bears watching.
It is also influenza season in the Southern Hemisphere, and mass gathering events like the Hajj provide excellent venues for sharing regional viruses.
The good news is, that while mass gatherings may provide greater opportunities for disease outbreaks, history has shown that serious outbreaks have been rare (for an exception, see The Impact Of Mass Gatherings & Travel On Flu Epidemics).
Last year, in The Lancet: Proactive Surveillance for Avian Influenza H5N1 and Other Priority Pathogens at Mass Gathering Events, Dr. Ziad Memish et al. argued that the Hajj and other mass gathering events can also offer unique opportunities to identify, and quantify new or emerging disease risks, including HPAI H5N1.
Previous (limited) studies (see EID Journal: Respiratory Viruses & Bacteria Among Pilgrims During The 2013 Hajj and 2015's EID Journal: ARI’s In Travelers Returning From The Middle East) would seem to bear this proposal out.
Even if MERS and H5N1 weren't in the wings, these are exactly the sort of things we should be doing for all mass gathering events.
But, given our current climate of `Don't Test, Don't Tell' (see From Here To Impunity), it isn't at all clear whether the resources, or the political will, still exist to get it done.
Today 90% of global COVID hospitalizations and deaths are no longer reported, novel flu infections are often only belatedly announced (if at all), and even testing of cattle and dairy workers for H5N1 in the United States has met with stiff resistance.
The reality of life in 21st century is that disease threats that once were local, can now spread globally in a matter of hours or a few days. Vast oceans and prolonged travel times no longer protect us against infected travelers crossing borders.
Our current capacity for denial of these facts may be comforting or economically advantageous in the short term, but is likely to be quite costly in the end.
