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Coronavirus Umrah Link Raises Concerns
After returning from the performance of Umrah, a person is fighting for his life in a UK hospital after having contracted an infection from this virus. This incident raised an alarm when his son also caught the infection from him which shows evidence that the virus can spread from person to person.
The above comments indicate the index case (60M) for the UK cluster was infected while performing Umrah, raising concerns that the novel coronavirus is widespread in Saudi Arabia. The export of an infectious disease always raises concerns that the disease in the exporting country is widespread. The concerns were increased when the virus was confirmed in two relatives who had not traveled outside of the UK. Most concerning was the presence of the virus in a contact who recovered without hospitalization or medical treatment, confirming mild or asymptomatic cases who would not seek medical attention.
The current surveillance for the novel coronavirus targets severe hospitalized cases. Prior to the most recent case, all prior confirmed cases had severe disease. However, even in cases with severe disease, such as the surviving members of the cluster in Jordan, as well as two of the four cases in the Riyadh cluster, detection of the virus was problematic. The false negatives, as well as the targeting of severe cases have raised concerns that the confirmed cases represented a small fraction of the human cases.
In addition to the index case for the UK cluster, the other case in the UK, a Qatari national (49M) who was transported to England last September by airbus also developed symptoms while preforming Umrah in Saudi Arabia. Although his symptoms subsided, they reappeared in Qatar prior to transport to England. Moreover, the first confirmed case, a Saudi national (60M) was diagnosed in Jeddah, which is close to Mecca.
This geographic clustering, as well as the Riyadh cluster and case (45M) raises concerns that the virus is common in Saudi Arabia, but largely missed due to testing protocol. A recent paper on French Hajj attendees cites testing of nasal swabs, which were negative. However, the WHO recommendations for testing cite a lower concentration of virus in the upper respiratory tract and recommends testing samples from the lower respiratory tract.
Therefore, more testing of samples from the lower respiratory tract in severe cases, as well as expanded testing of milder cases, including those infected with influenza, is dictated by the results obtained for the latest cluster in the UK.