MERS Virus Saudi Arabia
A man wearing a surgical mask as a precautionary measure against the MERS coronavirus walks near a hospital in Saudi Arabia. Reuters

A deadly virus spreading through Saudi Arabia may force thousands of Muslims to cancel their pilgrimage to Mecca this year after Saudi officials urged the young, elderly and unwell to forgo hajj, one of the five pillars of Islam and a journey that all Muslims are expected to carry out in their lifetime.

Health Ministry officials hope that by limiting those most prone to contracting Middle East respiratory syndrome, or MERS coronavirus, they can curb the spread of the new disease.

Hajj placed 1.75 million foreign pilgrims in contact with 1.4 million Saudi pilgrims last year, and even bigger numbers are expected this coming October. Meanwhile, at least 2 million other religious travelers could visit Saudi Arabia over Ramadan, which began last week. Health officials fear that such contact could prove a deadly mix for a disease that has been, thus far, largely contained within the kingdom.

The SARS-like coronavirus has already killed 38 people in Saudi Arabia and 45 worldwide, according to the World Health Organization, which said it had been informed of a total of 81 laboratory-confirmed cases since September 2012, including a Qatari patient who died in a UK hospital on June 28.

The UN agency said, in its latest update, that it didn't currently recommend any outright travel or trade restrictions, but it did put pressure on Saudi Arabia after emergency meetings on MERS last week.

“I think we’re always worried in a globalized world that infection can travel quickly from one country to another,” Dr. Keiji Fukuda, WHO assistant director general for health security, said at a press conference earlier this month. “We see that with the evidence of some of the infections in Europe being related to travel to the Middle East. But, you know, when we look at the overall situation, it’s not just the worry about that that we have to take into consideration.”

Scientists have little understanding of how MERS spreads or why it appeared in the first place. Nevertheless, the Saudi Health Ministry set up a medical surveillance system at every border outlet in the kingdom earlier this month to screen visitors and look for “any person showing any symptom of the virus as defined by WHO.”

The ministry also issued a set of regulations on Friday for potential visitors, including a recommendation to postpone travel “for the elderly and those suffering chronic illnesses, like heart, kidney, respiratory disease and diabetes.” Pregnant women and children were also warned to stay away.

A statement, posted on the Health Ministry’s website, offered “health awareness guidelines” such as washing hands and limiting direct contact with infectious people. The guidelines also mandate face masks in overcrowded places such as Mecca, and valid certificates of vaccination against meningitis and polio for pilgrims from specified countries.

Though largely centered in Saudi Arabia, doctors have identified MERS cases in Jordan, Qatar, the United Arab Emirates, France, Germany, Italy, the UK and Tunisia -- many of which involved patients who either traveled to or were in contact with people in Saudi Arabia.

“Travelers to the Middle East who develop symptoms either during travel or after their return are encouraged to seek medical attention and to share their history of travel,” WHO said in its advice for travelers. “People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands) and to delay travel until they are no longer symptomatic.”

MERS primarily affects the elderly, children under the age of 15 and those with pre-existing conditions. Like SARS, which killed 775 people and sickened 8,000 others nearly a decade ago, the coronavirus wreaks havoc on the respiratory system. Patients generally suffer from fevers, coughing and shortness of breath, though symptoms vary.

"The clinical syndrome is similar to SARS, with an initial phase of nonspecific fever and mild, nonproductive cough, which may last for several days before progressing to pneumonia," a study published in the New England Journal of Medicine last month noted. Unlike SARS, however, MERS also causes rapid kidney failure, and more than half of those known to have caught it have died.