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DUBAI: As Saudi Arabia prepares to receive up to 1 million Hajj pilgrims from around the world for the first time since the COVID-19 pandemic in 2020, the shadow of a new virus looms large horizon, raising the inevitable question of whether monkeypox will be the next global health crisis.
So far, more than 5,700 cases of monkeypox have been reported in 52 countries, according to the US Centers for Disease Control and Prevention.
Europe accounts for almost 90% of all confirmed and reported cases worldwide since mid-May. As of this week, 31 countries across the continent have reported at least one case of monkeypox. A handful of cases have been identified in the Middle East, mostly in the United Arab Emirates.
The World Health Organization has ruled that the spread of monkeypox is not yet considered a global health emergency. However, WHO Director-General Tedros Adhanom Ghebreyesus expressed concern about the rapidly evolving threat.
Experts are divided on whether the jump in the number of monkeypox cases worldwide from 800 to 3,500 in June is cause enough for alarm.
Smallpox, which belongs to the same virus family as monkeypox, was eradicated in the 1980s through mass vaccination. Some scientists believe that monkeypox spreads due to the reduced protection of the human population against smallpox.
Others think climate change is likely to blame for the spread of the virus, as the space between human communities and animal habitats is shrinking.
Dr Mike Ryan, executive director of the WHO Health Emergencies Programme, suggested that as the planet faces increasing levels of ecological fragility and climate stress, the behaviors of animals and humans are affected.
Citing recent findings, researchers from the US National Institutes of Health said the monkeypox virus strain has mutated 12 times more than expected since 2018.
The current strain is said to be circulating at an abnormally fast rate, which could alter its regular contamination patterns.
Under these circumstances, how afraid should the Arab world be of the monkeypox virus?
The unprecedented rise in cases is concerning, but the threat can be controlled, says Dr Abdullah Algaissi, a virologist and assistant professor at the Faculty of Medical Sciences at Jazan University, Saudi Arabia.
Noting that it is still unclear whether monkeypox is an airborne virus or not, he told Arab News: “Although the main route of infection is sexual contact or contact with blisters or rashes of infected people, there is evidence to suggest that monkeypox can be transmitted through the respiratory system.
What is certain is that close and prolonged contact with an infected person must take place for there to be contamination.
For the same reasons, according to Dr. Gregory Poland, an infectious disease expert and director of the vaccine research group at the Mayo Clinic, monkeypox should not be a major concern during the upcoming Hajj season.
While those who live or have close contact with infected people are at higher risk of contracting the disease, an increased risk of infection during Hajj is “unlikely”, he told Arab News.
“Monkeypox is a rare but dangerous infection similar to the now eradicated smallpox virus, but it is not nearly as transmissible and has a very low mortality rate if treated correctly and quickly.”
According to Dr. Algassi, signs of monkeypox infection include skin lesions such as blisters around the genitals, hands, legs, face and arms, fever and swollen lymph nodes. Symptoms are more severe for immunocompromised people, he said, but “rarely fatal”.
Dr Algassi explained that the first outbreak was reported in monkeys in 1958, before it became clear that rodents were the source of infection.
“Monkeypox virus is a zoonotic virus that is usually transmitted from animal hosts to humans or even other animals and belongs to a larger family called pox virus,” he said.
The first human case of monkeypox was diagnosed in the Democratic Republic of Congo in 1970 and quickly became endemic in several African countries. However, the disease has rarely spread outside of Africa.
A health protocol issued by the Saudi Ministry of Health last month requires pilgrims arriving from Nigeria to complete a monkeypox declaration form 24 hours before departure.
The ministry said earlier that it was fully prepared to monitor and deal with any cases of monkeypox, and that no cases had been recorded in the Kingdom so far.
All necessary medical and laboratory tests were available in the Kingdom, the ministry said, adding that it had issued guidelines for healthcare workers on the matter. The ministry also said it has a comprehensive preventive and curative healthcare plan to deal with any cases.
Regarding COVID-19, the ministry announced an approved list of vaccines along with the doses required for each inoculation. He also provided plans to handle any cases that arise during the Hajj season by providing tents for the isolation of infected pilgrims.
Appearing this week on “Frankly Speaking”, Arab News’ flagship weekly topical talk show, Hisham Saeed, Saudi Arabia’s deputy minister for Hajj and Umrah services and official spokesperson, said that despite the news threat of monkeypox, “we are ready to handle any case, any scenario.
A medical team of 30,000 doctors and nurses, as well as more than 185 hospitals in the Kingdom and more than 100 medical centers in the holy sites of Mina, Arafat and Medina, will be ready to treat pilgrims suffering from any illness, according to Said.
He said that although more pilgrims will be allowed this year than in the past two years, the total number will still be limited due to health concerns.
“This year we have the decision to go for 1 million because the pandemic still exists, it is not over yet and we are not operating full capacity for this year,” Saeed said.
Indeed, according to Dr. Poland, unlike monkeypox, COVID-19 continues to be a threat in huge crowds and gatherings. “This is a much bigger problem because vaccination rates are likely to be low or variable and bringing large numbers of these people together for days poses a risk and a threat,” he said. he told Arab News.
Echoing the same concern, Dr. Algaissi cited the emergence of new variants such as the omicron subvariant, BA.5, which gives COVID-19 an “evolutionary advantage”, adding that these variants could be introduced from country to country via travelling.
That said, he noted that “most of the world is now vaccinated, which provides a primary layer of protection, especially against serious infection or death.”
Dr. Algaissi further highlighted the strict precautionary protocols adopted by health authorities in Saudi Arabia as essential to manage any potential outbreaks during the Hajj season.
In addition to being fully vaccinated, wearing masks in holy places and practicing basic hygiene precautions are essential during Hajj.
“Most importantly, if a pilgrim experiences respiratory symptoms during Hajj, they should strictly follow these instructions and avoid contacting others to stop spreading the infection,” Dr Algaissi said.
Avoiding “skin-to-skin contact with others” will also help reduce the chances of spreading monkeypox.