Face Veils and the Saudi Arabian Plague

A scary new Middle Eastern virus is affecting far more men than women.
The MERS virus up close (in yellow). (AP)

At first, it causes a fever and mild cough. In a few days, full-blown pneumonia sets in and it moves on to wreak havoc on the kidneys. There's no cure or vaccine, and about six out of 10 patients die.

Health officials are reacting to this new Saudi Arabian virus with the appropriate level of alarm:

"My greatest concern right now is the novel coronavirus," Dr. Margaret Chan, director-general of the World Health Organization, said in a World Health Assembly meeting in May. "We do not know where the virus hides in nature. We do not know how people are getting infected. Until we answer these questions, we are empty-handed when it comes to prevention."

The new SARS-like disease, also known as MERS, has infected at least 60 people in the Middle East and killed at least 38. Four new deaths were announced Monday. It's appeared in eight countries, but most of the affected live in Saudi Arabia. Now health officials are scrambling to figure out how to curb its spread during Ramadan, the ongoing holiday that ends in a massive celebration, and before the October Hajj pilgrimage, in which millions of Muslims gather at Mecca.


"Everyone is very aware of the fact that Ramadan begins next month and that there will be a large, large movement of people in a small crowded spaces," Gregory Hartl, a spokesman for the WHO, told the Telegraph. "So the more we know about this virus before that starts the better."

This week, 80 doctors and health officials are meeting in Cairo to try to come up with an appropriate response to the virus, whose origin has so far baffled specialists.

The disease first appeared last fall in Saudi Arabia and seemed similar to a strain carried by bats. It comes from the same family as SARS, which killed 800 people worldwide in 2003, and it similarly spreads through close contact and causes severe immune system reactions. What's alarming about MERS is that it spreads within hospitals, even when patients are not in close proximity to one another, and its mortality rate is much higher -- 65 percent .

Saudi Arabia strictly enforces the separation of the sexes, and in another confusing development, more than twice as many men as women have contracted MERS -- making for interesting case study how cultural practices impact responses to disease.

The author of a recent New England Journal of Medicine study on the virus, Alimuddin I. Zumla, said he didn't know the reason behind the gender difference, but then he offered the New York Times a guess:

"I don't think the virus prefers any gender," Dr. Zumla said, adding that he suspected that Saudi women might be protected by their veils, which cover their mouths and noses and might help keep the virus out.

Over at Discover, infectious disease specialist Rebecca Kreston pokes holes in that theory. The niqab, or face veil, doesn't reduce the likelihood of catching respiratory infections, it seems:

In a 2001 study on the effect of the niqab veil on incidence of respiratory disease in Saudi women, researchers unexpectedly found that bronchial asthma and the common cold "were significantly more common in veils users;" wearing the veil may have contributed to dense, wet spots close to the mouth and nose which could faciliate the growth of organisms that lead to infection.

Indeed, in a 2006 study of respiratory infections during the Hajj, researchers did find that pilgrims were more likely to contract a virus when they stayed at the Hajj longer or when they prayed at particularly crowded mosques. They also found that while men at the Hajj could reduce the likelihood of infection by wearing a protective face mask, that didn't hold true for women and their niqabs. (However, the authors note that women sometimes take off their veils when inside and in the presence of other women, so it's not a perfect proxy for a facemask, which is worn more consistently.)

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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