TIME 100

TIME 100: The People in Health You Need to Know

The 2014 TIME 100 list–the annual determination of people who influenced the world in the past year for better or worse–is here, and we highlight the leaders making a difference in health.

This year, TIME recognizes nine innovators who tackled issues from hunger and maternal health to marijuana and aging.

  • Christy Turlington Burns, an ambassador for maternal health. Burns founded Every Mother Counts, which provides poor countries with health education, medicine and emergency care.

“When [mothers] are healthy, everyone thrives. Christy is helping make that happen.” –Melinda Gates, co-chair of the Bill & Melinda Gates Foundation

  • Ertharin Cousin, a Chicagoan who helps feed the world. As head of the U.N.’s World Food Program, Cousin is responsible for feeding over 100 million people each year.

“Her goal is nothing short of eradicating global hunger in our lifetimes, creating a world where no child or adult knows the feeling of an empty stomach” –Rahm Emanuel, mayor of Chicago, served in the Clinton and Obama administrations

  • Aliko Dangote, doing well and doing good for Africa. Dangote is one of the richest men in Africa who also dedicates his time to ridding countries of infectious diseases.

“This year, Nigeria is on pace for its lowest number of polio cases ever. Aliko is a big reason why” –Bill Gates, co-chair of the Bill & Melinda Gates Foundation

  • Robert Lanza, in the vanguard of stem-cell research. Dr. Lanza is the chief scientific officer at the biotech firm Advanced Cell Technology, and found a way to turn adult cells into stem cells that may soon be turned into new treatments, or cures, for diseases like diabetes and Alzheimer’s.

“The controversies may continue, but thanks to Lanza the science will too.” –Alice Park, health and medicine writer for TIME and author of The Stem Cell Hope

  • José Mujica, the revolutionary who legalized pot. As Uruguay’s president, José “Pepe” Mujica signed a law making the country the first to legalize the production and sale of marijuana.

“Uruguay has embarked on a bold and fascinating experiment that will be closely watched by supporters of legalization in other countries–including myself” –Meghan McCain, co-host of Pivot’s TakePart Live

  • Arunachalam Muruganantham, an unlikely health crusader. Muruganantham designed a simple machine to make sanitary napkins after seeing how hard it was for his wife to get access to affordable ones.

“The invention has sparked interest around the world. It’s a truism for a reason: Empathy is the most revolutionary emotion” –Ruchira Gupta, founder of Apne Aap, an Indian anti-sex-trafficking organization

  • David Sinclair, bringing us closer to reversing aging. Sinclair is a genetics professor at Harvard Medical School who discovered a compound that makes old cells act young again.

“Immortality is out of reach, but living more years with a body that’s robust enough to make the most of them is a real possibility” –Dr. David Agus, professor of medicine and author of A Short Guide to a Long Life

  • Alice Waters, pioneer of good food for all. As a respected chef, Waters promotes accessible produce for everyone, including for the youngest eaters, with the Edible Schoolyard Project.

“She proved the power of a chef, showing an entire generation that one passionate person can reshape the eating habits of a nation” --Ruth Reichl, a food writer whose first novel, Delicious!, will be published in May

relationships

Stop Obsessing Over Finding The Perfect Partner

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Tim Robberts—Getty Images

When it comes to relationships, we disagree over who makes the ideal mate

Evolution tells it straight: Some people make more desirable partners than others. Current theories on mate value go a little like this: People who have it all, including good looks and status, can land a partner who also has it all. The people who don’t, well, they’re going to have to settle. But new research published in the Journal of Personality and Social Psychology suggests what anyone who’s fallen for a pretty face knows: finding the ideal partner for you is much more complicated. In fact, the more we get to know someone, the more our opinion of their desirability changes.

To reach these findings, the researchers at the University of Texas at Austin conducted three studies in which they asked participants to rate a group of people for their perceived value. Some of the factors were basic, like how attractive they are, or how outgoing. Other factors went deeper, with participants ranking whether a person seemed likely to be a good, committed partner.

In the first study, participants rated people they’d never met; in the second study they rated people they’d known for a few months; and in the third study they rated people they had known for at least three years. When people ranked individuals they didn’t know, people tended to agree on who was a catch and who wasn’t—it came down to superficial markers like good looks and likability. But researchers also found that as people got to know each other, perceptions changed and people tended to disagree about who seemed like a good partner and who didn’t.

“[As we spend more time with someone] we stop agreeing on how desirable or undesirable they are,” says study author Dr. Paul W. Eastwick, an assistant professor in the department of human development and family sciences. “We start to have very idiosyncratic opinions of one another.” The findings show that who we ultimately determine to be an ideal mate is unique, and we can greatly differ in our opinions of who is attractive, intelligent, popular, and who would make a good relationship partner.

So when it comes down to it, sure: At “hello,” some people have a leg up on others. But once someone is a known quantity, their desirability isn’t so clear-cut: Attractiveness and social status give way to compatibility and how suitable someone is for an actual relationship. “These findings are a good thing if people don’t care about getting the [conventionally ideal] mate, but care about finding the mate that is good and compatible for them,” says Eastwick.

Infectious Disease

Ebola Virus Death Toll Rises to 142 in West Africa

Doctors Without Borders called the outbreak 'unprecedented', as reported deaths continue to rise in Guinea and Liberia. However, the number of new infections has slowed

A total of 142 people have now died from an Ebola outbreak in Guinea and Liberia, the World Health organization said on Wednesday. Doctors Without Borders said that the size of the outbreak is unprecedented.

The World Health Organization debunked rumors that the virus was spreading to other countries, however, in a statement on their website. They said nineteen suspected cases reported in Sierra Leone have tested negative.

Doctors in Guinea and Liberia don’t have any experience with the virus, as this is the first time it has emerged in western Africa. WHO said that Guinea has reported 208 cases, including 136 deaths. Liberia has reported 34 cases, including six deaths.

The Ebola virus kills up to 90 percent of those infected, shutting down the immune system and bringing on fever, headache, muscle pain and bleeding.

Environment

Lead Didn’t Bring Down Ancient Rome—But It’s Still a Modern Menace

Roman aqueducts led to lead contamination
Aqueducts like this one contaminated Roman tap water with lead Moment via Getty Images

Lead levels were high in ancient Rome's tap water—but not high enough to cause the collapse of its civilization

You could fill a book with theories on why the ancient Roman Empire declined and fell—which, in fact, is what the 18th British historian Edward Gibbon did in his magisterial Decline and Fall of the Roman Empire. But if you don’t have time to read the 3,000 or so pages in Gibbon’s full work, here’s one very simple theory: it was lead. Canadian scientist Jerome Nriagu published an influential 1983 paper arguing that high levels of the neurotoxin lead—which contaminated water and other beverages through lead aqueducts and lead cups—caused mental disabilities and erratic behavior among members of Roman high society. Nriagu even reviewed the personalities and habits of Roman emperors between 30 B.C. and 22o A.D.—a list that includes notorious nutjobs like Nero and Caligula—and concluded that two-thirds of them suffered from symptoms of chronic lead poisoning. It’s hard to keep an empire going when your living god of an emperor has been brain-poisoned.

An empire brought down by one of its signature innovations, the aqueduct — it’s a theory that has stuck with the public, although experts have long been skeptical of its merits. It turns out that the theory was half-right: In a new study in the Proceedings of the National Academy of Sciences (PNAS), a group of French and British researchers report that the tap water in ancient Rome was indeed contaminated with lead, with levels up to 100 times higher than those found in local spring water at the time. But while Roman tap water might not have passed modern-day standards, it’s almost certain that the contamination wasn’t extensive enough to be responsible for the collapse of Roman civilization.

As lead author Francis Albarede of Claude Bernard University in Lyon told the Guardian:

Can you really poison an entire civilization with lead? I think it would take more than lead piping in Rome to do that.

Still, any amount of lead can pose a danger to the human brain, especially those of young children, so Rome’s contaminated water couldn’t have helped. In fact, the more researchers learn about lead, the more dangerous it seems—and the more important it becomes to get lead out of the environment. There’s a fascinating body of research, summed up in this excellent piece by Mother Jones‘s Kevin Drumm, that links the drastic drop in violent crime in the U.S. over the past two decades to the phasing out of leaded gasoline in the early 1970s, which greatly reduced lead levels in the environment.

The theory is that children in the 1940s, 50s and 60s were exposed to high levels of lead in leaded gasoline and lead paint. High blood lead levels are directly correlated with a loss of IQ points. But more than that, lead seems to particularly damage the parts of the brain linked to aggression control and executive function. Lead seems to affect boys more—and men, of course, make up the vast majority of violent criminals. When those lead-exposed boys became young adults in the 1970s and 80s, it wasn’t surprising that so many of them fell into violent crime. But once they aged out by the 1990s, that cohort was replaced by a generation of children who largely hadn’t been exposed to high levels of lead, and violent crime dropped.

But while most—though not all—American children are no longer exposed to high levels of lead, it’s still a major problem in poorer countries around the world. NGOs like the Blacksmith Institute are working to clean up lead contamination, though far more needs to be done. Lead may not have brought down the Roman Empire—you’ll need to go back to Gibbon for that—but two thousand years later, it’s still a public health menace.

medicine

Michigan Man Among 1st in U.S. To Get ‘Bionic Eye’

Bionic Eye
In this April 16, 2014 image from video Dr. Naheed Khan, right, works with Roger Pontz, left, on an exercise to test how well he sees shapes on a computer screen at the University of Michigan Kellogg Eye Center, April 16, 2014, in Ann Arbor, Mich. Mike Householder—AP

(ANN ARBOR, Mich.) — A degenerative eye disease slowly robbed Roger Pontz of his vision.

Diagnosed with retinitis pigmentosa as a teenager, Pontz has been almost completely blind for years. Now, thanks to a high-tech procedure that involved the surgical implantation of a “bionic eye,” he’s regained enough of his eyesight to catch small glimpses of his wife, grandson and cat.

“It’s awesome. It’s exciting — seeing something new every day,” Pontz said during a recent appointment at the University of Michigan Kellogg Eye Center. The 55-year-old former competitive weightlifter and factory worker is one of four people in the U.S. to receive an artificial retina since the Food and Drug Administration signed off on its use last year.

The facility in Ann Arbor has been the site of all four such surgeries since FDA approval. A fifth is scheduled for next month.

Retinitis pigmentosa is an inherited disease that causes slow but progressive vision loss due to a gradual loss of the light-sensitive retinal cells called rods and cones. Patients experience loss of side vision and night vision, then central vision, which can result in near blindness.

Not all of the 100,000 or so people in the U.S. with retinitis pigmentosa can benefit from the bionic eye. An estimated 10,000 have vision low enough, said Dr. Brian Mech, an executive with Second Sight Medical Products Inc., the Sylmar, Calif.-based company that makes the device. Of those, about 7,500 are eligible for the surgery.

The artificial implant in Pontz’s left eye is part of a system developed by Second Sight that includes a small video camera and transmitter housed in a pair of glasses.

Images from the camera are converted into a series of electrical pulses that are transmitted wirelessly to an array of electrodes on the surface of the retina. The pulses stimulate the retina’s remaining healthy cells, causing them to relay the signal to the optic nerve.

The visual information then moves to the brain, where it is translated into patterns of light that can be recognized and interpreted, allowing the patient to regain some visual function.

When wearing the glasses, which Pontz refers to as his “eyes,” he can identify and grab his cat and figure out that a flash of light is his grandson hightailing it to the kitchen.

The visual improvement is sometimes startling for Pontz and his wife, Terri, who is just as amazed at her husband’s progress as he is.

“I said something I never thought I’d say: ‘Stop staring at me while I’m eating,’” Terri Pontz said.

She drives her husband the nearly 200 miles from tiny Reed City, Mich., to Ann Arbor for check-ups and visits with occupational therapist Ashley Howson, who helps Roger Pontz reawaken his visual memory and learn techniques needed to make the most of his new vision.

At the recent visit, Howson handed Pontz white and black plates, instructed him to move them back and forth in front of light and dark backgrounds and asked that he determine their color.

Back home, Terri Pontz helps her husband practice the techniques he learns in Ann Arbor.

For them, the long hours on the road and the homework assignments are a blessing.

“What’s it worth to see again? It’s worth everything,” Terri Pontz said.

The artificial retina procedure has been performed several-dozen times over the past few years in Europe, and the expectation is that it will find similar success in the U.S., where the University of Michigan is one of 12 centers accepting consultations for patients.

Candidates for the retinal prosthesis must be 25 or older with end-stage retinitis pigmentosa that has progressed to the point of having “bare light” or no light perception in both eyes.

Dr. Thiran Jayasundera, one of two physicians who performed the 4.5-hour surgery on Roger Pontz, is scheduled to discuss his experiences with the retinal prosthesis process during a meeting of the American Society of Cataract and Refractive Surgery on Friday in Boston. He calls it a “game-changer.”

Pontz agrees: “I can walk through the house with ease. If that’s all I get out of this, it’d be great.”

 

The Man Who Co-Discovered HIV 30 Years Ago on Why There Won’t Be a Cure for AIDS

Dr. Robert Gallo, who co-discovered the cause of AIDS three decades ago and helped pave the way to blood testing for HIV, says a cure is unlikely, despite advances in drug treatments that have dramatically reduced the deaths from infection

On April 23, 1984, Secretary of Health and Human Services Margaret Heckler called a press conference to make a stunning announcement: Hoarse from laryngitis, the Reagan appointee spoke for less than a minute, but her words sparked an international firestorm: “The probable cause of AIDS has been found: a variant of a known human cancer virus,” she said.

The data on which she based her statement hadn’t yet been published, which was unusual in scientific circles. But this was 1984, three years after the mysterious and fast-moving acquired immunodeficiency syndrome (AIDS) was first described, and the pressure — from public-health officials, the scientific community and from patients — to find the thing responsible could excuse some shortcuts to the glacially paced process of scientific publishing. At the time, more than 4,100 people had been diagnosed with the newly identified disease; every day, 20 new cases were logged by the Centers for Disease Control and Prevention (CDC), and 1,807 had already died of AIDS.

Finding the culprit responsible, then, should have been something to celebrate. Except that not everyone agreed that Heckler was heralding the right guy. She credited National Cancer Institute scientist Dr. Robert Gallo with the discovery of HTLV-III, which he was confident caused AIDS. Heckler said Gallo was also to thank for figuring out how to grow the virus, making possible a blood test for detecting it.

But in the previous year, Pasteur Institute virologist Dr. Luc Montagnier and his colleagues had published a paper describing another candidate, a virus he called lymphadenopathy virus (LAV). Gallo and Montagnier, who knew of each other’s work, believed that HTLV-III and LAV were related strains of the same virus, and in March 1984, they agreed to make a joint announcement introducing the world to the related strains of the virus responsible for causing AIDS. That changed when the New York Times published an article quoting CDC director Dr. James Mason saying that Montagnier had identified the cause of AIDS as LAV.

(MORE: China’s Secret Plague)

Unwilling to lose ground in the high-stakes race to find the cause of AIDS, Heckler called the press conference to highlight the efforts that scientists under her charge had made. “I told the French group we would announce together, so I was excessively nervous,” says Gallo of the now legendary press conference. But he didn’t have much of a choice; Heckler asked him to fly in from a scientific conference he was attending in Italy to contribute to the announcement. “Do I wish there [hadn't been] a press conference? Of course,” he says. (Attempts to reach Montagnier several times were unsuccessful.)

At the time, Gallo had 48 isolates of HTLV-III from AIDS patients, while the French had one of their LAV. Gallo also had been able to coax four of the isolates to grow robustly in the lab, which was essential for developing a blood test to identify the virus and, later, for testing drugs designed to thwart infection. In a handout to bolster her brief statement, Heckler mentioned the French contribution – as a “collaboration.”

(MORE: Treatment as Prevention: How the New Way to Control HIV Came to Be)

That June, Montagnier and Gallo finally held their joint press conference to announce that HTLV-III and LAV were most likely one and the same virus. But the damage had already been done; with a patent and commercial rights at stake, the French government sued the U.S. in 1985, claiming Montaigner had identified LAV first, and developed a test to detect antibodies made against the virus. It took the White House to resolve the dispute two years later; President Reagan and French Prime Minister Jacques Chirac announced an agreement in which Montagnier and Gallo would be recognized as the co-discoverers of the human immunodeficiency virus (HIV).

Even world leaders, however, couldn’t truly put the matter to rest. Montagnier was awarded the Nobel Prize for Physiology or Medicine in 2008 along with Françoise Barré-Sinoussi, a Pasteur Institute colleague, for “their discovery of human immunodeficiency virus.” Gallo was not mentioned.

“I was surprised, and yes, I was disappointed, but I congratulated them,” Gallo says of being overlooked.

(MORE: Government-Backed Group Calls for Universal HIV Testing of Adults)

In the years since, Gallo has continued to work on retroviruses, the family to which HIV belongs, and now believes that it won’t be possible to completely cure HIV. Advances in drug treatments that interfere with the virus’ ability to infect and reproduce in healthy cells have dramatically reduced the deaths from infection — in fact, most public-health experts rarely use the term AIDS, which refers to the full-blown, advanced stages of the disease, and talk more about HIV infection. And in recent years, exciting studies showing that using the same drugs that can treat HIV, but giving them to healthy, uninfected people who are at high risk of getting infected, can block the virus from invading their cells at all. They’re enough to get experts, including executive director of UNAIDS Michel Sidibe, talking about bringing new infections down to zero and eliminating deaths from HIV as well.

(MORE: Anti-HIV Drugs Help Prevent Infection in Heterosexuals)

“Do I think [UNAIDS] will end the epidemic? No, I don’t; I think we’d be kidding ourselves,” says Gallo. Until an effective vaccine is developed that can protect people completely from becoming infected with HIV, he says, we can only talk about functional cures — getting people who are infected with HIV to the point where the virus remains at undetectably low levels — and unable to become activated again.

That seems to be the case with two young children, born to HIV-positive mothers, who are the first to be functionally cured of HIV after receiving powerful antiviral drugs in adult doses within hours of birth. “We will never replace active immunization,” he says. “But using [antiviral] drugs [to prevent infection] could be an important intermediary step to controlling the epidemic.” For some, that step may be disappointingly small for a 30-year effort. But for those living with HIV today, it’s a giant one toward keeping them alive.

Correction: The original version of this story misspelled the surname of Dr. Luc Montagnier.

How the Heck Do You Make Powdered Alcohol?

It looks like powdered alcohol is no longer approved, but we're still wondering how it's made

The Internet was in a tizzy yesterday over what appeared to be the approval of powdered alcohol, which had the potential to be added to water or food, or snorted.

But if it sounds too ridiculous to be true, it probably is—for now. The labels for the powdered alcohol, branded “Palcohol,” were approved in error, and the product’s label approval was rescinded yesterday by the Alcohol and Tobacco Tax and Trade Bureau (TTB). The company that makes Palcohol, Lipsmark, had this to say on its site: “We have been in touch with the TTB and there seemed to be a discrepancy on…how much powder is in the bag. There was a mutual agreement for us to surrender the labels. This doesn’t mean that Palcohol isn’t approved. It just means that these labels aren’t approved. We will re-submit.”

So while it appears powdered alcohol’s move to market has been stalled, we’re still scratching our heads: Considering how quickly liquid alcohol evaporates, do you make it powdered?

Palcohol, it turns out, is not the first attempt at a powdered alcohol. According to patent data, General Foods Corporation (now a subsidiary of Kraft) patented a couple of ways to make “alcohol-containing powder” in the early 1970s. In their process, they took a carbohydrate and broke it down through a process called hydrolysis, rendering it into a white powder. According to John Coupland, a professor of food science at Penn State University and spokesperson for the Institute of Food Technologists, they then combined that powder with pure liquid alcohol, which stuck to the powder, essentially capturing the alcohol in white dust. “It would feel dry to your hands,” Coupland says.

The Palcohol makers are not revealing how they make their product, which comes in cosmopolitan, mojito, margarita, and lemon drop flavors. “They say that they are trying to patent it at the moment, which suggests they have something novel, but I have no clue what that could be,” says Coupland.

So it looks like powdered alcohol is indeed possible, but won’t be for sale anytime soon. For now, you’re still going to have to consume your alcohol with dinner—instead of sprinkled on top of it.

 

What Americans Think About Birth Control Coverage

A new survey published Tuesday in the journal of the American Medical Association finds that an overwhelming majority of Americans—69 percent—say all health plans in the U.S. should be required to cover the cost of birth control

There’s debate over whether all health plans in the United States should be required to cover the cost of birth control. An overwhelming majority of Americans—69%—say yes, according to a breaking survey published in the journal JAMA.

While this suggests the issue is less divisive than previously thought, it’s still a hot-button topic in the courts. In June, the Supreme Court is expected to reach a decision in the Hobby Lobby case, in which the owners of the arts-and-crafts chain, who are Southern Baptists, contend that their right to exercise religious freedom are infringed upon by the Affordable Care Act provision requiring them to guarantee no-cost birth control and emergency contraceptive coverage for their employees.

Although most Americans are in favor of the mandated birth control coverage—77% of women and 64% of men—it was the least agreed upon when compared with other health services under the ACA provision. Coverage of preventive services like mammograms and colonoscopies, vaccinations, mental health care, and dental care all had more support than mandatory contraceptive coverage, according to the JAMA poll. (Birth control coverage has the most support among women, and black and Hispanic respondents.)

The researchers hope their data can be used to inform the ongoing national debate over contraceptive coverage.

Saudi Arabia

Fears Rise Over MERS Outbreak While Saudis Fumble

The deadly Middle East Respiratory Syndrome has neither no definitive origin, nor a known cure, so global public health officials are becoming increasingly concerned by the Saudi government's sluggish response as the number of human cases continues to rise

The sudden spike in cases of Middle East respiratory syndrome, or MERS, in Saudi Arabia came soon after camel-racing events at the Jenadriyah Festival in Riyadh. That suggested the surge in the incurable coronavirus, which resembles pneumonia but is fatal to 1 in 3 who contract it, confirmed what scientists already knew of the disease: that camels seem to be reservoirs for the virus, and transmit it to humans more easily than humans do to one another.

But with the number of cases picking up, there are worries that may be changing. And if the virus has mutated to increased person-to-person contagion, it has potentially catastrophic implications for another annual festival: the yearly pilgrimage to Mecca and Medina known as hajj. More than a million Muslims from around the globe gather in the western Saudi cities during the first week of October, then return to their home countries, which last year numbered 188. In an age when international travel has dramatically exacerbated the spread of new viruses like SARS, virologists say the mounting concern is only too clear.

The worries are aggravated by the performance of the Saudi government, which has failed to confirm whether the virus is, in fact, mutating. The Saudis have either not performed tests that would reveal the changes, or have not shared them with international authorities, virologists complain. On Monday, Health Minister Abdullah al-Rabiah was fired amid mounting criticism of the kingdom’s handling of the budding crisis.

“It’s frustrating,” says Ian Mackay, an associate professor at the Australian Infectious Diseases Research Centre at the University of Queensland, who compared the Saudi handling of MERS with China’s response to the 2013 outbreak of bird flu. “With the H7N9 virus, China provided almost too much information. You worried about the privacy of some of the patients, given the level of detail that China was providing.

“But we’re seeing the complete opposite extreme in Saudi Arabia, where you can’t even get the sex of the patient in some cases,” Mackay tells TIME. “And the WHO doesn’t seem to be getting that information either.”

Indeed, the World Health Organization as good as confirmed it did not have the latest information from Riyadh in declining to comment on the outbreak on Tuesday afternoon. “Kindly be advised that we cannot comment on latest MERS figures since we do not have the latest case count,” the WHO’s media office says in an emailed reply to questions from TIME. “And we can only communicate and comment on the cases that we have been officially notified of by a member state, namely Saudi Arabia.”

Concerns that the virus may have mutated are focused on two clusters of cases among health care workers: one cluster is in Jeddah, the western Saudi city through which pilgrims pass en route to nearby Mecca. The other cluster is among paramedics in Abu Dhabi, in the United Arab Emirates.

Mackay, who noted the clusters in his blog, says he can see two possible explanations: “One is a fairly bad but widespread breakdown of infection control and prevention protocols” among the health care workers — that is, nurses or doctors failing to use gloves, surgical masks or other standard measures designed to prevent infection while working with a MERS patient. Such a breakdown would be possible even in a well-equipped and prosperous Gulf nation, Mackay noted, but for both outbreaks to take place at the same time “would be fairly coincidental.”

The other, more alarming possibility? “The other avenue is the virus has changed and become more easily transmitted between humans,” Mackay said.

That is cause for concern way beyond the Middle East. “When humans readily transmit to humans, that’s what will cause a worldwide outbreak,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told National Public Radio. “We are very concerned that … with what we’ve seen over the last two weeks … we may be at that point now.”

Whether the virus has, in fact, mutated dangerously cannot be known until the Saudis examine the genome of the latest samples of the virus and share the results. The WHO has said it is “working closely” with the kingdom, but has not issued any conclusions. Another way to find out if the virus has mutated would be if the number of cases were to skyrocket. But with only 344 cases worldwide so far — a decade ago, SARS infected at least 8,000, and killed 775 — the count remains low, and awareness is growing.

In 2013, concerns over MERS kept many as a million people away from hajj, an obligation that the Koran imposes upon any Muslim who can afford the trip. Saudi authorities discouraged attendance by the very young, the elderly, pregnant women, and people already suffering from chronic illness, a major risk factor for the virus. Still, more than 3 million people circulated at the holy sites for five days, at close quarters. With the risk of mass contagion in the air this year, the world may be hoping for a better reaction from Saudi Arabia than it has got so far.

Correction: The original version of this story misstated the name of the institution that scientist Ian Mackay belongs to. He works for the Australian Infectious Diseases Research Centre.

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