Consider canceling religious gatherings, WHO issues advisory for Ramadan amid coronavirus pandemic
Issuing interim guidance, the World Health Organization (WHO) has said that canceling religious and social gatherings should be seriously considered during the coronavirus pandemic.
The guidelines titled 'Safe Ramadan practices in the context of the COVID-19' highlights public health advice for social and religious practices and gatherings during Ramadan that "can be applied across different national contexts".
"Cancelling social and religious gatherings should be seriously considered. WHO, therefore, recommends that any decision to restrict, modify, postpone, cancel, or proceed with holding a mass gathering should be based on a standardized risk assessment exercise. These decisions should be part of a comprehensive approach taken by national authorities to respond to the outbreak," says the WHO.
It states that if social and religious gatherings are canceled where possible, virtual alternatives using platforms such as television, radio, digital, and social media can be used instead.
"The holy month of Ramadan is marked by social and religious gatherings where Muslim families and friends unite to break their fast together, after sunset during iftar or before dawn during suhour. This year Ramadan falls between late April and late May as the COVID-19 pandemic continues. If Ramadan gatherings are allowed to proceed, measures to mitigate the risk of COVID-19 transmission should be implemented," says the guidance.
The WHO states that a strong communication strategy is essential to explain to the population the reasons for decisions taken. Clear instructions should be given and the importance of following national policies reinforced.
"The communication strategy should also include proactive messaging on healthy behaviors during the pandemic and use different media platforms," says the WHO.
The transmission of COVID-19 is facilitated by close contact between people, as the virus is spread through respiratory droplets and contact with contaminated surfaces. To mitigate the public health impact, several countries have implemented physical distancing measures aimed at interrupting transmission by reducing interaction between people.
"These measures are fundamental control mechanisms to control the spread of infectious diseases, particularly respiratory infections, associated with large gatherings of people. Physical distancing measures, including the closing of mosques, monitoring of public gatherings and other restrictions on movement, will have direct implications for the social and religious gatherings central to Ramadan," says the WHO.
Experts recommend that national health authorities be considered the primary source of information and advice regarding physical distancing and other measures related to COVID-19 in the context of Ramadan.
"Compliance with these established measures should be assured. Religious leaders should be involved early in decision making so that they can be actively engaged in communicating any decision affecting events connected with Ramadan," says the WHO.
The WHO guidelines stipulate practicing physical distancing by strictly maintaining a distance of at least 1 meter (3 feet) between people at all times. Experts also call for using "culturally and religiously sanctioned greetings" that avoid physical contact, such as waving, nodding, or placing the hand over the heart.
The WHO has also recommended measures that should be applied to any gathering during Ramadan, such as prayers, pilgrimages, and communal meals or banquets.
"Consider holding the event outdoors if possible; otherwise, ensure that the indoor venue has adequate ventilation and airflow. Shorten the length of the event as much as possible to limit potential exposure. Give preference to holding smaller services with fewer attendees more often, rather than hosting large gatherings,” say guidelines.
It also recommends considering measures to facilitate contact tracing if an ill person is identified among the attendees of the event. Experts suggest avoiding the crowded gathering associated with iftar banquets, one can consider using individual pre-packaged boxes/servings of food.
"These can be organized by centralized entities and institutions, which should adhere to physical distancing throughout the whole cycle (collecting, packaging, storing and distribution)," says the advisory.
Experts also say that no studies of fasting and risk of COVID-19 infection have been performed. They suggest healthy people should be able to fast during this Ramadan as in previous years, while COVID-19 patients may consider "religious licenses regarding breaking the fast in consultation with their doctors, as they would do with any other disease."
Mass gatherings
The WHO has also released separate guidelines on mass gatherings during the COVID-19 pandemic, which answers several key questions. Experts describe high profile international sporting events such as the Olympics or World Cups as well as international religious events such as the Hajj count as mass gatherings.
"Lower profile conferences and events can also meet WHO's definition of a mass gathering. An event counts as a 'mass gatherings' if the number of people it brings together is so large that it has the potential to strain the planning and response resources of the health system in the community where it takes place," says the WHO.
Does the WHO recommend that all international mass gatherings be canceled due to COVID-19. The answer is no. Experts say as each international mass gathering is different, the factors to consider when determining if the event should be canceled may also differ.
The guidelines recommend that when organizers and health authorities are determining whether to hold a mass gathering, they should determine what is an acceptable risk and what additional measures should be implemented to mitigate the risks.
"Any decision to change a planned international gathering should be based on a careful assessment of the risks and how they can be managed, and the level of event planning. The assessment should involve all stakeholders in the event, and in particular, health authorities in the country or community where the event is due to take place," say experts.