COVID 19: Will the 2020 Hajj pilgrimage and Tokyo Olympic Games be cancelled?

Viral aetiology of severe acute respiratory illness among patients admitted during the 2022 peri-Hajj period

Introduction

Severe acute respiratory illness (SARI) among pilgrims continues to be an important healthcare issue. The aim of this study was to describe the viral aetiology of patients admitted to hospitals in the holy cities of Makkah and Madinah during the 2022 peri-Hajj period.

Methods

This is a retrospective analysis of patients admitted to hospitals with SARI. Patients were tested with multiplex polymerase chain reaction for the most common viral aetiologies.

Results

In total, 179 cases of SARI were identified during the study period. Of these, 101 (56.4%) were males, 78 (43.6%) were females, and 78 (43.6%) were Saudi. The mean age was 58.60 years (standard deviation 20.5) years. The most common age group was ≥65 years (n=68, 36%), followed by 55-59 years (n=37, 19%). The most common comorbidities were diabetes mellitus (n=67, 36%), hypertension (n=65, 35%) and chronic lung disease (n=34, 18%). Eighty-five (47.5%) patients tested negative and 94 (42.5%) tested positive for various viral aetiologies. The most frequently detected viruses were severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (n=28, 15%) and influenza (n=22, 12%); of the influenza cases, 16 were influenza A (6 (43%) were H3N2), and six were influenza B. The only case of Middle East respiratory syndrome coronavirus (MERS-CoV) was in a citizen, and none of the visitors or residents had MERS-CoV. Of the total cases, 27 (14%) died during the follow-up period. In a binary regression analysis, only age was associated with mortality (P=0.002).

Conclusion

The most commonly detected viruses among patients admitted to hospital with SARI were SARS-CoV-2 and influenza. It is important to continue surveillance of admitted and non-admitted patients in different Hajj periods to identify any shift in the aetiologic agents.

Bridging science and spirituality: the intersection of religion and public health in the COVID-19 pandemic

Background

The COVID-19 pandemic has had global impacts on social interactions and religious activities, leading to a complex relationship between religion and public health policies. This article reviews impact of the COVID-19 pandemic on religious activities and beliefs in relation to the spread of the virus, as well as the potential of religious leaders and faith communities in mitigating the impact of the pandemic through public health measures and community engagement.

Methods

A literature review was conducted using PubMed and Google Scholar, with search terms including "religion," "COVID-19," "pandemic," "coronavirus," and "spirituality." We included English articles published between January 2020 and September 2022, focusing on intersection of religion and COVID-19.

Results

We identified two main themes emerging, with the selected 32 studies divided in 15 studies focused on the relationship between religious practices, beliefs, and the spread of COVID-19, while 17 studies explored the role of religious leaders and faith communities in coping with and mitigating the impact of COVID-19. Religious activities were found to correlate with virus spread, particularly in early days of the pandemic. The relationship between religiosity and adherence to government guidelines was mixed, with some studies suggesting increased religiosity contributed to misconceptions about the virus and resistance to restrictions. Religious beliefs were also associated with vaccine hesitancy, particularly conservative religious beliefs. On the other hand, religious leaders and communities played a crucial role in adapting to COVID-19 measures, maintaining a sense of belonging, fostering emotional resilience, and upholding compliance with public health measures. The importance of collaboration between religious leaders, institutions, and public health officials in addressing the pandemic was emphasized.

Conclusions

This review highlights the essential role of religious leaders, faith-based organizations, and faith communities in promoting education, preparedness, and response efforts during the COVID-19 pandemic. Engaging with religious leaders and communities can improve pandemic control and prevention efforts. Collaboration between religious leaders, governments, and healthcare professionals is necessary to combat vaccine hesitancy and ensure successful COVID-19 vaccination campaigns. The insights from this review can guide future research, policy development, and public health interventions to minimize the impact of the pandemic and improve outcomes for individuals and communities affected.

Professional Athletes Maintain High TNF-Alpha or IFN-Gamma Related Inflammatory Status after Recovering from COVID-19 Infection without Developing a Neutralizing Antibody Response

INTRODUCTION

Professional athletes are endangered by COVID-19 and belong to the high-risk population due to their lifestyle. To obtain information on the behavior of COVID-19 in professional athletes, serological, cytokine, and virus neutralization capacities were analyzed.

MATERIALS AND METHODS

Hungarian national teams participated in international sports events during the early phases of the COVID-19 epidemic in 2020. Altogether, 29 professional athletes volunteered to donate plasma. Their serological status was evaluated by IgA, IgM, and IgG ELISAs and the highest virus neutralization titer in an in vitro live tissue assay. Plasma cytokine patterns were analyzed with a Bioplex multiplex ELISA system.

RESULTS

Surprisingly, only one athlete (3%) had anti-SARS-CoV-2 IgG, while IgA was more common (31%). Neither plasma showed direct virus neutralization in a titer over 1:10; hence, they were not suitable for reconvalescent treatment. The 'cytokine storm' markers IL-6 and IL-8 were at baseline levels. In contrast, either the TNF-alpha-related cytokines or the IFN-gamma-associated cytokines were elevated. There was a strong negative correlation between the TNF-alpha- or IFN-gamma-related cytokines.

CONCLUSIONS

Professional athletes are susceptible to the SARS-CoV-2 infection without developing long-term immunity through neutralizing immunoglobulins. Elevated secretory and cellular immunity markers indicate that these systems are probably responsible for virus elimination in this subpopulation.

Clinical and Serological Findings of COVID-19 Participants in the Region of Makkah, Saudi Arabia

Makkah in Saudi Arabia hosts the largest annual religious event in the world. Despite the many strict rules enacted, including Hajj cancellation, city lockdowns, and social distancing, the region has the second highest number of new COVID-19 cases in Saudi Arabia. Public health interventions that identify, isolate, and manage new cases could slow the infection rate. While RT-PCR is the current gold standard in SARS-CoV-2 identification, it yields false positive and negative results, which mandates the use of complementary serological tests. Here, we report the utility of serological assays during the acute phase of individuals with moderate and severe clinical manifestations of SARS-CoV-2 (COVID19). Fifty participants with positive RT-PCR results for SARS-CoV-2 were enrolled in this study. Following RT-PCR diagnosis, serum samples from the same participants were analyzed using in-house ELISA (IgM, IgA, and IgG) and microneutralization test (MNT) for the presence of antibodies. Of the 50 individuals analyzed, 43 (86%) showed a neutralizing antibody titer of ≥20. Univariate analysis with neutralizing antibodies as a dependent variable and the degree of disease severity and underlying medical conditions as fixed factors revealed that patients with no previous history of non-communicable diseases and moderate clinical manifestation had the strongest neutralizing antibody response "Mean: 561.11". Participants with severe symptoms and other underlying disorders, including deceased individuals, demonstrated the lowest neutralizing antibody response. Anti-spike protein antibody responses, as measured by ELISA, showed a statistically significant correlation with neutralizing antibodies. This reinforces the speculation that serological assays complement molecular testing for diagnostics; however, patients' previous medical history (anamnesis) should be considered in interpreting serological results.

"A Divine Infection": A Systematic Review on the Roles of Religious Communities During the Early Stage of COVID-19

The objective of this systematic review was to summarize the roles that religious communities played during the early stage of COVID-19 pandemic. Seven databases were searched and a total of 58 articles in English published between February 2020 and July 2020 were included in evidence synthesis. The findings of the literature showed diverse influences of religion as a double-edged sword in the context of COVID-19 pandemic. Religious communities have played detrimental and/or beneficial roles as a response to COVID-19 pandemic. A collaborative approach among religious communities, health science, and government is critical to combat COVID-19 crisis and future pandemics/epidemics.

The role of Saudi women in crisis management within the family: The COVID-19 pandemic as a model

BACKGROUND

Women play a pivotal role in managing crises and diminishing their serious consequences both in the family and society. In the first place, the spread of coronavirus disease 2019 (COVID-19) is one of the most severe crises in the world. Accordingly, many precautionary measures have been taken in many countries, including Saudi Arabia, such as border closures, lack of movement, and quarantine procedures, leading to an unprecedented impact on the daily lifestyle, and contributing significantly to increasing pressures on women because of her multiroles in family and work. This study aims at identifying the role of women in managing family crises during COVID-19.

MATERIALS AND METHODS

This was a descriptive, cross-sectional study. An online survey was conducted using self-designed electronic questionnaire consisting knowledge about the role of Saudi women in managing family during COVID-19 crises. The questionnaire was applied to 324 Saudi working women in Riyadh and Najran, with an average age of 33 years.

RESULTS

The results indicate that the role of Saudi women during the COVID-19 crisis was approximately 82%. Moreover, results showed that the prevalence of the social, psychological, and professional role of Saudi women during crisis was 82.24%, 83.40%, and 78.80%, respectively, which indicates the importance of the role of Saudi women in managing family crises during COVID-19.

CONCLUSION

Based on these results, the study emphasizes the importance of urging responsible persons to provide a package of rescue and stimulus, including social protection measures. Furthermore, it empowers Saudi women in all sectors of society and provides them with all means of support to help them achieve their mandated role in society generally and in their families particularly.

Exploring health impact and safety measures against transmission of COVID-19 pandemic in Saudi Arabia

The pandemic of Covid-19 at the global level cannot be underestimated. Arab world including Saudi Arabia is affected with the pandemic of Covid-19. More importantly, the surge of the numbers of infected individuals in Iran has brought fear and anxiety in the whole region in general and Saudi Arabia in particular. Several studies have investigated the prevalence of the virus in different countries from various perspectives. Nonetheless, little focus is given to academic research on health challenge of the virus resulting to fear and anxiety in the recent time in the context of Saudi Arabia. This study primarily aims at exploring the health effect of Covid-19 in Saudi Arabia despite the fact that, the World Health Organization (WHO) has clamored for preventive measures in addressing global health effect of the virus. The methodology of the study is systematic literature review (SLR) and content analysis of the secondary data on health impact of Covid-19 and preventive measures against its transmission in the country are critically analyzed. The results of secondary data of the study indicated that a number of confirmed cases, active cases and deaths in Saudi Arabia manifested negative impact of Covid-19 on citizens' health especially fear and anxiety despite the fact that records have showed steady recovered cases in the country. More specifically, the findings indicated that, health impact of Covid-19 are as follows namely: fear or anxiety, negative attitude among health workers and women in health workforce. Similarly, Saudi Arabia has put in place various preventive measures such as: preventive measures against transmission of Covid-19 which are as follows: institutional preparedness and strengthening mechanism, curfews and lockdowns and suspension of activities and order of social distancing. In conclusion, this paper has lucidly highlighted the health effect of Covid-19 and safety measures against the transmission of Covid-19 have been elaborated in the context of Saudi Arabia. It is thereby suggested that, the outcome of this study can be helpful to the health workers and policymakers in the country to be acquainted with the magnanimity of the novel coronavirus as well as putting effective safety mechanisms in place in curtailing the spread of Covid-19 in Saudi Arabia.

The Impact of COVID-19 on the Preparation for the Tokyo Olympics: A Comprehensive Performance Assessment of Top Swimmers

BACKGROUND

The Olympic preparation of athletes has been highly influenced by COVID and post-COVID syndrome. As the complex screening of athletes is essential for safe and successful sports, we aimed to repeat the 2019-year sports cardiology screening of the Olympic Swim Team before the Olympics and to compare the results of COVID and non-COVID athletes.

METHODS

Patient history, electrocardiogram, laboratory tests, body composition analysis, echocardiography, cardiopulmonary exercise test (CPET) were performed. We used time-ranking points to compare swimming performance.

RESULTS

From April 2019, we examined 46 elite swimmers (24 ± 4 years). Fourteen swimmers had COVID infection; all cases were mild. During CPET there was no difference in the performance of COVID (male: VO2 max 55 ± 4 vs. 56.5 ± 5 mL/kg/min, p = 0.53; female: VO2 max 54.6 ± 4 vs. 56 ± 5.5 mL/kg/min, p = 0.86) vs. non-COVID athletes (male VO2 max 56.7 ± 5 vs. 55.5 ± 4.5 mL/kg/min, p = 0.50; female 49.6 ± 3 vs. 50.7 ± 2.6 mL/kg/min, p = 0.47) between 2019 and 2021. When comparing the time results of the National Championships, 54.8% of the athletes showed an improvement (p = 0.75).

CONCLUSIONS

COVID infection with short-term detraining did not affect the performance of well-trained swimmers. According to our results, the COVID pandemic did not impair the effectiveness of the preparation for the Tokyo Olympics.

Kumbh Mela Religious Gathering as a Massive Superspreading Event: Potential Culprit for the Exponential Surge of COVID-19 Cases in India

The Kumbh Mela is a significant religious gathering of millions of Hindu devotees in India. It is celebrated on certain auspicious days in the Hindu calendar and attracts millions of pilgrims across the country. Despite the religious intention of millions of Hindu devotees, it raised public health concerns as it became a massive superspreading event for COVID-19. Being the second most populous country, India became the second most affected country during the COVID-19 pandemic. In addition to the arrival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and the presence of the double mutated variant, which was first identified in India, the Kumbh Mela probably aggravated the country's COVID-19 situation which resulted in an uncontrollable second wave. Several cases of COVID-19 across India had been contact-traced to returnees from the event who acted as a nidus to help spread the infection. As a consequence, India's healthcare system was severely challenged as a result of the overwhelming hospitalizations and increasing fatalities resulting in an acute manpower shortage in healthcare along with the depletion of drugs and medical supplies despite being one of the largest pharmaceutical hubs globally. Leaders and governments around the world should learn from India's experience and thereby take preventive measures to manage potential superspreading events to curb the spike of COVID-19 cases.

The Emergence, Persistence, and Dissemination of Antimicrobial-Resistant Bacteria in Environmental Hajj Settings and Implications for Public Health

The emergence of antimicrobial resistance is causing the loss of what was once considered the miracle cure. The transmission of antimicrobial resistance during mass gathering is a potential threat in addition to other infectious diseases. Here, we review the English language literature on the rate and the acquisition of antimicrobial resistance during the Hajj. There is a variable incidence of methicillin-resistant Staphylococcus aureus, Escherichia coli, and Enterobacteriaceae. There had been no report of multi-drug-resistant Mycobacterium tuberculosis. Continued surveillance of antimicrobial resistance coupled with public health measures are needed to decrease the rate of emergence of resistance.

Public Knowledge, Attitudes, and Practice towards COVID-19 Pandemic in Saudi Arabia: A Web-Based Cross-Sectional Survey

(1) Background: COVID-19 has become a worldwide public health problem. No previous study has investigated factors associated with COVID-19 knowledge, attitude, and practice (KAP) after completely lifting the curfew in all Saudi Arabia regions and cities. Therefore, adequate knowledge, a positive attitude, and correct control of COVID-19 are essential to eradicate the disease. Hence, this study aims to assess factors associated with KAP of COVID-19; (2) Methods: This cross-sectional web-based survey was performed with the participation of 4305 individuals aged over 15 years living in Saudi Arabia from 11 to 19 August 2020. They were included using the snowball sampling method; (3) Results: Of the 4305 participants, 94.9% were Saudis, 60% females, and 45.4% were in the age group of 20-34 years, 61.7% married, and 49.3% from the Eastern Province of Saudi Arabia. Most of the participants demonstrated good KAP levels (89.6%, 87.2%, and 87.2%) towards the COVID-19 pandemic, respectively. In addition, most of the participants (85.8%) used the internet and social media as a source for COVID-19 information (4) Conclusions: The finding showed that most of the participants demonstrated good knowledge of COVID-19, positive attitudes, and demonstrated good practices for preventing the spread of disease infection.

The Hajj and COVID-19: How the Pandemic Shaped the World's Largest Religious Gathering

The Hajj pilgrimage, one of the five pillars of Islam, is held in Saudi Arabia in the second week of Dhu’l-Hijjah, the last month of the Islamic calendar. It is one of the world’s largest mass gatherings, constituting more than 2.5 million Muslim pilgrims from more than 180 countries. The COVID-19 pandemic posed a significant public health threat for such mass gatherings. Thus, a health risk assessment for the 2020 Hajj was held by the Saudi Arabia Ministry of Health and the WHO Collaborating Centre for Mass Gatherings Medicine, which concluded that foreign pilgrims should be excluded from the 2020 Hajj and that the number of pilgrims should be significantly reduced. Timely decisions allowed the Saudi government to conduct the Hajj, despite an initial postponement. However, the number of pilgrims was significantly downscaled, and extensive new protocols were set in place because of the pandemic. This article aims to shed light on the challenges faced and efforts made by Saudi Arabia to mitigate the spread of COVID-19 during the religious proceedings of the Hajj.

The Tokyo Olympic Games and the Risk of COVID-19

Purpose of Review

We reviewed the occurrence of outbreaks at past Olympics and discuss the threat of the COVID-19 pandemic at the Tokyo Games.

Recent Findings

Evidence for large respiratory tract infection outbreaks at past Olympics is scant. Nevertheless, in order to control the spread of the COVID-19 outbreak, the Tokyo 2020 Olympics were postponed for 2021. Given the high contagiousness of the disease and the epidemiology of COVID-19 in Japan, this decision was appropriate and important in order to safeguard athletes and the public. However, it is a major problem for Japan, involving massive financial losses and a lost opportunity for athletes, coaches, and instructors.

Summary

Up-to-date epidemiological data is needed on which to base an appropriate decision regarding the Tokyo 2021 Olympics. The actual effect of cancellations of such events in reducing the spread of COVID-19 needs to be determined.

Incidence of COVID-19 among returning travelers in quarantine facilities: A longitudinal study and lessons learned

INTRODUCTION

The emergence of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) had resulted in an unpresented global pandemic. In the initial events, the Kingdom of Saudi Arabia implemented mandatory quarantine of returning travelers in order to contain COVID-19 cases.

MATERIALS AND METHODS

This is a longitudinal study of the arriving travelers to Quarantine facilities and the prevalence of positive SARS-CoV-2 as detected by RT-PCR.

RESULTS

During the study period, there was a total of 1928 returning travelers with 1273 (66%) males. The age range was 28 days-69 years. Of all the travelers, 23 (1.2%) tested positive for SARS-CoV-2. Of the first swab, 14/1928 (0.7%) tested positive. The positivity rate was 0.63% and 0.92% among males and females, respectively (P = 0.57). The second swab was positive in 9 (0.5%) of the other 1914 who were initially negative with a positivity rate of 0.39% and 0.62% among males and females, respectively (P = 0.49). There was no statistical difference in the positivity rates between first and second swab (P = 0.4). Of all travelers, 40 (n = 26, 1.3%) were admitted from the quarantine facility to the hospital due to COVID-19 related positive results or development of symptoms such as fever, cough, and respiratory symptoms; and 14 (0.7%) were admitted due to non-COVID-19 related illness.

CONCLUSION

This study showed the efforts put for facility quarantine and that such activity yielded a lower incidence of positive cases. There was a need to have a backup healthcare facility to accommodate those developing a medical need for evaluation and admission for non-COVID-19 related illnesses.

COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges

Social distancing at its various levels has been a key measure to mitigate the transmission of COVID-19. The implementation of strict measures for social distancing is challenging, including in the Kingdom of Saudi Arabia (KSA) due to its level of urbanization, its social and religious norms and its annual hosting of high visibility international religious mass gatherings. KSA started introducing decisive social distancing measures early before the first case of COVID-19 was confirmed in the Kingdom. These ranged from suspension or cancelations of religious, entertainment and sporting mass gatherings and events such as the Umrah, temporary closure of educational establishments and mosques and postponing all non-essential gatherings, to imposing a curfew. These measures were taken in spite of their socio-economic, political and religious challenges in the interest of public and global health. The effect of these actions on the epidemic curve of the Kingdom and on the global fight against COVID-19 remains to be seen. However, given the current COVID-19 situation, further bold and probably unpopular measures are likely to be introduced in the future.

Mapping COVID-19 related research from Saudi Arabia, a scoping review. Between reality and dreams

OBJECTIVES

To map research production by Saudi-affiliated investigators in order to identify areas of strength and weakness. Method: We followed the Arksey and O'Malley (2005) framework. Medline and Cochrane databases were searched with a focus on identifying articles related to COVID-19 and Saudi Arabia following the PRISMA protocol. The study was conducted at King Saud University, Riyadh, Saudi Arabia between March and May 2020. Results: A total of 53 articles were ultimately included. Most of the research production from Saudi Arabia was opinion and narrative reviews related to the clinicopathological features of COVID-19 as well as control and prevention of virus spread.  Conclusion: The results of this scoping review identify a relative deficiency in original research, which requires further investigation.

COVID-19 in the Eastern Mediterranean Region and Saudi Arabia: prevention and therapeutic strategies

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Prevention strategies for SARS-CoV-2 infection in Saudi Arabia.

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Therapeutic options for COVID-19 in Saudi Arabia.

The cancellation of mass gatherings (MGs)? Decision making in the time of COVID-19

Our recommendation, as experts who have monitored health hazards at the Hajj for over 15 years, especially if the situation with COVID-19 continues to escalate globally is that Hajj 2020 will be at risk of being suspended and a means for Muslims to fulfill their rights in the future either personally or even by proxy need to be announced. The same holds true for the Summer 2020 Olympics in Japan and for many other MGs and large gatherings. Decisions in the time of COVID-19 will be closely followed and will be a blueprint for other mass gatherings.