Escalating the 2022 Hajj during the third year of the COVID-19 pandemic

Evidence for transmission of SARS-CoV-2 at religious mass gatherings: A systematic review

Background

Transmission of SARS-CoV-2 at major mass gatherings (MGs) has been observed during the COVID-19 pandemic.

Methods

In this systematic review done according to the PRISMA guidelines, PubMed and Scopus databases were searched for relevant studies to describe the epidemiology of SARS-CoV-2 in relation to major religious MGs including the Grand Magal of Touba (GMT), Hajj, Umrah, Kumbh Mela, Arbaeen and Lourdes pilgrimage during the COVID-19 pandemic.

Results

Ten articles met the inclusion criteria and were included.No cases of SARS-CoV-2 were detected at 2020 and 2021 GMT or at the 2020 Hajj. In a small study, 7 % of tested individuals were positive after the 2022 GMT. SARS-CoV-2 prevalence during the 2021-2022 Hajj and Umrah seasons varied from 0 to 15 % in different studies. At the 2021 Kumbh Mela, 0.4 million COVID-19 cases were diagnosed among returning pilgrims across India and 1 % tested positive during a one-day survey conducted on participants. During the 2021 Arbaeen pilgrimage, 3 % pilgrims were tested positive. No relevant data were found in relation to SARS-CoV-2 transmission at the 2021 Arbaeen and Lourdes pilgrimages.

Conclusion

The transmission of the SARS-CoV-2 virus during religious MG events depends on many factors such as: the number and density of pilgrims, the intensity of circulation of the virus in the hosting country and in countries sending international participants at the time of the event, the transmissibility of virus variants at the time of the event, the various preventive measures adopted, and the immune status of the pilgrims.

Herding during different types of crises: The COVID-19 health crisis and Russia-Ukraine political crisis

We analysed herding behaviour in the recent pandemic and conflict. We employed the cross-sectional dispersion of daily stock returns to estimate herding's intensity in the Saudi stock market. We conducted all analyses for the entire sample and four sub-samples. Additionally, we investigate the existence of the asymmetry in the investors' responses; whether there are differences between up and down markets and between high-volatility and low-volatility days. We found that herding did not occur in the pre-COVID-19, occurred in the during-COVID-19, disappeared in the post-COVID-19 and did not occur during the Russia-Ukraine conflict. Robustness checks confirm our finding that herding manifested in the during-COVID-19 period. Additionally, no difference exists between bearish and bullish or high-and low-volatility days, pushing aside the asymmetry in the investors' responses. This study may raise investors' awareness of their cognitive bias's influence on their decisions, improving market efficiency by increasing the rationality of investors' decisions.

The relationship between hand hygiene and rates of acute respiratory infections among Umrah pilgrims: A pilot randomised controlled trial

BACKGROUND

There is a lack of randomised controlled trials (RCTs) investigating the role of hand hygiene in preventing and containing acute respiratory infections (ARIs) in mass gatherings. In this pilot RCT, we assessed the feasibility of establishing a large-scale trial to explore the relationship between practising hand hygiene and rates of ARI in Umrah pilgrimage amidst the COVID-19 pandemic.

METHODS

A parallel RCT was conducted in hotels in Makkah, Saudi Arabia, between April and July 2021. Domestic adult pilgrims who consented to participate were randomised 1:1 to the intervention group who received alcohol-based hand rub (ABHR) and instructions, or to the control group who did not receive ABHR or instructions but were free to use their own supplies. Pilgrims in both groups were then followed up for seven days for ARI symptoms. The primary outcome was the difference in the proportions of syndromic ARIs among pilgrims between the randomised groups.

RESULTS

A total of 507 (control: intervention = 267: 240) participants aged between 18 and 75 (median 34) years were randomised; 61 participants were lost to follow-up or withdrew leaving 446 participants (control: intervention = 237:209) for the primary outcome analysis; of whom 10 (2.2 %) had developed at least one respiratory symptom, three (0.7 %) had 'possible ILI' and two (0.4 %) had 'possible COVID-19'. The analysis of the primary outcome found no evidence of difference in the proportions of ARIs between the randomised groups (odds ratio 1.1 [0.3-4.0] for intervention relative to control).

CONCLUSION

This pilot trial suggests that conducting a future definitive RCT to assess the role of hand hygiene in the prevention of ARIs is feasible in Umrah setting amidst such a pandemic; however, outcomes from this trial are inconclusive, and such a study would need to be very large given the low rates of outcomes observed here.

TRIAL REGISTRATION

This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12622001287729), the full protocol can be accessed there.

Travel and tourism to the Kingdom of Saudi Arabia: what are the health risks?

Tourism in Saudi Arabia has been rapidly growing and evolving in recent years as part of the Saudi government’s efforts to diversify its economy away from oil dependence and promote the country as a tourist destination. The country aims to invest $800 billion in the next decade, particularly targeting international travellers.

Effectiveness of COVID-19 vaccines against ICU admission during Omicron surge in Saudi Arabia: a nationwide retrospective cohort study

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused significant economic damage and forced a slew of limitations to be placed by regulatory bodies worldwide. As the SARS-CoV-2 virus continuously mutates over time, it's crucial to understand how well the vaccines are effective against a new variant.

OBJECTIVES

To measure COVID-19 vaccine effectiveness against ICU admission with the Omicron variant in Saudi Arabia regions.

METHODS AND MATERIALS

A retrospective cohort study was conducted of vaccinated and non-vaccinated individuals who tested positive during Omicron dominant period (Jan 1, 2020- Jun 11, 2022). We used a Cox proportional hazards model based on calendar time to assess the vaccine's effectiveness while controlling for age and gender.

RESULTS

A total of 14103 individuals who were divided into fully vaccinated included 8388 (59.5%) individuals, partially vaccinated included 1851 (13.5%) individuals, and un-vaccinated included 3864 (27.4%) individuals. Higher age was associated with a higher risk of ICU admission (HR = 1.03, 95% CI: 1.02, 1.04). Three doses are associated with a lower risk of ICU admission compared to the single dose (HR = 0.09, 95% CI: 0.04, 0.20). By studying the distribution of Omicron infection among different regions, Al-Madinah Al-Monawarah had the highest proportion at 60.23 per 100,000 population (95% CI: 57.05, 63.53). In contrast, Al-jouf had the lowest proportion at 4.51 per 100,000 population (95%CI: 2.891, 6.713). The vaccination status was significantly different in different regions, as the highest proportion of fully vaccinated participants inhabited in Tabouk region, with 71.8% of its cases. Out of all regions, Najran had the highest proportion of ICU admission among Omicron cases with 20% (95% CI: 9.94%, 34.22%). While the lowest rates existed in Riyadh with 0.86% (95%CI: 0.61%, 1.17%).

CONCLUSION

We found that a booster significantly enhanced protection against severe COVID-19. The partially vaccinated and unvaccinated participants were at significantly higher risk of ICU admission when compared to the fully vaccinated participants. Furthermore, in future, it is worth investigating the effectiveness of a booster when other potential factors (e.g., region, comorbidities, etc.) are included, particularly among future variants of COVID-19.

Coronavirus and co-infections: A Saudi Arabian perspective

Mortality due to infectious diseases continues to rise globally, despite advances in antimicrobial therapy and supportive care. This is evident with the occurrence of coronavirus disease 2019 (COVID-19) pandemic, instigated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Saudi Arabia, an eminent country within the Arab region, has had significant impact during global pandemics, concomitant with the fact that millions of Muslims travel to Saudi Arabia for pilgrimages every year. Herein, we discuss the significance of SARS-CoV-1, SARS-CoV-2, as well as the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia with particular reference to global transmission and/or emergence of new variants due to genetic mixing of different strains. Furthermore, we also discuss the role of Saudi Arabia with reference to novel emerging infectious diseases and re-emerging infections, such as Ebola, zika, and monkeypox, as well as in the context on coinfections. Future strategies to limit the spread of viral infections and the pivotal role of Saudi Arabia, are deliberated upon.

Health Workers' Knowledge and Attitude towards Monkeypox in Southwestern Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Monkeypox outbreaks in non-endemic countries emphasize the importance of being prepared to prevent its progression to a pandemic. To effectively control monkeypox, healthcare providers must have sufficient knowledge and good attitudes and practices to limit its spread. We initiated this project to assess the factors associated with health workers' knowledge and attitude toward monkeypox in southwestern Saudi Arabia.

METHODS

We included 398 eligible health workers working at various health facilities. Data was collected using an online survey, and participants had an opportunity to consent. We conducted descriptive statistics for all variables and used chi-square statistics, t-test, and multivariate analysis to establish the association between health workers' demographic characteristics and knowledge of monkeypox disease.

RESULTS

The mean age was 30.93 ± 8.25 years for the included participants, and most of them were between 22 and 29 years, male, single, nurses, working in government hospitals, and had worked for at least five years. The chi-square and t-test showed that the participants' knowledge level was significantly related to age, marital status, job title, and medical practice. Most of the participants had low knowledge and good attitudes toward monkeypox prevention measures. Multivariate analysis showed that higher knowledge was associated with younger age after controlling all other significant bivariate relationships between knowledge and demographics.

CONCLUSIONS

This study found low knowledge levels and high good attitude levels of monkeypox among the participants. As such, there is a need to support health workers in understanding monkeypox epidemiology, prevention, and treatment. Therefore, Saudi Arabia will be making significant strides to being well prepared and ready to handle future monkeypox outbreaks.

Worldwide poliomyelitis outbreaks: should mass gathering organizers be concerned?

The polio is the longest PHEIC and the continued occurrence of outbreaks of cVDPV would put further risks globally. The binary nature of PHEIC declarations would not support the continued polio PHEIC due to the requirement of tiered or graded strategies to combat such diseases.

Impact of a Health Education Intervention on the Incidence of Influenza-Like Illnesses (ILI) During Hajj via Smartphone Application

This study was aimed at demonstrating the impact of a health education intervention on reducing the incidence of influenza-like illnesses symptoms among Malaysian Hajj pilgrims. This study utilizes a quasi-experimental study in the evaluation of the impact of the intervention. Participants were recruited during Hajj orientation courses organized by private Hajj companies. Participants from two companies were assigned to an intervention group and control group, respectively. The intervention group received a smartphone-based health education intervention guided by the Health Belief Model (HBM), while the control group received a regular Hajj guide intervention smartphone application before departure to Hajj. Data on the incidence of influenza-like illnesses (ILI) were collected from participants from two Hajj companies before and after returning from Hajj. Data analysis was conducted using SPSS with descriptive analysis, and analytical tests were conducted at 5% significance level. A total of 102 pilgrims completed the study in both intervention and control groups. The incidence of ILI and Non-ILI symptoms were statistically significant when the intervention and control groups (p = 0.049) were compared. In conclusion, health education has an impact on reducing the incidence of ILI and non-ILI among Hajj pilgrims.

The emergence of novel infectious diseases and the public health impact of mass gathering events: risks and challenges

To date, there is the continuous emergence of novel infectious diseases endangering individuals' health and well-being worldwide. Over the past few decades, around forty contagious diseases, such as Severe Acute Respiratory Syndrome coronavirus-1 (SARS), Middle East Respiratory Syndrome coronavirus (MERS), Ebola, Zika, and newly, COVID-19 and Monkeypox outbreaks, have been reported globally. Zoonotic transmission is the major cause of these emerging infections in humans. These, whether caused by previously unknown pathogens or by those already well-known to science, heighten global concerns about the spread of communicable diseases and the resulting increase in death and disability. 

Low Prevalence of Syndromic Respiratory Tract Infections among Returning Hajj Pilgrims Amidst the COVID-19 Pandemic: A Post-Hajj Survey

This study estimates the point prevalence of symptomatic respiratory tract infections (RTIs) among returned Hajj pilgrims and their contacts in 2021. Using the computer-assisted telephone interview (CATI) technique, domestic pilgrims were invited to participate in this cross-sectional survey two weeks after their home return from Hajj. Of 600 pilgrims approached, 79.3% agreed to participate and completed the survey. Syndromic definitions were used to clinically diagnose possible influenza-like illnesses (ILI) and COVID-19. Median with range was applied to summarise the continuous data, and frequencies and proportions were used to present the categorical variables. Simple logistic regression was carried out to assess the correlations of potential factors with the prevalence of RTIs. The majority of pilgrims (88.7%) reported receiving at least two doses of the COVID-19 vaccine before Hajj. Eleven (2.3%) pilgrims reported respiratory symptoms with the estimated prevalence of possible ILI being 0.2%, and of possible COVID-19 being 0.4%. Among those who were symptomatic, five (45.5%) reported that one or more of their close contacts had developed similar RTI symptoms after the pilgrims’ home return. The prevalence of RTIs among pilgrims who returned home after attending the Hajj 2021 was lower compared with those reported in the pre-pandemic studies; however, the risk of spread of infection among contacts following Hajj is still a concern.