The Pakistan Medical Association (MPA) and other associations of medical doctors have denounced [[1], [2], [3]] Pakistan government's decision allowing mosques to open for daily five-time congregational prayers during the holy month of Ramadan amid the COVID-19 pandemic [4].
Pakistan's doctors fear that the easing of social distancing and lockdown measures would increase cases of COVID-19 [5] with a possibility of collapse of the healthcare system of the country. They have stressed that the government should not ease the lockdown but extend it and take strict preventative measures including disallowing congregational prayers in mosques. Congregational prayers remain temporarily stopped in other Muslim countries including Saudi Arabia where Islam's two holiest mosques in Mecca and Madinah remain temporarily closed for the worshipers [6].
Ramadan is Islam's holiest month during which Muslims observe fasting from dawn to sunset for the whole month, and pray in large congregations, especially during night-time prayer. This year, however, Ramadan is different for Muslims because of the COVID-19 pandemic. Following public health advice, congregational prayer in mosques, and religious services of other faiths, remain suspended in numerous countries that have enforced a lockdown to contain COVID-19.
Nonetheless, Pakistan has allowed the opening of mosques for five-time daily congregational prayers subject to the observance of a 20 point code of conduct [7]. The main points include wearing of face masks while praying, maintaining a 2 m distance between worshippers during the congregational prayer, removing prayer mats from mosques, praying on the floor that will be disinfected, a ban on breaking of the fasting and communal eating in mosques, performing ablution (wudu) at home, no hand shaking, and banning old and sick people from praying in mosques [8].
Although some of these preventive measures might be helpful, the medical community in Pakistan foresees the possibility of a risk of spread of COVID-19 because of large numbers of worshipers praying closer to each other especially during the night-time Ramadan prayer, which lasts for about 60-90 minutes. Public health advice suggests that staying for about 15 minutes or more at about 1–2 m distance with someone with COVID-19 can result in catching the infection [9].
Even before Ramadan, the incumbent government in Pakistan was reluctant to impose a lockdown, while the provincial governments especially in Sindh province supported the lockdown and declared it on 23rd March [10], which paved the way for a nationwide lockdown. However, lockdown restrictions were eased in the country and shops were allowed to open a few days before the beginning of the month of Ramadan [11]. Soon after the easing of social distancing and lockdown, a surge in new cases of COVID-19 was noted by health professionals. Consequently, the PMA and other doctors' organisations held press conferences in three provincial capital citie i.e. Karachi [1], Lahore [2], and Peshawar [3] and demanded an extension to the lockdown and the implementation of strict measures to protect public health [5]. However, health providers’ advice and pleas remain hitherto unheeded, and the general public remains confused and caught between divergent views and messages about the COVID-19 crisis.
Pakistan has 37218 confirmed cases of COVID-19 and 803 deaths related to it (as on 14th May) [12] showing a burden of 179 confirmed cases per 1 M people and a 2.2% case fatality rate. However, about 73% of confirmed cases and 43% of total deaths due to COVID-19 involve people aged 20–59 years in the country [12]. This is important as the major burden of COVID-19 in Pakistan is in the working age population, which should be a major concern for the country.
Health officials have warned that the COVID-19 situation can go out of control if public health advice and preventive measures are not taken seriously by both the governments and the public [2,3]. Pakistan must look at the scientific evidence and the impact of lockdowns and social distancing on COVID-19 in other countries.
Ethical approval
Not applicable as all data reported in this work is available online and in the public domain.
Sources of funding
No funding.
Author contribution
SGSS conceived, planned and under took the study. He identified the relevant literature and collated data available online and in the public domain. He synthesised the literature, analysed data and wrote the manuscript.
Research registration unique identifying number (UIN)
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Guarantor
Syed Ghulam Sarwar Shah (SGSS).
Provenance and peer review
Not commissioned, internally reviewed.
Data statement
No specific data were collected for this article. All data reported in this article are publically available at http://covid.gov.pk.
Declaration of competing interest
Author declares no conflict of interest.
Acknowledgements
The views expressed in this article are author's own academic views and not of his employer organization.
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