The 2020 Grand Magal of Touba, Senegal in the time of the COVID-19 pandemic

Dear Editor,

The Grand Magal de Touba will take place in early October this year in central Senegal. In past years, the event which celebrates the departure in exile of Cheikh Amadou Bamba, the founder of the Mouridism gathered more than 4 Million Muslim pilgrims in Touba, a city with an approximately one million inhabitants at baseline. Senegal is currently facing the COVID-19 pandemic as many African countries. According to the Center for Systems Science and Engineering at John Hopkins University there was more than 14,150 cases reported in Senegal as of 10 September with 293 deaths (https://coronavirus.jhu.edu/map.html). Syndromic surveillance studies conducted on Grand Magal pilgrims over recent years have demonstrated that respiratory tract infections are among the most frequent causes of consultations at health care structures during the event [1]. A prospective cohort study showed that the prevalence of respiratory tract infection symptoms was 42% among pilgrims with a 5-fold increase following the participation to the Grand Magal [2]. Common coronaviruses were the most frequently acquired respiratory viruses [2]. The occurrence of a dengue outbreak in Touba during the 2018 Grand Magal raised the risk for further spread to other regions in Senegal through viremic Mourid pilgrims returning to their place of residence where Aedes mosquitoes are present [3]. Several mass gathering events have been recently cancelled including the Umrah pilgrimage in Saudi Arabia [4] and the Olympics in Japan. The Hajj this year was limited to 1000 participants residing in Saudi Arabia, while the event usually gathers more than two Millions participants from more than 180 countries [5]. Grand Magal pilgrims travel from all Senegal to Touba in overcrowded buses. The vast majority of them are hosted in Touba and around, in familial houses or spiritual guides (Marabout) houses where they sleep all together in the same rooms. For lunch and dinner, Senegalese traditionally closely gather around a single large dish a food. In addition, during the event, streets around the Grand Mosque and the general market present an extremely high density of population. All these conditions are very likely to favor the transmission of respiratory pathogens among pilgrims. The religious authorities in Touba just confirmed that the Grand Magal will be held in Touba in early October. Given that the medical resources available during the event are suboptimal [6], we recommend that individuals at risk for severe COVID-19 because of their age or because of chronic medical conditions refrain from gathering with pilgrims this year and celebrate the Grand Magal at home. This recommendation is the subject of a report which was submitted to health and religious authorities [www.majalis.org/download/Magal-Cpovid19.pdf]. Participants should strictly adhere to face mask use, cough etiquette and hand hygiene since social distancing will be challenging in the context of the pilgrimage. Surveillance of the circulation of the virus among pilgrims will be of paramount importance.