Since the emergence of COVID-19 at the end of December 2019 in China, this pandemic has affected over 160 million persons with nearly 3.5 million deaths (https://www.worldometers.info/coronavirus/). To date, almost every country in the world has been affected and international travel has been greatly affected. Additionally, many mass gatherings in 2020 have been postponed or canceled. The Summer Olympics and Paralympics in Tokyo, Japan were rescheduled to 2021 [1]. The 2020 Umrah pilgrimage has been suspended and the 2020 Hajj was strictly limited to only 1000 domestic pilgrims with persons aged ≥65 years or with chronic diseases being excluded [2]. In Senegal, the Grand Magal of Touba took place on October 06, 2020 attracting million participants from Senegal and beyond. With several preventive measures, including checking for fever in pilgrims, mandatory wearing of face masks, social distancing of 1.5 m between pilgrims, hand hygiene, and 14 days of quarantine for Hajj pilgrims, the two religious mass gatherings were successfully ended with no major public health incident and no cases of COVID-19 [3,4].
The Tokyo Olympic Games will take place from July 23 to August 8, 2021 and the Paralympics from August 24 to September 5, 2021. Currently, COVID-19 is still circulating in Japan with around 5000 to 6000 new cases per day, while only 1,000 to 1,500 new cases were recorded at the time the event was planned in 2020 (Fig. 1 ). The Japanese authorities announced that it would expand and extend a state of emergency in Tokyo through May 31 due to the ongoing coronavirus pandemic. In addition, only 1% of the population has received COVID-19 vaccination in Japan to date (https://ourworldindata.org/covid-vaccinations?country=OWID_WRL). Furthermore, 60% of Japanese want Games to be cancelled (https://www.theguardian.com/sport/2021/may/10/tokyo-olympics-poll-shows-60-of-japanese-people-want-games-cancelled). This requires the authorities to make a very prudent decision, taking into account the economic benefits, health of the community and athletes and the risk of an outbreak of the disease following the event.
Fig. 1.
COVID-19 daily cases in Japan, Kingdom of Saudi Arabia and Senegal, host countries of Tokyo Olympic Games, Hajj pilgrimage and Grand Magal of Touba, respectively (https://www.worldometers.info/coronavirus/).
This year, the Umrah pilgrimage was limited to persons immunized against COVID-19 (https://www.reuters.com/world/middle-east/covid-vaccination-requirement-perform-umra-pilgrimage-saudi-state-tv-2021-04-18/). The 2021 Hajj is planned from July 17 to 22, the Kingdom of Saudi Arabia (KSA) is considering overseas pilgrims from this year Hajj under “special conditions” to be announced at a later date (https://www.reuters.com/world/india/saudi-arabia-considers-barring-overseas-haj-pilgrims-second-year-sources-say-2021-05-05/). The Grand Magal is planned around September 25, 2021 in Touba. The number of new cases is stable at the current time in KSA and decreasing in Senegal (Fig. 1).
Decision about maintaining or canceling such large mass gathering requires the host countries provide the necessary epidemiological data on which to base risk assessment. Notably, the identification of new variants of concern (VOCs) which may differ both in terms of spreading capacity and disease severity is of paramount importance [5].
We recommend that elderly persons or those suffering chronic medical conditions putting them at higher risk of severe COVID-19 defer participation in mass gatherings this summer unless they are fully immunized against COVID-19. Allowing individuals already immune to the virus (either by vaccination or after recovery) to participate to mass gatherings should be carefully considered [6]. The efficacy of the different vaccines which are currently available worldwide is not equal. In addition, the predominant circulating virus strain at the destination of participants may be less responsive to vaccine. VOCs having a E484K mutation have significantly reduced susceptibility to vaccine-induced and convalescent sera [7]. Moreover, the duration of protection conferred by COVID-19 vaccines remains unknown to date. Furthermore, vaccinated people can still carry the virus while being asymptomatic, even though the viral load is not high [8]. Quarantine of participants at home for a reasonable period of time following the event should also be considered. Systematic screening of participant for SARS-CoV-2 carriage by PCR or antigenic test should be considered when possible. Participants should strictly adhere to individual preventive measures such as face mask use, hand hygiene and social distancing. Finally, real-time surveillance of SARS-CoV-2 circulation among participants will be of primary importance to detect outbreaks at mass gathering events.
References
- 1.Hoang V.T., Al-Tawfiq J.A., Gautret P. The Tokyo olympic games and the risk of COVID-19. Curr Trop Med Rep. 2020:1–7. doi: 10.1007/s40475-020-00217-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Jokhdar H., Khan A., Asiri S., Motair W., Assiri A., Alabdulaali M. COVID-19 mitigation plans during Hajj 2020: a success story of zero cases. Health Secur. 2021;19(2):133–139. doi: 10.1089/hs.2020.0144. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Zumla A., Azhar E.I., Shafi S., Memish Z.A. COVID-19 and the scaled-down 2020 Hajj Pilgrimage - decisive, logical and prudent decision making by Saudi authorities overcomes pre-Hajj public health concerns. Int J Infect Dis. 2020;S1201–9712(20) doi: 10.1016/j.ijid.2020.08.014. 30643-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Sokhna C., Goumballa N., Hoang V.T., Bassene H., Parola P., Gautret P. The Grand Magal of Touba was spared by the COVID-19 pandemic. Int J Infect Dis. 2021;105:470–471. doi: 10.1016/j.ijid.2021.01.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Dao TL, Hoang VT, Colson P, Lagier JC, Raoult D, Levasseur A, et al. Severity of COVID-19 infection and different SARS-CoV-2 variants: current evidence. Preprints. DOI : 10.35088/0852-c785. [DOI] [PMC free article] [PubMed]
- 6.Schlagenhauf P., Patel D., Rodriguez-Morales A.J., Gautret P., Grobusch M.P., Leder K. Variants, vaccines and vaccination passports: challenges and chances for travel medicine in 2021. Trav Med Infect Dis. 2021;40 doi: 10.1016/j.tmaid.2021.101996. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Gupta R.K. Will SARS-CoV-2 variants of concern affect the promise of vaccines? Nat Rev Immunol. 2021 doi: 10.1038/s41577-021-00556-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Levine-Tiefenbrun M., Yelin I., Katz R., Herzel E., Golan Z., Schreiber L., et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med. 2021 doi: 10.1038/s41591-021-01316-7. [DOI] [PubMed] [Google Scholar]