COVID-19 and the scaled-down 2020 Hajj Pilgrimage

COVID-19 and the scaled-down 2020 Hajj Pilgrimage – Decisive, logical and prudent decision making by Saudi authorities overcomes pre-Hajj public health concerns

International Journal of Infectious Diseases.

Published: 6th August 2020

This year’s Hajj Pilgrimage took place at the end of July, under very different circumstances as a result of the COVID-19 pandemic. In comparison to the previous year, where 2.4 million pilgrims from 182 countries attended the 2019 Hajj, only 1,000 local pilgrims were allowed. In the lead up to Hajj 2020, major public health concerns were voiced in the wake of the global COVID-19 pandemic and in particular concerning the growing number of COVID-19 cases in the Middle East. However, with the major public health preparedness measures that the Saudi authorities took, the Hajj pilgrimage ended on Monday 3rd August 2020 with no major public health incident. The rest of this article will be a summary of the recently published article in the International Journal of Infectious Diseases ‘COVID-19 and the scaled-down 2020 Hajj Pilgrimage – Decisive, logical and prudent decision making by Saudi authorities overcomes pre-Hajj public health concerns’.

The novel coronavirus and its explosive global spread caught health authorities across the world by surprise and shed a light on how global public health systems were unprepared to deal with an emerging infectious disease. As result of the appearance of this novel coronavirus, alongside prevention and control issues of public health and lockdown measures to limit the spread of the disease; a spotlight was shone on Mass Gatherings – particularly that of sporting and religious events. Mass Gathering events present important health challenges in relation to public health services and the general health of a country, those who attended and their own home countries.

Mass Gathering events and COVID-19

In light of COVID-19, the World Health Organization (WHO) alongside global Mass Gathering partners,  developed major recommendations for tackling the spread of this disease. Since the end of February 2020 there has been an increase in both the cancellation and temporary suspension/postponement of national and international sporting, musical, religious and other Mass Gatherings event – as countries across the world took public health measures to control the spread of COVID-19.

Although there has been focus on major sporting events, there has been a global shift in focus to Saudi Arabia in regards to the Umrah and Hajj pilgrimages. Annually, an estimated 10 million people from 182 countries travel to Saudi Arabia for these religious pilgrimages.  Whilst the Umrah pilgrimage can be performed anytime during the year  – in the eyes public health safety, the Saudi authorities announced on February 27th, 2020 that there would be restricted inbound flights and local and international pilgrims prevented from travelling to Makkah and Madinah for the Umrah pilgrimage.

Social and economic impacts of The Hajj and COVID-19

Projected numbers to attend Hajj 2020 were estimated to be 2.4 million pilgrims, but the authorities were aware that the growing COVID-19 pandemic could change things drastically. There was a constant stream of announcement made by the Saudi Ministry of Health to inform potential pilgrims globally that the format for Hajj 2020 would differ and that this was being evaluated based on any potential changes in the COVID-19, situation both in the Middle East but also globally. Some major countries where a large number of Muslim pilgrims originate from had already announced that they would bar their pilgrims from attending 2020 Hajj, prior to the Saudi authorities announcing the scaled down Hajj.

Hajj 2020 – Decisive political and public health action

The Saudi government made the decision amidst the global spread of COVID-19 showing no signs of lessening and discussions of the pros and cons of holding Hajj led to a scaled down Hajj.

A major aspect of this decision came down to the fact that pilgrims attending Hajj would often be elderly with potential comorbidities, that they would be in close proximity where respiratory tract infections spread easily, and lastly, many pilgrims originate from countries with weak public health systems. With this in mind, it would be a major public health challenge for Hajj rites to be completed by all pilgrims. A scaled down Hajj would allow a small number of pilgrims to attend under strict supervision and public health guidance.

For the first time since the formation of the Kingdom of Saudi Arabia in 1932, pilgrims were barred from arriving in Saudi Arabia from foreign countries. Of the 1000 pilgrims allowed to attend, two thirds of ‘foreign’ residents with a negative COVID-19 test would comprise of a pool of local workers, health care workers and security personnel – particularly those recovered form COVID-19.  Anyone aged above 65 years or with comorbidities would be barred.

Although all holy sites would remain open physical distancing and adequate disinfection measures were put in place during the pilgrims’ journey. The wearing of masks was mandatory and pilgrims would have to keep a social distance of one and a half meters and were subject to regular temperature checks, with the possibility of quarantine if required. Amenity kits were provided to pilgrims’ which included disinfectants, masks, a prayer rug, the ihram (seamless white garment required to be worn by pilgrims) and sterilised pebbles for the stoning ritual at Jamaraat. Furthermore, no pilgrims would be allowed to carry out regular customs of touching the Kaaba or kiss the black stone at its corner. Pilgrims would also have to be quarantined for 14 days post-Hajj.

Previous Scaled-down Hajj pilgrimages

What must be highlighted is that the 2020 Hajj was not the first time the Hajj has been scaled down. Historically, several infectious disease outbreaks led to the scaling down of the Hajj, with cholera throughout the 19th Century which led to the suspension of Hajj in 1837 and 1846. Lessons learnt from this led to the establishment of quarantine ports to limit the spread of the disease during Hajj. Since Saudi Arabia’s foundation in 1932 the Hajj has never been cancelled and has not missed any year.

Hajj 2020 – A Public Health Success

On Monday 3rd August 2020, The Hajj 2020 came to a successful end amidst ongoing concerns of a potential  public health catastrophe. Despite the public health, political, economic and religious concerns around Hajj 2020, the Saudi authorities acted through extensive experience of organising the annual Hajj through leadership and commitment to improving public health issues in relation to religious mass gatherings. These actions of preparedness and strict implementation of public health prevention and intervention measures pre-Hajj, during Hajj and post-Hajj, serves as an exemplar for other mass gathering religious and sporting events.

The ongoing COVID-19 pandemic has highlighted the conditions threat of new emerging infectious diseases – particular that of the Middle East Respiratory Syndrome (MERS).  The WHO reported that as of August 2nd 2020, there have been a total of 17,660,523 cases worldwide, of which 275,905 cases are from Saudi Arabia.

An emphasis has been put on the importance of the need for collaboration and commitment in public health efforts by the WHO. Mass gathering events that regular recur should be used as a global example of the use for surveillance platforms and provides opportunities for research and evaluation to be conducted for a range of public health issues.

Please click here for full article co-authored by director of MGHN, Dr Shuja Shafi, published in the International Journal of Infectious Diseases titled ‘COVID-19 and the scaled-down 2020 Hajj Pilgrimage – Decisive, logical and prudent decision making by Saudi authorities overcomes pre-Hajj public health concerns’.

Written by: Amran Mohamed, Research Assistant at Mass Gatherings & Global Health Network