With the global spread of COVID-19, concerns arise about mass gathering events which will further facilitate disease spread. This report welcomes KSA decision to suspend uma
Mass gathering (MG) medicine emerged against the backdrop of the 2009 pandemic H1N1 Public Health Emergency of International Concern (PHEIC) when the Kingdom of Saudi Arabia (KSA) hosted the largest ...annual mass gathering of over 3 million pilgrims from 180 plus countries. However, the events surrounding the latest threat to global health, the PHEIC COVID-19, may be sufficient to highlight the role of mass gatherings, mass migration, and other forms of dense gatherings of people on the emergence, sustenance, and transmission of novel pathogens. The COVID-19 spread illustrates the role of MGs in exacerbation of the scope of pandemics. Cancellation or suspension of MGs would be critical to pandemic mitigation. It is unlikely that medical countermeasures are available during the early phase of pandemics. Therefore, mitigation of its impact, rather than containment and control becomes a priority during pandemics. As the most systematically studied MG-related respiratory disease data come from KSA, the cancellation of Umrah by the KSA authorities, prior to emergence of cases, provide the best opportunity to develop mathematical models to quantify event cancellations related mitigation of COVID-19 transmission in KSA and to the home countries of pilgrims. COVID-19 has already provided examples of both clearly planned event cancellations such as the Umrah suspension in KSA, and where outbreaks and events were continued.
...is routine travel to and from Saudi Arabia by Saudis, permanent residents, and non-pilgrim visitors for commerce and tourism, estimated to be about 3 million people each month. ...transmission ...among returning Saudi Shiite pilgrims in the eastern province, affecting mostly Saudi citizens (45 94% of 48 cases). ...general non-specific spread by routine international travel in the political and diplomatic hub of Riyadh province, mostly among the Saudi population (12 67% of 18 cases).
•The COVID-19 pandemic can no longer be mitigated by a nationwide approach of individual nations alone.•Considering an ‘all hands-on deck’ concept, we present a comprehensive list of tools and ...entities responsible for and enabling them, as well a conceptual framework to achieve the maximum impact.•Included are the roles of individuals, communities, government and other sectors such as school systems, health, institutions, and business.•We call on all countries to act synergistically to minimize everyone's risk, to maximize collaboration, and to commit to shared progress.
The COVID-19 pandemic can no longer be mitigated by a nationwide approach of individual nations alone. Given its scale and accelerating expansion, COVID-19 requires a coordinated and simultaneous Whole- of-World approach that galvanizes clear global leadership and solidarity from all governments of the world. Considering an ‘all hands-on deck’ concept, we present a comprehensive list of tools and entities responsible for enabling them, as well a conceptual framework to achieve the maximum impact. The list is drawn from pandemic mitigation tools developed in response to past outbreaks including influenza, coronaviruses, and Ebola, and includes tools to minimize transmission in various settings including person-to-person, crowd, funerals, travel, workplace, and events and gatherings including business, social and religious venues. Included are the roles of individuals, communities, government and other sectors such as school systems, health, institutions, and business. While individuals and communities have significant responsibilities to prevent person-to-person transmission, other entities can play a significant role to enable individuals and communities to make use of the tools. Historic and current data indicate the role of political will, whole-of-government approach, and the role of early introduction of mitigation measures. There is also an urgent need to further elucidate the immunologic mechanisms underlying the epidemiological characteristics such as the low disease burden among women, and the role of COVID-19 in inducing Kawasaki-like syndromes in children. Understanding the role of and development of anti-inflammatory strategies based on our understanding of pro-inflammatory cytokines (IL1, IL-6) is also critical. Similarly, the role of oxygen therapy as an anti-inflammatory strategy is evident and access to oxygen therapy should be prioritized to avoid the aggravation of COVID-19 infection. We highlight the need for global solidarity to share both mitigation commodities and infrastructure between countries. Given the global reach of COVID-19 and potential for repeat waves of outbreaks, we call on all countries and communities to act synergistically and emphasize the need for synchronized pan-global mitigation efforts to minimize everyone's risk, to maximize collaboration, and to commit to shared progress.
...weaknesses of health systems in the Central African nations make the region a sponge that absorbs and sustains epidemics3 3 (Table 1). ...out-migration of health personnel from Central African ...countries to southern African countries and elsewhere is common making surge capacity a challenge even if temporary international emergency support is made available. 430 refugee doctors from DRC successfully integrated in the South African health system in 2017 4,5. ...people of the central African region have the lowest of human development indices in the world (Table 1).
•Health systems in the least developed, fragile, and conflict-affected countries (LDFCAC) are chronically underfunded and are often sustained largely by international development assistance.•The ...perception of the impact of coronavirus disease 2019 (COVID-19) in LDFCAC populations is likely to be dwarfed by their experience with other existential threats, such as the daily need to find food for their families, violence, or even death from conflicts.•LDFCAC must have access to tests, treatments, and vaccines as they become available in developed countries.•As long as human mobility cannot be adequately curtailed, circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in LDFCAC will become a permanent threat.•There is an urgent need in LDFCAC for funds to expand testing and contact-tracing, and when feasible, for the use of proximity-tracing technology and apps that allow people to self-report symptoms and confirmed infections.
The relentless spread of coronavirus disease 2019 (COVID-19) and its penetration into the least developed, fragile, and conflict-affected countries (LDFCAC) is a certainty. Expansion of the pandemic will be expedited by factors such as an abundance of at-risk populations, inadequate COVID-19 mitigation efforts, sheer inability to comply with community mitigation strategies, and constrained national preparedness. This situation will reduce the benefits achieved through decades of disease control and health promotion measures, and the economic progress made during periods of global development. Without interventions, and as soon as international travel and trade resume, reservoirs of COVID-19 and other vaccine-preventable diseases in LDFCAC will continue ‘feeding’ developed countries with repeated infection seeds. Assuring LDFCAC equity in access to medical countermeasures, funds to mitigate the pandemic, and a paradigm change in the global development agenda, similar to the post-World War II Marshall Plan for Europe, are urgently needed. We argue for a paradigm change in strategy, including a new global pandemic financing mechanism for COVID-19 and other future pandemics. This approach should assist LDFCAC in gaining access to and membership of a global interdisciplinary pandemic taskforce to enable in-country plans to train, leverage, and maintain essential functioning and also to utilize and enhance surveillance and early detection capabilities. Such a task force will be able to build on and expand research into the management of pandemics, protect vulnerable populations through international laws/treaties, and reinforce and align the development agenda to prevent and mitigate future pandemics. Lifting LDFCAC from COVID-related failure will offer the global community the best economic dividends of the century.
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