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WHO EMRO Weekly Epidemiological Monitor: Volume 13, Issue no 33; 16 August 2020

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Hajj 2020 season in the context of COVID-19 pandemic

The Hajj is one of the largest annual mass gatherings in the world, and has a strong impact on international public health. This year, the Hajj season came while the COVID19 pandemic is still in full force, so the Kingdom of Saudi Arabia allowed only one thousand pilgrims to participate while taking many precautions to make Hajj as safe as possible.

Editorial note

Every year, millions of Muslim pilgrims travel on a religious journey called the "Hajj" to Mecca city in Saudi Arabia, where authorities tackle major challenges to prevent and minimize the related public health risks. In 2020, Hajj rituals began on 28 July, almost 6 months after WHO declared COVID-19 a public health emergency of international concern. Available evidence adequately highlights the role of mass gatherings, mass movement and different types of close contacts of individuals, in the transmission of pathogens in general, and COVID-19 has unmistakably delineated the role of mass gatherings in the intensification of the scale of the pandemic.

After much speculation over whether Hajj would be held this year, Saudi authorities announced on 22 June that it will hold Hajj but with only a very limited number of pilgrims from various nationalities who already reside in Saudi Arabia. The decision was taken to ensure physical distancing measures are adhered to, as one of the main preventative measures to address the spread of COVID-19 (see photo).

Around 70% of pilgrims attending this year’s Hajj were non-Saudi residents while the other 30% were Saudi nationals, including health care providers and security personnel who had recovered from the disease. The pilgrims were aged 20 to 50 years. PCR negative results were required for all pilgrims in addition to absence of comorbidities such as diabetes, hypertension, cardiac diseases and renal dysfunctions. Pilgrims went through a 10 day home quarantine period before and after the pilgrimage while in Mecca.

Smart digital bracelets were used to follow the movement of pilgrims during the quarantine period. Each pilgrim signed a commitment to follow public health instructions including physical distance, wearing a mask, observing hand hygiene, and reporting any illness. The ministry of health performed 1485 PCR tests for eligible pilgrims before Hajj, with 4 individuals coming out positive and being sent for isolation and treatment instead. The ministry also performed 2544 PCR tests for the staff who provided the needed services to pilgrims including health care workers and security personnel.

During the commencement of rituals, the ministry provided the necessary medical services through a number of hospitals, primary health centres and clinics to ensure access for pilgrims throughout the different stages of their rituals (see table). Moreover, the surveillance and rapid response system was enhanced to ensure the early detection of all suspected COVID-19 cases. 466 pilgrim consultations were registered at the different health care facilities, none were diagnosed as COVID-19. After Hajj, all pilgrims were under another 10 days of home quarantine and were followed up on using the smart bracelets and regular home visits. None of them was diagnosed with COVID-19.

The efforts undertaken by Saudi authorities to apply best public health measures can be taken as guidance for organizing other mass gathering events. The WHO Director-General praised the steps taken by the country that resulted in the successful completion of the Hajj and the safety of pilgrims throughout the entire process.