Eid ‘may have been superspreader that fuelled high Covid-19 deaths among Muslims’

Family and religious gatherings during Ramadan may have inadvertently acted as Covid-19 superspreader events in Muslim communities, some of South Africa's leading scientists and public health specialists have suggested.

Writing in the South African Medical Journal, the experts said high Covid-19 deaths among Muslims suggested the observation of Eid at the end of Ramadan in May may have had a role in spreading Covid-19.

They said the fact that Muslims constitute 4.9% of Covid-19 deaths nationally when they make up only 1.9% of the population meant the pandemic was taking a disproportionately heavy toll in the Islamic community.

“Notably, no such differences between the trajectory of deaths in the Muslim community relative to national trends was evident in 2020 when all places of worship were restricted from operating,” said a team led by Dr Waasila Jassat from the National Institute of Communicable Diseases.

“The sharp and steeply rising increase in deaths among Muslims after Ramadan is even more evident.

“The current weekly number of deaths in the Gauteng Muslim communities has already surpassed the peak weekly deaths reported in the community during the first and second waves.”

The high death toll “likely materialised due to infections that coincided with the last third of the fasting month (Ramadaan) that is observed by Muslims, which culminated in the observation of Eid-ul-Fitr”, they said.

“Although reasons for this are multifactorial, it is likely to include higher attendance in places of worship and social gatherings over the Eid celebration period.”

Muslim organisations across the country report daily numbers of known Covid-19 deaths to a co-ordinating group, Muslim Stats South Africa.

By June 10, 2,826 Covid-19 deaths were recorded in the Muslim community, predominantly of Indian/Malay descent — which happen to be most-at-risk of Covid-19 deaths in the country.

The MRC reported 166,794 excess natural deaths in SA for the same time period, suggesting reported Covid-19 deaths are probably underestimated by a factor of three.

An analysis of mortality by race group reveals that compared with whites, South Africans of Indian ancestry have a 35% increased risk of dying of Covid-19 when hospitalised,

Black and coloured people have a 23-24% higher risk of death after Covid-19 hospitalisation.

This heightened risk is independent of other underlying risk factors such as diabetes, which is highly prevalent in people of Indian ancestry compared with whites.

Compared with all other race groups, South Africans of Indian ancestry have an 11% increased risk of death after Covid-19 hospitalisation.

“These findings provide circumstantial evidence that gatherings at the end of Ramadaan and Eid-ul-Fitr likely led to superspreader events among Muslims in Gauteng, which has resulted in a large number of avoidable deaths,” the experts wrote.

“It is unclear whether the SARS-CoV-2 Delta variant (first identified in India) may have contributed to the early outbreak in this community, as the variant is 60% more transmissible and likely more virulent.

“As Covid-19 cases continue to increase, it is important that adequate mitigation strategies be adopted nationally, including in the Muslim and other religious communities, to avoid further preventable Covid-19 deaths.

“Superspreader events can occur owing to gatherings of even a few people in poorly ventilated indoor spaces, particularly in the absence of face mask-wearing.”

Other scientists on the team that wrote the medical journal article are vaccinologist  Shabir Madhi from Wits University and the Medical Research Council (MRC);  Zameer Brey from the Bill and Melinda Gates Foundation; Salim Parker from the University of Cape Town; Shoyab Wadee from Wits Donald Gordon Medical Centre and the Islamic Medical Association; and Muhammad Wadee from Muslim Stats South Africa.

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