Is Wudu the Secret of Pakistan's Success Against COVID19?

 الطُّهُورُ شَطْرُ الإِيمَانِ” – “Cleanliness is half the faith [Sahih Muslim Hadith] 

 India is setting new global records in daily COVID19 cases while neighboring Pakistan has seen an unrelenting decline in coronavirus cases in recent weeks. This is happening in spite of the fact that both nations have taken similar measures on paper to contain the spread of the novel coronavirus. Both have imposed lockdowns. Both have required people to wear face masks in public. Both share similar climates, demographics and socioeconomic conditions. Then why this difference? Is it in the implementation of such measures? Or the fact that people in Muslim-majority Pakistan wash their hands before prayers much more often everyday with or without soap, a hygiene practice highly recommended by public health experts during the pandemic? Or could it be that fewer women in Pakistan participate in the work force?  Let's examine this difference.

Muslim Wudu Includes Hand-washing

The best practice to limit transmission of coronavirus is to wash your hands with soap and water. Multiple studies have shown that hand-washing even without soap is quite effective in killing viruses and bacteria. A 2011 study from researchers at the London School of Tropical Hygiene found that washing with water alone reduced bacteria on hands to about one-quarter of their prewash state. A Japanese study reported that Washing your hands under running water — even without soap — is more effective at stopping the spread of flu germs than using ethanol-based hand sanitizers. When a significant percentage of a large population such as Pakistan's does indeed wash their hands under running water even without soap, the collective benefit has the potential to be large. 

As the COVID19 pandemic began, many Muslim scholars began to recommend that people wash their hands for 20 seconds with soap before doing wudu.  While British urban neighborhoods with large ethnic minority populations make up more than three quarters of England's coronavirus hotspots, the numbers coming from Muslim communities in areas which could be expected to be hard-hit are low.

Coronavirus Case Trajectory in India, Pakistan, Bangladesh & United States

In terms of global numbers, there are no major Muslim-majority countries among the most affected by coronavirus, with the possible exception of Iran. As of now, the top 5 nations most affected by COVID19 cases are: United States, Brazil, India, Russia and Peru. Measuring by deaths per million, the top 5 are: Belgium, Spain, UK, Italy and Sweden. Muslims make up a tiny percentage of populations in these countries.

COVID19: Government Response Stringency Index. Source: Our World in...

Professor Richard Webber of Newcastle University has attributed this phenomenon to cultural habits such as frequent hand washing (wudu) that may be protecting England's Muslims from coronavirus. The Webber Phillips report shows that of 17 coronavirus hotspots in Britain – three quarters of which have large minority populations – Muslim areas are ‘conspicuous by their absence’.

Muslim women, however, may be protected and contribute to lower rates among their communities because so few of them have jobs – a report by the Young Foundation shows just 29 per cent of British Muslim women are employed. Labor force participation rate of women in India and Pakistan is about the same at 22%.

COVID19 Impact. Source: Worldometer August 24 2020

Dr. Syra Madad,  the 34-year-old Pakistani-American head of New York City’s Health and Hospitals System-wide Special Pathogens Program, conveys the importance of personal hygiene in containing the spread of viruses. She takes regular breaks to say her prayers at the Islamic Center of New York University. Before entering the prayer room, Madad stops to perform wudu, and washes her hands, mouth and face as well as her feet, according to a Washington Post report.

Dr. Madad is featured in a 6-part Netflix documentary series "Pandemic: How to Prevent an Outbreak". She had warned of a deadly pandemic in December, 2019, just days before China reported to the World Health Organization that it was treating dozens of patients for a novel virus of unknown origin.  We now know it as coronavirus or Covid-19. The series debuted in January 2020, but recent events have pushed it into Netflix’s “Top 10 in the U.S. Today.”

Dr. Syra Madad is a devout Muslim. The Netflix series shows her praying at her home in Long Island, New York. She says, "I live and breathe being a Muslim. It shapes my daily life. I don't drink I don't meat that's not halal.....I do no harm and help others".

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Comment by Riaz Haq on September 5, 2020 at 11:18am

#India's new grim milestone: India adds 76,456 cases new cases to pass #Brazil for 2nd spot for nations worst hit by #COVID19. Only #Trump's #US now has more #coronavirus cases than #Modi's India. Coronavirus case growth in India now the world's fastest. http://covid.gov.pk/stats/global

https://twitter.com/haqsmusings/status/1302308856614117377?s=20

Comment by Riaz Haq on September 5, 2020 at 11:18am

#Coronavirus Crisis Shatters #India’s Big Dreams of middle-class lifestyle for its people, powerful military and global superpower status that could someday rival #China. #Modi's #lockdown-and-scatter policy being blamed for it. #BJP #COVID19 #economy https://www.nytimes.com/2020/09/05/world/asia/india-economy-coronav...

A sense of malaise is creeping over the nation. Its economic growth was slowing even before the pandemic. Social divisions are widening. Anti-Muslim feelings are on the rise, partly because of a malicious social media campaign that falsely blamed Muslims for spreading the virus. China is increasingly muscling into Indian territory.

Scholars use many of the same words when contemplating India today: Lost. Listless. Wounded. Rudderless. Unjust.

“The engine has been smashed,” said Arundhati Roy, one of India’s pre-eminent writers. “The ability to survive has been smashed. And the pieces are all up in the air. You don’t know where they are going to fall or how they are going to fall.”

In a recent episode of his weekly radio show, Mr. Modi acknowledged that India was “fighting on many fronts.” He urged Indians to maintain social distancing, wear masks and keep “hale and hearty.”

India still has strengths. It has a huge, young work force and oodles of tech geniuses. It represents a possible alternative to China at a time when the United States and much of the rest of the world is realigning itself away from Beijing.

But its stature in the world is slipping. Last quarter the Indian economy shrank by 24 percent, while China’s is growing again. Economists say India risks losing its place as the world’s fifth largest economy, behind the United States, China, Japan and Germany.

“This is probably the worst situation India has been in since independence,” said Jayati Ghosh, a development economist at Jawaharlal Nehru University in New Delhi. “People have no money. Investors aren’t going to invest if there is no market. And the costs have gone up for most production.”

Many neighborhoods in the capital of New Delhi where low-paid workers used to live are deserted, shell-like, a hot wind blowing through empty, tin-walled shacks. A few years ago, when the economy was expanding at a 9 percent clip, it was difficult to find a place here to rent.

When Mr. Modi was swept to power in 2014 on a tide of Hindu nationalism, many Indians felt their nation had finally found the forceful leader to match their aspirations.

But Mr. Modi has concentrated his energies on divisive ideological projects, like a new citizenship law that blatantly discriminates against Muslims or tightening the government’s grip over the mostly Muslim region of Kashmir.

Quarter by quarter, India’s economic growth rate has been dropping, from 8 percent in 2016 to 4 percent right before the pandemic. Four percent would be respectable for a developed country like the United States. But in India, that level is no match for the millions of young people streaming into the work force each year, hungry for their first job.

Many of the complaints that investors make about India — the cumbersome land policies, the restrictive labor laws, the red tape — predate Mr. Modi. But his confidence and absolutism, the same qualities that appealed to many voters, may have added to the problems.

Four years ago he suddenly wiped out nearly 90 percent of India’s paper currency to tamp down corruption and encourage digital payments. While economists cheered both goals, they say the way Mr. Modi sprang this move on India did long-lasting damage to the economy.

That impulsiveness emerged again when the coronavirus struck. On March 24, at 8 p.m., after ordering all Indians to stay indoors, Mr. Modi shut down the economy — offices, factories, roads, trains, borders between states, just about everything — with four hours’ notice.

Tens of millions of Indians lost their jobs instantly. Many worked in factories or on construction sites or in urban homes, but they were migrants from rural India.

Comment by Riaz Haq on September 6, 2020 at 7:21am

#Pakistan records lowest daily death toll of 2 deaths from #COVID19. Pakistan's infection rate has significantly dropped to around 500 per day or less in recent weeks, compared to an average of 5,000 daily cases in May and June. #coronavirus #SouthAsia http://v.aa.com.tr/1964317


Pakistan recorded just two deaths from the coronavirus Sunday, the lowest single-day fatality number since the surge of the pandemic in May, according to health officials.

The number of deaths stand at 6,342, with the additional fatalities.

Another 484 infections were reported, bringing that tally to 298,513.

More than 90% of all patients, or 285,898, have recovered, but 535 are in critical condition.

Pakistan's infection rate has significantly dropped in recent weeks, compared to an average of 5,000 daily cases in May and June.

The highest number of single-day cases was nearly 7,000 last month.

The government is currently following a "mini smart lockdown" strategy. Instead of closing entire streets or shopping centers, only houses or workplaces where infections are reported will be sealed.

The country has conducted more than 2.7 million tests, according to statistics.

Comment by Riaz Haq on September 9, 2020 at 7:39am

No wonder #Modi's #India has such a serious #COVID19 #pandemic! MP minister Imarti Devi: "Born in cow dung, #coronavirus can't come near me. #Indian #Hindutva politicians have come up with their own version of Covid-19 “cures” #Modi https://indianexpress.com/article/trending/viral-videos-trending/ma... https://www.southasiainvestor.com/2020/08/is-wudu-secret-of-pakista...


From injecting disinfectant, drinking alcohol to having papads as immunity booster, politicians of all hues have come up with their own version of Covid-19 “cures”, albeit without any scientific basis. The latest to join the list is Madhya Pradesh minister Imarti Devi, who recently said in Gwalior that she cannot be infected with Covid-19 because she was born in gobar (cow dung) and mitti (mud).

In a viral clip, Devi can be seen telling journalists in Gwalior how wrongly it was reported by the media that she had tested positive for Covid-19.

“Tumahi they, akele tum. Tumey humein corona bata deo. Imarti Devi matti mey paida bhai, gobar mein paida bhai, itte karre kitanu hain ki, Corona ke aas paas nahi aa payein.” (Only you were there and you said that I have corona. I was born in soil and cow dung. There are so many germs there that corona will not come anywhere near me.)

Comment by Riaz Haq on September 9, 2020 at 10:45am

#Woodward book: #Trump says he knew #coronavirus was ‘deadly’ and worse than the flu while intentionally misleading #Americans. It's based in part on 18 on-the-record interviews Woodward conducted with the president between December and July. #COVID19 https://www.washingtonpost.com/politics/bob-woodward-rage-book-trum...

Trump shared with Woodward visceral reactions to several prominent Democrats of color. Upon seeing a shot of Sen. Kamala D. Harris of California, now the Democratic vice-presidential nominee, calmly and silently watching him deliver his State of the Union address, Trump remarked: “Hate! See the hate! See the hate!” Trump used the same phrase after an expressionless Rep. Alexandria Ocasio-Cortez (D-N.Y.) appeared in the frame.

Trump was dismissive about former president Barack Obama and told Woodward he was inclined to refer to him by his first and middle names, “Barack Hussein,” but wouldn’t in his company, to be “very nice.”

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“Trump never did seem willing to fully mobilize the federal government and continually seemed to push problems off on the states,” Woodward writes. “There was no real management theory of the case or how to organize a massive enterprise to deal with one of the most complex emergencies the United States had ever faced.”

Woodward questioned Trump repeatedly about the national reckoning on racial injustice. On June 3, two days after federal agents forcibly removed peaceful protesters from Lafayette Square to make way for Trump to stage a photo opportunity outside St. John’s Church, Trump called Woodward to boast about his “law and order” stance.

“We’re going to get ready to send in the military slash National Guard to some of these poor bastards that don’t know what they’re doing, these poor radical lefts,” Trump said.

In another conversation, on June 19, Woodward asked the president about White privilege, noting that they were both White men of the same generation who had privileged upbringings. Woodward suggested that they had a responsibility to better “understand the anger and pain” felt by Black Americans.

“No,” Trump replied, his voice described by Woodward as mocking and incredulous. “You really drank the Kool-Aid, didn’t you? Just listen to you. Wow. No, I don’t feel that at all.”

As Woodward pressed Trump to understand the plight of Black Americans after generations of discrimination, inequality and other atrocities, the president kept answering by pointing to economic numbers such as the pre-pandemic unemployment rate for Blacks and claiming, as he often has publicly, that he has done more for Blacks than any president except perhaps Abraham Lincoln.

In another conversation about race, on July 8, Trump complained about his lack of support among Black voters. “I’ve done a tremendous amount for the Black community,” he told Woodward. “And, honestly, I’m not feeling any love.”

Comment by Riaz Haq on September 10, 2020 at 7:31am

Pakistan has used the infrastructure it developed in its fight against polio to tackle COVID-19, said the Director-General. Community health workers, previously used to vaccinate children for polio, have been redeployed for contact tracing and monitoring.


https://www.weforum.org/agenda/2020/09/5-countries-we-can-all-learn...

7 countries (Pakistan, Italy, Thailand, Mongolia, Mauritius and Uruguay) to learn from

The Director-General highlighted 7 countries, amongst many, whose preparation and response offer lessons for the rest of the world.

Thailand

Thailand has benefited from 40 years of health system strengthening, he explained.

A well-resourced medical and public health system is supported by strong leadership. Coupled with 1 million village health volunteers, and strong communication, the nation has built trust and compliance and confidence among the general population, he said.

Italy

Italy was one of the first countries to experience a large outbreak outside of China, said Dr Tedros. It "took hard decisions based on the evidence and persisted with them". Unity and solidarity, along with the dedication of health workers, helped bring the outbreak under control, he explained.

Mongolia

Mongolia also reacted quickly. It activated its State Emergency Committee in January and didn't report a case until January and still has no reported deaths.

Mauritius

Mauritius used previous experience with contact-tracing and a swift response to overcome high-risk issues - high population density, high rate of non-communicable diseases and lots of international travellers.

Uruguay

Uruguay has one of Latin America's most 'robust and resilient' health systems in Latin America, explained Dr Tedros. Sustainable investments in public health were built on political consensus, he added.

Pakistan

Pakistan has used the infrastructure it developed in its fight against polio to tackle COVID-19, said the Director-General. Community health workers, previously used to vaccinate children for polio, have been redeployed for contact tracing and monitoring.


And more...

There are many other countries who've done well, added Dr Tedros. From Japan to New Zealand and Viet Nam, many countries have fared better because of lessons learned during previous outbreaks of disease, such as SARS or Ebola.

Having learned the lessons of previous pandemics, it's therefore "vital that we learn the lessons this pandemic is teaching us," he concluded.


------------


Dr Tedros called on countries to invest in public health, as a "foundation of social, economic and political stability".

Significant progress has been made in medicine, he said, but too many countries have neglected their public health systems:

"Part of every country’s commitment to build back better must therefore be to invest in public health, as an investment in a healthier and safer future."

But there are countries the rest of the world can learn from, he said in his opening remarks. Here's a summary of what he said.

Comment by Riaz Haq on September 10, 2020 at 10:39pm

Coronavirus: What explains Pakistan doing so much better than India?

Was it India’s botched lockdown?

By Shoaib Daniyal

https://scroll.in/article/972694/coronavirus-why-is-pakistan-doing-...

With this (smart lockdown), not only did Pakistan avoid the hardship India’s economy went through but Pakistani economist Anjum Altaf argues that this lax lockdown might have, paradoxically, helped Pakistan better contain Covid-19.

India’s total lockdown tried to trap workers in the cities. The attempt, however, failed spectacularly. So massive was the migration from the cities, that some described it as the biggest movement of people on foot since Partition. ”With no work, in India workers trickled back to the villages,” said Altaf. “But in Pakistan, the lockdown was so lax, workers still found work. And so there was barely any movement back to the villages.”

Altaf therefore argues that when the virus came to the big cities in Pakistan, it stayed there. But in India the policy response inadvertently pushed it out into the villages. “There is, therefore, a chance that Pakistani cities reached herd immunity locally – which would explain the curve bending – but in India, this will take a long time, since the virus has been pushed out all across the country,” he said.

Indian economist Kaushik Basu also proposed a similar theory where India’s lockdown “itself became the source of the virus’s spread”. “By having people huddle together, infecting one another, and then having the same people travel hundreds of miles, the pandemic has been made much worse than it need have been,” wrote Basu.

Calling it a “lockdown-and-scatter” policy, Basu argues that “some 4 or 5% of India’s population were literally sent off like sprinklers across the nation”.
The fact that India’s lockdown saw cases surge – rather than drop – as well the spread of the pandemic into rural India tend to back up Basu and Atlaf’s point

Comment by Riaz Haq on September 12, 2020 at 5:17pm

#Coronavirus: #India reports record daily jump of almost 100,000 new cases for 2nd consecutive day. India has more than 4.65 million infections, with only #UnitedStates recording a higher figure, with more than 6.4 million. #COVID19 #Modi #BJP #Hindutva https://news.sky.com/story/coronavirus-india-reports-record-daily-j...

The western state of Maharashtra has been particularly hard-hit, with total confirmed cases of coronavirus passing one million late on Friday, the first place anywhere in the world to cross that mark.

If the state, which is India's richest, were a country, it would rival Russia for the fourth highest number of cases globally.

Russia has now recorded 1,057,362 after a further 5,488 new infections were recorded on Saturday, with authorities saying a further 119 people have died, pushing the total number of deaths to 18,484.


Government officials and experts have claimed the increases in Maharashtra and elsewhere across the country are likely to be down to the economy re-starting, local festivals and lockdown fatigue.

"I am so disappointed with the pandemic situation in India," said Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, who has been tracking India's COVID-19 situation closely.

In a tweet, she continued: "It is getting worse and worse each week, but a large part of the nation seems to have made the choice to ignore this crisis."

Comment by Riaz Haq on September 13, 2020 at 6:33pm

No peak in sight for #India #coronavirus cases with huge daily increases in new cases. https://scroll.in/article/972767/was-health-official-lav-agarwal-ri...

https://twitter.com/haqsmusings/status/1305315803454038017?s=20

Lav Agarwal, the joint secretary in the Union health ministry assigned to brief the media during the early days of the pandemic, had on several occasions remarked that India’s peak in terms of daily cases “may never come”.

At the time, it seemed like a baffling claim. The conventional epidemiological understanding is that the curve of a pandemic is usually symmetric: a sharp surge of cases is followed by a peak or a plateau after which news cases start declining.

But six months into the pandemic in India, Agarwal’s words seem to have been curiously prophetic – India’s Covid-19 graph continues to shoot up with no peak or plateau in sight.

This is almost singularly unique. Most countries have seen at least one peak or plateau even as some have seen new infections rise again. (India’s graph did momentarily slow down in mid-August raising some hope, but it did not sustain).

What explains this?

India, after all, clamped down one of the world’s harshest and longest lockdowns to contain the spread of the virus.

Six months after the lockdown started, why is the graph still rising?

Multiple pandemics
Observers say the explanation is rather simple: India’s size. This has meant that different places are at different stages of the pandemic.

“While in some of the original high-burden cities, the curve has largely plateaued or even gone down, in some other places growth is picking up,” said health economist Riju M John. “The national average is just an aggregation of what is happening around the country.”

DCS Reddy, who heads the research group on epidemiology and surveillance constituted by the Indian government’s National Task Force for Covid-19, explained: “The pandemic has now entered the rural areas where a larger number of people actually leave, so no wonder the overall numbers are going up because of the sheer size of our population.”

Other countries
But how did other big countries rein in the virus then?

Epidemiologists say India’s situation cannot directly be compared to any other country. “The only country you can maybe think of is the United States,” said Reddy, a former professor and head of community medicine at the Institute of Medical Sciences at Banaras Hindu University.

The United States, Reddy said, experienced two major surges: the first driven by eastern states like New York and New Jersey, and the second largely by Texas and Florida.“These are heavily populated states,” Reddy pointed out. “After they peaked, the virus moved inwards where fewer people live.”

In contrast, in India, rural areas are heavily populated. “In fact, almost 70% of our total population lives there,” said Reddy. To make matters worse, health infrastructure is weak in these areas. “I also doubt how much the messaging of physical distancing and mask wearing has reached those places.”

India’s lockdown did not help, Reddy added, since it led to a mass exodus of itinerant workers, stranded without jobs and money, from urban centres to rural areas, carrying the virus with them.


A lockdown that did not work
T Jacob John, one of India’s leading virologists, agreed that India’s harsh lockdown had made things worse. “I would compare India to Europe,” he said, pointing out that Indian states are as large, if not larger, than European countries. “So, a nationwide lockdown was illogical – what we needed was staggered and localised lockdowns in each state depending on the stage of the pandemic in that place.”

That way, Jacob John said India’s pandemic curve could have been flatter, leading to less pressure on medical facilities and, consequently, possibly fewer deaths. “Over a long period, say a year and a half, the number of infections would be the same anyway, but we would buy time and not have such a high peak as we are now.”

Comment by Riaz Haq on September 15, 2020 at 3:48pm
#Covid_19 spreading at the fastest rate in the world. #Coronavirus cases cross 5 million mark with 91,120 daily new cases. Total Cases: 5,018,034

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