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 15, 2020 at 6:50pm

Millions of Children in #Pakistan Return to School Post-#coronavirus Crisis after a 6-month closure. An Asian Development Bank report praises Pakistan for achieving “notable success in containing the dual health & economic challenge". #education #health https://www.voanews.com/covid-19-pandemic/millions-children-pakista...

The largest return to school in the world comes as daily infections and deaths from the outbreak in the country of 220 million have steadily declined. Officials reported around 400 new cases and six deaths in the last 24 hours.

Prime Minister Imran Khan’s government had closed more than 300,000 educational institutions in mid-March as part of a nationwide lockdown to contain the spread of the virus that causes the COVID-19 disease.

Authorities have since gradually lifted all curbs on businesses across Pakistan and opened public places, including gyms, tourist destinations and restaurants, but schools remained closed.

The restriction confined more than 50 million school and university-going Pakistanis to their homes in the South Asian country where officials estimate nearly 23 million children already have no access to education.

“Let us welcome our children and students on the first day of opening of educational institutions,” tweeted Faisal Sultan, a special assistant to the prime minister on national health services.

“Please don't forget basic protective steps. Masks, reduced density in classes, hand hygiene. Parents, school administrators, teachers, students — all together,” Sultan cautioned.

Officials have recorded more than 302,000 cases, including close to 6,400 deaths, while 96% of the patients have recovered.

Pakistan’s countermeasures and supply of emergency assistance to millions of poverty-stricken families directly affected by ensuring economic lockdowns have been widely lauded.

An Asian Development Bank report released Tuesday praised Pakistan for achieving “notable success in containing the dual health and economic challenge" presented by the infection.

The government’s rapid mobilization of a $7 billion relief package comprising emergency financial support to daily wage earners, cash transfers to low-income families, accelerated procurement of wheat, support for health and food supplies and financial support for small and media enterprises helped shield the poor and most vulnerable during the pandemic, the report said.

"As the curve flattens and business activity resumes, the economy is showing signs of resilience and recovery, said ADB country director Xiaohong Yang.

The head of the World Health Organization (WHO) last week included Pakistan among seven countries that he said the world can learn from about how to fight future pandemics.

“Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children for polio have been utilized for surveillance, contact tracing and care,” Tedros Adhanom Ghebreyesus said.

Comment by Riaz Haq on September 17, 2020 at 8:39am

Your #Coronavirus Test Is Positive. Maybe It Shouldn’t Be. In 3 sets of data in #Massachusetts , #NewYork and #Nevada , up to 90% of people testing positive for #COVID19 carried barely any virus. Low virus load may not be contagious.- The New York Times

https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html

Some of the nation’s leading public health experts are raising a new concern in the endless debate over coronavirus testing in the United States: The standard tests are diagnosing huge numbers of people who may be carrying relatively insignificant amounts of the virus.

Most of these people are not likely to be contagious, and identifying them may contribute to bottlenecks that prevent those who are contagious from being found in time. But researchers say the solution is not to test less, or to skip testing people without symptoms, as recently suggested by the Centers for Disease Control and Prevention.

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The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.

This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are.

In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found.

On Thursday, the United States recorded 45,604 new coronavirus cases, according to a database maintained by The Times. If the rates of contagiousness in Massachusetts and New York were to apply nationwide, then perhaps only 4,500 of those people may actually need to isolate and submit to contact tracing.

One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.

Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said.


Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said.

A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on.

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Instead, new data underscore the need for more widespread use of rapid tests, even if they are less sensitive.

“The decision not to test asymptomatic people is just really backward,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, referring to the C.D.C. recommendation.

“In fact, we should be ramping up testing of all different people,” he said, “but we have to do it through whole different mechanisms.”

In what may be a step in this direction, the Trump administration announced on Thursday that it would purchase 150 million rapid tests.

The most widely used diagnostic test for the new coronavirus, called a PCR test, provides a simple yes-no answer to the question of whether a patient is infected.

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But yes-no isn’t good enough, he added. It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue,” Dr. Mina said.

Comment by Riaz Haq on September 19, 2020 at 10:49am

#India's #Economy Heads for Double-Digit Plunge as #CoronaVirus Spikes. Goldman Sachs estimates a 14.8% contraction in #GDP for fiscal 2020-21, while #ADB is forecasting -9%. OECD sees the #Indian economy shrinking by 10.2%. #COVID19 #Modi #BJP #Hindutva https://www.bloomberg.com/news/articles/2020-09-17/india-s-economy-...

India’s economic recovery prospects have gone from bad to worse after the nation emerged as a new global hotspot for the coronavirus pandemic with more than 5 million infections.

Economists and global institutions like the Asian Development Bank have recently cut India’s growth projections from already historic lows as the virus continues to spread. Goldman Sachs Group Inc. now estimates a 14.8% contraction in gross domestic product for the year through March 2021, while the ADB is forecasting -9%. The Organisation for Economic Co-operation and Development sees the economy shrinking by 10.2%.

The failure to get infections under control will set back business activity and consumption -- the bedrock of the economy -- which had been slowly picking up after India began easing one of the world’s strictest and biggest lockdowns that started late March. Local virus cases topped the 5 million mark this week, with the death toll surpassed only by the U.S. and Brazil.

“While a second wave of infections is being witnessed globally, India still has not been able to flatten the first wave of infection curve,” said Sunil Kumar Sinha, principal economist at India Ratings and Research Ltd., a unit of Fitch Ratings Ltd. He now sees India’s economy contracting 11.8% in the fiscal year, far worse than his earlier projection of -5.8%.

Goldman Sachs’s latest growth forecast came last week after data showed gross domestic product plunged 23.9% in the April-June quarter from a year ago, the biggest decline since records began in 1996 and the worst performance of major economies tracked by Bloomberg.

India is “likely to see a shallow and delayed recovery in corporate sector profitability over the next several quarters,” said Kaushik Das, chief economist at Deutsche Bank AG in Mumbai, who has downgraded his fiscal year growth forecast to -8% from -6.2%. That will “reduce the incentive and ability for fresh investments, which in turn will be a drag on credit growth and overall real GDP growth,” he said.

Still, foreign investor sentiment will likely return once the pandemic eases, said Todd Buchholz, a former White House economist and now author.

“The virus is seen as a temporary phenomenon,” he said in an interview. “Those investors who were lining up to invest in India in January 2020 will do so in 2021 also, and deregulation has to continue.”

Comment by Riaz Haq on September 19, 2020 at 1:11pm

#US #CDC director says face #masks may offer more protection against #COVID19 than a #vaccine. Dr. Redfield: "And I will continue to appeal for all Americans, all individuals in our country, to embrace these face coverings." #coronavirus https://www.cbsnews.com/news/covid-face-mask-protection-vaccine-cdc... via @CBSHealth

Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, said during his testimony before a Senate subcommittee on Wednesday that wearing face masks may be more effective at protecting against COVID-19 than a vaccine.


Lawmakers asked Redfield and other top health officials about the government's response to the coronavirus pandemic, and he was questioned about the CDC's recommendation that people wear masks — a practice President Trump has often dismissed.

"I'm not going to comment directly about the president, but I am going to comment as the CDC director that face masks, these face masks, are the most important powerful public health tool we have," Redfield said. "And I will continue to appeal for all Americans, all individuals in our country, to embrace these face coverings."

Redfield said if Americans wore face masks for several weeks, "we would bring this pandemic under control," because there is scientific evidence they work and they are our "best defense."

"I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine, because it may be 70%. And if I don't get an immune response, the vaccine is not going to protect me," Redfield said. "This face mask will."

Several experts contacted by CBS News agree with that assessment: Since vaccines do not guarantee an immune response, masks may be more effective at preventing COVID-19. The FDA has previously said it would approve a coronavirus vaccine that was at least 50% effective. While that could significantly reduce the number of hospitalizations and deaths, it would not completely eliminate the disease or guarantee protection.

George Rutherford, a professor of epidemiology and biostatistics and director of the Prevention and Public Health Group at UC San Francisco, said the CDC director is "completely right."

"The good thing about a vaccine is you don't need to remember to put it on every day," Dr. Rutherford told CBS News on Friday. "The bad thing is, it's probably not going to work nearly as well as masks."

"Let's say masks are 95% effective — and who knows what the vaccine is going to be, but say it's 80% effective — in that sense, masks could be better than vaccines," he continued. "I don't think we know yet, but for right now, it's the total name of the game. It's the most effective thing we have."

Rutherford said a large proportion of the population — about 60 or 70% — would need to get vaccinated in order to achieve something close to herd immunity. "Once you're vaccinated... you're probably pretty safe. Now, if we're still walking around with lots of transmission going on, among people who didn't get vaccinated, you may want to wear a mask as well."

Comment by Riaz Haq on September 20, 2020 at 12:25pm

#India's #coronavirus infections surge to 5.4 million with 92,605 new infections in 24 hours. India lags behind only the #US, which has 6.7 million cases. A total of 1,113 people died of #COVID19 in the last 24 hours, taking total mortalities to 86,752.
https://reut.rs/3hH8dFa


India’s coronavirus case tally surged to 5.4 million as it added 92,605 new infections in the last 24 hours, data from the health ministry showed on Sunday.

The country has posted the highest single-day caseload in the world since early August, and lags behind only the United States, which has 6.7 million cases in terms of total infections.

A total of 1,113 people died of COVID-19 in the last 24 hours, the health ministry said, taking mortalities to 86,752, which is a relatively low 1.6% of all cases.

Comment by Riaz Haq on September 23, 2020 at 12:22pm

‘Buses are packed, as are shops and markets’: #India’s rising #COVID-19 approaching cases in #US. Life alternates between slender hope & looming despair, with people uncertain of being alive tomorrow, yet thronging fish markets bereft of mask & distancing https://www.marketwatch.com/story/buses-are-packed-as-are-shops-and...

Atul Thakur, referring to major Hindu festivals occurring in October and November, poses that question in the Times of India. He is not talking about primacy in economic growth. Rather, he refers to the number of COVID-19 infections and the pace of their increase, which are likely to catapult India ahead of the U.S. by mid-September, conferring the dubious distinction of being the worst-affected nation on the planet.

With Unlock 4 having commenced and most institutions and services back in full-fledged operation, infections too are going through the roof, having increased by 1.5 million in the first 17 days of September. While permitting the reopening of transport, temples, gyms, businesses, industries, malls and wine shops, the government has run the gamut from total lockdown to near-normalcy.


Of course, government relaxation notifications stipulate “subject to SOP” (use of masks, social distancing, etc.), thereby absolving it of any blame for the rising death toll and knowing full well that adherence cannot be ensured or enforced.

Predictably, buses are packed, as are shops and wholesale vegetable and fish markets, with people shopping as if there is no tomorrow, which is a very real possibility. Many do not wear a mask and the less said about social distancing, the better. The police have mopped up a tidy sum by way of fines for mask-wearing noncompliance, though social distancing is not being enforced.

By now, the coronavirus has become a stark reality, with many people losing one of their family members, neighbors, friends or acquaintances to the infection. Last week, the block of flats both to the left and right of my own bore banners from the Pallavaram Municipality, cautioning of homes under quarantine due to COVID-19. Yet the realization of “It could be me tomorrow” doesn’t seem to have dawned on most.

One wonders whether this is the innate arrogance of man, who considers himself invincible enough to triumph over nature and disease, or just ignorance, plain and simple. India has reported more than 5.6 million cases, just behind 6.9 million confirmed cases in the U.S. as of Wednesday, and more than 90,000 deaths, still less than half the 200,000-plus COVID-related deaths in the U.S.

While malls, gyms and shops are crowded, temples — especially the smaller ones — still find visitors few and far between. “Hardly anyone drops in, though the temple is now open for several hours,” says Sri Jagannatha Bhattachariar, a priest of one of the smaller shrines in Chrompet, Chennai. It makes you wonder whether people have at last found God within themselves, rather than search for Him in shrines.

Rural and indigent pupils find it difficult not only to afford the devices required for online classes, but also to comprehend them fully, and some have died by suicide. And while the lockdown did provide people the opportunity to spend quality time with their families, cases of domestic violence have also been on the rise.

Comment by Riaz Haq on September 25, 2020 at 10:34pm

'So many bodies,' says ambulance driver as #India struggles to stem #COVID19 death toll. Businesses are reopening, hospitals are full and doctors see no end in sight."The most optimistic scenario is plateauing, but it's not going to end soon."- ABC News - https://abcn.ws/331Hnnd

With the windows of his ambulance rolled down and the siren blaring, Mohsin Khan, 41, told his attendant why he drives ambulances.

"I lost my mother because no ambulance came on time to attend to her," he said. "The helplessness I felt, I don't wish that on my worst enemy."

On COVID-19 duty since the beginning of the pandemic in India, Khan has seen and done it all: from rushing patients to hospitals across Delhi to being the sole witness to last rites being performed. But this particular trip to the cremation ground brought him a sense of complete helplessness, as it involved him shifting the body of a 3-year-old COVID-19 victim, the youngest he has ever carried.

"She just reminds me of my daughter, she is somebody's child," he said tearfully.

"Sometimes I end up spending my entire day in cremation grounds and cemeteries. There are just too many bodies," he said as he waited to hand over the stretcher at the crematorium.

Since April 17, when Khan picked up his first COVID-19 patient, he has seen the numbers in cases and deaths rise consistently.

"My ambulance was the only one in the fleet until then," he said. "But with an increase in the number of cases and deaths, we now have 17 ambulances."

Some days, death is the only thing he sees.

"There are so many bodies and so many patients," he said. "On some days, we don't even have time to eat. There have been times when I have had to take six patients at once."

India this month surpassed Brazil as the country with the world's second-highest number of recorded infections. According to the Johns Hopkins Coronavirus Resource Centre, the country has 5.6 million total cases, putting it not far behind the United States, which has 6.8 million.

Testing in India also includes the rapid antigen tests, which result in a higher portion of false negatives, Dasgupta told ABC News.

"Antigen tests have been there for quite some months now and were meant for special situations like containment zones and people with high probability of illness," Dasgupta said. "But it's being done more generally now. On the plus side, this has pushed up testing numbers, but on the minus side you're picking up less than you would from such a high number of tests."

In March, India instituted a stringent lockdown to curb the crisis and give India's overburdened health care system a shot at dealing with the pandemic. But the lockdown plan did not account for the millions of internal migrants working in cities. Most of them were daily wage laborers who, overnight, found themselves without work and shelter.

They were left with no choice but to undertake arduous journeys, often on foot, to go back to their villages located thousands of miles away. And that contributed to the spread of the virus.

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