In light of the suspension of Jummah prayers and the mosque closings across the nation, I want to share my expertise as an epidemiologist.

Some people are in denial of the enormity of the crisis and do not agree with the rulings on Jummah prayers being canceled. Others think that this crisis is hyped up. They are asking, isn’t this like the flu or just a little worse than the flu?

It is not.

It is much worse than the flu.

Before I explain why, I would like to iterate that we must not panic. We cannot think clearly if we panic. Allah reminds us in the Quran:

“It is not righteousness that ye turn your faces Towards East or West; but it is righteousness- to believe in Allah and the Last Day, and the Angels, and the Book, and the Messengers; to spend of your substance, out of love for Him, for your kin, for orphans, for the needy, for the wayfarer, for those who ask, and for the ransom of slaves; to be steadfast in prayer, and practice regular charity; to fulfill the contracts which ye have made; and to be firm and patient, in pain (or suffering) and adversity, and throughout all periods of panic. Such are the people of truth, the Allah-fearing.”

Surah Al-Baqara, verse 177

While we should not panic, we should also not be skeptical about the unanimous consensus of all medical experts. Medical experts are authorities on medical issues.

“O ye who believe! Obey Allah, and obey the Messenger, and those charged with authority among you. If ye differ in anything among yourselves, refer it to Allah and His Messenger, if ye do believe in Allah and the Last Day: That is best, and most suitable for final determination.”

Surah An-Nisa, Verse 59

This is a true crisis

We need everyone to do their part to prevent infections. The following is concise Epidemiology 101 for the non-epidemiologist regarding why there is so much concern by health authorities on the seriousness of Covid-19.

This is a crisis because of two simple mathematical reasons: the case fatality rate and the reproductive rate.

Let's dispel the notion that "novel coronavirus is just like the flu". Sharing this striking comparison of #Flu, #COVID19, #SARS and #MERS made by @BioRender. #COVID19 is 30x more deadly and almost 2x more contagious than the flu. We have no existing immunity to COVID19. pic.twitter.com/fdJgsSFMnB

— Prof. Akiko Iwasaki (@VirusesImmunity) March 13, 2020

Case Fatality Rate

First, the case fatality rate – or the death rate – is the number of people who die if they have the disease, which in this context is the infection. In other words, out of the people who have the infection, this number represents how many will die.

For the flu, the case fatality rate is 0.1.For Covid-19, the case fatality rate based on the 133,000 so far infected as of March 13 and the 4,945 who have died is 3.7. This is not the true case fatality rate as some people with the mild infection are not being counted.

Some experts believe the case fatality rate is 2.0, which is 20 times higher than the flu. Dr. Anthony Fauci, who for over three decades has been the Director of the National Health Institute (allergy and infectious diseases) gave an estimate of 1.0 when he testified to Congress several days ago, and 1.0 is 10 times more than 0.1

If everything else that is important (such as the reproductive rate) was the same between the flu and Covid-19, then the number of people dying would be 30,000 times 10, which is 300,000.

Reproductive Rate (Basic Reproductive Number)

The other important number is the reproductive rate. The word “reproductive” in this name is not focused on the reproductions of the virus in one body, but the reproduction of cases. Technically this is called the basic reproductive number, but for ease of communicating, I will call it the reproductive rate.

The reproductive rate is related to how infectious the organism is from one person to another and what steps society is taking to limit the infections from spreading.

The exact definition of the reproductive rate (basic reproductive number) is the expected number of cases directly generated by one infected case in a population where all individuals are susceptible to infection.

Case Fatality plus Reproductive Rate Equals:

For the flu, the reproductive rate is 1.3. For Covid-19, the reproductive rate is between 2 and 3. The reproductive rate for Covid-19 is twice as high as the flu virus. Therefore we have to multiply the estimated number of deaths of 300,000 by 2, which is 600,000.

The case fatality rate could be lower than 1.0, it could be closer to 0.8 In fact, in South Korea, it is 0.9 so far. In Italy however, it is almost 5% because there are so many elderly people in Italy. In both of these cases, the case fatality rate of COVID-19 is still many, many times higher than that of the flu, which is 0.1.

To put it simply, at even a 1.0 case fatality, we can expect 600,000 people to die from COVID-19 in the US alone if we don’t follow the CDC guidelines. That’s not counting the huge number of people with other diseases who are at risk of dying from the effect of the healthcare system being overloaded beyond its capacity.

This is bad news. However, this disaster scenario is based on us treating it “just like the flu.” If we decide to take things seriously instead, and treat this as an emergency as it truly is, then InshaAllah 600,000 people don’t necessarily have to die. Following CDC guidelines to reduce the spread of the disease as well as the impact to the healthcare system can save hundreds of thousands of people.

We can lower the case-fatality rate and the reproductive rate, and the number of lives saved will be much, much greater than the number of lives who will die.

This is good news. We can, and will Insha’Allah, save lives by acting to lower the spread of COVID-19.

Malaysia reported an additional 190 confirmed infections on Sunday, an increase of 80% of cases over a day and bringing its total to 428. Most of the cases stemmed from a Muslim religious gathering held from Feb. 27 to March 1, which authorities said was attended by 14,500 Malaysians and about 1,500 foreigners. Malaysia is the worst-infected nation in the Southeast Asia. Bloomburgquint.com

We need to be on the same page

I mean this literally. We need to be on the same page, and that is the webpage of the CDC website:

The CDC, of Centers for Disease Control and Prevention, is the agency responsible for preventing and limiting epidemics. You can keep yourselves, families, and the public at large safer by following their guidelines. Familiarize yourself with the following, and please ensure that all your family and friends have too:

1. How COVID-19 spreads

2. Symptoms

3. Steps to Prevent Illness

4. Older People and People with Chronic Diseases at Higher Risk

5. What to Do if You are Sick

6. Frequently Asked Questions and Answers

The first five sections are the responsibility of every person to learn, since every person can spread the infection and thus contribute to the reproductive number of COVID-19.

“The Muslim is the one from whose hand and tongue people are safe. ” – Prophet Muhammad ﷺ (An-Nasai)

For the many health professionals in the Muslim community, I encourage all health professionals to see the following resources on preparing your  practice to deal with Covid 19.

Do not go to Mosques until further notice

This is not an issue of a certain school of thought, but is the judgment of scholars from all schools of thought. Medical and religious experts are in agreement with regards to the suspension of Jummah for the protection of the community.

Please read the following joint statement by the Fiqh Council of North America, Islamic Society of North America, Islamic Medical Association of North America, and American Muslim Health Professionals. See also this declaration from the Assembly of Muslim Jurists in America regarding the suspension of Friday congregation. 

Mosques are higher risk than churches

In Iran, the first cases started in Qom, a city that often sees more attendance to mosques and more gatherings than other cities. Most cases were in Qom and then spread to other cities. The number of grave plots dug for the dead and dying is large enough to be visible by satellite imagery.

How is this relevant to the disease, and why are mosques more vulnerable than churches or other places of worship?

• Many attendees do wudu at the mosque. CDC guidelines are to not to touch the eyes, nose, or mouth, as these are mucous membranes. During wudu, the nasal mucous membranes are touched up to 3 times, the eyes mucous membranes are touched up to 3 times during the face rinse, and the mouth mucous membranes are touched up to 3 times.
• Wudu does not require soap, so coronavirus particles (from an infected person) remain even after completing Wudu.
• The vast majority of mosques do not have automatic sensors in their water taps, and attendees open and close them by hand shortly after touching their eyes, nose, mouth.
• Almost all people close the taps with their bare hands versus holding a paper towel.
•  Even if paper towels are used, there can be cross transference to the paper towel roll. There may be ways to limit transference but the risk cannot be eliminated.
• People often relieve themselves before doing wudu, and clean their private areas with their left hand. We don’t have data on coronavirus in mucous membranes in the private areas, but we do know that the virus can often be in the GI tract in addition to the respiratory tract and eyes and nose, etc.
• CDC guidelines say to use Social Distancing, staying 6 to 10 feet apart from others. But in the congregational prayer, we are standing shoulder to shoulder and some are also foot to foot.
• Some attendees touch their faces after making dua, which is the first step in the virus’s transmission.
• There are often handshakes and sometimes even hugs among some attendees, further spread person-to-person transmission.
• A higher percentage of Masjid attendees are elderly, and thus, further susceptible to infection.

Allah tells the Prophet Muhammad ﷺ that he has been sent as a mercy to all the worlds, and in following his sunnah, we strive for the same. By attending the mosques in the time of a pandemic, whether for the regular salah, Jumah prayers or ‘Eid prayers, we will not be a mercy to mankind. We will be a danger to it, spreading the coronavirus and increasing the number of people who suffer from it.

The bottom line, according to the epidemiology of this disease, is this:

It is guaranteed that some – likely a large number- will get infected if people go to mosques. And some of those people will die. And it is guaranteed that the infection rate will increase in the wider (non-Muslim) community because of this as well.

What to do if you think you have COVID-19

In general, call your doctor or ER if you think you are sick with Coronavirus. Do not automatically go to the ER or the doctor, first call ahead. Before even calling, familiarize yourself with what the symptoms of COVID-19 are.

Separate yourself from other family members and people at home, and call your doctor to get instructions to see if you need to be tested and to receive other very important instructions regarding supportive care to address your infection and to prevent the spread of it to other household members.

The doctor will instruct you as to whether you need to come to his/her office or go to the ER and when you need to go. Also by calling first, if you do need to go to the doctor’s office or the ER, they will make preparations to prevent the spread of infection from you to others as you come.

Social distancing in action: Death rates for the 1918 flu pandemic were heavily reduced by social distancing measures taken by the city of St. Louis, but not Philadelphia.

Do not delay calling your doctor since some people might deteriorate quickly, but try to read the CDC guidelines before calling so you can know whether you even need to call.

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

In summary

• We must not panic, but we must be prepared.
• We must recognize that this is a crisis due to the case fatality rate and reproductive rate of COVID-19
• Read the sections on COVID-19 at www.cdc.gov.
• Do not attend congregational prayers, Jumah prayer, weekend schools, etc. until further notice
• Believe, with the help of Allah, that we can change the bad news to good news if we follow all the CDC guidelines in every section

Let us be calm but also serious. Let us also be grateful that we live in a time when governments are much more proactive than the past. Let us be grateful to our medical community. Let us not overwhelm ourselves with unverified articles or forwards on Whatsapp. Let us read and circulate medical information from only authorized sources such as the CDC.

And let us remember that we are so vulnerable and fragile and that we must often remember and supplicate to Allah for forgiveness, protection, and guidance. Thank you and may Allah keep us, our families, and all safe. Ameen.