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“It’s much worse than the flu.” An Epidemiologist’s Perspective on COVID-19

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.

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Before I explain why, I would like to iterate that we must not panic. We cannot think clearly if we panic. Allah subḥānahu wa ta'āla (glorified and exalted be He) 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

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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.

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.

If you develop emergency warning signs for COVID-19 get medical attention immediately (call 911 to get immediate help).  Emergency warning signs include*:
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face
*This list is not conclusive.  Please consult your medical provider for any other symptoms that are severe or concerning.

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.

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Omer Abid, MD, MPH is a licensed Physician in Illinois and Michigan Board Certification in Preventive Medicine. He was a Epidemic Intelligence Service Officer in EIS fellowship at the Centers for Disease Control and Prevention (CDC) from 2003-2005. He worked as an epidemiologist for several years for the Ministry of Health and Ministry of National Guard of Health Affairs, Kingdom of Saudi Arabia. Currently working as an Addiction Medicine Physician at Insight Institute of Neurosurgery and Neuroscience (INSIGHT), Flint, Michigan

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#Current Affairs

This Eid And Beyond Boycott Goods Made With Enslaved Labor Of Uyghurs Even If It Is Your Favorite Brand

Bidding farewell to Ramadan, celebrating Eid?

Well, the Muslims of East Turkestan under Chinese occupation had neither Ramadan nor will they have Eid…

Not only that, the Chinese Communist Party (CCP) run government has transferred Uyghurs and other ethnic minority citizens from East Turkestan to factories across the country. Under conditions that strongly suggest forced labour, Uyghurs are working in factories that are in the supply chains of at least 83 well-known global brands in the technology, clothing and automotive sectors, including Nike, Gap, Adidas, Ralph Lauren, Carters and others. Read Uyghurs for Sale for more information

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CCP is also pressuring governments across the world to extradite Uyghurs back to occupied East Turkestan.

Here is what you can do to help them:

Action Items

  1. Keep making dua for the oppressed of East Turkistan and the world.
  2. Boycott Chinese products! Do not be complicit in slave labour. Start with focusing on the companies in the graphic. Share it with #SewnWithtTears, #StopChina, #BoycottChina. Write to them and demand that they do better.
  3. Raise awareness on the plight of Uyghurs and the East Turkistani cause. Learn more at SaveUighur.org
  4. Work towards reducing your country’s economic dependence on China.
  5. Build alliances with all people of conscience to demand a cessation of China’s oppression of all faith groups, be it Muslim Uyghur, Hui; Chinese Christian; or Tibetan Buddhist.
  6. Encourage and promote fairer trade and commerce with Muslims and others rather than China.
  7. Inquire about Uyghur diaspora members in your area. Organize to help out orphans, widows, and students.
  8. Pressure governments to provide legal protection to Uyghur refugees-exiles by granting either citizenship or refugee/asylee status. Stop the “extradition/repatriation” of Uyghurs to China!
  9. Get your universities/endowments to divest from China. Raise awareness about Chinese espionage and hired guns in academia. Demand academic and financial support for Uyghur scholars and students. Request more academic attention and funds for Central Asian, Uyghur, Turkistani studies. 

Read a greater discussion of action items in A Response to Habib Ali Al-Jifri’s Comments on the Uyghurs, which also contains a greater discussion on East Turkistan’s history and its current situation. A condensed Arabic version of the article can be found here

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30 Khawaatir in 30 Days- A Parent’s Guide | Day 9: A Good Word

Now that we have learnt about the life of this world, let’s talk about a good word.

I want you all to close your eyes and think of a beautiful tree. 

Question: Who can tell me what their tree looks like? Is the tree big and strong? Does it have lots of branches and leaves? Does it have fruit?

Now, I want you to think of a time when someone said something really nice to you.

Question:  What are some of the nice statements you remember people telling you?

Question: How did those statements make you feel?

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Yes, they fill us up with a warm feeling. We may have felt proud of ourselves and we may have felt loved. Do you know that Allah [wt] describes a good word to a good tree? 

In Surah Ibrahim, Allah subḥānahu wa ta'āla (glorified and exalted be He) says:

أَلَمْ تَرَ كَيْفَ ضَرَبَ اللَّهُ مَثَلًا كَلِمَةً طَيِّبَةً كَشَجَرَةٍ طَيِّبَةٍ أَصْلُهَا ثَابِتٌ وَفَرْعُهَا فِي السَّمَاءِ 

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تُؤْتِي أُكُلَهَا كُلَّ حِينٍ بِإِذْنِ رَبِّهَا ۗ وَيَضْرِبُ اللَّهُ الْأَمْثَالَ لِلنَّاسِ لَعَلَّهُمْ يَتَذَكَّرُونَ 

Have you not considered how Allah presents an example, [making] a good word like a good tree, whose root is firmly fixed and its branches [high] in the sky? [Surah Ibrahim; 24]

It produces its fruit all the time, by permission of its Lord. And Allah presents examples for the people that perhaps they will be reminded. [Surah Ibrahim; 25]

Question: Now, I want you to think of a time when someone said something mean to you. How did that make you feel?

It’s not fun to remember the mean stuff right? Allah subḥānahu wa ta'āla (glorified and exalted be He) continues in Surah Ibrahim and says:

وَمَثَلُ كَلِمَةٍ خَبِيثَةٍ كَشَجَرَةٍ خَبِيثَةٍ اجْتُثَّتْ مِن فَوْقِ الْأَرْضِ مَا لَهَا مِن قَرَارٍ

And the example of a bad word is like a bad tree, uprooted from the surface of the earth, not having any stability. [Surah Ibrahim; 26] 

Question: What do you think are good words we can use to build strong, firmly rooted trees?

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30 Khawaatir in 30 Days- A Parent’s Guide | Day 8: The Life of This World

Now that we have learnt about qalbun saleem, let’s talk about the life of this world.

Question: Do you know that there is an ayah in the Qur’an that takes us through all the stages of life and tells us what we find to be the most important aspect based on our age?

This ayah is found in the chapter named Al-Hadeed. 

Question: Does anyone know what Hadeed means? 

Yes! It means iron! The verse in Surah al-Hadeed starts by saying:

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اعْلَمُوا أَنَّمَا الْحَيَاةُ الدُّنْيَا لَعِبٌ وَلَهْوٌ 

“Know that the life of this world is play and amusement.”

Question: When you were really, really young, what was something that was important to you?

Yes, playing! You would use your imagination, play with your toys, and build legos. That is what  لَعِبٌ la’bun means. Then you got a bit older and you wanted to hear stories and be entertained. 

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Question: Can you tell me in what other ways you’re entertained? (Examples can include watching TV, reading books, etc)

Yes! This is what is meant by  لَهْوٌ l(ahwun). Then we get a bit older and our goals change. The ayah continues by saying, وَزِينَةٌ وَتَفَاخُرٌ بَيْنَكُمْ (wa zeenatun wa tafakhirun baynakum). All of a sudden, you become a tween and a teenager, and you really care about your looks. You want to dress in the nicest clothing and look beautiful. This is zeena

Then you get even older and you enter college. You compete with your classmates and show off your knowledge and skills to impress future employees. This is tafaakhirun baynakum , i.e. boasting with one another. 

Then what usually happens after college? Work, marriage, and children! The ayah continues by saying, وَتَكَاثُرٌ فِي الْأَمْوَالِ وَالْأَوْلَادِ (wa takathur fil amwaali wal-awlaad), i.e. and competition in increasing wealth and children.

As parents, we try to give you the best life and education, and we work hard to provide for you. But, we always have to remember that it won’t be permanent, right? 

Question: We will be so happy, like farmers watching our seeds grow into beautiful plants, but what happens in the fall when it’s no longer sunny and becomes windy and cold? 

Yes, the plants turn yellow. Remember that toy you used to love playing with as a really little kid? Is it as interesting to you anymore? Remember that TV show you could not stop watching? You even memorized all the lines in it. Do you remember the title? Are you interested in something else now?

This is the example of our whole life. Once we get something we once were so excited to have, we realize that after some time has passed, that it has “turned yellow” to us. 

Question: What do you think that means?

Yes! It’s not as interesting as it once was. So knowing that this is going to happen, how can we make sure to not get distracted by the bright and shiny and stay focused on Allah subḥānahu wa ta'āla (glorified and exalted be He)?

We’re in luck, because Allah subḥānahu wa ta'āla (glorified and exalted be He) gives us the answer! Allah subḥānahu wa ta'āla (glorified and exalted be He) says:

 “سَابِقُوا إِلَىٰ مَغْفِرَةٍ مِّن رَّبِّكُمْ وَجَنَّةٍ 

Race toward forgiveness from your Lord and Jannah! 

Question: How do you think we can race towards Allah subḥānahu wa ta'āla (glorified and exalted be He)?

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