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      The coronavirus disease-2019 pandemic, social distancing, and observance of religious holidays: Perspectives from Catholicism, Islam, Judaism, and Hinduism

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          Abstract

          In December 2019, Chinese authorities reported the emergence of a cluster of severe respiratory infections of unknown etiology in Wuhan (Hubei province, China).[1] The seventh-identified human coronavirus and third-novel coronavirus to emerge in the past 17 years, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was isolated in January 2020 as the cause of the SARS-like atypical pneumonia called coronavirus disease 2019 (COVID-19).[2 3] Although much still remains to be learned about the pathogenicity of SARS-CoV-2, the virus appears to spread primarily through air-borne droplet nuclei or small particles and requires contact points within the mouth, nose, eyes, or other parts of the upper aerodigestive system.[1] There is also early evidence of fecal-oral transmission.[1] Despite global efforts to slow the spread of SARS-CoV-2, the World Health Organization (WHO) has declared COVID-19 a pandemic[4] and the United States (like many countries) has declared a National Emergency.[5] Since the WHO declared a pandemic, governments worldwide have advised against public gatherings and encouraged their population to stay at home as much as possible. Physical distancing strategies (PDS), ranging from less restrictive social distancing to complete closure of society or “shelter-in-place” orders, have been suggested as an approach to contain and mitigate the severity of the COVID-19 pandemic.[1] PDS are designed to dramatically shift social mixing patterns and are often used in epidemic settings.[1] Consequently, religious practices of many are undergoing profound changes. For some, the expressions of faith may emphasize close contact, such as hand-holding and sharing communion in Christian churches, standing shoulder-to-shoulder during prayer in Mosques, or touching or kissing religious objects at synagogues. In some cases, religious gatherings have proven to be hotbeds for outbreaks, with some labeled as super-spreaders, including the Shincheonji Church of Jesus (Republic of Korea) and Tablighi Jamaat (Malaysia, India). In Washington D. C., a rector tested positive for the virus after performing communion at an Episcopalian church, causing more than 500 congregants to self-quarantine for 2 weeks.[6] At the heart of this is a conflict between the rational requirements of health and the traditional requirements of religion; rational health-conscious behavior including PDS, versus religious traditions that promote (or require) social gathering. Hence, which of these principles should come first? The crisis has prompted many religious leaders to appeal to their followers to not only take safety precautions, but also to embrace their spirituality to help confront the health, social, and economic challenges ahead.[6] A Pew Research Center survey conducted March 19–24, 2020, found that 59% of US adults who had earlier indicated they attended religious services at least once or twice per month said they were attending services in person less and watching greater numbers of religious services through varied media modalities.[7] This manuscript explores how some are approaching religious observance during the COVID-19 pandemic. CATHOLICISM A thorough discussion of Catholic law is outside the scope of this manuscript, but we refer the readers to our prior discussions on the topic.[8] The Catholic Church has precedent for modifying practice requirements in the face of an infectious pandemic. For example, during the influenza pandemic of 1918, Bishop John Patrick Farrelly (Catholic Diocese of Cleveland) sent a letter to all priests stating “to abide by every ruling of their respective boards of health and aid in every way to check the spread of Spanish influenza.”[9] In addition, during the 1918 pandemic, priests requested that mass be observed in homes, and hymns and Bible readings were published through the newspapers. The coronavirus pandemic has challenged the Catholic Church to find new ways to celebrate Liturgical celebrations. As worldwide social distancing mandates were released in March 2020, the Pope established directions on how to celebrate Holy Thursday, Good Friday, Easter Vigil, and Easter Sunday in line with these government guidelines.[10] This meant that the faithful would join the Pope spiritually through the media (television, radio, and web), and Sunday Mass has been held virtually in accordance with local health ordinances. In addition, Bishops worldwide have suspended Sunday obligation. While some Dioceses have canceled and even prohibited their priests from hearing confessions or anointing the sick, others have encouraged confessions to be offered in accordance with the Centers for Disease Control and Prevention recommendations and local directives, and that anointing of the sick be offered where health-care providers allow access to priests (with the proper precautions taken). Some churches have been left open for people to pray individually.[11] Overall, the limitations on mass gatherings, which include religious gatherings, will remain in place while stay-at-home orders are in place. These stay-at-home order timelines will differ by locality, making it difficult to make a projection for the Church as a whole. ISLAM A thorough discussion of Islamic law is outside the scope of this manuscript, but we refer the readers to our prior discussions of the topic.[8 12 13] The decision on how to handle religious observance and PDS during the COVID-19 pandemic is not unanimous among Muslim scholars.[14 15] The International Islamic Fiqh Academy (IFA) affiliated with the Organization of Islamic Cooperation (OIC) has recommended adhering to PDS, including the permissibility of closing mosques to prayers, and suspending Tarawih prayers, Eid prayers, performance of pilgrimage (Hajj and Umrah), closing educational institutions, and adopting the principle of distance education.[16] Of note, there is precedent for suspending the Hajj pilgrimage (July 28–August 2); this has been done before, including for plagues and cholera outbreaks.[6] Fasting during the 9th month (Ramadan) of the Islamic lunar calendar is a religious obligation for able-bodied adult Muslims as prescribed in the Qur'an 2:186.[13] Fasting is obligatory upon every adult Muslim who is of sound mind, not ill, and not traveling (Quran 2:184). Historically, the decision to fast in the event of illness depends upon the nature and severity of illness.[13] A comprehensive discussion of all medical illnesses, medications, and procedures in the context of Ramadan is beyond the scope of this manuscript; however, readers are referred to our summary of judicial rulings in the form of fatawa published elsewhere.[13] All 13 identified fatawa (1 Sunni, 11 Shi'a, 1 joint Sunni and Shi'a) indicate that illness is a valid reason exempting one from fasting.[13] Although specific verbiage may vary, the most common criteria are that the patient reasonably and justifiably fear that the fast will cause him/her significant loss or harm.[13] Two fatawa indicate exemption for patients prohibited to fast by a physician.[13] Furthermore, as pertains to fasting during the month of Ramadan during the COVID-19 pandemic, it has been stated that health practitioners who are weak or too busy with patient care to take the predawn meal (Sahūr), may break the fast if needed.[16] However, they must still adhere to the rules of atonement as pertains to intentional or unintentional missing of a fast, Kaffarah and Fidya, respectively.[16] Recommendations from the Muslim Council of Britain concur with the IFA-OIC. As regards healthcare personnel, their ruling expands on that of the IFA-OIC: “Health-care workers wearing personal-protective equipment or doing long shifts can be at real risk of dehydration or making clinical errors because of this, so they're exempt from fasting because this could impact on their health or the health of others.”[17] In addition, they recommended organizing prayers at home, including Tarawih, the congregational prayers and lectures performed after the night prayer (Isha) each night during the month of Ramadan.[17] Moreover, they advised streaming Tarawih in one's home, either prerecorded or live and arranging virtual Iftars (meal eaten after sunset/fast completion during Ramadan) with loved ones.[17] They also stressed the importance of looking out for one's health.[17] In North America, the National Muslim Coalition Statement on Coronavirus/COVID-19 Pandemic (comprised of 34 Muslim civil society organizations) has urged Muslims make every effort to support self-quarantine and social distancing as advised by your local, regional, state, and national public health or government authorities.[18] Congregants should avoid all public gatherings to protect themselves, their families, and communities. The task force recommends mosques, community centers, schools, and other public centers, suspend all nonessential gatherings until further notice.[18] People have been advised to pray the congregational Friday prayer (Ṡalāt al-Jumuāah) in their homes.[18] In addition, in Indonesia, the world's largest Muslim nation, mainstream Islamic organizations have issued religious pronouncements in agreement with those above. In contrast, the European Council for Fatwā and Research issued Fatawa that following live or prerecorded Tarawih is not valid, and that the Friday prayer in the homes is not valid behind the direct broadcast or modern means of communication (fatwa No. 4/30). JUDAISM A thorough discussion of Jewish law is outside the scope of this manuscript, but we refer the readers to our prior discussion of the topic.[8] Beyond impacting the weekly Sabbath (Shabbat), numerous Jewish holidays have or will likely occur during the immediate period of this pandemic including: Purim (March 9–10), Passover (April 8–16), and Shavout (May 28–30). Additionally, others including Rosh Hoshanah (September 18–20), Yom Kuppur (September 27-28), Sukkot (October 2–9), and Shemini Atzeret/Simchat Torah (October 10–11) could potentially be affected. The answer as to how Jewish observance is impacted by COVID-19 is complex, because decisions between (and even within) different denominations may differ. Although, in these unusual times, most denominations are more lenient about using technology on holidays and Shabbat. The Committee on Jewish Laws and Standards and the Rabbinical Assembly office have urged those who are ill to stay home, and those whom medical authorities have recommended for quarantine or self-quarantine to follow medical advice and stay in quarantine.[19] This is based (in part) on the principle of pikuach nefesh (saving a life takes priority over Sabbath observance) which overrides almost every other Jewish value.[19] For those who have been medically advised or mandated by health authorities to stay away from congregational worship they have offered recommendations. Those who wish to be part of a weekday minyan to recite prayers requiring a minyan, including mourner's kaddish, may connect virtually (through audio or video) with a minyan (whether of their own congregation or another) whose members are meeting in person, preferably in their time zone.[19] They may recite kaddish, kedushah, barkhu, etc., and hear Torah reading along with that minyan.[19] Congregational leadership should provide guidance for home davening and Torah study for those not able to attend Shabbat or Yom Tov services.[19] These sentiments have been embraced by many in the Orthodox community as well. Rabbinic leaders and organizations across the Orthodox spectrum have, individually, declared the health threat presented by COVID-19 a mortal threat (Sakanas Nefashos).[20] Furthermore, Jewish tradition teaches that love (Chesed) is not merely an inner emotion, it is a way of behaving toward others that makes the love manifest.[20] Moreover, whereas Orthodox Jewish practice normally prohibits the use of electronics on the Sabbath and Jewish festivals, the aforementioned have (in part) led Rabbinical leaders to encourage practitioners to avoid travel and celebrate Passover (Pesach) as they sheltered in the place.[21] The limitation against holding Minyanim (a quorum of ten Jewish adults required for certain religious obligations) was to remain in place without exception.[21] The burning of chametz was discouraged so as not to add stress or burden to emergency responders.[21] Additionally, a number of Orthodox Rabbis have temporarily endorsed the use of audio and visual technology to aid the observance of the Shabbat, holidays, and other religious observances.[22 23] Of note, however, this practice is not universally accepted, and some other leaders have voiced disagreement.[22 23] Some Rabbis have expressed concern that such loosening of the rules, even if expressly done only to address a pressing (and presumably temporary) need, might nevertheless create new norms of behavior that will outlast the current crisis. HINDUISM Hinduism is the world's third largest religion after Christianity and Islam, but uniquely it has no single founder, no church hierarchy and no central authority. This means that greater decision-making power lies in the hands of local religious leaders. The Hindu faith has 18 holidays between now and Diwali (November 14). There remains considerable debate amongst Guru's and religious leaders on whether and how to modify religious practice. Regarding the recent holiday Holi, India's health ministry stopped short of explicitly banning celebrations, but senior government figures led by the example. Prime Minister Narendra Modi tweeted last week that he would not take part in any Holi gatherings given that “experts across the world have advised to reduce mass gatherings to avoid the spread of covid-19.”[24] It has largely been left to the local administration and temple trusts to decide how these events are to be conducted.[25] Although many festivals were canceled, including New Delhi, others continued (e.g., Uttarakhand).[25] Similarly, despite government requests to celebrate at home, Ayodhya pilgrims were not prevented from gathering to observe the 9-day Celebration of Ram as per usual custom. Conversely, Temples across North American have been closed to the public. CONCLUSION The question on if and how to observe PDS varies within and between religions. As this pandemic could extend (through subsequent waves) for a prolonged period, it is important that health-care providers, religious leaders, and the population at large work together on strategies that allow successful and meaningful fulfillment of religious obligations while maintaining public security and welfare.

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          Most cited references23

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            • Article: not found

            Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding

            Summary Background In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. Methods We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus. Findings The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues. Interpretation 2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. Funding National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.
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              The 2019–2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper

              What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a “new normal” are discussed in this article.
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                Author and article information

                Journal
                Int J Crit Illn Inj Sci
                Int J Crit Illn Inj Sci
                IJCIIS
                International Journal of Critical Illness and Injury Science
                Wolters Kluwer - Medknow (India )
                2229-5151
                2231-5004
                Apr-Jun 2020
                08 June 2020
                : 10
                : 2
                : 49-52
                Affiliations
                [1]Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
                [1 ]Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
                [2 ]Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA, USA
                Author notes
                Address for correspondence: Dr. Andrew C. Miller, Department of Emergency Medicine, Nazareth Hospital, 2601 Holme Avenue, 3 rd Floor, Marian Building, Philadelphia 19152, PA, USA. E-mail: Taqwa1@ 123456gmail.com
                Article
                IJCIIS-10-49
                10.4103/IJCIIS.IJCIIS_60_20
                7456291
                b9df69d9-3f88-4eef-9d0c-da3de1664468
                Copyright: © 2020 International Journal of Critical Illness and Injury Science

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 02 May 2020
                : 02 May 2020
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                Emergency medicine & Trauma

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