key: cord-0877211-ges0hl6v authors: Sarwar Shah, Syed Ghulam title: Doctors in Pakistan denounce opening of mosques for congregational prayers during Ramadan amid the COVID-19 pandemic: Correspondence date: 2020-05-15 journal: Int J Surg DOI: 10.1016/j.ijsu.2020.05.006 sha: bb969ad709a62bf72f6553ddc81f94a36b1cf775 doc_id: 877211 cord_uid: ges0hl6v nan Pakistan Medical Association (MPA) and other associations of medical doctors have denounced [1] [2] [3] the Pakistan government's decision to allow mosques to open for five-time daily congregational prayers during the holy month of Ramadan amidst the COVID-19 pandemic [4] . Pakistan's doctors fear that the easing of social distancing and lockdown measures will increase the number of COVID-19 cases [5] and the healthcare system of the country might collapse. They have urged the government not to ease the lockdown but to extend it and take strict preventative measures including disallowing congregational prayers in mosques, which remain temporarily closed in other Muslim countries including Saudi Arabia where Islam's two holiest places-Mecca and Madinah-remain closed [6] . Ramadan is Islam's holiest month during which Muslims observe fasting from dawn to sunset for the whole month and pray in large congregations, especially during the night-time prayer. However, this year Ramadan is different for Muslims because of the COVID-19 pandemic. Following public health advice, congregational prayer in mosques and religious services of other faiths remain suspended in numerous countries that have enforced a lockdown to contain COVID-19. Nonetheless, Pakistan has allowed the opening of mosques for five-time daily congregational prayers subject to the observance of a 20 point code of conduct [7] . The main points of the agreement include wearing of face masks while praying, maintaining 2 m distance between worshippers during the congregational prayer, removing prayer mates from mosques, praying on the floor that will be disinfected, ban on breaking of the fasting and communal eating in mosques, performing ablution (wudu) at home, no hand shaking, and banning old and sick people from praying in mosques [8] . Although some of these preventive measures might be helpful, the medical community in Pakistan foresees a possibility of risk of spread of COVID-19 because there will be large numbers of worshipers praying close to each other especially during the night-time Ramadan prayer which lasts for about 90 minutes. Public health advice suggests that staying for about 15 minutes or more at about 1-2 m distance with someone with COVID-19 can result in catching the infection [9] . Even before Ramadan, the incumbent government in Pakistan was reluctant to impose a lockdown, while the provincial government especially in the Sindh province supported the lockdown and in fact declared it on 23 rd March [10] , which paved the way for a nationwide lockdown. However, lockdown restrictions were eased in the country and shops were allowed to open a few days before the beginning of Ramadan [11] . Soon after the easing of social distancing and lockdown, a surge in the new cases of COVID-19 was noted by health professionals. Consequently, PMA and other doctors' organizations held press conferences in Karachi [1] , Lahore [2] , and Peshawar [3] and demanded an extension of the lockdown and the implementation of strict measures to protect public health [5] . However, health providers' advice and pleas remain hitherto unheeded, and the general public remains confused and caught between divergent views and messages about the COVID-19 crisis. 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Doctors demand strict lockdown, urge religious scholars to review decision to open mosques CJP to review decision on prayer congregations Medics advocate strict lockdown until Eid Pakistan's Government Is Caught Between a Mosque and a Hard Place India and Pakistan ease coronavirus lockdown restrictions, India and Pakistan Ease Coronavirus Lockdown Restrictions Muslims Around The World Face A Different Kind Of Ramadan, NPR Govt, religious scholars issue 20-point policy agenda regarding prayer congregations during Ramazan President Alvi outlines plan agreed with ulema on congregational prayers during Ramazan Department of Health, COVID-19 (Coronavirus): Health advice The Brookings Institution Pakistan Extends Coronavirus Lockdown, Eases Curbs on Economic Activity, Voice of America (VOA) Name of the registry: 2. Unique Identifying number or registration ID: 3. 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A few data statistics reported in this article are publically available at http://covid.gov.pk NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington Way, Headington, Oxford, OX3 9DU, England, UK E-mail address: Sarwar.Shah@ouh.nhs.uk