Modeling rapidly disseminating infectious disease during mass gatherings

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Measuring the impact of suspending Umrah, a global mass gathering in Saudi Arabia on the COVID‑19 pandemic

This article uses a stratified SEIR epidemic model to evaluate the impact of Umrah, a global Muslim pilgrimage to Mecca, on the spread of the COVID-19 pandemic during the month of Ramadan, the peak of the Umrah season. The analyses provide insights into the effects of global mass gatherings on the progression of the COVID-19 pandemic locally and globally

Threat of antimicrobial resistance among pilgrims with infectious diseases during Hajj : lessons learnt from COVID-19 pandemic

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of anti-microbials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness, and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj

A proposed framework for developing user-centred mobile healthcare applications for the biggest annual mass gathering (Hajj) post COVID-19

The Hajj pilgrimage being the largest annual mass gathering globally with two to three million participants from over 180 counties, will remain a high priority for diseases surveillance for future epidemics or any other international public health emergencies with rapid scalability. This paper highlights the importance of monitoring mass gatherings during a pandemic and how mHealth applications can reduce the burden on health facilities during a mass gathering and tackle future infectious diseases outbreaks. The paper also highlights the importance of developing a user-centred application when designing for a diverse group of users with a shared purpose. As a result, a framework has been proposed to update the current applications or design and develop future mobile health applications. The framework has been developed based on the rationale and evidence found in the literature

Crowd and environmental management during mass gatherings.

Crowds are a feature of large cities, occurring not only at mass gatherings but also at routine events such as the journey to work. To address extreme crowding, various computer models for crowd movement have been developed in the past decade, and we review these and show how they can be used to identify health and safety issues. State-of-the-art models that simulate the spread of epidemics operate on a population level, but the collection of fine-scale data might enable the development of models for epidemics that operate on a microscopic scale, similar to models for crowd movement. We provide an example of such simulations, showing how an individual-based crowd model can mirror aggregate susceptible-infected-recovered models that have been the main models for epidemics so far

A scoping review of the risk factors and strategies followed for the prevention of COVID-19 and other infectious diseases during sports mass gatherings: Recommendations for future FIFA World Cups

ObjectiveSports mass gatherings of people pose particular concerns and place an additional burden on the host countries and the countries of origin of the travelers. It is imperative to identify how countries dealt with various communicable diseases in the context of previous world cups and identify possible advice for protection from outbreaks.MethodsA scoping review was employed in this study and a PRISMA extension for scoping reviews was employed to guide the reporting of this study. A systematic search was performed using PubMed, Embase, Web of Science, SCOPUS, SportDiscus, and Google scholar. The search strategy included two main strings viz “communicable disease” AND “sport” AND “setting” as keywords for each string. A total of 34 studies were included in this review.ResultsInformation on risk factors for infectious diseases during FIFA, and recommendations for disease prevention in various stages of the event: pre-event, during, and post-event were charted. These strategies can be achieved with the empowerment of the public by enhancing their social responsibility and the coordination between the healthcare system, the ministry of public health, and other stakeholders.ConclusionThe findings will support planning for protection strategies to prevent any outbreak while having the FIFA World Cup or any other sports gatherings. A model was constructed to present the findings and recommendations from this review

An assessment of the disaster preparedness knowledge of emergency medical services providers in Hajj of 2016.

Objectives: 1) Assess knowledge regarding disaster preparedness for mass gathering among SRC-EMS providers during the Hajj 2016 2) Explore the relationship between the demographic variables and knowledge about disaster preparedness among SRC-EMS providers during the Hajj 2016 3) Explore the sources of knowledge for SRC-EMS providers about disaster preparedness. Method: The data collection for this study was a cross-sectional survey using an online Qualtrics survey. It was convenience sample of 1650 respondents. For the analyses descriptive statistics was used, one-way ANOVA and Bonferroni correction for multiple comparisons tests, multiple regression analyses, and Pearson’s product coefficients. Results: The main findings in this study was providers in the age of 35-39 years and master’s degree had more general knowledge of disaster preparedness. Paramedics had more general knowledge of disaster preparedness and physicians had more knowledge of the Hajj. The military sector had more knowledge of disaster preparedness than other sectors. The trainings, workshops and drills should be held four times per year, the duration should be 6-12 months, trainings no more than 9 hours and workshops and drills more than 20 hours for retaining high knowledge of disasters. Thus, the characteristics of multiple regression analysis model for general knowledge of disaster preparedness are the level of EMS provider, highest level of education, and number of workshops ever attended and characteristics of knowledge of the Hajj model are the number of drills attended and level of EMS providers. Most sources of general knowledge of disaster preparedness are continuing education, university courses the media and the most sources of knowledge of the Hajj are real disasters, continuing education, university courses, and the media. Conclusion: This study indicates a relationship between the demographic variables with general knowledge of disaster preparedness and knowledge of the Hajj 2016. It provides valuable insights into understanding predictive factors. Also, it defines the sources of knowledge about disaster preparedness for mass gathering among SRC-EMS providers. This study offers recommendations to the Saudi government for improving the knowledge of disaster preparedness for SRC-EMS providers such as improving training and education and changing the scope of practice for Saudi EMS system

Epidemiology of Hajj Pilgrimage Mortality: Analysis for Potential Intervention

BackgroundThe Hajj is the annual mass gathering of Muslims that occurs in Makkah, Saudi Arabia. The Saudi Vision 2030 predicts the attendance of 30 million pilgrims each year by 2030. Cost-effective healthcare services during the Hajj are important to manage this increase in the number of pilgrims. Communicable diseases have always been a concern during the Hajj. However, little is known about the impact of the preexisting chronic diseases on morbidity and mortality during the Hajj. Furthermore, the quality of services provided by Hajj hospitals warrants further study.ObjectivesA relatively large number of pilgrims admitted to Hajj hospitals die during their stay. This dissertation aims to describe patterns of inpatient, all-cause mortality during the Hajj and the relationship between mortality and preexisting chronic diseases as well as the services provided in Hajj hospitals.Study Design and PopulationThe population included pilgrims who were admitted to Hajj hospitals in Makkah and sacred sites during five Hajj seasons between 2012 and 2017, excluding 2015. A retrospective, matched, case-control study design was utilized with a ratio of deaths to surviving controls of 1:2, resulting in 2,237 cases of mortality being matched to 4,474 control cases based on age and gender using a one-stage sampling approach. The data was extracted from hospital admissions offices and medical records.Methods Preexisting chronic diseases included diabetes mellitus, hypertension, and cardiovascular diseases. Medical services provided by Hajj hospitals included intensive care unit (ICU) admission, intubation, radiology imaging (MRI and CT scan), endoscopy, and blood transfusion. Covariates included individual-level variables (age, gender, nationality, length of stay, mode of admission, discharge diagnosis, and Hajj status) as well as hospital-level variables (hospital location, hospital of discharge, bed-to-doctor ratio, and bed-to-nurse ratio). Hierarchical, logistic regression models were used to examine the medical services. The effect measure modification of the copresence of more than one chronic disease was also examined. For every independent variable that was evaluated, the prevalence, crude and adjusted odds ratios (AORs), and corresponding 95% confidence intervals (CIs), were calculated.Results The rate of inpatient all-cause mortality was higher in Makkah hospitals compared to sacred site hospitals. Also, inpatient, all-cause mortality was significantly associated with diabetes (AOR: 1.44, 95% CI: 1.27-1.63), hypertension (AOR: 1.34, 95% CI: 1.17-1.53), and cardiovascular diseases (AOR: 1.32, 95% CI: 1.14-1.53). Moreover, effect measure modification was present in the association between diabetes and cardiovascular diseases and the association between hypertension and cardiovascular diseases, but not the association between diabetes and hypertension. Finally, patients who were admitted to the ICU or who received radiology imaging, endoscopy, or blood transfusion were more likely to die during their hospital stay compared to those patients not receiving those services (ICU AOR: 8.00, 95% CI: 7.8-8.2; radiology AOR: 1.60, 95% CI: 0.98-2.60; endoscopy AOR: 1.99, 95% CI: 1.37-2.88; blood transfusion AOR: 4.00, 95% CI: 2.59-6.24). However, the mortality rate was lower in intubated patients compared to nonintubated patients (AOR: 0.54, 95% CI: 0.35-0.82).ConclusionThe current focus on public health issues during the Hajj should be equally distributed between communicable and noncommunicable diseases. Although advanced services are provided by Hajj hospitals, interventions to address the increased risks, including mortality, faced by pilgrims with preexisting, chronic diseases should be further investigated and considered

The crowd psychology of the Hajj

This thesis is the first study of the crowd psychology of the annual Hajj, or pilgrimage to Mecca (Makkah) in Saudi Arabia, to employ self-categorization theory (SCT). The thesis aims to document and understand the perspective of pilgrims from a social psychological point of view, since no one has done that before, as well as to understand the perceptions of the Hajj management. Specifically, the thesis focuses on crowd perceptions, feelings of safety and the reasons for these feelings, and relations between subgroups in the crowd and between pilgrims and management. A literature review in Chapter two highlights the history and culture of the Hajj and the issues in managing the Hajj. Academic perspectives on crowd psychology are discussed in chapter three. Chapters four and five present respectively a UK pilot study of pilgrims and a field pilot study of pilgrims and management. Chapter six (the main interview study with pilgrims) indicates that despite the inconveniences, participants felt safe, secure and wellbeing inside the Grand Mosque during Hajj. Chapter seven (the main interview study with Hajj management) explores the participants’ understanding of crowd behaviour, crowd psychology and its relation to safety, danger and their own role. In Chapter eight (the major study of the thesis), a survey of 1194 pilgrims at the Hajj found that identification with the crowd predicted enjoyment of the crowd. Also, for those high in identification with the crowd, crowd density increased perceptions of safety. Perceived support was found to mediate these positive effects of social identity on feeling safe. Chapter nine critically explores the findings of the thesis and discusses them in relation to relevant literature. It also reflects on the implications of the study for the theory of crowd psychology, and considers what lessons there might be for the management of the Hajj. This chapter concludes the thesis and outlines suggestions for further research