Abstract

COVID-19 poses grave challenges for mass gatherings. One of the world’s largest annual gatherings, Arbaeen, occurs in Iraq. We studied respiratory symptoms and risk and protective factors using representative sampling of Arbaeen pilgrims in 2019 to inform prevention of COVID-19 transmission. Structured sampling was used to recruit walking pilgrims. A questionnaire asked about respiratory symptoms, risk, and preventive factors, including hygiene-related resources of toilet facilities. The commonest symptom reported by the 1842 participants (63.3% male, 36.7% female) was cough (25.6%). Eating in mawkibs (rest areas) with indoor kitchens and drinking only packaged water were associated with lower risk of cough (AOR = 0.72, CI = 0.56–0.94; AOR = 0.60; CI = 0.45–0.78, p < 0.05). Facemask use was associated with increased risk of cough (AOR = 2.71, CI = 2.08–3.53, p < 0.05). Handwashing was not protective against cough, or against (one or more of) cough, fever, or breathlessness in multivariate analysis. Toilet facilities often lacked running water (32.1%) and soap (26.1%), and had shared hand towels (17%). To reduce risk of respiratory infections including COVID-19 during Arbaeen or other mass gatherings, needs include running water, soap, and hygienic hand drying options or hand sanitiser. Education on proper handwashing and facemask approaches and monitoring around food preparation and eating spaces are needed.

Highlights

  • Mass gatherings have been held over history for sporting, social, religious, and other events

  • The current study is the first to have attempted to recruit a representative sample of Arbaeen walkers to examine respiratory symptoms, risk, and preventive factors

  • It demonstrated that respiratory symptoms were common among walkers, with cough affecting over a quarter (25.6%) and sore throat affecting 18.0%

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Summary

Introduction

Mass gatherings have been held over history for sporting, social, religious, and other events. Due to the close contact of participants in congested areas, such gatherings have a high potential to accelerate transmission of infectious disease. A mass gathering of two million people in Mexico, the Iztapalapa Passion Play in April 2009, is believed to have accelerated the spread of the last pandemic caused by influenza A(H1N1)pdm09 [1].

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