Ramadan 2020 and Beyond in the Midst of the COVID-19 Pandemic: Challenges and Scientific Evidence For Action

Abstract

Background: Ramadan is a sacred month in Islam, which involves 29–30 days of dawn-till-dusk dry-fasting. Millions of Muslims observed Ramadan fasting (RF) this year in the midst of the COVID-19 pandemic. Certain ethnic groups worldwide, including Muslims, have been disproportionately affected by COVID-19, raising fears that fasting could bring additional health risks. This directly impacted on the current challenges faced by health professionals. The COVID-19 virus is expected to become seasonal. Therefore, the evidence presented in this review is valid beyond Ramadan as intermittent fasting is practiced more widely, irrespective of religion, throughout the year as a therapeutic and prophylactic means for several conditions. 
 Methods: A wide range of literature databases were searched for the effects of RF and intermittent fasting on human health and then linked to COVID-19 impact to generate the evidence.
 Results: This review presents a body of evidence proving RF is safe and beneficial for healthy people who adopt a balanced diet, drink plenty of fluids, and engage in regular physical activity. Fasting reduces levels of pro-inflammatory cytokines (IL-1β and IL-6), which are associated with severe COVID-19. Furthermore, increased handwashing and hygiene during Ramadan may reduce infection risks. For some, social isolation, physical inactivity, reduced access to food and stress – linked to the pandemic – may minimize the benefits that is achieved during a “normal” Ramadan.
 Conclusions: RF during the COVID-19 pandemic is not a cause of concern for healthy people. However, people who are ill are exempt from fasting and should seek medical advice if they wish to fast. RF during the COVID-19 pandemic is a unique experience and future research will reveal its impact on human health.
 Key words: COVID-19; Ramadan; fasting; health; mental; exercise; isolation; lockdown; diabetes; biomarkers