Magal de Touba in times of Covid-19: a major health challenge

The Grand Magal of Touba, religious capital of the Mouride brotherhood, located 200 km east of Dakar, in central Senegal, is scheduled for the beginning of October, more exactly from 5 to 6. This annual religious event has gathered, in recent years, more than 4 million Muslim pilgrims in Touba. Senegal, like many countries in Africa and elsewhere in the world, is currently facing the Covid-19 pandemic. According to the Center for Systems Science and Engineering at Johns Hopkins University, more than 14,839 cases have been reported in the country as of September 30, with 310 deaths.

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Epidemiological data from the Grand Magal of Touba

Epidemiological research on health risks initiated long before the current Covid-19 crisis, carried out on the Magal de Touba by a team from the Institute for Research for Development (IRD) of Dakar and the IHU-Méditerranée Infection de Marseille led by Cheikh Sokhna highlight the health characteristics of this type of gathering. The final objective of this research is to make recommendations to the health and religious authorities of the Diourbel region for better management of transmissible infectious diseases in terms of diagnosis and treatment, but also to put in place preventive strategies during the Magal. . They also aim to improve the health care offer and, ultimately, to prevent the possible globalization of communicable diseases. This research on syndromic surveillance carried out among pilgrims to Grand Magal over the past few years has shown that respiratory tract infections are among the most frequent causes of consultations in healthcare facilities during the event.

A prospective cohort study showed that the prevalence of symptoms of respiratory tract infection was 42% in pilgrims. This prevalence was 5 times higher among pilgrims following their participation in Grand Magal compared to non-participants in Magal. The occurrence of a dengue epidemic in Touba during the 2018 Grand Magal increased the risk of spread to other regions of Senegal due to the return of Mourid pilgrims to their place of residence where Aedes mosquitoes – the main vector of the disease. dengue – are present. Common coronaviruses were the most frequently acquired viruses. Several mass gatherings have recently been canceled, including the Umrah pilgrimage in Saudi Arabia and the Olympics in Japan. This year’s Hajj was limited to 1,000 participants residing in Saudi Arabia. The event usually brings together over ten million participants from over 180 countries.

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Favorable conditions for propagation

The usual conditions of transport, in crowded vehicles (both in the bus stations and on the heavily congested roads leading to Touba), as well as the extreme promiscuity they create, on the way there and on the return from Magal, may be a major factor in the spread of the virus. The vast majority of them are accommodated in Touba and its surroundings, in family houses or houses of spiritual guides (marabouts) where they all sleep together in the same rooms. For lunch and dinner, the Senegalese traditionally congregate tightly around a single large dish. In addition, during the event, the streets around the Grand Mosque and the general market have an extremely high population density (see photos). All of these conditions are likely to favor the transmission of respiratory pathogens in pilgrims.

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How to live with the virus

To manage a health risk, the health authorities “enroll” the populations, asking them to adopt preventive behavior and to go for a consultation in the event of illness. But the individuals targeted by these injunctions may decide to resist them. To understand this resistance, a first step consists in documenting how these individuals perceive the risk to be managed. This is what my team did in 2018 in collaboration with a social science team by conducting an exploratory survey to study risk perceptions at Magal.

These surveys have shown that beyond the risk of an epidemic, 92% of those questioned believe that Magal can promote an epidemic. However, 49% put the risk of catching a disease into perspective. Other beliefs can act as a barrier to taking preventive measures (86% think prayers protect against disease), knowing that the majority (55%) admit that it is difficult to follow prevention advice and hygiene during the Magal.

It should be remembered that the slogan “Learn to live with the virus” invites everyone to be aware that the danger (the virus), the enemy, is there, everywhere, and that every precaution must be taken not to be contaminated and not spread. This therefore amounts to respecting barrier measures, wearing a mask, etc. This attitude is very different and far preferable to that adopted by some Senegalese, namely wanting to “live with the virus”, which would consist in letting the virus circulate and contaminate the population, knowing that only the strongest will survive.

The strategies and modalities for celebrating the Magal of Touba, in the context of Covid-19, should, as far as possible, integrate this important paradigm, in order to avoid a catastrophic spread of the epidemic, given that the medical resources available during the event are not optimal. These various health and socio-anthropological data allow us to propose measures of resilience to Covid-vid-19, health and safety measures, major decisions and awareness-raising.

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Some useful recommendations

According to the traditional methods of grouping disciples in Touba, measures to mitigate the risk of transmission of Covid-19 could nevertheless be considered. These measures, the effects of which on the containment of the current rate of spread of the virus could not however be guaranteed, are essentially:

1) put in place a system intended to prevent and deal with all risks and, more generally, to provide resident populations and pilgrims with the health care necessary to fight against Covid-19;

2) invite those at risk of severe Covid-19 due to their age or chronic health problems to refrain from participating in the pilgrimage this year;

3) invite the hosts of the Magal and the dahiras – an association serving as a link between the faithful and their spiritual guides – to limit the number of residents in their places of reception and to better organize their cohabitation;

4) provide free and en masse protective masks for as many pilgrims of the Magal as possible;

5) strengthen the supply of handwashes, hydro-alcoholic gel, soaps and other types of materials and products useful in the fight against Covid-19.

Religious and social gatherings (see photos on places visited by pilgrims), animal slaughter (see photos on animal slaughter), gatherings in kitchens, etc. are current activities of Magal. Therefore, preventive measures, including risk communication and community participation strategies, aimed at individuals, families, communities and governments, are needed to convey messages about behavior in the community. adopt and promote the adoption of essential measures to prevent and reduce as far as possible the spread of infection.

Participants must strictly adhere to these recommendations, as social or physical distancing will be difficult in the context of Magal. Monitoring the circulation of the virus among pilgrims will be of utmost importance. These recommendations are the subject of a report which has been submitted to health and religious authorities. Awareness of this new context of health crisis constitutes an unprecedented challenge for the traditional celebration of the Magal of Touba, whose modalities include gatherings, promiscuity and other highly infectious aspects.

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* Cheikh Sokhna is research director at IRD, Research Institute for Development.

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