Safer pilgrimage in the pandemic age

In our latest module, Professor Hinde Iraqi sets out the steps healthcare professionals should take to support safe pilgrimage for their Muslim patients with diabetes in the era of COVID-19.

Performing Hajj – a pilgrimage to Mecca – at least once in your lifetime is one of the Five Pillars of Islam. As the largest mass gathering in the world it also presents particular hazards in the time of a COVID-19 pandemic, exacerbating the challenges many pilgrims with diabetes already face in fulfilling this religious duty.

With so many pilgrims gathered together in often confined spaces, the risk from COVID-19 is a major consideration for any pilgrim. But as Professor Iraqi spells out, the risk for people with diabetes is significantly greater. “Patients with diabetes are at a greater risk of developing a severe manifestation of COVID-19, with a resultant higher risk of mortality due to respiratory complications,” she says. “The combination of COVID-19 and diabetes affects inflammatory and immune responses resulting in an increase in hospitalisation and death of people with type 1 and type 2 diabetes. Studies have shown that people with type 2 diabetes have nearly twice the risk of dying from COVID-19 when compared to those without type 2 diabetes, while people with type 1 [diabetes] have a nearly 3.5-fold risk of dying from COVID-19 compared to people without type 1.” 

Coupled with this, the rites of Hajj – several of which involve challenging physical activity – can present other hazards for people with diabetes, independent of the risk from COVID-19. As well as the danger of other infectious diseases, some of the rites of Hajj can put people with diabetes at a higher risk of developing complications – particularly hypoglycaemia and foot problems, but also hyperglycaemia, diabetic ketoacidosis (DKA), hyperglycaemia hyperosmolar state (HHS), dehydration, cardiovascular and renal disease. In addition, some practices during the Hajj may put them at greater risk of certain diseases of the eye.

So what steps should healthcare professionals take to help their patients with diabetes to fulfill this religious duty? One of the key recommendations Professor Iraqi urges upon any healthcare professional with patients considering undertaking the Hajj is a consultation one or two months before the pilgrimage is due to take place. “People with diabetes planning to perform Hajj should be encouraged to consult their healthcare provider before the pilgrimage,” she says. “An assessment must be made of their health status to determine their fitness for the Hajj journey in the COVID-19 era. This should consider the needs of individuals and would usually include the discussion of many points, including infection-prevention measures such as social distancing and hygiene maintenance, diabetes review and estimation of the risk for each individual. Additional precautions are needed for high- and very high-risk individuals who wish to perform Hajj despite the risk – such as, for example, those with uncontrolled blood glucose levels and/or with an elevated risk of cardiovascular complications. They also need to be informed about current vaccination status and identification and planning for any further vaccination required; any further evaluation needed before the Hajj journey; the importance of regular self-monitoring and patient education and access to education and support. And of course, any additional COVID-19-specific advice to support a safe pilgrimage.”

For a more complete understanding of how to support people with diabetes to perform Hajj safely, enrol on Professor Iraqi’s module ‘Diabetes, Hajj and COVID-19’.