Pandemics and prayer: The impact of cattle markets and animal sacrifices during the muslim Eid festival on COVID‐19 transmission and public health

Globally, as of July 24, 2020, the World Health Organization has reported 15,257,287 confirmed cases of coronavirus disease 2019 (COVID-19), including 628,240 deaths. 1 The causative virus for this global pandemic; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a Betacoronavirus, subgenus Sarbecovirus, which originated in bats and spread within humans following an amplification and/or recombination event in an unidentified mammalian host. 2 The highly contagious virus is spread by human-to-human transmission via droplets or direct contact. 3 This pandemic has caused organized religion, along with adherence to age old traditions, to re-evaluate itself with respect to congregational gatherings, burial rites, pilgrimage and other established acts of worship. 4 One such act of worship which needs to be urgently discussed in the context of COVID-19 is the annual Eid-ul-Adha festival celebrated by billions of Muslims worldwide. Eid-ul-Adha marks a sacred Islamic ritual of mass animal sacrifice according to Islamic principles. During this time domestic animals; including goats, sheep, cattle and camels, are transported en masse from rural to urban areas where they are placed in temporary animal holdings. 5 The animal sacrifice is made per affording household; as such millions of animals are stored for slaughter; oftentimes in unregulated holdings, and health checks are not able to be enforced uniformly. 5 Moreover, freelance/non-professional butchers meet the exponential demand for animal slaughter during this time. 5 Following slaughter, uncooked animal meat is distributed in the community, and animal carcasses, including internal organs, and hides are disposed off within the community. According to the Islamic Lunar Calendar, this year Eid-ul-Adha will be celebrated from 30th July to August 3, 2020 (subject to sighting of the moon). 6 This comes at a time when many Muslim majority countries are stilling struggling with the public health crisis posed by COVID-19, with variable success in controlling the transmission of the virus. The threat posed by COVID-19 during Eid-ul-Adha is twofold. First, mass animal migrations and the fulfill-ment of religious rites by millions will risk an explosive surge in COVID-19 cases due to the ensuing congestion and social mixing within the context of Eid celebrations. Second, our current epidemiologic and phylo-genetic evidence base clearly demonstrates that SARS-CoV-2 has uncertain zoonotic origins and host range, with the potential to spill into many potential animal hosts. SARS-CoV-2 infection is mediated via the viral Spike protein receptor binding domain binding to angiotensin I converting enzyme 2 (ACE-2) receptor, which is preserved in mammals, and is expressed on ciliated bronchial epithelial cells and type II pneumocytes. 7 A structural analysis of ACE-2 receptor in vertebrates has shown artiodactyl mammals (which include domesticated cattle, sheep and goats) express ACE-2 receptors and were classified as medium score for binding to SARS-CoV-2 Spike protein. The authors posited that such animals have some risk of infection, and further investiga-tion into the role of ruminant artiodactyls as reservoirs for SARS-CoV-2 is warranted. 7 This finding has been re-iterated in a comparative x-ray structural analysis of SARS-CoV-2 spike protein receptor binding domain to ACE-2 receptors in humans and putative intermediate hosts. The study showed that cattle and sheep contain only 2 amino