https://orcid.org/0000-0002-7924-8425
On 11 March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Population densities and intensity of social contacts are the main drivers for propagation and amplification of this novel respiratory virus SARS-CoV-2.1 Hence, mass gatherings are a risk factor for rapid spread of COVID-19.
Malaysia has recorded the highest number of COVID-19 cases in Southeast Asia (4817 cases and 77 deaths as of 13 April 2020) (Figure 1). The first case was reported on 25 January 2020 involving three Chinese-national from Wuhan who entered Malaysia on 23 January 2020 from Singapore. Since then, positive cases gradually increase to 22 on 15 February 2020 which remain plateau for nearly 2 weeks. It seems that the containment measures (contact tracing and isolation) practiced at that time were effective to prevent disease spread. However, several new cases were reported from 28 February 2020 to 14 March 2020 and the number increased to more than 4000 cases by 1 April 2020.2
More than 35% of the COVID cases in Malaysia are directly linked to the Sri Petaling mass gathering that took place on 27 February 2020 to 1 March 2020. The Sri Petaling gathering is a Moslem missionary movement attended by more than 19 000 people, including 1500 from India, South Korea, Brunei, China, Japan and Thailand.3 This religious gathering involved follower of Tabligh, the largest Islamic missionary group with the aim to urge Moslems to practice Islam by following Prophet Muhammad’s way of life, in its perfection. Part of this movement involved an annual gathering of Tablighi from all around the world, in which participating countries took turn to organize this event. Tablighi gathering involved the sharing of communal space such as prayer hall during congregational prayers and sermons, collective eating from one plate and sharing of sleeping area.
The Sri Petaling participants were urged to come forward to the nearest Ministry of Health (MoH) facility in order to be tested. The plead to come forward was made in official press conferences and social medias. Those who did not come for the test were traced based on their addresses. Health Ministry of Malaysia was working together with the police to ensure that all participants be tested immediately even though they are not showing any symptoms. As on 13 April 2020, 19 032 tests were conducted from a total of 21 920 samples taken. From these samples, 1701 samples were positive. This contributes 35% from the total number of COVID-19 cases, the biggest cluster so far in Malaysia.
The Sri Petaling event became the catalysis for the subsequent spread of COVID-19 in Malaysia. Rapid identification and isolation of cases as well as contact tracing is logistically very challenging in the context of such a mass gathering with many participants returning to their countries of origin. In response, the government enforced movement control order under the Prevention and Control of Infectious Disease Act 1988 and the Police Act 1967 as a mitigation strategy to prevent COVID-19 starting from 18 March 2020 to 31 March 2020. In this phase, social distancing was adopted by closing of all government and private premises (except those in essential services) including all kindergartens, schools and institutions of higher learning. The movement control order also includes prohibition of mass movements and gatherings regardless of the purpose. The obligatory Friday prayer was also suspended and replaced by Zohor prayer (daily midday prayer) at home.
COVID-19 cases in Malaysia from 25 January 2020 until 14 April 2020
However, the lag time between the Sri Petaling gathering and movement restrictions and social distancing allowed further spread of COVID-19 (Figure 2). As the attendees of Sri Petaling gathering had returned to their respective hometowns in other parts of Malaysia, attended their local mosques for mass prayer and participated in various other cultural ceremonies, second generations of COVID-19 cases started to sprout linked to the Sri Petaling gathering. One of the sub-cluster is in Simpang Renggam, Kluang Johor in South Malaysia, where a sharp increase in COVID-19 cases was reported after 15 March 2020.2 The two main areas in Simpang Renggam that were affected were due to religious classes and a wedding reception attended by participants from the Sri Petaling gathering as they were not compliant to isolation and quarantine measures. Since then, more than 200 positive cases of COVID-19 were reported from Simpang Renggam. Subsequently, the Malaysian government enforced Enhanced Movement Control Order (EMCO) to the two areas in Simpang Renggam effective from 27 March 2020.4 Throughout this period, residents were ordered to stay at home while visitors were not allowed to enter the quarantined areas. All entry and exit points were monitored by the Armed Forced and Civil Defense Force to ensure 100% compliance. Basic necessities such as food and medicine were supplied by the Malaysian government until the EMCO was lifted on 14 April 2020. In addition, phase 2 of the movement control order was announced to the rest of the country effective from 1 April 2020 until 14 April 2020 to curb further transmission. Phase 2 involved tighter implementations in which essential services such as supermarkets, petrol stations and eateries were only allowed to operate within a restricted time. Failure to comply can result in imprisonment and fine.
Local spread of COVID-19 cases originated from Sri Petaling, Kuala Lumpur
International spread of COVID-19 cases originated from Sri Petaling, Kuala Lumpur
Sri Petaling gathering have also cause regional spike of COVID-19 cases across Southeast Asia. Nearly, 10% of attendees were overseas participants from Brunei, Thailand, Cambodia, Vietnam, the Phillipines and Indonesia. In fact, there were also participants from China and South Korea. When these overseas participants returned to their respective countries, cases linked to this gathering were reported across Southeast Asia (Figure 3). Many participants, unaware that they have contacted the virus from the Sri Petaling gathering, did not practice social distancing and 14 days recommended isolation upon returning to their hometown. In Brunei for example, two participants from Sri Petaling was the country’s first positive COVID-19 case before the figure jumped to 136 as off 14 April 2020. Similarly, 13 Indonesians and 19 Filipinos have also contacted COVID-19 virus from their involvement in the Sri Petaling gathering. Other countries affected were shown in Figure 3.
Malaysia is not alone in announcing the prohibition of religious mass gatherings. Increasingly, evidence is mounting that mass gatherings have led to further spread. Effective from 27 February 2020, the Saudi government has suspended Umrah visa in their effort to break the chain of transmission of COVID-19.5 Based on our experience, we recommend that mass gatherings, be it for religious or other purposes, should be cancelled and banned throughout the period of the COVID pandemic.
Authors Contributions
N.F.C.M. and H.A.E. conceived the idea and wrote the manuscript. M.K.A.A.R. conducted data analysis. S.S. and M.K.A.A.R. interpreted data and contributed to writing.
Funding
This work was supported by Incentive Grant Universiti Sains Malaysia (Grant number: 1001/PPSK/8123055).
Authors Statements
No potential conflict of interest was reported by the authors.
