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Does fasting during Ramadan raise the infection risk?

Gudrun Heise
May 5, 2020

Ramadan is a holy time for Muslims where they pray together, fast together and break the fast together. Fasting is a strain on the body, but does it also increase the risk of getting infected with the coronavirus?

A boy praying in a mosque in Sri Lanka
Image: Reuters/D. Liyanawatte

During Ramadan, the Islamic month of fasting, Muslims abstain from eating and drinking from sunrise to sunset. After sunset they break the fast. There are about 16 hours in-between.

Normally, a healthy body becomes used to the change without any problems and switches to so-called starvation mode, meaning that it gets by with less energy intake while still functioning. Giving up food is, in fact, not such a big deal for the body; a bigger problem is the lack of fluids. Especially people who are ill need a lot of them, because fluids help the body to cope with illnesses or recover from them.

There is as yet no research on whether fasting leads to a weakening of the immune system, theoretically making it easier for the novel coronavirus to enter the body. After all, the coronavirus has created a situation that is new for everyone — including scientists.

Caution with preexisting conditions

However, people who have health problems must think very carefully about how far they can tolerate fasting, and talk to their doctor beforehand. The World Health Organization (WHO) advises COVID-19 patients to consult a doctor and possibly abstain from fasting this year. Ultimately, only a doctor can judge whether a person is too ill or too weak or whether the risk of infection is too high. 

Read more: Ramadan under lockdown: Muslims start an unusual month of fasting

Muslim patients perform Ramadan prayers at the Singapore Expo Convention Hall and Exhibition Centre, which has been converted into a facility for patients recovering from the coronavirus disease (COVID-19), in Singapore, April 24, 2020.
There will be no large meetings this year due to the risk of infectionImage: Reuters/M. Nasiruddin

Islamic religious communities generally advise people to postpone fasting if there is a life-threatening risk or the danger of delaying the healing of an illness. There will also be no large gatherings this year. The Iftar, or breaking of the fast, will take place mainly at home and in the family circle.

The exceptions

The elderly, sick and infirm, pregnant women and travelers are traditionally exempt from fasting. Women who are breastfeeding or menstruating and children before puberty also belong to this group and do not have to follow the normal strict rules during Ramadan.

Chronically ill people, for example, need energy to fight whatever disease they have. According to the World Health Organization (WHO), however, healthy believers can carry out Ramadan this year amid the coronavirus pandemic in the same way as they do every year. The WHO does not draw a connection between fasting and a greater risk of infection. 

Read more: Intermittent fasting: Is it worth the hype?

Not all fasting is the same

Fasting during Ramadan is different from many other forms of the practice that are used in a bid to lose weight, purify the body or detoxify. When breaking the daily fast after sunset, Muslims are allowed to eat and drink as much as they wish. This replenishes the body's reserves — until the next evening. So it is not a complete renunciation of food and liquid. 

Read more: How to stay healthy at home during the coronavirus lockdown

Sudanese men gather in prayers in a street in the capital Khartoum after breaking their fast during the Muslim holy month of Ramadan on April 25, 2020.
According to the WHO, healthy believers can carry out Ramadan just as they do every year.Image: Getty Images/A. Shazly

Fasting between sunrise and sunset can be easily bridged by a healthy person. The WHO also deals with the necessary health requirements for participating in fasting and has compiled a page with tips for Ramadan. There it says: "Healthy people should be able to (...) fast as in earlier years." The organization does not see any special risks and dangers from fasting or a need for any restrictions.

The problem begins in the throat

Researchers and doctors now know that the novel coronavirus can settle in the throat and multiply. This is the place where swabs are taken for tests for COVID-19, as it is here that the viral load is highest after infection.

The viruses can then spread further by droplet infection if people sneeze or cough. Keeping the throat moist — i.e., drinking a lot — was therefore a recommendation that many doctors gave at the beginning of the coronavirus crisis, saying that it could make it more difficult for the viruses to multiply. 

Read more: Coronavirus: Are outdoor sports healthy exercise or a dangerous risk?