Endurance in Observing Ramadan amid the Coronavirus Outbreak

In an article titled “Ramadan Fasting amid Covid 19 Pandemic”, the author mentioned an assumption that fasting for approximately 14 hours a day in a month will reduce body immune system. This is supported by a fatwa issued by Muhammadiyah stating that “health workers may leave Ramadan fast”. Logically, if fasting is considered to increase the immunity, then it is obligatory for the medical personnel to observe fast, a statement which contradicts the fatwa. Moreover, in Indonesian Lawyer Club (ILC) forum, doctors told a fact that many health workers contract Covid-19 due to some reasons, such as the lack of food, eating less nutritious food, consuming egg every day, etc. This fact was responded by the Jakarta Governor who immediately instructed his staff to provide nutritious food for those health workers, and so forth.

Previously, some readers of the first article responded it with delivering some arguments based on some research in foreign countries published in media such as Kompas, Hidayatullah, and some others. These research were released before the pandemic, stating that fasting can improve the immune system. After a careful reading, the research are still inconclusive and debatable, as explained by Professor Valter D. Longo et al. (2014), who said “We could not predict that prolonged fasting would have such a remarkable effect in promoting stem cell-based regeneration of the hematopoietic system”. The nature of Ramadan fast is a prolonged one, therefore, the findings cannot be taken as a rationale for Ramadan fast. A study by some researchers from Israel, Italy, and Morocco (2017) published in a journal “Frontiers in Immunology”, suggests that “The influence of Ramadan fasting on immune system regulation remains elusive; …” However, some British experts were skeptical of the research. Dr. Graham Rook, emeritus professor of immunology at University College London, said the study sounded "improbable".

Accidentally/Fortunately, the author obtains a corona virus prevention manual titled "The Coronavirus Prevention Handbook, 101 Science-Based Tips That Could Save Your Life.” The Chief Editor is Wang Zhou, MD, Chief Physician of Wuhan Center for Disease Control and Prevention.

Probably, to show the quality, credibility and scholarship in dealing with Covid-19, he introduced his position, work experience, achievements, and expertise. There are several Editors in Chief involved in the writing process, including Wang Zhou, Qiang Wang, Ke Hu, Zaiqi Zhang, the list is 3 pages long, and so it is not written here. They handled thousands of cases of people infected with the corona virus in Wuhan, China, and carried out various methods and experiments for 2-3 months. Some of them passed away and the majority can recover from Covid-19. Most Chinese people welcome these doctors as ‘heroes’ when they returned to their hometown. Dahlan Iskan (the former State-Owned Enterprises (SOEs) Minister) has once described this touching moment with compliment in his article which went viral.

This book was written, as stated by Nanshan Zhong in the Foreword that “Given the fact that no effective medicine is available for viral infectious diseases, the preventive measures including control of the source of infection, early detection of patients, cutting off transmission, and protecting susceptible population are paramount. Although medical institutions and workers are the main force fighting the disease, public participation is also indispensable for a rapid epidemic control. Therefore, it is extremely important to disseminate the relevant information to the public. With that in mind, Professor Wang Zhou of the Wuhan Center for Disease Control and Prevention organized a panel of experts to compile this Handbook about the overview of the coronaviruses and its transmission, detection and treatment of the disease, precautions for individuals and public places, and basics about contagious diseases. With graphic illustrations and plain language, this book is intended to serve as a systematic introduction to the scientific knowledge on COVID-19.” (2020).

To the author, this book can serve as a scientific reference to prevent the Corona virus transmission. Besides having expertise and experience in the use of experimental methods involving thousands of people, these doctors are mandated to help contain the same case in Italy, America, and Indonesia. One of the guidelines mentioned in the book is “What lifestyle is recommended amid the outbreak of COVID19?” Wang Zhou (2020) explains it as follow.

1. Eat high-protein foods daily including fish, meat, eggs, milk, legumes and nuts, keep an adequate intake based on daily diet. Do not eat wild animal meats.
2. Eat fresh fruits and vegetables every day, and increase the intake based on daily diet.
3. Drink no less than 1500 mL of water per day.
4. Have a varied, diverse diet of different types, colors and sources. Eat more than 20 kinds of food every day. Eat a balanced diet of animal- and plant-based foods.
5. Ensure enough intake of nutrition based on the regular diet.
6. Undernourished, elderly people and patients with chronic wasting diseases are recommended to supplement with commercial enteral nutrition solutions (foods for special medical purpose), and supplement no less than an extra 2100 kJ daily (500 kcal).
7. Do not fast or go on a diet during an epidemic of COVID-19.
8. Ensure regular rest and a minimum of 7 hours of sleep each day.
9. Start a personal exercise regimen with no less than 1 hour of exercise per day. Do not participate in group exercises.
10. During an epidemic of COVID-19, it is recommended to supplement with multi-vitamins, minerals, and deep-sea fish oil.

The summary of the guideline is as the following:

1. We need to eat proper nutritious food and keep an adequate intake based on daily diet.
2. Do not fast or go on a diet.
3. Exercise and take a good rest.

Hence, it is clear that based on the reference explained by the experts, i.e. doctors in Wuhan, fasting is forbidden amid the pandemic of Covid-19. The author’s assumptions about the effect of fasting, which can reduce immunity and cause the society unprepared for coronavirus infection, are elicited from experts and experimental research. The research mentioned is a trial and error by doctors in Wuhan to prevent or contain the corona virus and help thousands of patients to recover from it despite some deaths.

Thus, this finding is in contrast to the research of Professor Valter D. Longo and researchers from Israel, Italy and Morocco, where the object of research is healthy people. The current case is related to corona virus outbreak, therefore, the recommendation of doctors in Wuhan is surely more valid.

If the problem is analyzed logically and systematically, then the way to promote immunity and to prevent the infection of corona virus is having adequate intake based on daily diet and nutritious food. Otherwise, the different situation occurs. When a person consumes no food or lacks nutritious food, his immunity weakens and vulnerable to get infected. A good analogy is nutritious food and drinks in the body functions as fuel in a car. No matter how good the drive system in a car is, without adequate intake (gasoline), the vehicle cannot start.

Translated from "Seberapa Daya Tahan Puasa Ramadan Menghadapi Serangan Corona (6 April 2020)"

Related article

Part 1 "Ramadan Fasting amid COVID19 pandemic"
Part 2 "Making up for Missed Ramadan Fasts Collectively"
Part 4 "Is observing Ramadan fast better than taking advantage of the concession given by Allah?"
Part 5 "Weighing The Advantages and Disadvantages of Observing Ramadan Fast amid COVID-19 Outbreak Compared to That When the Pandemic is Over"

Translation Team

Ummu Lathifah Ahmad, M.Pd
Panca Andi Wibowo, SE
Siti Muhayaroh, S.Pd