Analysis of covid-19 burden, epidemiology and mitigation strategies in muslim majority countries

Background: Muslim majority countries have experienced a considerable burden of COVID-19 infection. However, there has been a relative lack of research comparing COVID-19 outbreaks and responses between Muslim-majority countries. Aims: This study aimed to analyse COVID-19 burden, epidemiology and mitigation strategies in Muslim-majority coun-tries. Methods: We use a mixed-methods approach to describe the course of the COVID-19 pandemic throughout the Islamic world, highlight the range of non-pharmaceutical interventions used and the speed with which they were implemented, and investigate reasons behind the differing responses between Muslim-majority countries. The number of cases and deaths per million population, and the mean time taken to implement a range of policies, were compared across the Islamic world. Cases per million population and the mean estimated doubling time for cases was compared between Mus-lim-majority countries on the basis of governance systems, rapidity of institution of mitigation strategies and conflict groups. We also evaluated pushback to implementation of measures within MMCs, especially from religious quarters. Results: Non-democratic regimes had much shorter doubling time of cases compared to functional democratic Mus-lim-majority countries (mean 33.9 versus 66.5 days, P = 0.002) and a significantly greater proportion of countries appeared to have flattened the curve by 1 June 2020 (43.8% versus 12.5%, P < 0.03). The doubling time was also significantly greater among countries who implemented lockdown and mitigation measures early (66.7 versus 16.7 days, P < 0.003). Conclusion: Our analysis indicates wide diversity in the COVID-19 response across Muslim majority countries with clear indication that functional democracies were able to contain the epidemic significantly better than nondemocratic regimes. Future analysis should focus on determination of sub-national differentials and risks as well as targeting of interventions.