It is noteworthy that the expression of this receptor is higher in people of Asian countries than in Europe and the United States, and also in men more than women ( 15, 16). One of the most important issues in recent research is that COVID-19 has a surface receptor on lung cells, esophageal epithelial cells, and ileum enterocytes: this is called the angiotensin converting enzyme 2 (ACE-2) ( 13, 14). It has been reported that many pilgrims are hospitalized due to respiratory illness during these gatherings ( 10– 12). Also, more than 20 million people visit Karbala in Iraq, another important Shia Muslim religious event, which goes on for 40 days. About 2.5 million Muslims from Islamic countries travel to Mecca each year to perform the Umrah pilgrimage. Islamic countries have some of the most populous political and economic centers in the world with special religious and cultural practices, such as the annual Hajj of Mecca in Saudi Arabia, the pilgrimage of Imam Reza in Mashhad, and the consumption of unique animal foods such as camels ( 8, 9). 84% of patients die and at least 10% show symptoms ( 7). So far, the exact number of deaths from COVID-19 is not known, due to the actual number of patients not having been identified, but previous studies have reported that ~2. Older people with underlying health problems, and/or immunodeficiency, are more likely to have a poor outcome when they are infected with the virus ( 5, 6). Humans have failed to fight this deadly virus successfully, and about 6 million people worldwide have been infected with the virus, thousands of whom have died. It has been several months since COVID-19 spread from China, but in such a short time a pandemic has occurred due to its very high spreading capability ( 5). However, in 2019, coronavirus developed a more severe respiratory disease in lung cells, caused by a novel coronavirus called COVID-19. The MERS-CoV virus was first reported in 2012 in Saudi Arabia from a sputum sample of a patient with pneumonia ( 4). The most well-known coronaviruses are human pathogens, including Middle East Respiratory Syndrome (MERS-CoV) and Acute Respiratory Syndrome (SARS-CoV), which have killed large numbers of people in Asia and the Middle East ( 3). Since human coronaviruses have been identified around the world, they have been identified as mild human pathogens. Fasting means avoiding drinking and eating over time periods that vary from 13 to 18 h a day, depending on the season ( 2). One of the religious rituals of healthy adult Muslims is fasting from sunrise to sunset in Ramadan (during 29 or 30 days). Muslims were estimated to make up about one-fourth (1.6 billion) of the world's population, and Islam is the second largest religion after Christianity ( 1). In this study, we will look at the proposed health effects of fasting and its impact on the immune system, the effects of Ramadan intermittent fasting on resting values and responses of immunological/antioxidant biomarkers in elite and recreational athletes, together with the important health, nutrition, and exercise advice that fasting people need to follow in the event of a COVID-19 outbreak. Therefore, the proposal of usable exercise programs and effective nutritional strategies is imperative. In such an unprecedented situation, there are many Muslims who doubt whether they can fast or not. Lack of facilities, poor health and many traditions that lead to public community gatherings have made many Islamic countries susceptible to this dangerous virus. Moderate exercise training and proper nutrition are the most important factors to support immune function. In dealing with COVID-19, maintaining good hygiene and supporting the immune system are effective, preventive approaches. The pandemic COVID-19 has made Ramadan very important this year because the virus has infected millions of people around the world and killed thousands, especially people with immunodeficiency. This year (2020), Ramadan is very different from previous years due to the outbreak of a terrible microscopic giant called coronavirus disease 2019 (COVID-19).
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