The Centre for Evidence-Based Medicine in Oxford has published a review for clinicians looking after people who have symptoms of COVID-19 and are thinking about fasting during the month of Ramadam (23 April 2020 to 23 May 2020).
Ultimately, the final decision to fast or not rests with the individual concerned, in discussion with their clinician and trusted religious authority, the review panel stated.
The panel searched PubMed and Google Scholar databases between 5-21 March 2020 for all studies from database inception using search terms to describe fasting in Ramadan along with terms to describe COVID-19, infection and dehydration. No specific studies looking at fasting in the context of COVID-19 were found.
However, one study recently reviewed the link between intermittent fasting and immunity in Ramadan in light of COVID-19, which found no evidence to suggest an adverse effect from fasting during the COVID-19 pandemic on asymptomatic healthy individuals who have previously fasted safely. This conclusion is in line with World Health Organization interim guidance that for otherwise healthy individuals who have previously fasted safely, it is safe to fast this year, while COVID-19 patients may consider religious licenses regarding breaking the fast in consultation with their doctors, as they would do with any other disease.
However, patients with fever and prolonged illness secondary to COVID-19 can become severely dehydrated and are at risk for sudden acute deterioration. As such, these patients should not fast (or cease fasting) and ensure adequate hydration, the review said.
Prior to commencing fasting, any comorbidities need to be risk-stratified and discussed with the patient’s clinician. In light of this, the review panel have developed a risk matrix spanning a range of conditions with a view to help patient-centred shared decision-making.
