Brain, Behavior, and Immunity xxx (xxxx) xxx

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Brain Behavior and Immunity

journal homepage: www.elsevier.com/locate/ybrbi

Viewpoint Anti-pandemic lessons and altruistic behavior from major world religions at the time of COVID-19

Jaouad Bouayed a,*, Feng Q. Hefeng b,c, Mahesh S. Desai b,d, Bin Zhou e, Tsuriel f, Rachid Soulimani a, Torsten Bohn g a Universit´e de Lorraine, LCOMS/Neurotoxicologie Alimentaire et Bioactivit´e, 57000 Metz, France b Department of Infection and Immunity, Luxembourg Institute of Health (LIH), 29, rue Henri Koch, L-4354 Esch-sur-Alzette, Luxembourg c Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, D-45122 Essen, Germany d Odense Research Center for Anaphylaxis, Department of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark e Translational Research Center for Medical Innovation, 1-5-4 Minatojima-minamimachi, chuo-ku, Kobe 650-0047, Japan f Ariel University, 65 Ramat Ha’Golan St, Ariel, Israel g Nutrition and Health Research Group, Department of Population Health (DoPH), Luxembourg Institute of Health (LIH), 1 A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg

ARTICLE INFO

Keywords: Pestilence SARS-CoV-2 Christianity Islam Confucianism Buddhism Hinduism

The COVID-19 induced global crisis has highlighted the importance The concepts of quarantine and isolation are embedded in religion of self-isolation for the sake of the health of larger communities, and around the world. In the Judaism, the Babylonian rules that “if religious background may be an important factor. Altruistic behavior is a there is plague in the town, go home” (Rashi, 2020). 200 years ago, trait that has been existing within the puzzling repertoire of human Akiva Eger received a letter of appreciation from the King of behavior. Religion-related altruistic behavior, including quarantine and Prussia, Friedrich Wilhelm III as he did institute regulations including isolation, has been successfully employed as an adapted defense strategy directives to isolate areas of infection that greatly helped preventing against pandemics, constituting a common and shared legacy that cholera spread in (Rashi, 2020). mankind has had to adopt to fight their spread. It is motivated by a In Leviticus in the bible (13:46) it is stated: “As long as they have the perceived reward from God, such as entry to paradise, and can thus be disease they remain unclean. They must live alone, they must live regarded as a reward behavior. It could be argued that fear of punish­ outside the camp”. In 1666, in line with this statement, such altruist and ment - receiving a fine or social outing - are likewise drivers to follow cautious behavior was seen in Eyam, UK. This remote tiny hamlet was protective orders. However, such measures are often not in place (not hit by the Great Bubonic Plague. It was apparently infected via flea- during early phases of a pandemic), leaving unselfishbehavior including infested clothes arriving from the already plagued London. Following patience as the main protective defense strategy. Altruistic behavior the perishing of the first victims, the rector of the village, William may be more effective than enforced behavior, as it can interact with the Mompesson, decided to quarantine the village, in order to prevent its brain’s dopamine reward system, involving pleasure and satisfaction further spread. Despite not being very popular, he convinced his pa­ (Fig. 1). rishioners to close the village, neither allowing anyone in nor out. He

* Corresponding author. E-mail address: [email protected] (J. Bouayed). https://doi.org/10.1016/j.bbi.2021.04.023 Received 25 February 2021; Received in revised form 27 April 2021; Accepted 28 April 2021 Available online 1 May 2021 0889-1591/© 2021 Elsevier Inc. All rights reserved.

Please cite this article as: Jaouad Bouayed, Brain, Behavior, and Immunity, https://doi.org/10.1016/j.bbi.2021.04.023 J. Bouayed et al. Brain Behavior and Immunity xxx (xxxx) xxx

Fig. 1. Interrelation of altruistic behavior in the background of religion and its relation to disease spread during a pandemic such as COVID-19. Fear of fine/punishment and social outing may likewise play a role. As history has shown, religion is an important element of worldwide culture that has been influ­ encing human behavior, thinking, ideals and moral concepts, among others. During the history of the Homo sapiens, altruistic ancestral behavior, also independently from race, religion and geography, is a common and shared legacy for all of humanity, on which one may contemplate and learn lessons from our heritage.

was fully aware that this was a death sentence for many of those who Interestingly, such altruistic appearing behavior including self- stayed and were not yet infected – including his wife who succumbed to imposed isolation is also practiced by many social animals faced with the pestilence, though he himself survived the infection. Such actions deadly infectious diseases, including honeybees, ants, and badgers who required a lot of stamina from the villagers, as most business and trade die far from their congeners in isolation (Shakhar and Shakhar, 2015). suffered from this self-imposed isolation during 4 months, not to Self-withdrawal is also observed in ill dogs who leave their owners, mention the psychological effects of not receiving family and friends, dying alone (Shakhar and Shakhar, 2015). Thus, collective behavior and to depend on external delivery of food and other goods. A strong defense strategies based on an altruistic approach, as applied by our conviction was surely needed to overcome these human needs, and ancestors, appear as a natural and very effective method to protect surely the actions can be described as selflessor altruistic, as almost half communities against pandemics. of the Eyam villagers succumbed to the disease, but avoided spread to Collective altruistic behavior, whether based on religious conviction other communities. or on other ethical considerations and cultural factors, prevents the In Islam, the prophet Muhammad (570–632) said “If you hear of an community against individual, irresponsible and super-spreading outbreak of plague in a land, do not enter it; but if the plague breaks out behavior exerted by a minority. Regarding COVID-19, only 10% of the in a place while you are in it, do not leave that place” (Khan, 1996). In population was said to be responsible for 80% of its transmission 639, the commandment of the prophet Muhammad was executed by the (Bouayed and Bohn, 2021a, 2021b). Even when seen from a modern Caliph Omar ibn al-Khatab and his top commander Abu Ubayda ibn al- clinical vantage point, such early isolation measures appear most effi­ Jarrah during the plague of Amwas (a village near Jerusalem). When cient. Asymptomatic, pre-symptomatic individuals and those with mild reminded by the citation of the Prophet, the Caliph interrupted his symptoms constitute the key to the COVID-19 transmission (Bouayed expedition toward Syria, where the plague was spreading, and returned and Bohn, 2021a, 2021b); alone the pre-symptomatic SARS-CoV-2 in­ with his companions to Medina, the capital, saying his famous Islamic fections may suffice to sustain the pandemic (Ferretti et al., 2020). expression “We flee from the God’s destiny to God’s destiny”. His top In Wuhan, the recent several-month strict lockdown could not have commander refused to leave Syria, even if he received the convocation succeeded without the long-established isolation rules and deep-rooted of the Caliph to meet him, recalling the prophet’s commandment pro­ collectivism teachings embedded in Confucianism, the core belief of hibiting Muslims to fleeingor enter a plague-affected land. Regrettably, Chinese, Japanese and other Asian populations. For instance, in The the plague ended up killing up to 25,000 soldiers and their relatives, Analects of Confucius (475–221BCE), it is documented that “Confucius’ including Abu Ubayda ibn al-Jarrah. student Ran BoNiu who caught an infectious disease (scabies), was only Thus, isolating entire areas, as exemplified in the history to prevent visited by Confucius from the window”. further spread of a pandemic, impedes among other, pre-symptomatic Consequently, such religion-driven behavioral patterns have been individuals moving to neighboring places, infecting fellow citizens and aiding to limit the spread of infectious diseases. As demonstrated by our reducing the exchange of contaminated goods. In these isolated areas, ancestors during pandemics, our modern society still relies on such the number of fatalities was striking, but the human sacrificewas not in altruistic attitudes, limiting the spread of infections, including self- vain as it allowed to save surrounding communities. This has also been isolation, social withdrawal/distancing and quarantine. realized in earlier cultures. Smallpox, plague and cholera were often associated with avoiding villages or marking a certain area by putting a References flag at the top of a tall object such as a tree to denote possibility of disease spread. In the Chinese Tang Dynasty, Buddhist monks isolated Bouayed, J., Bohn, T., 2021a. Adapted sickness behavior – Why it is not enough to limit and treated patients with infectious disease in their temples. As recorded the COVID-19 spread? Brain Behav. Immun. 93, 4–5. https://doi.org/10.1016/j. – bbi.2020.12.028. in the Book of Changes (1046 771BCE), if you feel sick, you should Bouayed, J., Bohn, T., 2021b. Behavioral manipulation—key to the successful global actively isolate yourself to avoid further spread. In Hinduism, after the spread of the new coronavirus SARS-CoV-2? J. Med. Virol. 93 (3), 1748–1751. death of a relative, family members observe an isolation period from the Ferretti, L., Wymant, C., Kendall, M., Zhao, L., Nurtay, A., Abeler-D¨orner, L., Parker, M., Bonsall, D., Fraser, C., 2020. Quantifying SARS-CoV-2 transmission suggests public, a practice that prevents potential diseases spreading from a epidemic control with digital contact tracing. Science 368 (6491), eabb6936. corpse. https://doi.org/10.1126/science:abb6936.

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Khan, M.M., 1996. The English translation of Sahih Al-Bukhari. Ref: 5728. In-book Shakhar, K., Shakhar, G., 2015. why do we feel sick when infected-can altruism play a reference. Sahih al-Bukhari Book 76, Hadith 43. role? PLoS Biol. 13, e1002276. Rashi, T., 2020. Justificationsfor medical quarantine in jewish ethics. J. Relig. Health 59 (6), 2678–2691.

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