Crowd Management and Strategies for Security and Surveillance During the Large Mass Gathering Events: The Prayagraj Kumbh Mela 2019 Experience.

The Kumbh Mela is the largest religious and spiritual mass gatherings on the Earth. In this way, it remains a source of fascination for vast numbers of Hindus throughout the world. Around 240 million pilgrims participated during Kumbh Mela 2019. The Crowd management and the strategy for Security and surveillance have become a big challenge for such huge gatherings. This paper tries to find out the various risk factors and its management. It examines the role and responsibilities of various stakeholders in crowd management. Despite of some difficulties like lack of knowledge of number of people, crowd psychology and its behaviour pattern, this paper provides a comprehensive approach for risk analysis, preparedness, management and mitigation. The purpose is to make spiritual mass gathering events incidence free and enhance user experience by applying design thinking approach. Although this paper tried to cover all the aspects of crowd management and strategies for security and surveillance during mass gathering events, still many more approaches are there which can be further explored. The mega tent city that accommodates nearly millions of pilgrims in the river bed is significant not only for India, but also for mass gathering research at international level to draw policy. This provides the multifunctional issues to study the mega crowd events. This provides the opportunity to generate the field level evidence and document base for disaster management.

Extended Ecological Restoration of Bacterial Communities in the Godavari River During the COVID-19 Lockdown Period: a Spatiotemporal Meta-analysis.

The unprecedented COVID-19 pandemic has had major impact on human health worldwide. Whilst national and international COVID-19 lockdown and travel restriction measures have had widespread negative impact on economies and mental health, they may have beneficial effect on the environment, reducing air and water pollution. Mass bathing events (MBE) also known as Kumbh Mela are known to cause perturbations of the ecosystem affecting resilient bacterial populations within water of rivers in India. Lockdowns and travel restrictions provide a unique opportunity to evaluate the impact of minimum anthropogenic activity on the river water ecosystem and changes in bacterial populations including antibiotic-resistant strains. We performed a spatiotemporal meta-analysis of bacterial communities of the Godavari River, India. Targeted metagenomics revealed a 0.87-fold increase in the bacterial diversity during the restricted activity of lockdown. A significant increase in the resilient phyla, viz. Proteobacteria (70.6%), Bacteroidetes (22.5%), Verrucomicrobia (1.8%), Actinobacteria (1.2%) and Cyanobacteria (1.1%), was observed. There was minimal incorporation of allochthonous bacterial communities of human origin. Functional profiling using imputed metagenomics showed reduction in infection and drug resistance genes by - 0.71-fold and - 0.64-fold, respectively. These observations may collectively indicate the positive implications of COVID-19 lockdown measures which restrict MBE, allowing restoration of the river ecosystem and minimise the associated public health risk.

Knowledge and transmission risk awareness of tuberculosis among the pilgrims attending a religious mass gathering in India: a cross-sectional study.

BACKGROUND: Tuberculosis infection accounts for more annual deaths than any other single infectious disease, except the Corona Virus infection. It is a significant global issue and India is one of the most affected countries. Religious mass gatherings congregate millions of pilgrims at one place. Over-crowding is a high-risk factor for the transmission of tuberculosis. Knowledge and awareness of the disease are proven prerequisites for the spread-prevention and early diagnosis of tuberculosis. The present study was designed to explore the knowledge of tuberculosis and awareness of disease transmission risk among pilgrims attending a religious mass gathering, the Kumbh Mela (2016) in Ujjain, India. METHODS: Self-reported data on the pilgrims' tuberculosis-knowledge were collected using a cross-sectional study design. A contextual, pre-tested questionnaire was used, using the convenience sampling method. In addition to the anonymous descriptive analyses, a composite knowledge-score was developed to enable comparisons between demographic groups. RESULTS: In total, 1665 pilgrims participated in the study with 38.8 years of mean age and 59% literacy rate. The most recognized symptoms of tuberculosis were "Cough for more than 15 days with sputum" (94%) and "Blood in sputum" (81%). Most participants knew that tuberculosis is an infectious disease (93%) and not hereditary (91%). Additionally, 84% considered it is a potentially lethal disease that requires extensive treatment. However, vaccine awareness was poor (4%). "Direct contact with tuberculosis patient" (78%) and "To be in a crowded area" (4%) were considered as the most important risk factors for tuberculosis transmission. For the composite knowledge-score, a significantly higher mean score was seen among those with at least ten years of schooling compared with illiterates (p <  0.001). Occupation and residency also affected the mean score. CONCLUSION: Most pilgrims attending the Kumbh Mela had basic knowledge of the characteristics of tuberculosis, but some important knowledge gaps concerning the transmission risks associated with crowded situations existed. These gaps need to be addressed in future policies to enable safer mass gatherings and to end the TB epidemic, globally.

Study of Spiritual Health Determinants in Indian Saints (Sadhus) at Ujjain Kumbh Mela (Simhast) 2016.

Spirituality is the oldest and most intrinsic health determinant. Unfortunately, it has surfed rough weather for a reasonable time. In spite of this chronic inattention, still in India we have established communes (saints) who thrive on spiritual living. Though they are an integral part to Indian society, their spiritual health and its determining factors are difficult to find. This study was to estimate the 'spiritual score and rank' of Indian saints and explore its psychological and social associates and predicates. Development of spirituality in Indian saints is practice oriented and multidimensional. This study was conducted in 2016-2017; data collection was done during Kumbh Mela (Simhasta) at Ujjain from 17th May to 16th June 2016. Spiritual health assessment was done by 'spiritual assessment inventory' (SAI), mental health by 'GAINN-SS' and pertinent social factors by self-designed pretested questionnaire. Descriptive, Chi-square, ANOVA and ordinal regression analysis were done by SPSS version 20. Data from 962 participants were analyzed. Their clan breakup stands at: 459 (47.7%) as Shiva followers/Shaviates, 251 (26.1%) Vishnu followers/Vaishnavites and 252 (26.2%) belonged to neutral/Sikhism clan. The mean age for participants was 54.6 years (SD ± 14.65), and mean spiritual score 165.18 (SD ± 10.78). 49.3% cases recorded a spiritual grade ≥ 'good.' Majority had formal education till 10th standard; 576 (60%) and 717 (74.5%) did not raise a family. Gurus (spiritual teachers) imparted spiritual training to 685 (71%), and Puranas (spiritual and moral scriptures) provided spiritual knowledge to 319 (33%). Worldly detachment was the objective in 249 (77%) for pursuance of spiritual life. Both Chi-square and ANOVA showed significant (p ≤ .05) associations of spirituality with participants hailing from spiritual (p ≤ .03) and religious (p ≤ .02) inclined families. Partisan from Vaishnavite clan (Akhada) demonstrated better grade (p ≤ .00). Self-motivated subjects under the guidance of Gurus recorded strong associations with spiritual scale. Role of family and friends was noticeable associates to spirituality. Attainment of nirvana and serving the society had notable spiritual associations. Ordinal regression analysis model also lends support (p < .05) to the clan factor, family background, role of religious and spiritual scriptures, motivation from self- and close quarters, objective of attainment of enlightenment and daily yogic and religious practices as notable factors with positive prediction potentials for spiritual growth. Like other health domain, spirituality has its own determinants which are intrinsic and interdependent. 49.3% of cases scoring spiritual grade ≥ 'good' need to be noted.

Corynebacterium godavarianum sp. nov., isolated from the Godavari river, India.

A Gram-stain-positive, rod-shaped, non-motile bacterium, strain PRD07T, was isolated from Godavari river, India during the world's largest spiritual and religious mass bathing event 'Kumbh Mela'. Molecular analysis using 16S rRNA gene sequencing and phylogenetic analysis reveals the distinct phylogenetic positioning of strain PRD07T within the genus Corynebacterium. The strain demonstrated highest sequence similarity to Corynebacterium imitans DSM 44264T (97.9 %), Corynebacterium appendicis DSM 44531T (97.1 %) and <96.7 % with all other members of the genus Corynebacterium. The G+C content of PRD07T was 68.5 mol% (Tm) and the DNA-DNA hybridization depicts 61.09 % genomic relatedness with C. imitans DSM 44264T. Chemotaxonomic assessment of strain PRD07T suggested presence of C16 : 0 (31.6 %), C18 : 0 (3.5 %) and C18 : 1ω9c (58.6 %) as the major cellular fatty acids. The major polar lipids of strain PRD07T were phosphatidylglycerol, diphosphatidylglycerol and glycophospholipid. Differentiating molecular, phylogenetic and chemotaxonomic characteristics of strain PRD07T with its closest relatives necessitated the description of strain PRD07T as a novel species of genus Corynebacterium for which the name Corynebacteriumgodavarianum sp. nov., has been proposed. The type strain is PRD07T (=MCC 3388T=KCTC 39803T=LMG 29598T).

World's Largest Mass Bathing Event Influences the Bacterial Communities of Godavari, a Holy River of India.

Kumbh Mela is one of the largest religious mass gathering events (MGE) involving bathing in rivers. The exponential rise in the number of devotees, from around 0.4 million in 1903 to 120 million in 2013, bathing in small specified sites can have a dramatic impact on the river ecosystem. Here, we present the spatiotemporal profiling of bacterial communities in Godavari River, Nashik, India, comprising five sites during the Kumbh Mela, held in 2015. Assessment of environmental parameters indicated deterioration of water quality. Targeted amplicon sequencing demonstrates approximately 37.5% loss in microbial diversity because of anthropogenic activity during MGE. A significant decrease in phyla viz. Actinobacteria, Chloroflexi, Proteobacteria, and Bacteroidetes was observed, while we noted substantial increase in prevalence of the phylum Firmicutes (94.6%) during MGE. qPCR estimations suggested nearly 130-fold increase in bacterial load during the event. Bayesian mixing model accounted the source of enormous incorporation of bacterial load of human origin. Further, metagenomic imputations depicted increase in virulence and antibiotic resistance genes during the MGE. These observations suggest the striking impact of the mass bathing on river ecosystem. The subsequent increase in infectious diseases and drug-resistant microbes pose a critical public health concern.

Using mobile technology to optimize disease surveillance and healthcare delivery at mass gatherings: a case study from India's Kumbh Mela.

Background: Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people. Methods: We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals. Results: The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing. Conclusions: Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data.

Wireless Teleophthalmology: A Novel, Low-Cost, Flexible Network Architecture and Its Performance Evaluation for Remote Eye Care Solutions.

INTRODUCTION: This article proposes a novel, cost-effective, flexible, and easy-to-deploy wireless teleophthalmology network architecture and performance evaluation for its potential use in remote areas. This study has used practical telecommunication standards, which is widely deployed throughout India. METHODS: In the proposed scenario, patient's eye images are obtained using a specified imaging modality, and then sent to a server at the primary eye care centre (PECC) using ZigBee a short-range wireless network. It is linked to the main server at the base eye hospital (BEH) through a GSM/UMTS (3G)/WiMAX (Worldwide Interoperability for Microwave Access) network. After diagnostic evaluation of the eye image using various automated diagnostic software, data are sent to a physician in an urban center for further validation, which is connected through GSM/UMTS (3G)/WiMAX network. Performance evaluation of these wireless networks is carried out for their use in teleophthalmology application based on network parameters, namely throughput, average end-to-end delay, and average jitter. It is found that end-to-end delay is the most critical network parameter affecting overall quality of service (QoS) of the proposed teleophthalmology network. RESULTS AND CONCLUSIONS: The results demonstrate that WiMAX is the most suitable network among the considered networks for connecting PECC nodes with BEH main server, and further connecting main server with a doctor on the move. It is also deduced that for a given set of QoS parameters, WiMAX supports a load capacity of 22,000 packets at center nodes and the main server and it performs well even when the mobility speed of doctor exceeds 200 KPH.

Kumbh Mela 2013: Healthcare for the millions.

Mass gatherings pose challenges to healthcare systems anywhere in the world. The Kumbh Mela 2013 at Allahabad, India was the largest gathering of humanity in the history of mankind, and posed an exciting challenge to the provision of healthcare services. At the finale of the Mela, it was estimated that about 120 million pilgrims had visited the site. Equitable geospatial distribution of adhoc health care facilities were created on a standardised template with integrated planning of evacuation modalities. Innovative and low cost response measures for disaster mitigation were implemented. Emergency patient management kits were prepared and stocked across the health care facilities for crisis response. Dynamic resource allocation (in terms of manpower and supplies) based on patient volumes was done on a daily basis, in response to feedback. An adhoc mega township created on the banks of a perennial river (Ganga) in the Indian subcontinent for accommodating millions of Hindu pilgrims. Conventional mindset of merely providing limited and static healthcare through adhoc facilities was done away with. Innovative concepts such as riverine ambulances and disaster kits were introduced. Managing the medical aspects of a mass gathering mega event requires allocation of adequate funds, proactive and integrated medical planning and preparedness.

Technology, Training, and Task Shifting at the World's Largest Mass Gathering in 2025: An Opportunity for Antibiotic Stewardship in India.

The role of antibiotic overuse in intensifying selection pressures and contributing to the emergence of antimicrobial resistance is well established. The Kumbh Mela, a religious festival that occurs in 4 Indian cities of spiritual significance, is the world's largest mass gathering, attracting over 80 million pilgrims in 2013. Digital syndromic surveillance from the 2013 and 2015 Melas demonstrated a consistent pattern of antibiotic overuse, with an antibiotic prescribing rate of up to 31% for all patient encounters. As preparations for the 2025 Kumbh Mela begin, task shifting, point-of-care diagnostic and digital tools, robust clinician training, and community awareness can promote the restrained and evidence-based use of antibiotics, minimizing the potential for the emergence of antimicrobial resistance at the world's largest mass gathering.

An Aspect of Kumbh Mela Massive Gathering and COVID-19.

Purpose of Review: Kumbh Mela, a religious gathering of Hindus held in India, is the largest massive gathering event in the world. The COVID-19 pandemic is an unprecedented healthcare crisis in recent times with effects reverberating in all spheres of human lives. India has registered the second highest number of COVID-19 cases. This paper aims to dwell in the religious and social background of Kumbh Mela massive gathering, as well as the ritualistic practices that could potentially entail public health risks in the current situation. It also aims to identify possible preparatory and interventional measures to evade such risks. Recent Findings: In recent years, the increase in the number of people attending the Kumbh Mela has been phenomenal. Congregants are put up at the holy sites for several days. The sheer number of people assembling at the religious venues poses a great challenge to manage the crowds, to cater to the requirements of basic amenities, and to meet their healthcare needs. Some of the ritualistic practices could heighten the risk for transmission of respiratory pathogens. The COVID-19 pandemic has escalated over the past few months in India. The pandemic is expected to sustain its tempo in India throughout the foreseeable future. Organization of the forthcoming Kumbh Mela needs meticulous planning. Summary: Kumbh Mela is a Hindu religious gathering at the banks of India's rivers, held periodically. It witnesses assembly of huge numbers of people and has the potential to amplify the COVID-19 pandemic in India; this could overwhelm the healthcare system.

The Contribution of Wastewater to the Transmission of Antimicrobial Resistance in the Environment: Implications of Mass Gathering Settings.

Antimicrobial resistance (AMR) is the major issue posing a serious global health threat. Low- and middle-income countries are likely to be the most affected, both in terms of impact on public health and economic burden. Recent studies highlighted the role of resistance networks on the transmission of AMR organisms, with this network being driven by complex interactions between clinical (e.g., human health, animal husbandry and veterinary medicine) and other components, including environmental factors (e.g., persistence of AMR in wastewater). Many studies have highlighted the role of wastewater as a significant environmental reservoir of AMR as it represents an ideal environment for AMR bacteria (ARB) and antimicrobial resistant genes (ARGs) to persist. Although the treatment process can help in removing or reducing the ARB load, it has limited impact on ARGs. ARGs are not degradable; therefore, they can be spread among microbial communities in the environment through horizontal gene transfer, which is the main resistance mechanism in most Gram-negative bacteria. Here we analysed the recent literature to highlight the contribution of wastewater to the emergence, persistence and transmission of AMR under different settings, particularly those associated with mass gathering events (e.g., Hajj and Kumbh Mela).

Public health perspectives from the biggest human mass gathering on earth: Kumbh Mela, India.

Mass gathering events pose critical health challenges, especially for the control of diseases. The rising population, better connectivity, and scope of travel have increased the frequency and magnitude of mass gatherings and underscore the need to shift the discourse from reacting to the public health issues they throw up to taking active steps in preventing them based on evidence through research. The Kumbh Mela is a religious event in India that constitutes the largest number of people gathered at a specific place and at a specific time. It is older than the Hajj by centuries, yet the public health aspects related to this event, which is held every 3 years, have not been fully studied. Understanding the Kumbh Mela can highlight the health challenges faced and provide crucial lessons for the management of mass gatherings. This investigation used the Kumbh Mela in the city of Allahabad as a case study to describe the health problems and the efforts taken to manage them. In-depth studies of the Kumbh Mela in the future are required to generate evidence for context-specific measures to address the complex health challenges of mass gatherings.

A comprehensive review of the Kumbh Mela: identifying risks for spread of infectious diseases.

The Kumbh Mela in India is the largest mass gathering in the world which witnessed close to 100 million visitors in 2013. An event of this magnitude presents challenges. Increased population density, reduced hygienic conditions and exposure to environmental pollutants pave the way for easy transmission of pathogens. Due to the possibility of epidemics, the primary focus should be on identifying the potential risk factors and implementing appropriate preventive measures. The context of religion and psychology of the pilgrims is also closely associated with the evolution of the risk factors and so forms an important part of the discussion. We provide a brief background to the Kumbh Mela with a description of the existing and potential risk factors that require our attention.