Prayer and Pandemic: A Quasi-Experimental Study of Mosque Reopening During Ramadan and Infectious Disease Transmission

The COVID-19 pandemic prompted global restrictions on mass gatherings, yet the causal effect of large religious congregations on disease spread remains understudied and difficult to isolate. This study leverages a unique natural experiment from Pakistan, which, contraryto other Muslim nations, reopened mosques for congregational prayers for Ramadan in 2020 during a critical phase of the pandemic. We apply the synthetic control method toestimate the impact of this policy, constructing a counterfactual for Pakistan using countriesthat enforced mosque closures. We find that the reopening led to a significant increase in COVID-19 transmission, causing an estimated 5,600 additional cases and approximately 112 excess fatalities over 21 days after mosque reopening, representing a substantial portion ofthe national case load during this phase. These results provide robust, quasi-experimentalevidence on the public health costs of exempting religious gatherings from public health mandates. Conclusions about causality can be made, although with caution, given thenatural experiment setup, highlighting the critical need to manage the epidemiological risks of mass gatherings during a health crisis.