Pakistan’s Lockdown Ended a Month Ago. Now Hospital Signs Read ‘Full.’

By Zia ur-Rehman, Salman Masood and Maria Abi-Habib

Pakistanis stricken by the coronavirus are being turned away from hospitals that have simply closed their gates and put up signs reading “full house.” Doctors and nurses are falling ill at alarming rates, and are also coming under physical assault from desperate and angry families.

When Pakistan’s government lifted its lockdown on May 9, it warned that the already impoverished country could no longer withstand the shutdown needed to mitigate the pandemic’s spread. But now left unshackled, the virus is meting out devastation in other ways, and panic is rising.

Before reopening, Pakistan had recorded about 25,000 infections. A month later, the country recorded an additional 100,000 cases — almost certainly an undercount — and the pandemic shows no signs of abating. At least 2,356 people have died of Covid-19, according to official figures released Thursday.

Pakistan is now reporting so many new cases that it is among the World Health Organization’s top 10 countries where the virus is on the rise. The W.H.O. wrote a letter criticizing the government’s efforts on June 7 and recommended that lockdown be reimposed, stating that Pakistan did not meet any of the criteria needed to lift it.

Medical professionals now expect the virus to peak in July or August and infect up to 900,000, adding further strain to an already shaky health care system some warn may collapse.

But government officials have ruled out the possibility of a further lockdown and dismissed the recommendations by the W.H.O.

On a recent day in the sprawling port city of Karachi, Ali Hussain and his brother shuttled between public hospitals, looking for help and receiving none. Mr. Hussain’s older brother had a severe cough and fever but had been unable to get a coronavirus test for days.

“We cannot afford the private hospitals, they are charging tens of thousands rupees,” said Mr. Hussain, who earned 20,000 rupees per month, about $121, working at a textile mill before the lockdown.

Like many others, the Hussain family is suffering not only because of the coronavirus itself but also the economic devastation the pandemic has wrought. Mr. Hussain said he and his brother could barely afford to feed themselves since they lost their jobs in March, let alone pay for private care.

“We are completely broke and we do not know what to do,” Mr. Hussain lamented.

The World Bank projects that Pakistan’s economy will contract by 0.2 percent next fiscal year. Up to 18 million of the country’s 74 million jobs could be lost, according to the Pakistan Institute of Development Economics, an independent research firm set up by the government.

More immediately, Pakistan’s struggling health care sector is in deep crisis.

Only a third of Karachi’s 600 beds in intensive care wards are available to treat coronavirus patients in the city’s private and public hospitals, for a population of about 20 million, according to local health officials. According to the W.H.O., only 751 ventilators are dedicated to the pandemic in Pakistan, the world’s fifth most populous country, with some 200 million people.

Health care workers admit privately that they are referring patients like Mr. Hussain’s brother to other hospitals they know are at or over capacity because they fear being attacked by desperate families. Medical workers across Pakistan are being assaulted on a near-daily basis for not being able to admit patients or having to tell families that their loved ones had died.

“Our hospitals are completely exhausted,” said one doctor, who asked for his name to be withheld because he is a government employee.

Late last month, a family attacked the staff of one Karachi hospital with knives and iron rods after doctors declared their relative dead, rampaging through the emergency ward. On May 14, the emergency department of another major government hospital in Karachi was ransacked after health care workers refused to give over the body of their loved one, warning the family could contract the virus by handling the remains without using any precautions.
Sameer Mandhro @smendhro This is Karachi Civil Hospital. Doctors say over 70 persons attacked it's ER tonight at around 11am. Docs & staff remained unhurt. They say the attackers had iron rods, knives. "KOI CORONA NAHEN HAI. YE SAB DOCTORS KA DRAMA HAI," they shouted.

After several similar episodes, employees say that many hospitals are now handing over the bodies of coronavirus victims to their families anyway, worried more about the violent backlash than the pandemic’s spread.

The anger reflects the grief and panic that is setting in across the country, and also an erosion of trust between the state and its citizens.

Prime Minister Imran Khan and other officials have frequently dismissed the virus as a common flu, then rushed to urge people to stay home before dismissing the severity of the pandemic again. Unfounded rumors have spread on social media that the government is inflating coronavirus numbers to milk the international community for more aid money, secretly leaving patients to die of other causes.

The already low morale among health care workers has plummeted further since the lockdown was lifted. In March, doctors and nurses threatened to walk off the job and some called in sick, refusing to work if the government did not provide them with personal protective equipment. Some had to spend up to half of their salaries to buy their own masks, prices skyrocketing as panicked citizens hoarded supplies.

So far, at least 35 health care workers have died of the pandemic, the Pakistan Medical Association said in a statement Thursday. At least 3,600 health care workers are infected with the virus, according to official figures.The government “did not listen to what doctors were saying. Now the result of this negligence is obvious,” the Pakistan Medical Association said in its statement.

In Punjab, the country’s most populous province, a doctors’ association claimed earlier this month that 40 percent of the province’s medical staff had tested positive for coronavirus.

“While the pandemic stares us all in the face, the morale of health care providers has hit rock bottom,” said Dr. Salman Haseeb Chaudhry, who represents the Young Doctors Association, at a news conference this month.

At a protest among health care workers on Tuesday, Shafiq Awan, the leader of a paramedic association in Karachi, said the government was not heeding their advice.

“We need protective gear, not salutes and praises. If we start dying or are unable to work, who will treat patients?” Mr. Awan asked.

Under withering criticism, Prime Minister Khan hit back on Thursday, saying that his government had responded adequately to the pandemic.

Mr. Khan was at first reluctant to impose a lockdown, stating in early March that the country’s economy could not weather the fallout. By the end of that month, the country’s powerful military sidelined Mr. Khan to shut down the country.

Both the government and military came under immense pressure from Pakistan’s powerful Islamists to loosen the lockdown during Ramadan, the holy month of fasting that started in April and ended last month. After just a few weeks, the lockdown was lifted.

“We are a low middle-income country, with two-thirds of the population dependent on daily incomes,” Dr. Zafar Mirza, the de facto health minister, said Wednesday.

“We have to make tough policy choices to strike a balance between lives and livelihoods.”

https://www.nytimes.com/2020/06/15/world/asia/pakistan-coronavirus-hospitals.html