Monday, March 23, 2020
#RT #Pakistan's first #coronavirus death exposes nation's vulnerability
When Saadat Khan, 50, returned to Pakistan on March 9 from a pilgrimage to Saudi Arabia, he was greeted in his village with a rousing welcome and a grand feast attended by more than 2,000 people, many of whom embraced him warmly.On March 18, less than 10 days later, Khan died at an isolation centre for coronavirus patients in the northwestern city of Mardan. He died from COVID-19, the day his test results came back positive.
Khan was Pakistan’s first fatality from a disease that is rapidly spreading through the country of 220 million people. The virus has already infected over 317,000 people worldwide, and killed more than 13,000.
The number of confirmed cases in Pakistan has soared to more than 800 from 22 last week, largely driven by a wave of pilgrims returning from Iran who Pakistani authorities said were inadequately tested and improperly isolated. At least four people have died from the disease in Pakistan in the past week.
Thousands of people now need to undergo the slow process of retesting, and authorities fear the number of cases could surge in coming days.
Health experts say there is a lack of public awareness in Pakistan about the virus and that the cash-strapped government is ill-prepared to tackle its spread. A shortage of quarantine facilities and testing labs have also hampered efforts to effectively deal with high-risk cases.In Sindh, Pakistan’s hardest-hit province, the situation is already grim, said Dr Naseem Salahuddin, the head of department for infectious diseases at Indus Hospital in Karachi. She said that the few hospitals equipped to handle COVID-19 cases in Karachi are either close to capacity or have shut their doors because they can’t handle the influx of suspected cases.“We’re likely to have a very big outbreak no matter what we do now,” she said. “And we will not be equipped to handle the numbers. There will be breakdowns at many levels.” Better border controls and quarantine measures should have been instituted a lot earlier, she said. “I think the cat’s now out of the bag.”
Dr Zafar Mirza, who said last week that some of Pakistan’s quarantine facilities had not been “ideal”, did not respond to Reuters’ requests for comment. The provincial health minister in Khan’s home province of Khyber Pakhtunkhwa also did not respond to a request for comment.
Mardan’s COVID-19 victim infected five people
Reuters interviewed three doctors involved in the case, as well as four people from Khan’s village, and reviewed medical case notes detailing his travel history. Together, they provide a picture of Khan’s last days, and illustrate why the South Asian nation is rapidly becoming the latest hotbed of the fast-spreading disease.
Fateful journey
In late February, Khan flew to Saudi Arabia to visit the holy city of Makkah for Umrah, a religious pilgrimage performed by millions of Muslims from across the world each year. Khan entered the country just before it shut its borders to Umrah pilgrims, in a bid to stem the spread of COVID-19. Khan was in Saudi Arabia for two to three weeks, according to the doctors handling his case and an acquaintance from his village. Medical case notes, provided by one of Khan’s doctors, show that he departed from the kingdom’s Jeddah International Airport on March 8 via flight number PK736, which landed the following day at Peshawar International Airport. At least two people who knew Khan said he was already ill when he got on the plane and needed assistance on arrival in Pakistan. Despite Pakistan having identified its first confirmed cases of COVID-19 two weeks prior, the case notes state Khan was only asked to fill out a form and did not undergo a medical screening at the Peshawar airport. Khan did not mention any illness, and he would have escaped detection anyway if he had taken fever suppressors, said a Peshawar airport official who asked not to be named. Authorities are also scrambling to trace dozens of other passengers on flight PK736 that night, as well as airport staff who assisted Khan.
Village Banquet
Khan first visited a district hospital close to his village on March 16, complaining of cough, fever and breathing issues. The doctor diagnosed him as a potential COVID-19 patient and had him tested for the virus. The sample was sent to Islamabad for testing, according to the case notes reviewed by Reuters. While it is unclear if doctors could have forced Khan into quarantine, the case notes indicate he refused to be isolated. Instead, he went home, where he lived with his wife, three sons, two daughters-in-law, three daughters and four grandchildren.
Hospital officials say Khan returned on March 17, when his symptoms intensified.
On March 18, test results confirmed he was infected with COVID-19, and he was moved to an isolation center, where he died the same day.
It is the events before his death, though, that have worried medical officials and alarmed many residents of his village. On March 9, Khan was greeted with a mass gathering in his village, as is traditional in Pakistan when someone returns from Umrah. According to local authorities, some 2,000 people were in attendance at the lunch – most of whom embraced Khan.
Khan also ran a popular “medical clinic” in his village – though he wasn’t a qualified doctor, say local health officials.
As is the case in many rural areas of Pakistan, people with just rudimentary medical knowledge often run such dispensaries to treat patients with ailments like fevers and colds, despite not having any qualifications.
Khan had not resumed his practice on returning to Pakistan, but his sons ran it for him while he stayed at home in “self-quarantine,” health officials from the village told Reuters.
However, they added, the “self-quarantine” involved his sons staying in the same room as him. The sons in turn also tended to dozens of patients at their father’s clinic during that period.
Reuters was unable to speak with anyone in Khan’s family.
Mass Panic
There is mass panic in the village, local residents told Reuters via phone, adding that no one had taken the coronavirus threat seriously prior to this.
“There are hundreds of people believed to have been infected but they are hiding and reluctant to go to hospital,” said Liaqat Ali Shah, a local social worker, adding that villagers feared being ostracized by the community and shunned by healthcare workers.
The village, Union Council Mangah, was locked down following Khan’s death, according to an official directive from authorities. A complete lockdown was ordered “with immediate effect and there shall be no entry and no exit,” the order seen by Reuters read. The village of about 7,000 people, has been declared a mass quarantine zone, according to the provincial government, and testing has begun. But residents of Mangah say none of the officials surveying the area have testing kits with them.
A medical worker on the ground said test kits were limited so they couldn’t test everyone and were only testing patients displaying symptoms.
“There’s a virtual lockdown in the village and movement is restricted,” a school teacher in the village, told Reuters via phone.
Despite this, at least four people showing symptoms, including two members of Khan’s family, are now missing and have gone underground, health officials told Reuters. All four had tested positive for COVID-19, the officials said.
https://tribune.com.pk/story/2182441/1-pakistans-first-coronavirus-death-exposes-nations-vulnerability/
#Pakistan #PTI government and #coronavirus
- There is no way if there is no will
The Sindh Chief Minister’s appeal for a three-day voluntary lock down was highly successful on Saturday. Shopping areas and government and private offices remained closed in Karachi. People remained confined to their homes and there were few vehicles on the road. This showed that with a dedicated and persuasive leadership a longer lockdown is also feasible, provided the vulnerable sections of society are ensured free and regular supply of food and medicines. In his address to the nation on Tuesday the Prime Minister had complained that the national economy was recovering from a very difficult time and it was therefore decided not to lock down the cities. It is apparently lack of will or loss of nerve on the part of Prime Minister Imran Khan, rather than paucity of resources, that stops the government from taking bold decisions. With big donations coming from the USA and China, and the World Bank and ADB together pledging $588 million for Pakistan’s fight against the pandemic, the government could have looked after the needs of the deserving during the period of lockdowns if it really wanted. Pakistanis’ philanthropy, that Mr Khan often talks about, could have also helped.
The Balochistan government has meanwhile announced partial lockdown. All shopping malls, crowded markets, restaurants as well as public transport within and between the cities, will remain closed for three weeks.
The two provinces directly ruled by the PTI have taken no credible measures to reduce social interaction which could exacerbate the spread of coronavirus. The Punjab government has not gone beyond restricting the public’s entry into parks and recreational spots like Murree. Shopping malls and hotels however remain open till 10 pm. Business areas in Lahore like Hall Road continue to draw milling crowds till late in the evening. There is no preparation for anything like a lockdown either in Punjab or KP.
With coronavirus cases in Pakistan increasing at a fast speed, the federal government needs to review its position regarding free mixing of people and the need for sequestration of large sections of population for testing that alone can stop the fast advance of the disease in Pakistan.
#پلیزگھرپررہیں - Pakistani doctors decry lack of supplies as lockdown looms
By Asad Hashim
Doctors raise alert over personal protection equipment shortage, as Taftan quarantine camp remains at the centre of the spread.
Pakistan has moved closer to a countrywide lockdown to attempt to control the accelerating spread of coronavirus cases across the country, as cases hit more than 850 and doctors complain of dwindling personal protective kits.
On Monday, a full lockdown went into effect in the southern city of Karachi, home to more than 20 million people, while Punjab province - home to almost half of Pakistan's 207 million people - also announced widespread restrictions on public movement.
The government in both areas has restricted people to their homes, other than to access essential services such as groceries, pharmacies or medical care, according to a government announcement.
Countrywide, Pakistan has so far recorded at least 859 cases of coronavirus, with six deaths and six patients making a full recovery, according to government data. The number of cases has more than quadrupled in a week.
In Karachi, citizens were ordered to remain within their homes and to only leave for emergencies or to obtain groceries or medicines.
"[The provincial] government is satisfied that it has become extremely urgent and important to prevent mixing/gathering/meeting of people by taking extreme measures to contain the spread of COVID-19 and therefore imposes ban on the movement and the gathering of people," read a government announcement.
The lockdown will remain in place until at least March 31, the statement said.
A day earlier, however, Pakistan's Prime Minister Imran Khan said that he was not prepared to place the entire country on lockdown because of the associated economic costs.
"Twenty-five percent of Pakistanis are below the poverty line ... today if I impose a complete lockdown then … my country's rickshaw drivers, pushcart vendors, taxi drivers, small shopkeepers, daily wage earners, all of them will be shut in their homes," Khan said in a televised address to the nation.
"If Pakistan had the resources that Italy has, that France has, that the US has, that England has, I would fully lock down all of Pakistan today."
The prime minister advised citizens to self-quarantine if they felt ill, and to limit their social contacts to stop the spread of the virus.
Pakistan's government has placed a ban on all public gatherings, closed educational institutions, shopping malls and other public places until at least April 3. On Saturday, the country also suspended all incoming international air traffic until April 4.
Quarantine woes
Sindh province, within which Karachi is located, has seen the highest number of cases across the country, recording at least 352 cases since Pakistan's outbreak began in late February.
At least 260 of those cases were tested at a quarantine camp in the city of Sukkur, established to house travellers who arrived in the country from Iran and had previously passed through the Taftan quarantine camp at the border.
The Taftan camp - criticised by those held there as lacking proper medical and social isolation facilities - has been at the centre of Pakistan's outbreak of cases.
At least 57 percent of all people who have tested positive for coronavirus in Pakistan passed through the camp at some stage, according to government data.
"In Taftan, everyone was sleeping in a single room, all our children were sleeping with us," said Hussain Bux Gopang, 48, currently housed at the Sukkur quarantine camp.
"There were very few medical checks in Taftan. They would check our temperature on our forehead [and] they had no other checking there."
Others echoed those complaints.
"They kept us in a tent [in Taftan]," said Lal Bux Khaskheli, 36, a labourer who arrived at Taftan from Iran on March 2. "It was very, very cold, and we had small blankets. It was very difficult there. We did get food on time, but … there were just a few bathrooms ... for about 600 people."
The camp at Sukkur, which currently houses more than 1,000 people, has been set up in a disused residential complex, and people held there say facilities are much better.
"Per person, we get one room, with a bed, a prayer mat, a towel, soap," said Gopang. "Conditions are good here. This is 100 percent better than Taftan."
Khaskheli, however, disagreed, saying while there was better medical care and testing, those in the Sukkur quarantine camp were still not being treated for their pre-existing conditions.
"We have not been asked about our symptoms or what we should be doing in order to save ourselves from infection," he said. "The least they should do is monitor our conditions."
In addition to Sukkur, people who passed through Taftan are also being held at separate quarantine camps across the country, in Multan (1,247 people), Dera Ghazi Khan (782), Dera Ismail Khan (269), and just outside Quetta (532), according to the National Disaster Management Authority (NDMA).
More than 400 people remain quarantined at Taftan, according to the provincial government's data.
Lack of supplies
Pakistani authorities say they are racing to secure supplies and hospital space in case numbers of COVID19 patients continue to rise. Currently, the government says it has more than 35 hospitals set up to deal with the outbreak, equipped with more than 118,000 beds.
Doctors across the country, however, have complained that they are battling the virus without proper protective equipment.
"We do not have personal protective equipment (PPE), or goggles, and even [face] masks we are buying from our own funds," said Dr Ahmed Zeb, 35, a spokesman for a doctor's union in the northwestern Khyber Pakhtunkhwa province. "We have nothing and we don't know where patients are coming from."
Dr Hazrat Akbar, 29, practising at a major hospital in Khyber Pakhtunkhwa, echoed those concerns.
"Only those on the front line have kits, those in emergency and casualty do not really have access to them," he told Al Jazeera.
At his hospital, which caters to thousands of patients a day, with a staff of more than 1,000, Akbar said there were less than 40 PPE kits left in storage.
On Friday, Lieutenant General Muhammad Afzal, the NDMA chairman, said the government was working on securing more PPEs and other resources for healthcare workers.
On Sunday, the health ministry announced that 14 metric tonnes of PPE, "including face masks, thermometers, gloves [and] gowns", had been dispatched to Pakistan.
On Sunday, authorities in Gilgit-Baltistan state said a young doctor had contracted the virus while screening travellers at a road checkpoint, and subsequently died.
"If we do not protect our healthcare providers and keep losing them ... what will we do? Won't it get worse than Italy and China?" asked Zeb.
بلاول کورونا وائرس پر قومی بیانئے کی تشکیل کیلئے متحرک
پاکستان پیپلز پارٹی (پی پی پی) کے چیئرمین بلاول بھٹو زرداری کورونا وائرس پر قومی بیانئے کی تشکیل کے لیے متحرک ہوگئے۔
بلاول بھٹو زرداری نے آل پارٹیز کانفرنس بلانے کے لیے سیاسی جماعتوں کے رہنماؤں سے رابطے کیے ہیں۔
چیئرمین پیپلز پارٹی نے مسلم لیگ (ن)، جمعیت علماء اسلام اور مسلم لیگ (ق)، بلوچستان نیشنل پارٹی (بی این پی) اور عوامی نیشنل پارٹی (اے این پی) کی قیادت سے رابطے کیے ہیں۔
بلاول بھٹو زرداری نے شہبازشریف، مولانا فضل الرحمٰن، پرویز الہٰی اختر مینگل اور ایمل ولی خان سے ٹیلی فونک رابطہ کیا ہے۔
بلاول بھٹو کا کہنا تھا کہ کورونا وائرس سے متعلق تمام سیاسی جماعتوں کو ایک پیج پر آنا ہوگا، کورونا وائرس سے بچاؤ کے لیے مشترکہ لائحہ عمل ضروری ہے۔
ترجمان چیئرمین پی پی پی کے مطابق سیاسی رہنماؤں نے کورونا وائرس پر ویڈیو لنک کے ذریعے آل پارٹی کانفرنس (اے پی سی) بلانے کے لیے اتفاق کیا۔