Sunday, April 19, 2020
Political considerations, which are clearly motivating the leaders who are advocating dangerous behaviour, have to be put aside for now. This could mean the difference between life and death.
By Sampath Perera
21 March 2020
The rapid spread of the deadly virus will be catastrophic for millions of people in this poverty stricken South Asian country of more than 200 million.
As of now, Pakistan reports the highest number of confirmed cases in South Asia. Despite severe COVID-19 outbreaks in neighbouring countries, including China to the east, the initial epicentre of the virus, and Iran to the west, Pakistani authorities did little to nothing to prepare for the inevitable spread of the coronavirus to the country.
While the government attempted to delay the spread of the virus by refusing to evacuate its citizens from China’s Hubei province and imposed air travel restrictions, no significant measures were taken to mount a medical response to the outbreak. According to reports, most initial tests were conducted on patients who had become infected while traveling in Iran.
Despite the rapid increase of cases, the government has allocated only a paltry 5.4 billion rupees ($34 million) to deal with the pandemic.
The actual infection numbers are certainly far higher than reported, given the severe lack of testing. Prime Minister Imran Khan’s Islamic populist Tehrik-e-Insaaf (PTI) government hurriedly convened the National Security Council March 13 amid reports indicating an unchecked spread of the virus. Following the military-government huddle, it shut down schools and the country’s borders while enforcing restrictions on air travel. However, fearing a backlash from an increasingly powerful Islamic right, the government did not ban prayers or large religious gatherings.
As panic built throughout the country, Reuters reported Wednesday that there was a “growing dispute in Pakistan between federal and provincial authorities.” Provincial authorities were scrambling to secure coronavirus testing kits, according to the report. Additionally, the central government has been blamed for its failure to test and quarantine those returning from abroad.
The criminal indifference of Pakistan’s ruling elite to the well-being of the masses was illustrated by Khan in an address to the nation on Tuesday. As the government is increasingly coming under criticism for a severe lack of testing kits in public health facilities and the prohibitive cost of the test in private medical centres, Khan demanded only those with “intense symptoms” to go to hospitals. “There is no need to worry,” he claimed, demagogically declaring, “We will fight this as a nation. And God willing, we will win this war.”
Pakistan’s public medical facilities are dilapidated, having been ravaged by decades of IMF austerity, and are utterly inadequate to fight a highly contagious and novel virus like the coronavirus. The medical crisis is enormously exacerbated by the poor living and hygienic conditions that the venal Pakistani bourgeoisie imposes on the majority of the population.
In the major cities, where whatever available social infrastructure is concentrated, health facilities were on life-support even before the arrival of coronavirus cases. In rural areas, including in the two most populous provinces, Punjab and Sindh, medical facilities are hardly existent. The situation is even worse in the war-ravaged former Federally Administered Tribal Areas that are now part of Khyber Pakhtunkhwa, and in Balochistan, where the military is brutally repressing a longstanding nationalist-separatist insurgency. The cost for the coronavirus test in a private facility, 7,900 rupees, or more than US $49, is about equal to the monthly income of most Pakistanis. With extreme poverty, food insecurity and widespread malnutrition among children, the consequences of the virus spreading widely in Pakistan will be catastrophic and far reaching.
Further worsening the current health emergency is the 20.4 percent cut the Khan government made in health expenditure from the 2018-19 financial year, in order to appease the IMF and Pakistan’s other creditors
The impact of the gutting of health care spending is exacerbated by skyrocketing inflation, which has been running at double-digit levels since July. Public health facilities face severe shortages of medical supplies and personnel, neglected maintenance of equipment and facilities, and a shrinking capacity to meet even the usual needs of the population, not to mention a highly contagious pandemic. Pakistan only provided 0.6 beds per 1,000 people in 2014, the latest statistic available from the World Health Organization. According to the country’s representative for the WHO, the federal and provincial governments have made only 2,000 isolation beds available to deal with the current pandemic.
While utterly indifferent to the horrendous social conditions and virtually non-existent health care services available to the vast majority of the population, Pakistan’s ruling elite fears the pandemic could trigger an economic collapse, which would threaten their wealth and potentially ignite a social explosion. Speaking to Associated Press, Khan appealed to the “world community” to consider “some sort of a debt write-off for countries” like Pakistan, while voicing concern that the virus outbreak and the measures to arrest its spread could trigger an “unstoppable slide backward” of the economy.
In his address Tuesday, Khan argued against shutting down daily life in the county’s cities with the claim, “people are already suffering” and if they were to be “saved from corona [virus]” by such means, then “they’ll die of hunger.” The PTI government, as its negligent response to the pandemic and the policies it has pursued in its year and a half in office demonstrate, is chiefly concerned with protecting the wealth of the super-rich.
Khan and his PTI won election in July 2018 by cynically promising an “Islamic welfare state.” Predictably, no sooner did they take office than they pivoted to imposing further austerity and began to lay the groundwork for seeking a new IMF bailout. Khan has increasingly staffed his government with prominent members of the former dictatorial regime of General Pervez Musharraf, which, in addition to making Pakistan the logistical linchpin of the US war in Afghanistan, carried out a wave of privatization and other “pro-investor” neo-liberal reforms.
Pakistan’s coronavirus outbreak has overlapped with the Khan government’s negotiations with the IMF over a further round of austerity and economic “reforms” so as to secure another $450 million tranche of the current $6 billion bailout package. According to reports, the IMF has agreed not to aggregate coronavirus related expenditure towards the budget deficit. Otherwise, the government is expected to fulfil its pledges to the IMF to cut social spending and raise taxes and electricity rates, further increasing the economic burdens on the poor. When massive floods in 2010 put millions of people at risk of starvation, disease and financial ruin, the government, then led by the Pakistan People’s Party, dutifully followed the diktats of the IMF and refrained from providing any substantial aid to the suffering masses. Khan’s rise to power in 2018 was facilitated by the country’s nuclear-armed military, which, having ruled the country for decades with Washington’s backing, continues to wield effective control over foreign and military policy, and internal security.
While Khan justifies his government’s negligent response to the coronavirus pandemic by claiming the state is bereft of resources, it is spending massive sums on Pakistan’s armed forces, amid dangerously escalating war tensions with India. In February 2019, the reactionary strategic conflict between India and Pakistan came to the brink of all-out war, after their air forces engaged in a dog-fight over disputed Kashmir.
The PTI government has allocated 16 percent of all state expenditure for defence. But this figure excludes pensions for retired military personnel, and never publicly revealed spending on major procurements and strategic programs.
According to the most recent data, Pakistan has 5,988 positive COVID-19 cases and 107 deaths but these numbers are understood to be greatly underestimated due to limited testing.“Even if we leave out the general population – only the healthcare workers, people who are working around those tested positive, are not being tested despite being at the highest risk,” says Dr. Kashaf Khalid, currently a junior doctor at Combined Military Hospital (CMH) Sialkot.Khalid adds that Sialkot, a city in Punjab, has been lucky and hasn’t had that many cases so far, but is concerned about the insufficient quantities of personal protective equipment (PPE) healthcare workers are being provided.
“At many facilities what we have observed is that doctors had to protest or refuse to work and then they were given the minimal required PPE,” she states. “Still, there are many hospitals where doctors are working in ERs/OPDs [emergency rooms/outpatient departments] and wards that either have to arrange PPE for themselves or are simply working without it.”
On April 6, 150 doctors and medical staff in the city of Quetta, in the southwestern province of Balochistan, were arrested for protesting the lack of PPE. The protests took place after 13 doctors in the city tested positive for the novel coronavirus, COVID-19.
Following the arrests, the Young Doctors Association (YDA) announced an immediate boycott of all medical services in Balochistan. The boycott has since ended after the YDA reached an agreement with the provincial government.
YDA’s demands included action against police officers for beating, manhandling doctors and the provision of PPE, medical kits and other facilities so that they could treat COVID-19 patients.
“There is just no proper system in place — not only is there a severe shortage of PPE, young doctors don’t even know the protocol to donning and doffing [the method of putting on and taking off the protective gear] the gear,” says Dr. Shehryar Khan, working at Mayo Hospital, one of the one of the oldest and biggest hospitals in Lahore.
Khan, earlier this month, shared on social media his experiences struggling and fighting to get sufficient PPE which gained a lot of traction.
“After I shared my experiences online and the reaction it had on social media, they have gotten a bit scared,” he says. “But, overall, doctors and medical staff are not being provided with the required PPE at all. The ones who have it have to struggle and demand it.”
According to an unreleased WHO report, at least 138 health workers have been diagnosed with COVID-19 in Pakistan, but the real numbers could be much higher.“It is not on paper but verbally we are being discouraged from conducting tests on possible COVID-19 patients unless they are critically symptomatic,” Khan says. “So doctors don’t even often know for certain if they have possibly been exposed or not.”Khan mentions a doctor he knows who was treating a patient who died “under suspicious circumstances with a travel history.” The doctor asked his hospital to test the diseased patient’s sample to confirm if he could have possibly been exposed to the novel coronavirus.
“The next day when he went to collect the results, he was told that the sample was never collected so he just has no way of knowing if he could have been exposed or not,” Khan says. “So many test samples are being ‘wasted’ to keep the numbers low intentionally as no hospital wants [a] high number of deaths from COVID-19 on their record. It is really just about those at the top just trying to save their jobs.”
A senior doctor based in Karachi, however, who is working with the provincial government on policies to build up healthcare capacities, and has requested his name not be mentioned, disagrees that doctors are being discouraged from getting their patients tested.
“I am part of a team working to identify testing capacities and we have only discouraged testing from labs that aren’t complying with national and WHO standards,” he states.
Pakistan performed nearly 15,000 coronavirus tests by the end of March, according to Health Minister Dr. Zafar Mirza. Officials have also stated that Pakistan’s testing capacity has been enhanced from 30,000 to 280,000 and would be further enhanced to 900,000 by mid April.
“The government is striving to increase the number of laboratories that are testing by inspecting the capacity of lab and technical staff available and more labs will soon be operating and be able to increasing testing capacities,” states the Karachi-based doctor. “As for PPE — yes, there is a shortage which needs to be sorted out as healthcare workers are at the frontlines and if they get infected, transmissions will exponentially increase even more.”
He thinks the government should take urgent steps to order local companies to manufacture PPE so the healthcare workers that are necessary to effectively implement the country’s National Action Plan to respond to the novel coronavirus are protected. The government’s National Action Plan against coronavirus, which was revealed on February 29 — just days after the first positive cases in the country — involves the full coordination of the federal government with provinces to deal with the viral outbreak, with some hospitals in every province dedicated to patients infected with the disease.
But most of March saw a lack of clarity at the federal level when it came to leading the country on decisions about social distancing, curfews, and lockdowns.
Prime Minister Imran Khan initially rejected calls for lockdowns.
“If we shut down the cities […] we will save them from corona at one end, but they will die from hunger on the other side,” he stated in a speech addressing the country where 39 percent of households live in poverty. Provincial leaders however, especially in Sindh, have been fairly efficient in imposing restrictions on public gatherings, except at mosques, and have also shut down schools and non-essential shops and markets. Khan has since hinted on imposing a curfew if the situation worsens stating that the country is “not immune to coronavirus” but also stated that he is confident that Pakistan will come out of this challenge stronger.
But as the number of patients continue to increase, doctors are increasingly concerned about the country’s healthcare and governance systems which fall short even during the best of days. Khalid has stated that they are “thinking of alternate ways to ventilate patients in case of a severe breakout, [given] the limited number of ventilators and other facilities we have throughout the country.” Hospital administrations are grossly overstating information about their capacities to health minister, who then share that inflates information with the federal government, claims Dr. Khan.
“Hospital administrations give inaccurate reports to health ministers who then, without fact-checking the information, pass it to the federal government — just so everything looks good on paper because everyone wants to save their jobs,” he says.
“But they are just upholding a shell at this point which will collapse when the burden on our capacity increases.”
India has questioned Pakistan on the ‘deficiencies’ in building Gurudwara Kartarpur Sahib, as five domes of the structure collapsed Saturday owing to strong winds.
The domes, which sources in the Pakistan government said were decorative ones made of fibreglass, were restored by a team of experts throughout Saturday night. Pakistan’s Science and Technology Minister Fawad Hussain Chaudhry also tweeted about it.
However, Indian government sources doubted the quick restoration work, saying they hoped the repair work would be long-lasting.