Saturday, June 13, 2020
Pakistan hospitals struggle as corona virus cases explode
Asad Hashim
Atiqullah did not know what else to do. He spent three days scouring the northwestern Pakistani city of Peshawar for a ventilator for his 60-year-old father, who had tested positive for the coronavirus and was in a critical condition.
![a group of people walking down a street: The real number of infections is likely far higher, with Pakistan currently testing about 25,000 people a day [Muhammed Semih Ugurlu/Anadolu]]({"default":{"load":"default","w":"80","h":"45","src":"//img-s-msn-com.akamaized.net/tenant/amp/entityid/BB15ogUz.img?h=449&w=799&m=6&q=60&o=f&l=f"},"size3column":{"load":"default","w":"62","h":"35","src":"//img-s-msn-com.akamaized.net/tenant/amp/entityid/BB15ogUz.img?h=351&w=624&m=6&q=60&o=f&l=f"},"size2column":{"load":"default","w":"62","h":"35","src":"//img-s-msn-com.akamaized.net/tenant/amp/entityid/BB15ogUz.img?h=351&w=624&m=6&q=60&o=f&l=f"}})
© [Muhammed Semih Ugurlu/Anadolu] The real number of infections is likely far higher, with Pakistan currently testing about 25,000 people a day [Muhammed Semih Ugurlu/Anadolu]
"The doctors were trying their best but we couldn't find a bed in the Intensive Care Unit [ICU]," he told Al Jazeera. "For three days we were trying to get him shifted into an ICU because he was in such a serious condition."
Ultimately, he found a bed in an isolation ward at the Lady Reading Hospital - the city's largest government hospital - but there was still no ventilator available.
"There was no space in any ICU, anywhere in the city, not just at Lady Reading," he said.
Finally, unable to afford to pay for his father to receive treatment at a private healthcare facility, Atiqullah, a 30-year-old hospital orderly, had no choice but to sit at his bedside and watch him die.
Pakistan has seen its coronavirus epidemic explode in the last two weeks, seeing multiple consecutive days of record deaths and case rises across the country, pushing hospitals in major cities to the brink of their allocated capacity.
On Thursday, the country saw 6,397 new cases take its tally to 125,933, with a single-day record 107 deaths taking the death toll to 2,520 since Pakistan's outbreak began in late February.
The real number of infections is likely far higher, with Pakistan currently testing about 25,000 people a day, which is half the number of daily tests recommended by the World Health Organization (WHO).
In a country that is home to 220 million people and a ramshackle health infrastructure that offers just six hospital beds per 10,000 people, doctors say they fear that the healthcare system could be on the brink of collapse.
A nurse wears a face mask at the Lady Reading Hospital in Peshawar [Fayaz Aziz/Reuters]Doctors ask for 'breathing space'
"There has not been a single day in the last week where we had a single bed available," said Dr Naveed Ahmed Khan, a surgeon at Peshawar's Hayatabad Medical Complex, one of the city's largest hospitals and a designated coronavirus care facility.
"Only if someone died or was discharged could we replace them with a new patient."
Peshawar, the capital of Khyber Pakhtunkhwa province, sees a large number of patients coming in from all over the province due to the relatively poor health infrastructure elsewhere, doctors say.
"Our hospital's condition is already overburdened and the health system is very weak," said Muhammad Kashif, a doctor at Lady Reading Hospital. "Right now, you won't find a single ICU bed in all of Peshawar. Our health system, if, God forbid, things remain as they are, it will definitely collapse."
Ahmed Zeb Khan, a doctor at a government facility in the northwestern town of Charsadda, says doctors have been pleading with authorities to reimpose a lockdown to gain some "breathing space" to increase hospital capacity.
"We have told the government over and over again to increase the capacity of the ICU and isolation wards, because you did not impose a [proper] lockdown and now we have no breathing space," he said. "Until that happens, the system is overburdened, and we are going towards a collapse."
In the southwestern city of Quetta, there has been a rapid increase in cases, according to official data.
Healthcare workers in Pakistan are putting their lives on the line as they battle the country's increased number of cases.
At least 3,635 healthcare workers have tested positive for the coronavirus since the outbreak began, according to government data. Thirty-five of those doctors, nurses and health staff did not survive.
"Our healthcare workers are exhausted, they have been working for three months straight without a break," said Peshawar's Dr Kashif. "The number of doctors that are dealing with coronavirus, there are too little. They need to induct more doctors."
Waseem Baig, a spokesman for the provincial health department in Quetta, said the two hospitals in the city designated for coronavirus patients were both full.
Shortage of hospital beds
Doctors in major cities across the country echoed Baig's concerns, saying their hospitals - both public and private sector - were at or nearing their capacity for coronavirus patients.
Official government figures paint a different picture of Pakistan's hospital capacity, showing that only 1,681 critical care beds are currently occupied countrywide, compared with a total capacity of 6,664.
The figures, however, can be misleading if seen at the country-level, given that while there are critical care beds available, there appear to be acute capacity shortages in larger cities where the caseloads are higher.
"People generally go towards bigger cities for treatment," explains Ahmed Zeb, who is also a doctors' union spokesman. "The burden falls on cities like Peshawar, where the burden is extremely high."
In Karachi, the country's largest city, patients travel for hundreds of kilometres seeking treatment, said Dr Seemin Jamali, head of the Jinnah Postgraduate Medical Centre (JPMC), the city's largest government hospital.
Currently, the JPMC has room for "two or three" more patients on critical care beds, as they work to add capacity to the system.
Misinformation about the coronavirus has also been a concern for doctors, with at least three incidents of violence reported across the country by angry relatives of patients who died from the virus.
"This is a pandemic and people don't believe us," said Jamali, whose hospital was attacked twice in the last month.
"They think that we are getting paid by the WHO to declare deaths as being due to the coronavirus."
A doctor and nurse wear protective masks as they stand in a passenger train's car after the government turned it into a hospital and quarantine centre, in Karachi [Akhtar Soomro/Reuters]Debate over lockdown
The countrywide increase in cases coincides with an almost complete lifting of lockdown restrictions by the government on May 22.
"Since the lockdown was ended, right after [the Muslim festival of] Eid we saw the cases rising rapidly," said Baig. "We saw our first 1,000 cases [in the province] in 50 days, and now we have seen 1,000 cases in just the last three days.
"We need a lockdown, nothing else. People are coming into the hospitals, we don't know who is infected and who isn't," he said.
On June 7, in a letter to provincial authorities in Pakistan, the WHO warned that if a new intermittent lockdown was not imposed, the country could see cases rise to more than 800,000 in July before beginning to level off.
"As of today, Pakistan does not meet any of the prerequisite conditions for opening the lockdown," said the letter, which detailed six criteria under which such decisions should be taken, including controlling disease transmission, effective contact tracing and community awareness.
On Thursday, however, Pakistani Prime Minister Imran Khan repeated his position that the country could not afford a strict lockdown due to its economic implications.
"Some people say 'lockdown, lockdown, lockdown!' as if that is a solution," he said in a televised address to the nation.
"Our situation is different from the US, China [and others], because 25 percent of our people are in poverty. So if we do a lockdown, the curse of it falls on the poor."
PM Khan called on citizens to observe social distancing guidelines to control the spread of the virus but also issued a warning.
"In the coming days, sadly I must say, that the number of deaths will increase in Pakistan."
'No space'
Epidemiologists say Pakistan will have to find a solution that incorporates its limited capacity for imposing lockdowns and inadequate healthcare infrastructure.
Dr Adnan Khan, a public health researcher and infectious disease specialist, says Pakistan needs to implement higher rates of testing, and more effective testing of contacts of coronavirus positive patients. The WHO has assessed Pakistan's isolation, tracking and testing regime as being "weak".
Moreover, he said the authorities could maximise the current capacity in the system by only admitting patients to hospital who are in need of critical care, freeing up space to increase the capacity for such beds.
"You need to do triage," Khan told Al Jazeera. "Do basic intake, check their fever and oxygen stats, and then you turn away anyone who is dealing reasonably well, and check in with them again the next morning.
"There is a capacity that even now can be expanded by three to four-fold if it is done rationally."
It is that lack of space in the system that appears to be contributing to higher rates of deaths, particularly in major cities like Peshawar.
"[If things continue like this] they will not be able to handle it," said Atiqullah, hours after burying his father.
"The resources were there to prevent the spread of the virus, but the problem was the ICU," he said. "The problem that there is no space."
https://www.msn.com/en-us/news/world/pakistan-hospitals-struggle-as-coronavirus-cases-explode/ar-BB15ohDr?ocid=msedgdhpConspiracy theories help coronavirus take root in Pakistan
By ADNAN AAMIR
Religious fervor and distrust of government combine with deadly results.The novel coronavirus is spreading faster in Pakistan than almost anywhere else in the world, yet most people do not take the pandemic seriously due to misinformation and conspiracy theories surrounding the virus.
As of Friday, COVID-19 cases in Pakistan had reached 125,933. Infections have risen by more than 500% over the last week. But despite the alarming numbers, the government has relaxed lockdowns across the country and has even decided to reopen the tourism industry.
Human Rights Watch said the move endangers people's health. The World Health Organization has recommended that Pakistan impose strict, intermittent lockdowns lasting two weeks to control the spread of the virus.
But the authorities have declined to act on the WHO recommendations. Zafar Mirza, special assistant to the prime minister for health, said the recommendations are not mandatory and that the government must take economic as well as health considerations into account.
Experts believe the government inaction is driven by the large slice of the population that does not take the coronavirus seriously due to conspiracy theories rampant on social media.
In April, for example, Tariq Jameel, Pakistan's most famous televised Islamic cleric, claimed the coronavirus is a sign of God's wrath over such sins as women dancing and dressing immodestly. Another fanciful notion is that the coronavirus is part of China's master plan for world dominance. Because Pakistan is China's ally, the thinking goes, it will not be affected. Bill Gates, Microsoft's founder and a philanthropist who has devoted a large chunk of his wealth to health issues, is accused of spreading the virus so he can make a fortune selling vaccines.
According to a poll conducted by Ipsos, a global market research and public opinion specialist, only 3% of Pakistanis have no misconceptions about the coronavirus -- how it spreads and methods for its prevention and treatment. The same poll revealed that a third of respondents believe in conspiracy theories related to the pandemic.
Although a number of these theories are believed around the world, experts say Pakistan's unique circumstances and culture make it a more receptive market than most for such ideas.
Malik Siraj Akbar, a South Asia analyst based in Washington, says conspiracy theories have always been widespread in Pakistan. "Some people are agitated over [these theories] now only because of the seriousness of the coronavirus pandemic," Akbar told the Nikkei Asian Review, adding, "A country like Pakistan, with inadequate resources and the enormous challenge of COVID-19, cannot afford to ignore science."
Akbar said Prime Minister Imran Khan appears to put more stock in fiction and religion than in science. In a televised address in March, Khan said: "Ninety percent of coronavirus cases are normal flu, and clear up without any treatment."
Khan's approach to the disease is very subjective, and based on his own fears and assumptions. He does not pay much attention to experts regarding the many lives a lockdown would save, Akbar says.
Another unique aspect of Pakistani society is that even well-educated people, including some doctors, spread COVID-19 conspiracy theories. As a result, laypeople are easily taken in because they have been shared by "experts."
Multiple doctors, for example, have suggested that senna leaves, a local herb, can treat the virus. As result, people have started using them in huge numbers, but there is no scientific evidence to support its effectiveness.
Shahzada Zulfiqar, president of Pakistan Federal Union of Journalists, believes a combination of illiteracy and religious conservatism fuels conspiracy theories. "Most of the experts and medical doctors who peddle conspiracy theories are inspired by religious dogmas," he told the Nikkei Asian Review.
Pakistan's closed society and proximity to Afghanistan adds a religious dimension to the conspiracy theories. "Based on the experiences of the recent past with respect to conspiracy theories on polio, we know that this kind of misinformation can have devastating consequences on the public health sector," said Akbar. The decadeslong polio vaccination campaign in Pakistan was previously derailed by attacks on the health workers fueled by the belief that the drops cause sterility in children.
Experts also blame the government for not debunking ill-founded claims. The general lack of trust in the government makes people more open to conspiracy theories.
Krzysztof Iwanek, head of the Asia Research Centre at the War Studies University in Warsaw, said the spread of conspiracy theories is fostered by the government's lack of effort in combating them. "The gaps in these [efforts] probably lead to Pakistan being affected [by the coronavirus] more than some other countries," Iwanek told Nikkei.
Experts also blame some in the Pakistani media for telling tall tales about the coronavirus. "The Urdu press has contributed to sending mixed and confusing messages, since it is dominated by the religious right," Akbar said. As a consequence, the coronavirus has been presented as a "science versus Islam" or "East versus West' issue in Pakistan. The media has given people with religious motivations a reason to believe in conspiracy theories, Akbar added.
The critical ingredient that remains missing from Pakistan's Covid response strategy
Dr Faheem Younus
The focus in Pakistan must shift from policy to mass education, from analysis to practice.We drive cars but don’t venture to fly a plane. Why? Because we are not trained pilots.
That’s how it is. Managing our personal Covid realities is like driving a car; carrying a nation through a mercurial pandemic requires trained pilots. But when non-professionals try to fly planes, nations end up with confusion and chaos.
That’s what may have happened with Covid-19 in Pakistan where June 5, 2020 marked the 100th day of the outbreak. And during those 100-days, who educated the country about the disease? Politicians, anchors, doctors, bureaucrats, and others. And what was the focus of those communications? Policy debates, boilerplate analysis, and a potpourri of treatment plans. Our national discourse largely revolved around a single word: lockdowns.
This needs to change. The focus must shift from policy to mass education, from analysis to practice. This requires a panel of experts endorsed by the government and the local medical bodies. They should study the evolving science of this novel coronavirus, then communicate its symptoms, diagnosis, treatment, and preventive strategies to laypeople, daily. The goal is to train a nation on how to tackle this pandemic.
Imagine if, during those first 100 days, a panel of experts answered questions from the general public every night on TV? Instead of fueling conspiracy theories or allowing folklore to muddle the conversation, imagine if these experts were regularly dispelling myths? How far along would Pakistan be?
That’s public health 101. Outbreak breed rumors. Having managed many outbreaks, I know why calm, honest, communication is vital. Sadly, on February 15, as the World Health Organisation (WHO) was warning the world about the risks of an "infodemic", Pakistan was veering into one.
Today, Covid-19 is going viral, literally. The total number of cases has crossed 120,000. And since our testing is almost 20 times less than many developed countries, it's plausible that the real number of cases might be manifold.
So, where do we go from here?
I believe a unified messaging about Covid-19 itself should be a top priority. Some may argue that it’s too late; the virus is already widespread. I disagree. According to the WHO, coronavirus might never go away — i.e., we don’t know how many 100-day cycles Pakistan will face. Others believe so many educational campaigns already exist, through apps, websites, TV ads, social media. I agree. But it's one-way communication. People don’t have a forum to ask their questions and see the experts. When armies attack countries, people find solace in hearing from their generals. Why shouldn’t Pakistanis hear from an expert medical panel during a pandemic?
Here is a suggested structure: based on competence, this three-person expert medical panel should constitute of specialists in epidemiology, infectious disease, and outbreak management. They should be coached in principals of mass communications and then provided with an hour on prime-time TV, across all channels, daily. TV channels should solicit questions from viewers ahead of time and allow the experts to give rapid-fire, data-driven answers. Be bold to reject urban legends. Be kind while listening to a difficult situation that may not have a solution. A good session should answer around 50 questions/hour. Let this panel become the face of Covid-19 defence in Pakistan. The idea is not to compete against the existing health structure but to complement it.
This system works. We implemented it in our hospitals after experiencing the first Covid-19 patient. Every day, we answered 30-40 questions from our team members on a 30-minute conference call. Despite being in an affluent country, we struggled with tests and supplies, but we never struggled with messaging. Witnessing our 3500+ strong team quickly adapted to a new reality was like watching a teenager quickly learn to drive.
And drive we must because nations cannot remain under lockdowns. Just like we learn the rules and risks of the road before getting our license, we should learn the rules and risks of driving through this pandemic. Accidents will happen, but they won’t paralyse us. With time we will become safe drivers. The panel should also be cognisant of four things: politics, trust, credibility, and expectations. Remain apolitical. Don’t lionise the government and/or criticise the opposition (or vice-e-versa). Earn people’s trust that the effort is sincere and not self-serving. Anchor your recommendations with WHO wherever possible. This will infuse discipline and credibility in the process. Yes, WHO has made some controversial decisions, but its core strategy has allowed many countries to contain the virus. Set the expectation that this panel will make errors, that they will backtrack some of their statements. That’s the nature of evolving science.
Gradually, this may shape a culture where mass communication practices deference to expertise. It costs very little. The government should opine on policy, economists should explain financial risks, and medical experts should talk about the virus itself.
People say, "how can a large resource-limited country like Pakistan win against Covid-19?" I ask, how did Vietnam — a third world country of nearly 100 million people — stop the pandemic in its tracks by limiting the number of infections to 332? How come they had zero Covid-19 deaths? Because they trusted the science, effectively communicated, and mounted a unified defence against a unified virus.
Maintaining the status quo will breed more confusion in the coming days. Misinformation loves a vacuum. Fill it with expertise or accept chaos. Each case, each death will fuel further panic.
If this plan is executed correctly, the next 100-days may look like this: Millions become engaged and educated through a daily question-answer session on TV. Within 1-2 months, they learn the rules of this disease and start following policies, instead of debating them. Pakistan’s economy opens, and Pakistanis carefully drive through this pandemic until we reach the destination of mass vaccination.
Boredom or Apathy: The most uneventful Budget of the last two decades
It looks like the work of an accountant, who was tasked to ‘balancing’ the books without giving much thought to underlying economic rationale.
It looks like the work of an accountant, who was tasked to ‘balancing’ the books without giving much thought to underlying economic rationale. The budget does not give any clear economic direction. The policy makers are either fatigued, or just too bored to even think, or bother with managing the economy anymore. This isn’t a pandemic coupled with a locust attack budget – this is a ‘lets wrap this up and go to Nathiagali for the weekend’ kind of budget.
In a time when all guns need to be loaded, all tools whether conventional or unconventional need to be leveraged – but here we are with copy-paste of a template driven prescriptive approach of one of our major lenders. Pakistan got its first economic contraction in the last 68 years, but it is being presented like a new normal. This is the time for unconventional policies to stimulate Aggregate Demand, to spur economic activity, to put cash in the pockets – the budget fails to do any of that.
Going into specifics, little to no effort has been put into expanding revenue base – a large chunk of economic activity happens outside the tax net, and despite efforts in the last few years, the incumbent government has most likely given up on expanding the tax net. A 73 percent increase in Petroleum Levy seems like probably the only thing the policy makers have control over. A silver lining is absence of any tax increases for the salaried segment, although real wages will be going down significantly, dampening Aggregate Demand in the process.
It is even futile to talk about military expenditure because that is the bare Minimum required to maintain a formidable military in a hostile environment. We have a revenue problem, and successive governments have failed to crack this problem
Expenditure has been squeezed, pointing towards austerity, at a time when austerity is the last thing that is required for stimulating the economy. Even welfare payments through BISP have been cut down. Austerity will further dampen Aggregate Demand, which means lower economic activity, and consequently lower tax collection. Do we really want to be stuck in a low-growth loop – because this is what everything is pointing towards.
Some may call this a business-friendly budget, some compromised by partisan politics may even call it a great budget, but it got a very status quo feel to it – its not a crisis budget. The country is going through a crises, a rare combination of health and economic crises – but policy makers seem to be as calm as a cucumber. Setting a target of real growth rate close to, or less than population growth rate is not an ambitious feat, it just reeks of apathy, and a lack of ambition resulting in a festival of mediocrity.
https://www.brecorder.com/news/1004128/boredom-or-apathy-the-most-uneventful-budget-of-the-last-two-decades
چیئرمین پاکستان پیپلز پارٹی بلاول بھٹو زرداری کا سابق وزیر اعظم شاھد خاقان عباسی کو ٹیلی فون
چیئرمین پاکستان پیپلزپارٹی بلاول بھٹو زرداری نے ہفتہ کے روز سابق وزیراعظم شاہد خاقان عباسی کو ٹیلی فون کرکے ان کی خیریت دریافت کی۔ بلاول بھٹو زرداری نے سابق وزیراعظم کا کورونا وائرس مثبت آنے پر تشویش کا اظہار کرتے ہوئے کہا کہ کورونا وائرس وباءکا شدت سے پھیلنا انتہائی تشویشناک ہے۔ وفاقی حکومت نے کورونا کے حوالے سے ڈاکٹروں اور طبی ماہرین کے مشوروں پر عمل ہی نہیں کیا۔ انہوں نے کہا کہ مجھے عوام کے ساتھ ڈاکٹروں اور طبی عملے کی زندگیوں کی بھی فکر ہے جو کورونا وائرس کے مریضوں کا علاج کرتے ہوئے اپنی جان کی بازی ہار رہے ہیں۔
بلاول بھٹو زرداری نے شاہد خاقان عباسی کی جلد صحتیابی کے لئے دعا بھی کی۔ چیئرمین پیپلزپارٹی بلاول بھٹو زرداری نے خیبرپختونخواہ اسمبلی کے سابق اسپیکر کرامت اللہ چگرمتی کو ٹیلی فون کرکے ان کے بھائی کے انتقال پر افسوس اور تعزیت کا اظہار کیا۔ بلاول بھٹو زرداری نے کرامت اللہ چگرمتی سے گفتگو کرتے ہوئے کہا کہ زندگی اور موت کے فیصلے کا اختیار صرف اللہ تعالیٰ کے پاس ہے، اس سلسلے میں انسان بے بس ہے۔ بلاول بھٹو زرداری نے مرحوم کے مغفرت اور بلند درجات کے لئے دعا بھی کی۔
تھرپارکر میں مزدوروں کی ہلاکت پر بلاول کا اظہار افسوس
چیئرمین پاکستان پیپلز پارٹی بلاول بھٹو زرداری نے تھرپارکر کے گاؤں راڑ کوؤ میں کنویں کی کھدائی کے دوران چار مزدوروں کی ہلاکت پر افسوس کا اظہار کیا ہے۔
بلاول بھٹو زرداری کا کہنا ہے کہ غریب مزدوروں کی جانوں کے ضیاع کی خبر سن کر دلی رنج ہوا۔
انہوں نے کہا کہ اس طرح کے حادثات کی روک تھام کے لیے اقدامات اٹھانے کی ضرورت ہے۔
بلاول بھٹو نے ہدایت کی کہ پارٹی کے مقامی عہدیداران اور کارکنان فوت ہونے والے مزدوروں کے لواحقین کا غم بانٹیں اور ان کے ساتھ ہر ممکن تعاون کریں۔
پی پی پی چیئرمین نے متاثرہ خاندانوں سے دلی تعزیت و ہمدردی کا اظہار بھی کیا ہے۔
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