- While bringing the world to a standstill
Utter confusion and chaos linger in the hearts of world leaders, policy-makers, health organizations and the rest of the world. As of 11th March 2020, the World Health Organization (WHO) has characterized COVID-19 (Coronavirus disease) as a “pandemic”. Scientists are in a race to find a vaccine for this ungodly pathogen that first took China by storm and has spread to 162 countries since. Reportedly, the vaccine is at least 6-9 months away. And even that will not be fully accessible to all countries immediately.
Currently, Pakistan has 236 confirmed cases nationwide – 172 in Sindh, while the rest have appeared in Balochistan, KP, Gilgit-Baltistan and Punjab. Confirmed cases in Pakistan are now doubling every 2 days and it is important to remember that these are just reported cases and only represent a fraction of the total. With our borders hitting China, Iran and Afghanistan, we are not safe, to say the least. Multiple cases, with travel history from UK, Syria and Iran, are being reported on a daily basis. It is not my intension to create panic, but instead to instill caution and to make my fellow comrades exercise preventive measures against this mysterious pathogen. Ring the alarm bells, it’s time to take cover and be cautious.
It could be said that the COVID-19 is a beta Coronavirus, like the MERS-CoV or SARS-CoV. MERS – Middle East Respiratory Syndrome reportedly took 858 lives globally and was transferred by dromedary camels to humans. SARS – Severe Acute Respiratory Syndrome (2003) caused 8,098 human infections and 774 deaths across 32 countries. The animal suspected to be responsible for SARS was the palm civet which was widely available in the wet market of Foshan, Guangolong in Southern China. These wet markets have been on the rise since late 1980s. The Law of the People’s Republic of China on the Protection of Wildlife was originally enacted to strengthen breeding, domestication and utilization of wildlife resources, due to which an industry was born.
Small local farms turned into industrialized units – bigger population of animals meant that sick animals could spread diseases more widely, and a vast variety of these species meant that they brought in their own set of genetic codes and viruses with them. Illegal trading of endangered species also began in these wet markets and by 2003 – when the industry was booming – we witnessed the SARS-CoV outbreak. These markets were temporarily banned after the outbreak. However, once the virus was contained, the same practices were legalized again. This lack of foresight caused similar emerging patterns to arise yet once again in Wuhan, Hubei (China).
We are living in simply incredulous times. It is a crisis situation, and we don’t need to reinvent the wheel to prevent the crisis. We need to merely ensure that the stringent measures and best practices that are adopted by other countries, with no regard to the economic consequences, should be immediately institutionalized in Pakistan.
COVID-19 stems from a similar practice. It has been speculated that a bat virus and a pangolin virus have traded genetics before spreading to humans, however, this data is inconclusive. At time of writing, COVID-19 had so far infected more than 189,631 individuals and taken more than 7 513 lives and these stats will inevitably continue to rise. The SARS episode warned us about the importance of changing animal husbandry processes or ‘more viruses would be born from the animal world’.
Italy is under complete lock-down with 28,000 confirmed cases and 2,158 deaths while Iran has over 14,000 confirmed cases and 853 deaths and is declared as a ‘crisis zone’ asking for global medical support. BBC reported, several individuals lost their lives while waiting to be tested. The UK, with its advanced National Healthcare System (NHS) is recalling its retired medical staff, increasing the number of ICU beds and encouraging online doctor appointments. On 14th March alone, the UK reported 248 new infections, while Germany expects 70% of its population to be affected in the near future. The US has declared a state of national emergency amidst travel bans and has released $50bn in federal funds. Most countries are restricting freedom of movement and suspending basic human rights – however – it is imperative to understand that this is for the greater good.
In the short-term, we have learnt that containment is, in fact, our best defense. The WHO rightly states that early counter measures are essential to lower the rate of infection growth, so the pandemic is spread out over time and extreme pressure on the healthcare system of any particular country is kept at a minimum. While the total number who get infected might not change, the containment measures are intended to avoid an outbreak trajectory in which many people get sick at the same time. This is the reason that limiting the magnitude of peak incidents of an outbreak is important.
What is worrisome is that Pakistan’s healthcare system is already compromised. We need to partake in social distancing, active testing, self-isolation, and take containment measures seriously. While private labs are providing PCR testing facilities, it costs Rs 7,900/ test kit and only a fraction of the population can afford this price.
After a recent investigation, it has come to light that Services Hospital in Lahore has been given the responsibility to treat the majority of potential COVID-19 patients. Currently Services hospital does not have any testing kits and the medical staff has not been given sufficient training if the situation deteriorates further. They have established an isolation ward albeit in the center of the hospital premises, rendering the concept of isolation null and void and putting a greater population at risk. Additionally, our healthcare officials have not been supplied with proper protective gear and only a limited amount of N95 masks are available.
When it comes to responding to this pandemic, it is important to learn from Singapore, Hong Kong and South Korea. These countries have managed to contain and delay the outbreak. They have introduced strong surveillance systems that give early warnings of infections to achieve rapid-contact-tracing, testing and isolation mechanisms. Tracing people-contacted by infected-individuals and testing them lies at the heart of this fight.
Singapore has been applauded for its transparency and straightforward communication to its citizens, and has successfully ingrained the concept of ‘social distancing’. In Hong Kong, the containment strategy is aggressively tracking down suspected cases and quickly quarantining any individual who has potentially been exposed. In Feb 2020 – 12,000 people were quarantined in various forms. Daily announcements of addresses and occupations of newly diagnosed individuals were made and residents who may have ‘come into contact’ with infected people were requested to come forward. South Korea is conducting the most amount of active testing, suggesting that their number of confirmed cases is closer to the total number of infected cases. Pakistan needs to enhance its testing capabilities by a large margin to have a clearer picture of the outbreak which will allow the infected persons to avoid spreading the virus and quickly receive the care they need.
It is now our civic duty to do our part and educate the public about all forms of preventive measures. Crowded places should be avoided at all costs. Public transportation facilities should be disinfected on an hourly basis, if not completely halted. Prayers should be said in the comfort of one’s home. Employers should monitor employees, their travel history, restrict non-essential travel, encourage work from home policies, and recommend self-isolation if symptoms are visible.
Everyone needs to be wary of COVID-19 symptoms, which could be as simple as fever, a dry cough and fatigue. Other symptoms also include shortness of breath (Dyspnea) and mild Pneumonia. However, in critical cases, it can lead to severe pneumonia, respiratory failure, septic-shock, multiple organ dysfunction and organ failure. While a majority of the population will recover, it is pertinent to inculcate in our society that people who have a reduced chance of surviving severe pneumonia are those who are above the age of 65, children under the age of 2 and people with pre-existing health conditions. Therefore, those who feel that they have been exposed to the virus and /or are experiencing mild symptoms and cannot get tested should self-isolate themselves for at least a period of 14 days in order to protect the more vulnerable.
On a daily basis, everyone needs to have good hand hygiene, disinfect surfaces and exercise social distancing. We are living in simply incredulous times. It is a crisis situation, and we don’t need to reinvent the wheel to prevent the crisis. We need to merely ensure that the stringent measures and best practices that are adopted by other countries, with no regard to the economic consequences, should be immediately institutionalized in Pakistan. Closing of schools and cancelling of PSL matches is indeed a step in the right direction, however, not sufficient. While the government has closed its borders, limited air travel, we should internally call for a halt down of activity till a full cognizance of the virus and a strategy for its containment is adopted.
