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May 22, 2020



May 22, 2020

The sunsets at Hayatabad in Peshawar are heavenly these days.

Through the weeks of lockdown and social isolation, the air has turned clean and clear. One can actually see the twinkling Northern Star as the sun settles behind the famous Tattara Mountain range along Torkham border, enveloped in clouds of vibrant hues in yellow, orange and golden, as if from an artiste’s palette.

But as we hear the news about easing of lockdown there is a mixed feeling of elation and despair – Why?

For public health experts and environmentalists, this brief interlude marked by a refreshing revival of health-restoring atmosphere shall soon be a thing of the past. Soon, the world will rush back to the old ways of life and in our hectic, everyday routines, the precious lesson received from months of isolation that the mindless race for economic progress also imperils our health and life expectancy, will be forgotten.

In a world without Covid-19, we always knew that the mountains existed along the border, but they never looked so close, or clear; their presence and beauty marred by pollution. Bordering Hayatabad is an industrial estate that became dormant for a few months during the lockdown, but slowly its engines are revving up again, guzzling fuel and exhaling dark clouds of toxic emissions into the clear sky. It will envelop the environs of a tranquil landscape as it picks up the pace of “normal industrial activity”

For decades now, this industrial pollution, so fetid and toxic, has been poisoning the people of this township as they sleep. One wakes up in the morning and smells a whiff of a faint sulfurous odour in the air, a remnant of the night-time production cycle. The slow poisoning of people by industrial pollution has continued in the past and in the post-Covid19 it would be business as usual.

The toxic effect of pollution chokes people in the long run, quite similar to the “cytokine-storm” that causes immediate death during Covid-19 infection. It is something we would rather not talk about because it relates to our erroneous notions of "development." Many large and small industries across Khyber Pakhtunkhwa, including Hayatabad, continue spewing hazardous emissions into the environment round-the-clock. The enormous plumes of toxic fumes from rickety vehicles are ignored despite the existing EPA regulations.

Peshawar was once known as the city of flowers and gardens. I can recall my early childhood growing up here till it was infected by the “development bug”. Slowly its broad tree-lined boulevards and shady roads were transformed into monstrous concrete structures. The transition was accompanied by billowing industrial and vehicular fumes. Out on its roads, the commute became insufferable and breathing difficult, leading to an exponential rise in physical and mental health problems.

However, new evidence has emerged linking health and wellbeing to a cleaner environment which can only be ignored at our peril. "Air pollution linked to raised Covid-19 death risk," says a BBC report published on World Earth Day. It throws into sharp relief a disease relationship that epidemiologists and public health experts have often warned.

"It is one of the first studies substantiating our suspicion and the hypothesis that severity of the Covid-19 infection may be augmented by particulate matter air pollution," says Prof Annette Peters, University of Munich. Another study, at the University of Siena, in Italy and Arhus University, in Denmark, suggests a possible link between high levels of air pollution and Covid-19 deaths in northern Italy.

According to a WHO report, 9 out of 10 people breathe air containing high levels of pollutants. Air pollution kills an estimated eight million people worldwide every year. More than 80% of people living in urban areas are exposed to pollution levels that exceed WHO guideline limits, with low- and middle-income countries suffering the highest exposure.

The European Public Health Alliance (EPHA) has warned of the higher overall death toll from the virus currently sweeping the world. Its report says that polluted air in urban areas causes hypertension, diabetes and other respiratory illness, also raising the risk factors for COVID-19 infection. “Air pollution from petrol and diesel vehicles is likely to increase mortality from the novel coronavirus in cities”, say public health experts. “Patients with chronic lung and heart conditions caused or worsened by long-term exposure to air pollution are less able to fight off lung infections and more likely to die”.

The silver lining to the pandemic is the emerging unanimity that a grossly consumerist model is untenable. As things stand, human greed far outstrips the earth's capacity as resources diminish rapidly in relation to a growing demographic explosion. Likewise, the COVID-19 pandemic has exposed the acute weakness of Public Health system in the economically developed world. USA and UK have the highest fatality rate owing to limited public and mostly privatized health system. In the absence of universal health coverage in the USA, a disproportionate number of the middle class and below is left out of the essential health services. President Trump, the worst critic of social reform of the public health system, has resorted to bail-outs worth trillions of dollars in face of growing fatalities.

The public health imbalance among the South Asian countries - Pakistan, India and Bangladesh - is sobering. Under multilateral donor structural reforms in health and education, the moderately performing public health systems are now transforming into a market-oriented (profit) model. The weakness of our public health system is a reminder to all that investment in health and education is as important as GDP growth. A Public Health proverb “Prevention is better than cure” has been proven right.

As governments mull over decisions to kick start business-as-usual, a “honeymoon period” of clear blue skies, heavenly sunsets, glittering stars, smog and smoke-free crisp air, and cleaner roads would soon be over.

The future sounds ominous. Clouds of haze and smog, unregulated traffic and industrial emissions, laden with hazardous CO, CO2, SO2 and NO2would return, unless the governments enforce the Clean Air Act. Pollution penalties and taxes can generate revenue as well as control vehicular and industrial emissions taking a heavy toll in terms of health and prosperity of populations worldwide.

Is this a wishful thought, then, that the future of the world is hinged to a cleaner and healthier world? If it is, how can we bid goodbye to Covid-19 with a sigh of relief when an equally diseased and debilitating future awaits us?

Adil Zareef is a Public Health specialist who teaches at Northwest School of Medicine, Peshawar.