Healthcare in a fix

May 31, 2020

Healthcare professionals fear that the fallout of easing lockdown restrictions may be more devastating than estimated earlier


ollowing the relaxation of lockdown restrictions on May 9, the number of coronavirus cases in Pakistan has almost doubled. Seeing an exponential growth in transmission and resultant mortalities due to the virus following easing of lockdown restrictions, healthcare professionals fear that the fallout of easing the lockdown may lead to devastating effects.

According to Pakistan’s National Covid-19 Dashboard, there were a total of 57,705 confirmed cases of coronavirus including 1,197 deaths (2.1 percent) and 18,314 recoveries (31.7 percent) till May 26. Prior to easing of lockdown, during the two-and-a-half months’ period between the confirmation of the first case of coronavirus in Pakistan on February 26 till easing of lockdown on May 9, there were 29,465 confirmed cases with 639 deaths (2.2 percent) and 8,023 recoveries (27.2 percent).

However, over a relatively short period after easing of lockdown on May 9, there were 28,240 new Covid-19 cases and 558 deaths. Meanwhile there were 10,291 recoveries.

In the Punjab, the number of confirmed cases rose to 20,656 and death toll to 352 (till May 26). The provincial government is struggling to cope with the load of patients at dedicated Covid-19 facilities. According to statistics of the Specialised Healthcare and Medical Education Department (SHC and MED), the Punjab government has established facilities with a total of 8,728 beds for coronavirus patients. These include 3,370 dedicated beds in teaching hospitals and 3,374 beds set up in field hospitals with the potential of setting up of another 1,984 beds in field hospitals.

However, in view of the recent spike in coronavirus cases, the authorities are especially hard-pressed with the limited availability of ventilators (a total of 1,296, out of which 40 are out of order). Meanwhile, there are only 351 dedicated beds in High Dependency Units (HDU) across the Punjab.

Amid claims and counter-claims regarding availability of personal protective equipment (PPEs) in hospitals, the increasing load on hospitals after easing of lockdown has made medical personnel extremely vulnerable to coronavirus. The orthopaedic ward of the Lahore General Hospital had to be closed down after 16 doctors were infected with the virus.

“The easing of the lockdown has had a devastating effect. It has put all preventive and curative strategies to rest. Now, coronavirus is driving the strategies,” says Dr Shahid Shaukat Malik, general secretary of the Pakistan Medical Association (PMA)-Lahore. He says the easing of the lockdown ahead of Eid-ul-Fitr, when people blatantly violated the proposed standard operating procedures (SOPs), had caused a spike varying between 6.5 percent and 10 percent in the number of cases. This, he said, had overburdened the health facilities.

The easing of lockdown has had a devastating effect. It has put all preventive and curative strategies to rest. Now, coronavirus is driving strategies,” says Dr Shahid Shaukat Malik, general secretary of the Pakistan Medical Association (PMA)-Lahore.

“What Pakistan needed was a three-week curfew-like lockdown to break the transmission line of the virus. Later, it could have been gradually eased.” Dr Malik, a professor of public health and community medicine, worries that the government has engaged experts of non-related specialties instead of availing the services of public health experts, epidemiologists, virologists, pulmonologists, and infectious disease experts to combat the virus effectively.

“The containment measures had to hit the economy anyway,” he says, adding that this needed to be tackled through a stimulus package by the government combined with private charity. He also calls the expenditure on field hospitals “a waste of money.” The government, he says, should instead have used trust hospitals like the 1,500-bed Gulab Devi Hospital already being run on government’s grants and attached teaching hospitals of private medical colleges equipped with infrastructure, ICUs, ventilators and oxygen supply. He says there are 3,500 ventilators in the Punjab out of which 2,200 are in the private sector. Yet, he says, these private health facilities are lying empty and the government has chosen to set up field hospitals.

Prof Dr Mahmood Shaukat, head of Corona Experts Advisory Group (CEAG)-Punjab, echoes Dr Malik’s observation saying that local evidence and not predetermined plans should drive strategies to contain the spread of coronavirus. “We will have to change our decisions frequently: impose a lockdown for two or three days, then relax it. It’s a tightrope walk for the government. A permanent lockdown will have a snowball effect on an already collapsing economy or risk faster proliferation of the virus,” he says. He does not think a permanent lockdown is viable.

The Young Doctors’ Association (YDA) Punjab president, Dr Salman Haseeb Chaudhry, who was himself diagnosed with Covid-19, lambasts the government for exposing the doctors and medical staff to the virus by denying them personal protective equipment (PPEs) during the spike in cases triggered following the easing of restrictions. “The health facilities are exhausted and human resource is exposed to the virus,” he says. He adds that the lockdown was eased apparently to appease businessmen.

“The government is not testing medical professionals for the infection,” he says estimating that 10 to 15 percent of medical staff in hospitals may have been infected with the virus.

Prof Dr Javed Akram, vice chancellor of the University of Health Sciences (UHS), Lahore, says that after easing of lockdown restrictions, the mortality rate had doubled. He says two to three deaths were being reported every hour in the country. “The mortality rate per million in Pakistan is four times that of Bangladesh, and twice as much as in India and in Sri Lanka,” he adds. Dr Akram also vehemently rejects herd immunity as a viable option. “It requires infecting at least 70 percent of the population over a period of three years and sacrificing over 1.5 million people with only 2 percent mortality.” He says there was no evidence of immunity being developed against the virus among already infected people. “And, even if immunity develops, we don’t know whether it will be long-lasting or short-lived.” Instead, he says, we are now witnessing people losing their immunity because the host response is different in Pakistan. “We have different antigenic response due to different genetic and environmental profiles,” he adds.

In view of the increase in the number of patients, he says, the health authorities are left only with the option of advising home isolation for Covid-19 patients under strict protocols.

Nabeel A Awan, the secretary for SHC&MED admits that after easing of lockdown restrictions, the patient load at health facilities had increased rapidly. “This highlighted certain limitations of our health system like deficiency of ICUs and HDUs equipped with ventilators, oxygen supply, etc. However, the department has prepared a contingency plan to rope in five trust hospitals, including Gulab Devi Hospital, running with government’s grants, and private teaching hospitals to share the burden of the patients.”

Regarding medical professionals’ reservations about setting up of field hospitals, he says that the required medical facilities in these hospitals were too little to cope with Covid-19 emergency and that led to the idea of establishing field hospitals. Awan says that the government has also increased the testing of medical personnel. “We are in the midst of a pandemic and have to face these challenges. Of course, we have to protect the frontliners first.”

In view of the surge in coronavirus infections and deaths in Pakistan, Special Assistant to the Prime Minister on Health Dr Zafar Mirza has warned the nation to take precautions saying otherwise it could turn into a “huge tragedy”. Lamenting the violation of the SOPs and instructions to control the spread of the virus, he has said that the government would consider re-imposing the lockdown if the upward trajectory of the virus continued.

The writer is a reporter for  The News in Lahore

Medical workers fear that fallout of easing coronavirus lockdown restrictions may be devastating