A cautious return

August 23, 2020

While the resumption of outdoor and wards services at hospitals offers relief for many, health experts warn of the possibility of a second wave of pandemic as the government lifts lockdown restrictions

Regular healthcare services in public hospitals across the Punjab have resumed after an over-four-months break that had witnessed a raging pandemic. With the reopening of various sectors of commerce and industry by the government earlier in August, provincial health authorities and public health experts are wary of a possible resurgence of coronavirus.

Healthcare services in almost all specialties had come to a sudden halt in the Punjab during late March after the emergence of Covid-19 positive cases sent the public as well as health authorities into a panic, forcing authorities to declare all hospitals as dedicated facilities for coronavirus patients.

While for many the resumption of outdoor and wards services at hospitals across the Punjab after Eid ul Azha (early August) offered much relief, the reopening of many sectors of the economy is keeping public health experts and health authorities on tenterhooks as they prepare to deal with a possible second wave of Covid-19, especially in view of the approaching congregations during Muharram, and the reopening of educational institutions.

The Punjab government, on the recommendation of the National Command and Operation Centre (NCOC), has opened all sectors, except education, in a bid to revive the economy after coronavirus cases not only registered a steep decline but also maintained a consistent downward trend for six weeks.

In Pakistan, as of August 18, a total of 289,832 Covid-19 positive cases had been confirmed. Out of this 270,009 had recovered and 6,190 deaths recorded. In the Punjab alone, 95,611 coronavirus positive cases had been confirmed out of which 88,861 patients had recovered and 2,185 fatalities recorded. The high recovery ratio among Covid-19 patients helped ease the burden on hospitals.

In view of the downward streak of cases in the Punjab, Specialised Healthcare and Medical Education Department (SHC&MED) allocated separate dedicated facilities for Covid-19 patients in Lahore at Mayo Hospital, Pakistan Kidney and Liver Institute (PKLI), Nawaz Sharif Hospital, Yakki Gate, and at the gynae ward of Sir Ganga Ram Hospital for women. Dedicated Covid-19 services were also available at the Government General Hospital, Ghulam Muhammad Abad, and Allied Hospital in Faisalabad, Nishtar Hospital in Multan, Rawalpindi Institute of Urology and Transplantation (RIUT) and Benazir Bhutto Hospital (BBH), Rawalpindi.

All remaining public sector hospitals, functioning under SHC&MED and Primary and Secondary Healthcare Department (P&SHD), have resumed routine healthcare services to all patients.

According to the Punjab government’s official statistics, as of August 18, a total of 113 Covid-19 patients are currently admitted in hospitals in the province, including 81 in public sector hospitals and 32 in private sector hospitals. Out of these 113 coronavirus patients, as many as 57 patients are admitted in tertiary care hospitals, 24 in primary and secondary healthcare hospitals and 32 in private hospitals.

In Lahore, according to latest statistics, as many as 35 Covid-19 patients are admitted in hospitals, including 22 in government hospitals and 13 in private hospitals.

“My mother has finally had her angiography. It was urgently advised by her doctor but was delayed due to closure of services amid the pandemic,” says Muhammad Afzal, a patent’s attendant at the Punjab Institute of Cardiology (PIC).

“We were forced to take our father to private hospitals for dialysis due to the discontinuation of services in public hospitals,” says Zahid Ali, an attendant of an elderly renal patient at the Shaikh Zayed Hospital’s National Institute of Kidney Diseases (NIKD). “Services are now restored in government hospitals, which is a huge relief for the poor,” he says.

Dr Salman Haseeb, of the Young Doctors’ Association (YDA), Punjab, says that coronavirus has been on a decline despite the recent reopening of sectors. He condemns the provincial bureaucracy for hastily closing all hospitals, which he says denied treatment to non-Covid patients. “The unattended loss of lives among non-Covid patients has been colossal,” he says, adding that the Sindh government had done better by adopting a home isolation policy from day one. “The Sindh government neither wasted millions of rupees on useless field hospitals nor dis-respected bodies as was done in the Punjab due to irrelevant burial guidelines for Covid-19 decedents,” he adds.

Nabeel A Awan, the SHC&MED secretary, confirms to The News on Sunday that healthcare services have resumed in all hospitals across the Punjab. “The hospitals, offering dedicated services for Covid-19 patients, have been directed to maintain and make available 40 percent of their optimum services for coronavirus patients at the time of pandemic’s peak earlier in mid June, and return to normal business,” he says.

“Although we are pleasantly surprised by the declining figures, the fear of the unknown lurks,” he says adding that the virus can make a comeback as has been witnessed in a second surge in the US and in neighbouring India. “We are bracing for a second surge during Muharram and when educational institutions reopen,” he says adding that at least 300,000 children in the US contracted the virus in just one week after reopening of schools.

“People must adhere to SOPs as no government can enforce these measures on its own.” He says that the awareness and persuasion would be vital to enforce the SOPs.

Special Assistant to Prime Minister on Health Dr Faisal Sultan has warned that Covid-19 may spread in Pakistan again if people ignored safety measures. “The slightest carelessness can lead to the re-emergence of the pandemic,” he warns.

Prof Dr Asad Aslam, co-chairman of the Corona Experts Advisory Group (CEAG) and the Mayo Hospital CEO, says that the reopening of all sectors of economy has not impacted hospitals so far as coronavirus incidences have been declining consistently. “Besides, a high ratio of recovery among Covid-19 patients has eased the burden on hospitals, allowing hospital administrations to revert to pre-coronavirus arrangements, and doctors to provide routine services to all patients,” he explains.

Will the Independence Day gatherings have an impact on the number of virus cases? Dr Aslam says that is yet to be seen as symptoms of coronavirus appear after 5 to 10 days, the incubation period of the virus being 14 days. Dr Aslam says that a second wave of coronavirus is possible during the first ten days of Muharram (from August 21 to 30), and authorities are closely looking to contain the possible spread of the virus. “The P&SHD has issued the SOPs for mandatory face masks; use of sanitisers; checking of temperature at entry points with immediate isolation for those with fever; no carpets; markings at 3-feet distance; and restricting Majaalis to two hours,” he says.

The CEAG, he says, is closely monitoring the situation for policy formulation to prevent any spread. “Testing has been maintained between 6,000 and 8,000 per day depending on the requirement to test suspected cases or contact tracing in case of confirmed patients.”

Dr Shahid Malik, community medicine expert and general secretary of the Pakistan Medical Association (PMA), Lahore chapter, advises policymakers to hold clinical audit of the pandemic through a scientific study of active cases, recovered patients, deaths, and new incidence/prevalence with a view to evolving a Disease Early Warning System (DEWS) in order to effectively tackle epidemics in the future. “Presently, there is no scientific explanation of the outbreak, spread and containment of the coronavirus in Pakistan or any prediction on scientific grounds to suggest a second spike,” he says.

As short term measures, he says, the government must ensure SOPs in public places as a new normal and establish flu clinics in hospitals for prevention and treatment of virus. As long-term measures, he suggests that the government establish an infectious diseases hospital at divisional level in the Punjab for study, research, prevention and treatment protocols against infections and viruses.

The writer is a reporter for The News in Lahore

A cautious return