Pakistan’s Lockdown Ended a Month Ago. Now Hospital Signs Read ‘Full.’ - The New York Times

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KARACHI — Pakistanis stricken by the coronavirus are being turned away from hospitals that have simply closed their gates and put up signs reading “full house.” Doctors and nurses are falling ill at alarming rates, and are also coming under physical assault from desperate and angry families.

When Pakistan’s government lifted its lockdown on May 9, it warned that the already impoverished country could no longer withstand the shutdown needed to mitigate the pandemic’s spread. But now left unshackled, the virus is meting out devastation in other ways, and panic is rising.

Before reopening, Pakistan had recorded about 25,000 infections. A month later, the country recorded an additional 100,000 cases — almost certainly an undercount — and the pandemic shows no signs of abating. At least 2,356 people have died of Covid-19, according to official figures released Thursday.

Pakistan is now reporting so many new cases that it is among the World Health Organization’s top 10 countries where the virus is on the rise. The W.H.O. wrote a letter criticizing the government’s efforts on June 7 and recommended that lockdown be reimposed, stating that Pakistan did not meet any of the criteria needed to lift it.

Medical professionals now expect the virus to peak in July or August and infect up to 900,000, adding further strain to an already shaky health care system some warn may collapse.

But government officials have ruled out the possibility of a further lockdown and dismissed the recommendations by the W.H.O.

Hospital staff praying before their shift in Quetta in March.Credit...Arshad Butt/Associated Press

On a recent day in the sprawling port city of Karachi, Ali Hussain and his brother shuttled between public hospitals, looking for help and receiving none. Mr. Hussain’s older brother had a severe cough and fever but had been unable to get a coronavirus test for days.

“We cannot afford the private hospitals, they are charging tens of thousands rupees,” said Mr. Hussain, who earned 20,000 rupees per month, about $121, working at a textile mill before the lockdown.

Like many others, the Hussain family is suffering not only because of the coronavirus itself but also the economic devastation the pandemic has wrought. Mr. Hussain said he and his brother could barely afford to feed themselves since they lost their jobs in March, let alone pay for private care.

“We are completely broke and we do not know what to do,” Mr. Hussain lamented.

The World Bank projects that Pakistan’s economy will contract by 0.2 percent next fiscal year. Up to 18 million of the country’s 74 million jobs could be lost, according to the Pakistan Institute of Development Economics, an independent research firm set up by the government.

More immediately, Pakistan’s struggling health care sector is in deep crisis.

The police arresting doctors in Quetta in April. The doctors were demanding facilities and prevention kits to deal with coronavirus patients.Credit...Arshad Butt/Associated Press

Only a third of Karachi’s 600 beds in intensive care wards are available to treat coronavirus patients in the city’s private and public hospitals, for a population of about 20 million, according to local health officials. According to the W.H.O., only 751 ventilators are dedicated to the pandemic in Pakistan, the world’s fifth most populous country, with some 200 million people.

Health care workers admit privately that they are referring patients like Mr. Hussain’s brother to other hospitals they know are at or over capacity because they fear being attacked by desperate families. Medical workers across Pakistan are being assaulted on a near-daily basis for not being able to admit patients or having to tell families that their loved ones had died.

“Our hospitals are completely exhausted,” said one doctor, who asked for his name to be withheld because he is a government employee.

Late last month, a family attacked the staff of one Karachi hospital with knives and iron rods after doctors declared their relative dead, rampaging through the emergency ward. On May 14, the emergency department of another major government hospital in Karachi was ransacked after health care workers refused to give over the body of their loved one, warning the family could contract the virus by handling the remains without using any precautions.

After several similar episodes, employees say that many hospitals are now handing over the bodies of coronavirus victims to their families anyway, worried more about the violent backlash than the pandemic’s spread.

The anger reflects the grief and panic that is setting in across the country, and also an erosion of trust between the state and its citizens.

Prime Minister Imran Khan and other officials have frequently dismissed the virus as a common flu, then rushed to urge people to stay home before dismissing the severity of the pandemic again. Unfounded rumors have spread on social media that the government is inflating coronavirus numbers to milk the international community for more aid money, secretly leaving patients to die of other causes.

Protesters in Karachi last week demanding the reopening of schools that were closed to help contain the coronavirus.Credit...Fareed Khan/Associated Press

The already low morale among health care workers has plummeted further since the lockdown was lifted. In March, doctors and nurses threatened to walk off the job and some called in sick, refusing to work if the government did not provide them with personal protective equipment. Some had to spend up to half of their salaries to buy their own masks, prices skyrocketing as panicked citizens hoarded supplies.

So far, at least 35 health care workers have died of the pandemic, the Pakistan Medical Association said in a statement Thursday. At least 3,600 health care workers are infected with the virus, according to official figures.

The government “did not listen to what doctors were saying. Now the result of this negligence is obvious,” the Pakistan Medical Association said in its statement.

In Punjab, the country’s most populous province, a doctors’ association claimed earlier this month that 40 percent of the province’s medical staff had tested positive for coronavirus.

The Coronavirus Outbreak

• Frequently Asked Questions and Advice

  Updated June 12, 2020

  • What’s the risk of catching coronavirus from a surface?

    Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

  • Does asymptomatic transmission of Covid-19 happen?

    So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

  • How does blood type influence coronavirus?

    A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

  • How many people have lost their jobs due to coronavirus in the U.S.?

    The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

  • Will protests set off a second viral wave of coronavirus?

    Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

  • How do we start exercising again without hurting ourselves after months of lockdown?

    Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

  • My state is reopening. Is it safe to go out?

    States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

  • What are the symptoms of coronavirus?

    Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

  • How can I protect myself while flying?

    If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

  • How do I take my temperature?

    Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.

  • Should I wear a mask?

    The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

  • What should I do if I feel sick?

    If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

  • How do I get tested?

    If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

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“While the pandemic stares us all in the face, the morale of health care providers has hit rock bottom,” said Dr. Salman Haseeb Chaudhry, who represents the Young Doctors Association, at a news conference this month.

At a protest among health care workers on Tuesday, Shafiq Awan, the leader of a paramedic association in Karachi, said the government was not heeding their advice.

Selling face masks in Karachi on Sunday.Credit...Shahzaib Akber/EPA, via Shutterstock

“We need protective gear, not salutes and praises. If we start dying or are unable to work, who will treat patients?” Mr. Awan asked.

Under withering criticism, Prime Minister Khan hit back on Thursday, saying that his government had responded adequately to the pandemic.

Mr. Khan was at first reluctant to impose a lockdown, stating in early March that the country’s economy could not weather the fallout. By the end of that month, the country’s powerful military sidelined Mr. Khan to shut down the country.

Both the government and military came under immense pressure from Pakistan’s powerful Islamists to loosen the lockdown during Ramadan, the holy month of fasting that started in April and ended last month. After just a few weeks, the lockdown was lifted.

“We are a low middle-income country, with two-thirds of the population dependent on daily incomes,” Dr. Zafar Mirza, the de facto health minister, said Wednesday.

“We have to make tough policy choices to strike a balance between lives and livelihoods.”

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