Doctors in Pakistan are warning that the country’s already weak healthcare system could soon be overwhelmed by coronavirus patients.
So far, with fewer than 2,000 deaths, the outbreak hasn’t been as deadly as some initially feared. But with the rates of new cases and new fatalities at their highest levels yet, and lockdown restrictions lifted, doctors say intensive care units are now being stretched almost to capacity in many major hospitals.
In Karachi, a city of 15 million people, data shows only a handful of ICU beds still available for Covid-19 patients. Whilst in Lahore, a doctor recounted to the BBC being forced to turn away a patient who needed a ventilator, after he had already been rejected by two other hospitals. Medics in Peshawar and Quetta described being under similar levels of pressure.
Officials acknowledge some hospitals are full but insist there are still large numbers of beds available elsewhere, and are making public information about where are they are, whilst new facilities are in the process of being built in Karachi. But doctors fear the number of critical cases will continue to rise, and say their efforts to treat patients are being hampered by conspiracy theories and mistrust.
“Many ill people try and stay at home… Only when their condition has gotten a lot worse do they come to the hospital,” a leading doctor in Quetta told the BBC.
As a result, he said, large numbers of his patients died shortly after arrival or in the ambulance.
“They don’t even give us the chance to try and treat them,” he lamented.
As well as concerns about the quality of medical care, and a reluctance for family members to be quarantined, bizarre rumours are swirling around, including claims that doctors are being paid by the World Health Organisation (WHO) to falsely declare patients as coronavirus sufferers.
One doctor from Karachi, who asked to remain anonymous, told the BBC she was recently contacted by a friend asking for medical advice, saying: “‘My son is having flu and fever but I do not want to take him to the hospital because doctors are just declaring every fever is Covid, and they’re taking 500 rupees ($3; £2.40) per case’.”
The theories might sound risible, but they have dangerous consequences – and not just for the patients. Hospitals in Karachi, Peshawar and Lahore have all seen incidents of patients’ families attacking staff.
At the Jinnah Postgraduate Medical Centre in Karachi, an isolation ward was trashed by a mob when the body of a patient wasn’t handed over immediately to the family. In Pakistan, funerals are normally carried out as soon as possible, as per Islamic tradition, with large numbers of mourners attending – neither of which are possible if someone dies, or is suspected of dying, with coronavirus. Dr Yahya Tunio a leading doctor at the hospital, told the BBC medical staff are “fighting both coronavirus and ignorance”.
Dr Jamal Awan, who works at Mayo Hospital Lahore, told the BBC security had to be increased on the wards after a number of recent violent flare-ups. He described the incidents as being rooted in a mix of anger at a lack of resources, and a fear that doctors are secretly killing patients through “poisonous injections”.
In one instance at the hospital, a family was told an ICU bed with a ventilator wasn’t available for their relative, who was in a critical condition and subsequently died. A doctor on duty at the time, Amara Khalid, told the BBC that 20 to 30 members of the group attempted to attack hospital staff. She said some of the relatives shouted out angrily: “If coronavirus is real… how are you not sick?”
Her husband, also working as a doctor at the time, was pushed inside the ward, and forced to perform CPR on the patient without any safety equipment. Dr Khalid is calling for awareness to be improved about the disease, security for staff improved, and restrictions placed on the numbers of relatives allowed into hospitals.
“I felt terrible, I even thought about leaving the job after that incident but we just can’t,” she said. “If everybody leaves, then who is going to work?”
In fact, hundreds of doctors have been infected with coronavirus in Pakistan. At least 30 healthcare workers are reported to have died from it.
At one major hospital in Peshawar, the entire gynaecological department was temporarily closed down after an outbreak amongst staff. A doctor from the hospital told the BBC about 100 of his colleagues had tested positive in total, the vast majority of whom were not even directly working with coronavirus patients.
He added that whilst levels of protective equipment had improved, he was sharing a face shield with colleagues, taking turns to use it on their respective shifts. Like many other doctors, he raised particular concerns about the lack of kit handed out to staff who aren’t, in theory, on the frontline against the virus, but remain exposed by caring for patients who may have been infected but have never been tested.
Many doctors fear the worst is yet to come, and have expressed frustration with the decision to lift the bulk of lockdown restrictions last month.
Dr Rizwan Saigol, who works at the Mayo Hospital in Lahore, told the BBC that even prior to the pandemic he had seen families “begging for ventilators”. Now, he said, the situation feels “really scary”. If the number of cases continues to rise, he added, “our hospitals will get exhausted… We do not have enough ICUs or ventilators”.
Prime Minister Imran Khan, however, has insisted the cost of a lockdown is simply too severe for those in the country already living a hand-to-mouth existence.
“Twenty-five per cent of our population lives below the poverty line – that means there are 50 million people who can’t afford to eat two meals a day… If we implement a lockdown like they had in Wuhan or Europe, what will happen to them?” he asked during a televised address earlier this week.
Mr Khan has appealed to people to follow social distancing rules, and face masks have been made compulsory in public. But he has clashed at times with local authorities like those in opposition-controlled Sindh province who were the first to impose strict restrictions on movement back in March.
Many healthcare workers, like Dr Yahya Tunio, from the Jinnah Postgraduate Medical Centre in Karachi, say they have seen a “surge in cases since lockdown restrictions were eased” a few weeks ago.
Dr Tunio told the BBC that ICU beds in the hospital, one of the largest in the city, were “full”, and that new patients were regularly having to be diverted elsewhere for critical care, even though most other hospitals are also in a similar state. “It is stressful and tense,” he added.
Another medic in Karachi, worried about infecting her relatives at home, and exhausted from long hours of work in a hazmat suit in high temperatures, described her feelings on seeing the continued large number of people on the streets.
“It’s heart wrenching… why are we going through all that for these people who just don’t care about themselves, who blame us for taking bribes?”
“Still,” she said, “we are doing it for them.”