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| ‘God Will Protect Us’: Coronavirus Spreads Through an Already Struggling Pakistan | ‘God Will Protect Us’: Coronavirus Spreads Through an Already Struggling Pakistan |
| (7 days later) | |
| KARACHI, Pakistan — Doctors are refusing to show up for work. Clerics are refusing to close their mosques. And despite orders to stay at home, children continue to pack streets across Pakistan to play cricket, their parents unwilling to quarantine them in crowded homes. | KARACHI, Pakistan — Doctors are refusing to show up for work. Clerics are refusing to close their mosques. And despite orders to stay at home, children continue to pack streets across Pakistan to play cricket, their parents unwilling to quarantine them in crowded homes. |
| Pakistan is facing its biggest challenge ever: how to mobilize its broken state as the number of coronavirus cases rapidly spreads in the world’s fifth most populous country. | Pakistan is facing its biggest challenge ever: how to mobilize its broken state as the number of coronavirus cases rapidly spreads in the world’s fifth most populous country. |
| More than ever, the epidemic is showcasing weaknesses in the government, and the tensions between it and the country’s powerful military. Many within the country’s clerical establishment have refused to help, rejecting calls to limit mosque gatherings and bringing together at least 150,000 clerics from around the world this month in a religious gathering that helped spread the virus. | More than ever, the epidemic is showcasing weaknesses in the government, and the tensions between it and the country’s powerful military. Many within the country’s clerical establishment have refused to help, rejecting calls to limit mosque gatherings and bringing together at least 150,000 clerics from around the world this month in a religious gathering that helped spread the virus. |
| By Thursday afternoon, Pakistan’s cases had risen to 1,098, up from some 250 a week ago. Eight deaths have been reported. But many fear that the real numbers are much higher because of a lack of testing and, in some cases, suppressed information. | By Thursday afternoon, Pakistan’s cases had risen to 1,098, up from some 250 a week ago. Eight deaths have been reported. But many fear that the real numbers are much higher because of a lack of testing and, in some cases, suppressed information. |
| Already, Pakistan was struggling to provide electricity, water and adequate health care to its 220 million people. Diseases that have been controlled elsewhere, like rabies and polio, still persist here. | Already, Pakistan was struggling to provide electricity, water and adequate health care to its 220 million people. Diseases that have been controlled elsewhere, like rabies and polio, still persist here. |
| In recent weeks, as the coronavirus’s march across the globe was intensifying, Prime Minister Imran Khan played down its dangers. Pakistani officials bragged that the country was virus-free, but little was being done to set up testing anywhere. | In recent weeks, as the coronavirus’s march across the globe was intensifying, Prime Minister Imran Khan played down its dangers. Pakistani officials bragged that the country was virus-free, but little was being done to set up testing anywhere. |
| Mr. Khan rejected calls from health care workers and provincial officials to enforce a lockdown, saying it would ruin the economy. Instead he urged citizens to practice social distancing and ordered everyone back to work, many returning to the sweltering, cramped factories that are the backbone of the economy. | Mr. Khan rejected calls from health care workers and provincial officials to enforce a lockdown, saying it would ruin the economy. Instead he urged citizens to practice social distancing and ordered everyone back to work, many returning to the sweltering, cramped factories that are the backbone of the economy. |
| Finally, the military stepped in on Sunday and sidelined Mr. Khan, working with provincial governments to deploy across the country and enforce a lockdown. They erected a maze of military checkpoints in cities like Karachi and sent baton-wielding police officers to violently disperse crowds. | Finally, the military stepped in on Sunday and sidelined Mr. Khan, working with provincial governments to deploy across the country and enforce a lockdown. They erected a maze of military checkpoints in cities like Karachi and sent baton-wielding police officers to violently disperse crowds. |
| But the action may be too late. Doctors and nurses are refusing to come to work, fed up with the weak initial response to contain the virus’s spread. | But the action may be too late. Doctors and nurses are refusing to come to work, fed up with the weak initial response to contain the virus’s spread. |
| [Analysis: Under Modi, India’s press is not so free anymore.] | [Analysis: Under Modi, India’s press is not so free anymore.] |
| And the extremist clerics who often heckle or march against the civilian government, with the tacit approval of the military, are refusing to help. They largely ignored Mr. Khan’s call to limit Friday prayer gatherings. And even after the military deployed to try to enforce a lockdown, several clerics made videos that went viral in recent days, urging Pakistanis to come back to the mosques to worship. | And the extremist clerics who often heckle or march against the civilian government, with the tacit approval of the military, are refusing to help. They largely ignored Mr. Khan’s call to limit Friday prayer gatherings. And even after the military deployed to try to enforce a lockdown, several clerics made videos that went viral in recent days, urging Pakistanis to come back to the mosques to worship. |
| To avoid mosques on Fridays would only invite God’s wrath at a time when people need his mercy, the clerics warned. | To avoid mosques on Fridays would only invite God’s wrath at a time when people need his mercy, the clerics warned. |
| “We cannot skip Friday prayers because of fears of coronavirus,” said Shabbir Chand, a trader who attended a packed service in Karachi, the country’s biggest city. “Instead, we should gather in even larger numbers in mosques to pray to God to protect us from this fatal disease.” | “We cannot skip Friday prayers because of fears of coronavirus,” said Shabbir Chand, a trader who attended a packed service in Karachi, the country’s biggest city. “Instead, we should gather in even larger numbers in mosques to pray to God to protect us from this fatal disease.” |
| A gathering of more than 150,000 people was held this month on the outskirts of Lahore by Tablighi Jamaat, one of the world’s largest proselytizing groups. The event was eventually called off at the urging of officials, but the participants had already come, sleeping and eating in close quarters. | A gathering of more than 150,000 people was held this month on the outskirts of Lahore by Tablighi Jamaat, one of the world’s largest proselytizing groups. The event was eventually called off at the urging of officials, but the participants had already come, sleeping and eating in close quarters. |
| The gathering proved a perfect transmission point, infecting indeterminate numbers of Pakistanis, at least two Kyrgyz citizens and two Palestinians who flew home and introduced the virus to the Gaza Strip. A similar gathering of Tablighi Jamaat in Malaysia infected more than 620 participants who then returned to half a dozen countries across Southeast Asia. | The gathering proved a perfect transmission point, infecting indeterminate numbers of Pakistanis, at least two Kyrgyz citizens and two Palestinians who flew home and introduced the virus to the Gaza Strip. A similar gathering of Tablighi Jamaat in Malaysia infected more than 620 participants who then returned to half a dozen countries across Southeast Asia. |
| In Pakistan’s capital, Islamabad, doctors and nurses at the Pakistan Institute of Medical Sciences, known as PIMS, who were tasked with screening coronavirus patients threatened to walk off the job this week if the government didn’t provide them with basic equipment like masks and gloves, which they received only on Saturday. | In Pakistan’s capital, Islamabad, doctors and nurses at the Pakistan Institute of Medical Sciences, known as PIMS, who were tasked with screening coronavirus patients threatened to walk off the job this week if the government didn’t provide them with basic equipment like masks and gloves, which they received only on Saturday. |
| In one case at the hospital, government officials who had tested a woman who died there after showing symptoms of the coronavirus disease, Covid-19, refused to share her test results with doctors and nurses there and told them not to talk to journalists about it, they said. | In one case at the hospital, government officials who had tested a woman who died there after showing symptoms of the coronavirus disease, Covid-19, refused to share her test results with doctors and nurses there and told them not to talk to journalists about it, they said. |
| The state has always been too impoverished to provide masks to the doctors and nurses at the emergency rooms of public hospitals, and they have always bought their own. But prices are surging as civilians hoard whatever they can, forcing emergency room doctors at PIMS to spend $70 of their $460 monthly salary on masks, some said. | The state has always been too impoverished to provide masks to the doctors and nurses at the emergency rooms of public hospitals, and they have always bought their own. But prices are surging as civilians hoard whatever they can, forcing emergency room doctors at PIMS to spend $70 of their $460 monthly salary on masks, some said. |
| While many of his colleagues called in sick this week, refusing to work as the virus surges, one doctor said he would continue to scrub in every day. | While many of his colleagues called in sick this week, refusing to work as the virus surges, one doctor said he would continue to scrub in every day. |
| “We have no other way. We just can’t think about it. If we don’t fight it, who will?” the doctor said, adding that morale was low among his colleagues. “So we tell each other, ‘Our profession is sanctified from God. God will protect us.’ But those are just words.” | “We have no other way. We just can’t think about it. If we don’t fight it, who will?” the doctor said, adding that morale was low among his colleagues. “So we tell each other, ‘Our profession is sanctified from God. God will protect us.’ But those are just words.” |
| If the virus spreads much further, Pakistan’s entire health care system may melt down. In Karachi, a port city of some 20 million, there are only 600 beds in intensive care wards. There are 1,700 ventilators across the country, and last week, there were only 15,000 N95 masks for doctors and nurses, officials said. | If the virus spreads much further, Pakistan’s entire health care system may melt down. In Karachi, a port city of some 20 million, there are only 600 beds in intensive care wards. There are 1,700 ventilators across the country, and last week, there were only 15,000 N95 masks for doctors and nurses, officials said. |
| “We don’t even have anti-rabies vaccines. How can we deal with thousands of people who will come here for coronavirus treatment?” said one doctor at a state-run hospital, who also complained that they had not been issued protective gear. As a government employee the doctor had been barred from talking to the media, and requested anonymity to express concerns. | “We don’t even have anti-rabies vaccines. How can we deal with thousands of people who will come here for coronavirus treatment?” said one doctor at a state-run hospital, who also complained that they had not been issued protective gear. As a government employee the doctor had been barred from talking to the media, and requested anonymity to express concerns. |
| In February, it became clear Pakistan was facing a major outbreak of coronavirus, as the disease surged in Iran, which quickly became an epicenter. Thousands of Pakistanis visit Iran every month for work or religious pilgrimage, and the countries share a long border. | In February, it became clear Pakistan was facing a major outbreak of coronavirus, as the disease surged in Iran, which quickly became an epicenter. Thousands of Pakistanis visit Iran every month for work or religious pilgrimage, and the countries share a long border. |
| Updated June 22, 2020 | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| 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. | 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. |
| 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. | 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. |
| 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. | 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. |
| 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. | 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. |
| 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. | 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. |
| 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. | 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. |
| 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.) | 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.) |
| 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. | 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. |
| 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. | 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. |
| Officials closed the border, but hundreds of Pakistanis managed to get back in anyway, either rerouting through Afghanistan to cross the border there, or bribing guards to get back in, witnesses and officials said. | Officials closed the border, but hundreds of Pakistanis managed to get back in anyway, either rerouting through Afghanistan to cross the border there, or bribing guards to get back in, witnesses and officials said. |
| In order to prevent thousands more from illegally crossing, officials decided to quarantine them in Taftan, a border town. But conditions were so bad — cramped and filthy, with the virus spreading quickly — that people being held there rioted, burning part of the camp down. | In order to prevent thousands more from illegally crossing, officials decided to quarantine them in Taftan, a border town. But conditions were so bad — cramped and filthy, with the virus spreading quickly — that people being held there rioted, burning part of the camp down. |
| “We had no proper food, no screening of anyone for coronavirus,” said Syed Haider Ali, a student who had been quarantined at Taftan. | “We had no proper food, no screening of anyone for coronavirus,” said Syed Haider Ali, a student who had been quarantined at Taftan. |
| “It was not an attack on the camp, but an attempt to rescue ourselves from the animallike treatment we were receiving,” he said. “We appealed to the government to treat us like humans, but it fell on deaf ears.” | “It was not an attack on the camp, but an attempt to rescue ourselves from the animallike treatment we were receiving,” he said. “We appealed to the government to treat us like humans, but it fell on deaf ears.” |
| The government kept some 4,600 people under a 14-day quarantine in Taftan and let most go after they developed no symptoms. They returned to their villages and cities across Pakistan, where dozens turned out to have been infected when they tested by local health care workers. | The government kept some 4,600 people under a 14-day quarantine in Taftan and let most go after they developed no symptoms. They returned to their villages and cities across Pakistan, where dozens turned out to have been infected when they tested by local health care workers. |
| Now the government is trying to build more quarantine centers, but they keep coming under attack by residents who live nearby and do not want the risk of another botched government operation. | Now the government is trying to build more quarantine centers, but they keep coming under attack by residents who live nearby and do not want the risk of another botched government operation. |
| In Karachi, military checkpoints have been erected every few hundred yards throughout the city and the police make rounds to enforce a lockdown, wielding batons to beat people back into their homes. | In Karachi, military checkpoints have been erected every few hundred yards throughout the city and the police make rounds to enforce a lockdown, wielding batons to beat people back into their homes. |
| But in the slums, a carnival-like atmosphere has burst out onto the streets, with schools shut down and children playing in the narrow alleyways that are lined with open sewers. During a recent visit by journalists, the police swept through the neighborhood, yelling at people to get back indoors. But residents ignored them, and, outnumbered, the officers soon gave up. | But in the slums, a carnival-like atmosphere has burst out onto the streets, with schools shut down and children playing in the narrow alleyways that are lined with open sewers. During a recent visit by journalists, the police swept through the neighborhood, yelling at people to get back indoors. But residents ignored them, and, outnumbered, the officers soon gave up. |
| Janangir Baloch, who lives with dozens of family members in a cramped three-story building, pointed at the children playing in the street as he explained why keeping them home was a lost cause. | Janangir Baloch, who lives with dozens of family members in a cramped three-story building, pointed at the children playing in the street as he explained why keeping them home was a lost cause. |
| “Tell me how I can observe social distancing when I live with 40 other people,” Mr. Baloch said. “It won’t work.” | “Tell me how I can observe social distancing when I live with 40 other people,” Mr. Baloch said. “It won’t work.” |
| Zia ur-Rehman reported from Karachi, Pakistan; Maria Abi-Habib from New Delhi; and Ihsanullah Tipu Mehsud from Islamabad, Pakistan. Salman Masood contributed reporting from Islamabad. | Zia ur-Rehman reported from Karachi, Pakistan; Maria Abi-Habib from New Delhi; and Ihsanullah Tipu Mehsud from Islamabad, Pakistan. Salman Masood contributed reporting from Islamabad. |