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| Pakistan’s Lockdown Ended a Month Ago. Now Hospital Signs Read ‘Full.’ | Pakistan’s Lockdown Ended a Month Ago. Now Hospital Signs Read ‘Full.’ |
| (32 minutes later) | |
| 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. | 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. | 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. | 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. | 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. | 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. | But government officials have ruled out the possibility of a further lockdown and dismissed the recommendations by the W.H.O. |
| 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. | 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. | “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. | 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. | “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. | 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. | More immediately, Pakistan’s struggling health care sector is in deep crisis. |
| 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. | 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. | 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. | “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. | 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. | 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. | 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. | 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. |
| 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. | 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. |
| Updated June 24, 2020 | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| 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. | 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. |
| 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. |
| 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. | |
| “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. | “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. | 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. |
| “We need protective gear, not salutes and praises. If we start dying or are unable to work, who will treat patients?” Mr. Awan asked. | “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. | 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. | 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. | 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 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.” | “We have to make tough policy choices to strike a balance between lives and livelihoods.” |