KARACHI: A struggling healthcare system, increased footfall at hospitals from panicked citizens, overworked healthcare providers, looming shortage of personal protective equipment (PPE) kits and fake news with little regard for public safety are some of the challenges that the coronavirus pandemic is leading to in Sindh.

Over the past two days, this reporter visited the Dow University of Health Sciences’ (DUHS) Ojha campus, Dr Ruth Pfau Civil Hospital, Indus Hospital and Aga Khan Hospital, witnessing worried citizens looking to get tested for coronavirus.

Experts say most of these citizens are absolutely unaware that they would not meet the screening criteria and would rather be seeing a general practitioner.

Over the past one week, the Ojha campus has seen a surge of people from all walks of life complain of symptoms.

“We went from 40-50 patients per day to at least 400 everyday. We have a limited number of kits and cannot test everyone. Many people leave very upset once they are told they don’t meet the screening criteria,” said assistant professor and internal medicine specialist Dr Shobha Luxmi. She is the in charge of the isolation unit at Ojha.

Most are turned away since they do not meet the coronavirus screening test criteria

All over the facility, many people are walking with green surgical masks, looking around apprehensively lest anyone sneeze.

“Right now the numbers are low but once these go up, we would need more medical staff and trained hands. There is a need to ensure that doctors who [are] not doing emergency service are deployed for coronavirus duty,” she said.

A similar situation is visible at Indus Hospital. Talking to Dawn, Dr Akhtar Aziz Khan, executive director at the facility, said at least 150 people were turning up every day to get tested for the virus.

“There is an extensive screening process so the test kits are not wasted. The reason behind increase in number of people is largely due to misinformation on social media, which is creating fear and panic among people,” said Dr Khan. “We counsel and send them away.”

Infectious diseases experts and lab workers reached by this reporter said the focus is on scaremongering. “So far there is no effective communication of who qualifies for the test. Not everyone with flu qualifies for screening,” they opined.

Things are not much different at the Civil Hospital where many citizens from lower socioeconomic strata are lining up.

There has been a substantial increase in people coming to the triage area and wanting to get tested.

“Some 40 people are showing up every day but most of them do not meet the screening criteria and are sent away,” says infectious diseases expert Dr Azizullah Khan Dhilloo, an assistant professor at DUHS. “Sometimes people do get agitated but that’s how work is.”

So what is the screening criteria? The patient will be asked a set of questions regarding their travel history and who they have been in close contact with. If the doctor rules out suspicion of coronavirus, the patient will be sent back.

Shortage of protective kits

One major issue that almost all infectious diseases experts, nurses, and lab techs shared with this reporter is the looming shortage of PPE kits.

Comprising specialised clothing and equipment — disposable masks, gowns, hoods, gloves and shoe covers, face shields, and protective eye gear — the PPE kits are worn by employees and care providers dealing with infectious diseases.

“Not only Ojha [campus] but all other hospitals will need more PPE kits and these are disappearing. Right now many public healthcare providers are buying these from our own pockets,” she said.

“We have asked WHO and Sindh government but anything is yet to materialise. We also need more trained hands — people who are willing to work in this crisis,” the doctor added.

Missing civic sense

Dr Luxmi said that some patients were sent for home isolation but admitted that there was no way to monitor if they would comply.

Sharing his observations after returning from the isolation camp in Sukkur, Dr Sunil Dodani, assistant professor at infectious diseases, Sindh Institute of Urology and Transplantation (SIUT), said: “There was too much panic and medical staff is very apprehensive but after conducting awareness sessions with the healthcare community, administration, media and pilgrims, I hope things will improve.”

Dr Dodani, who is also the treasurer of the Medical Microbiology and Infectious Diseases Society of Pakistan (MMIDSP), said the people did not have civic sense and were making things worse. “People at the facility in Sukkur are not complying. Following protocols, they have been lodged individually — one person per room — but continue to gather in rooms and lurk around.”

Social media mess up

The fake news often being shared on social media is making it difficult for tertiary care facilities in the city to deal with more footfall causing anxiety amongst masses.

“Social media has played a very bad role in coronavirus. There needs to be some regulation of things being shared on Facebook and Twitter,” said Dr Khan.

Interestingly, around Civil and Jinnah hospitals, many rickshaw drivers refuse to go near the facilities, preferring to drop people outside. “There are too many sick people, no one knows who might have coronavirus,” said a rickshaw driver.

Similarly, staff using ride-hailing services to reach Ojha campus said that more and more drivers were refusing trips to the facility, not because of distance but due to fear that an infected person might travel in their vehicle.

“Seeing all the posts and WhatsApp shares, we receive so many calls from people thinking they have coronavirus. However, the general public is still not able to understand the screening criteria,” said Dr Dhillon of DUHS.

Responding to a question about fears being raised by healthcare profession on isolation rooms being set up in medical facilities, he said: “isolation rooms in hospitals are there for chickenpox cases. This is a new experience for all of us. Ideally coronavirus can be managed at hospitals if the doctors, medical staff and patients strictly adhere to protocols but given the lax attitude of people here, best would be to have a separate facility for isolation once numbers start going up. Hotels owners should step up and give the facilities for isolation,” he said.

Overworked

With an information glut causing anxiety amongst general population, those at the front line of coronavirus are the most vulnerable to stress. Healthcare workers are already saying they are overworked and need support.

“It’s not just pair of hands which is needed: it is trained pair of hands which we need. Basic training is principles of infection prevention and control is necessary. Any person looking after a COVID patient should be well-versed in the technique of hand hygiene and appropriate selection and use of PPE,” the MMIDSP said on behalf of all infectious diseases professionals in Pakistan.

“Heightened fear of infection and its consequences, primarily because of lack of awareness ... this is the reason behind many healthcare providers in public and private settings refusing to serve. This needs to be tackled,” it added.

The society points out the failure of an effective communication strategy for healthcare providers and masses. “Rather than showing people fake news, the screening criteria should be disseminated using mass media in easy words so that tertiary care facilities are not overwhelmed,” the society added.

“There is a need to move some doctors and medical personal from non-emergency duties to this side else soon everyone will burn out. The doctors and nurses dealing with coronavirus are working 6-8 hours trying to manage these patients. Working while wearing a PPE kit is not easy,” said Dr Luxmi. “It’s very de-motivating when people say we are not working. It’s very difficult to put our lives on the line and help save lives.”

Published in Dawn, March 18th, 2020