Coronavirus: Are We Ready?

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Poor infrastructure, lack of critical equipment for doctors, and poor coordination between government and experts indicates Kashmir is not as ready as the officials claim, reports Shams Irfan

The Chuchot village in Leh periphery that was quarantined by authorities after pilgrims returning from Iran tested positive All the positive cases in the region belong to this hamlet

A week back when workers from Srinagar Municipal Corporation (SMC), came out wearing identical oversized raincoats to spray disinfectants on parked vehicles, streets and office tables, they were followed by cameras.

It was more of a photo-op than a serious effort to fight a deadly Coronavirus that has ravaged the entire world, killing more than 10,500 people, and infecting over 200 thousand.

These SMC workers enjoyed every bit of the media attention and posed happily. One could see their smiles even from behind their three-layered masks.

Within a week everything is about to change after the first positive case of Coronavirus has detected in old city Srinagar. The said person, an elderly lady, has returned from Saudi Arabia after performing Umrah. A number of people came to see her after her return thus putting everyone at risk.

However, she is not the only person who came from Saudi Arabia, one of the worse hit countries, and slipped into Kashmir without proper screening. She was part of a group of 41 pilgrims who came from Saudi Arabia. After arrival in Kashmir, these people scattered to different towns and cities.

But this is not the lone group, there were hundreds of such people who arrived in Kashmir since early January, via Srinagar airport, through Jawahar tunnel or in the train from Banihal Pass, without anyone checking them.

“We have no idea how many infected people are roaming in Kashmir streets carrying this virus,” said a senior epidemiologist who wished not to be named. “There are people in Kashmir who slipped in from China and Iran in the initial days without any screening.”

The epidemiologist, who is in charge of one of the Isolation Wards located in Srinagar, feels attitude to tackle a pandemic of such magnitude is missing in Kashmir.

“We only have official meetings. And in these meetings nothing happens except people-pleasing their officers,” said the epidemiologist who was part of many such meetings.

Since January, when the signs of Coronavirus turning into a global crisis became almost clear, Kashmir’s administration watched it silently grow into a pandemic. “We could have ordered new ventilators, sealed our entry points, equipped our labs, informed people, stopped the entry of foreigners, made a worst-case scenario plan, trained our staff etc. But we did nothing,” said the epidemiologist angrily.

The long window Kashmir had since January is now shut completely. The prevention part is almost over as the first case is confirmed in Srinagar. Now the challenge is how to tackle the community spread.

No Stopping

To check the spread of Coronavirus, almost all major countries have banned the entry of tourists. But on March 20, there were reportedly 32 Malaysian tourists in Gulmarg. These tourists were not quarantined before letting them mingle with the local population.

Back to ‘Normal’: Lal Chowk, the key historic spot of Kashmir returned to its post-August 2019 position as the trade stayed home and the transport remained off the roads. The situation was enforced by the looming threat of the virus infection after a lady was detected positive on March 18, 2020. KL Image: Bilal Bahadur.

Another group of five Israeli tourists, three male and two female, reached Kashmir on March 17, and they were also not quarantined. Apart from that Kashmir continues to host tourists from France (two male two female); two groups of 19 tourists from Indonesia, two couples from Singapore, and one lone tourist from Vietnam. All of them have travelled to India between last week of February and the first week of March.

After spending over a week in Delhi and elsewhere, they reached Kashmir in the second week of March. Since then they are here. Interestingly, they were let in without proper screening or putting them in necessary quarantine, either in Delhi or Srinagar. “Nobody is aware of their previous travel history before they landed in Delhi,” said the epidemiologist.

Also, thousands of non-local season workers have arrived in Kashmir since the first week of February. They had left Kashmir after August 5, 2019, lockdown.

According to sources, the highest number of arrival of non-local workers in a single day was on March 18, the same when the first case was detected in Khanyar, Srinagar. These workers came in thousands via train and by buses and taxis after celebrated Holi at home.

Those who came by road were screened at two locations before entering the valley, but those who came by train were not stopped at all. Nobody knows where they have been since August last year when they left in a hurry.

“I received around 20 workers after the Holi festival. Most of them came by train,” said Aqib, an industrialist who owns a factory in Khunmoh.  “I have no idea what to do. I cannot shut my plant as it means huge loss as we just started after eight months. But at the same time, I am really scared.”

Aqib is not sure if any of them have been screened at all or they are just lying to save themselves from the trouble.

Ambulance Chasing

According to official data, till March 15, a total of 35,435 domestic travellers who arrived at Srinagar airport were screened. Another 513 international tourists were screened upon arrival at the Srinagar airport.

Till the date, 1403 Kashmiri with travel history outside India (including those coming from Saudi Arabia, China, Italy and Iran), was screened at the airport.

But doctors feel official numbers don’t present the actual picture, as it fails to tell how many passengers slipped out without passing through the screening since January.

Also, doctors are sceptical about the efficacy and accuracy of the screening process adopted at the entry points.

“We just take thermal temperature and that is it,” said the epidemiologist. “There is no mechanism for follow-up of people who have international travel history. Ideally, they should have been put in quarantine for two weeks irrespective of the symptoms.”

Doctors visiting the old city locality and meeting the guesthouse owners for the infection assessment on March 19, 2020, a day after a lady was detected with Coronavirus infection. KL Image Bilal Bahadur

At screening point located in Lower Munda/Zig, a total of 2336 vehicles carrying 3310 passengers were screened before entering Kashmir. The official document also reveals that 410 participants of Khelo India Khelo, were screened before they spent two days in Gulmarg.

“Locking down Kashmir is much easier given its geographical location as it has just two entry points, Srinagar airport and Banihal pass. The government should have done that long ago,” said Tahir, a Srinagar based businessman.

Are we ready?

It created quite a scene in Srinagar’s SMHS hospital when a surgeon almost refused to enter the operation theatre and perform surgery, as he was not given a fresh mask.

“I have been working in this mask (three-layered) since last four days when its life period is just six hours,” said Dr Ahmad, who refused to give his full name fearing reprisal from authorities.

“You cannot imagine how scared we are as doctors. We don’t have enough masks, protective gears, bodysuits etc.,” said Ahmad. “There is just a single bottle of sanitizer available for the entire staff in emergency Operation Theatre.”

Two days back Dr Ahmed and his colleagues visited GMC Principal, Dr Samia Rashid and told her to shut the Outdoor Patients Department (OPD), entirely. After consulting the government authorities, Dr Rashid told them that the OPD cannot be shut.

“Thousands of patients visit the OPD section of SMHS hospital daily. They are not serious patients, but routine ones who can wait,” said Dr Khan, a cardiologist at SMHS, who permitted to use his last name only. “To stop the spread of the virus, this needs to be done. Also, it will release lots of pressure from doctors and medical staff.”

He feels that this saved manpower and energy can be utilized in the fight against Coronavirus. “We are not machines. We too are humans after all. We cannot go on like this for long,” said Dr Ahmad. “There is no plan for such a dangerous virus. Everyone is just passing the buck.”

Dr Ahmad is sceptical about the number of positive cases in Kashmir, as he believes that only aggressive testing can reveal the real quantum of the Coronavirus.

“Without testing one can never be sure about the number of positive patients in Kashmir,” said Dr Ahmad. “Ideally we should have done aggressive testing like South Korea so that those with positive results can be isolated before they infect others.”

There are hundreds of people who arrived in Kashmir since January before the screening process was started at entry points. “You detect, you Isolate and you treat is the only way out of this crisis,” said the epidemiologist.

To detect one has to test and that is where Kashmir is slow. As on March 20, a total of 186 samples were sent for testing to detect Coronavirus. Out of them, 178 tests are negatives, only four are so far found positive. The result of the remaining four is still awaited.

“For a population of eight million testings just 156 people is nothing more than a joke,” said Dr Ahmad. “It should have been in thousands by now as we are already in stage 2.”

But poor infrastructure, lack of equipment for doctors, and coordination between government and experts are slowing the response.

What we have?

A very confident voice greets one at the other end of the telephone in District Hospital, Anantnag. Catering to a huge population of around 15 lakhs, this hospital is a literal mess in normal days, as it remains jam-packed with patients.

To keep the ‘official show-off’ going, a six bedded special ward has been created in anticipation of the patients suffering from Coronavirus. The hospital has a total of six ventilators, out of which two have been dedicated to this special Corona Ward. “We are fully prepared to tackle any situation,” said the official on phone.

When asked what if more than five positive cases of Coronavirus arrive at the hospital in a single day, he said, he is sure it will never happen.

So far there is no positive case of Coronavirus in southern Kashmir. But many suspected people have been rounded up from Shopian. They are said to be part of the same Umrah group which Srinagar lady was.

“If we get a hundred cases in a single day across Kashmir, we are gone,” said the epidemiologist with a hint of fear and tension in her voice. “We are already doomed because of the stupidity of the men in-charge.”

With just less than 100 ventilators available across the hospitals in Kashmir valley, the situation looks alarming.

Deconstructing SARS-CoV-2

“Even half of these ventilators are not in good condition. I am not sure if they will function at all. And the one that functions properly, is already in use,” said Dr Ahmad. “It means practically we can tackle just fifty Coronavirus patients at maximum.”

But given the rate of spread elsewhere in the world, it is practically impossible to do much with this kind of readiness.

In SKIMS, Soura, which is the premium healthcare facility in Kashmir, a special OPD has been created for patients with flu. The same hospital is bracing for Coronavirus cases with a five bedded Intensive Care Unit (ICU), which has two dedicated ventilators. “There are 16 people under quarantine in SKIMS, out of which 15 have already tested negative and remaining one’s test is awaited,” said Dr Ghulam Hassan Itoo, who is the nodal officer for Coronavirus related cases. “Five people have been discharged after they were quarantined for 14 days.”

Unlike his colleagues, Dr Itoo is confident that Kashmir is well equipped to fight the full onslaught of the Coronavirus. “In case of emergency, we can convert our normal ICU’s into Corona Wards. That can be done in no time,” assured Dr Itoo.

But Dr Ahmad feels that during peak crises that Kashmir has been witnessing since the outbreak of militancy in the 1990s, they cannot handle even 30 trauma cases in a day.

“Imagine, over a hundred cases arriving in a day to any hospital in Kashmir. It will be devastating as we have no infrastructure and staff to handle that,” said Dr Khan.

Number Game

Most of the doctors Kashmir Life spoke to believed that the numbers of cases declared by the government authorities are not exact. They suspect the spread of Coronavirus much deeper into the society because of the initial callousness of the government. “The biggest threat is from those pilgrims who came back from Iran and Saudi Arabia and went home without testing or quarantine,” said Dr Abrar, a doctor from north Kashmir’s Sopore.

A photograph showing a quarantine facility for students who flew home has gone viral. on social media

When the screening counters were finally set up, they were manned by unprofessional staff, who let people slip through the counters easily.

A Pulwama resident walked past one such counter at the Srinagar airport and reached his hometown, without anyone stopping him. Upon arrival at home, he developed Coronavirus symptoms and visited SKIMS voluntarily. When his travel history was taken, it was realized that nobody stopped or screened him. Now the man and his banker wife both are in quarantine at SKIMS.

It took another week to set up screening counter at Lower Munda, for people arriving in Kashmir valley via Srinagar-Jammu road link. A local journalist, who came from Jammu on March 15, reported that two health workers noted body temperature casually at Lower Munda.

Several local taxi drivers bypassed the Lower Munda screening point by taking a shortcut to south Kashmir’s Anantnag district. This took one more week to plug.

“Who knows how many people with potential infection might have slipped in Kashmir by then,” said a south Kashmir based doctor who wished not to be named.

What we have

Given the condition of government-owned healthcare facilities in Kashmir, the upcoming fight against Coronavirus looks already a lost one. “In routine days we don’t have enough beds for patients. There are two and at times three patients sharing the same bed,” said Dr Ahmad.

“This cannot help us at all if we want to give Coronavirus a tough fight. We need infrastructure and that too good one.”

Surviving Epidemics

After the first case was detected in Srinagar, several government and privately owned facilities were converted into quarantined centres.“The response is too little and too late. We have no idea what we are pitted against this time,” said the epidemiologist with a hint of alarm in his voice.

Official Speak

Bhupinder Kumar, who heads the National Health Mission in Jammu and Kashmir, said the UT is far ahead in comparison to other states. “We did prepare early and we are better placed,” Kumar said. “In case of a pandemic, it is not hospital alone that can manage the crisis.” However, he asserts that infodemic is creating a bigger problem. Kumar said the UT has already placed an order worth Rs 70 crore to manage the deficit that was earlier detected.

Dr Shahid Iqbal Choudhary, Deputy Commissioner Srinagar, who is at the centre of implementing policies, said the administration is facing a problem at the entry points. “The people who are flying in are supposed, to be honest in telling the travel history but in most of the cases they just say they have flown from Delhi,” Choudhary said. “They should know their responsibility in telling the truth because it hits them, their family and the larger society.”

Girls wearing masks walking in a deserted Srinagar after restrictions were imposed on the movement of people in several areas as a precautionary measure to prevent the spread of novel Coronavirus disease on Thursday, March 19, 2020. KL Image By Bilal Bahadur

However, Choudhary was happy that society is supporting in ensuring social distancing. “At one point of time, the demand was that the students studying abroad should be brought home,” Choudhary said. “Now when they are coming, the same parents are keen to take their wards home and it is against the protocol.”

UT Systems

One major thing that is being missed in Srinagar is that the status of Jammu and Kashmir has changed. Earlier, the state government was powerful enough to make a decision and implement it. Now the administration in Jammu and Kashmir is part of the Union Home Ministry and only the protocols set for the entire country will be implemented in Jammu and Kashmir. Officials said ideally the highway should have been closed at Lakhanpur much earlier but that could not be done because intra-state travel was not stopped anywhere in the country. Interestingly, the check-post – that was functioning less as an economic unit and more as a regulator, became history on January 1, 2020, at a time when the Corona fever had not reached Milan or Washington.

(This report was part of the print issued that went to the market on March 21, 2020)

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