Unmasked

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For most of its history, Kashmir remained hidden behind multiple masks, literally and metaphorically. In wake of a looming Coronavirus threat, the people in the Vale are desperate to get a real mask, reports Khalid Bashir Gura in a detailed analysis of Kashmir preparedness to fight a virus that has impacted more than 80 countries and killed nearly 5600 people in 154 countries so far

KL Image by Bilal Bahadur

One has to jostle for space in the overcrowded lobby, amidst the clamour of patients and attendees in the suffocating corridors of SMHS hospital to reach the ‘isolated’ ward meant for Coronavirus (Covid-19) patients.

The ward is empty as no case of Coronavirus has been detected yet in Kashmir.

The black-and-white Coronavirus awareness posters pasted on its doors, downloaded from the World Health Organisation (WHO) website, seem to catch no one’s attention.

Outside the ward, the coloured Coronavirus health advisory board is fixed. But nobody pays attention. The hospital stench wafts through the air and people roam without masks.

One of the doctors at Super Specialty hospital, wishing to remain anonymous, said that they had to plead for masks. “Why can’t they arrange masks for emergency staff,” he almost shouted.

If one needs a mask, chances are you may not find it easily or if you buy it, the prices may be exorbitant. The masks that Kashmir needs, given its susceptibility to contagious diseases especially flu, are missing. Even the market is exhibiting a huge appetite. Pharmacists informed that these masks are being exported to various places especially China.

Health professionals in hospitals are now geared up to manage the mess if the fast-spreading virus touches Kashmir. KL Image by Bilal Bahadur

One of the leading pharmaceutical distributors said that the three-layer mask called N95 and others are manufactured in China. “There is a shortage because China is importing the masks it had exported to other countries to meet the shortfall at home due to spread of Coronavirus,” he said, “China is paying much higher rates to its outside buyers for the same it had exported earlier at low costs.”

“So, the distributors who have the masks earn more money by exporting it.’’

The normal rate of three-layer mask used to be Rs 2 which has now gone up to Rs 20.

“If there is a Coronavirus outbreak in Kashmir, the shortage of masks may see their prices skyrocketing as has happened in countries hit by the epidemic,” one chemist said.

Around SMHS, Kashmir’s main hospital, few shops that sold masks charged variable rates for them. For N95 the prices range from Rs 130 to190 and above. There are instances in which some drug stores sold N95 masks at Rs 250 apiece and above. Their duplicates go for Rs 30. But their effectiveness remains questionable.

Costly Masks

“Prices of masks are up because there is scarcity,” said Shahbaz Ahmad, one of the chemists near SMHS.

“The dealers are selling the stock to other lucrative markets where the Coronavirus has struck and it is bringing a lot of money”.

Contradicting Shahbaz, one of his salesperson on separate enquiry revealed there are a lot of masks assuming the reporter to be a potential buyer.

“People in Kashmir rarely wear N95 masks as they are costly,” Hilal Ahmed, another chemist, said. “We rarely keep the stock or prefer to keep it in a limited quantity. Only cheap masks sell which have a very limited life span.” He had a word of caution too: “Masks are not the only pre-requisite to fight Coronavirus, their appropriate use and disposal is essential which people seem to be unaware of as the crisis hasn’t emerged yet.”

Unchecked Outbreak

People suffering from a cough, running nose, sore throat, headache, chills, fever, difficulty breathing are usually patients of seasonal flu. But the Coronavirus pandemic that has gripped the globe also has the same symptoms.

Covid-19: An electron microscopic image of the 2019 novel coronavirus grown in cells at The University of Hong Kong

So medical advice is mandatory if the person has any travel history linking him to China, Iran, Italy, South Korea or any other 80-odd countries where the virus has made its presence felt. The person may not have visited personally but could have picked the infection from any other person who might have the ‘adverse’ travel history. A self-assessment is required about the contacts in recent past, up to almost 20 days.

Neo Coronavirus, with a size around 900 times smaller than the width of a human hair, is a highly contagious respiratory virus. It has killed 3387 people even though most of the one lakh infected people managed to survive. However, the mortality by the infection, initially at 2 per cent, has now gone up to 3.5 per cent. Societies with a dense population, underfunded and fragile health care system and high rate of migration are susceptible to a high infection once the virus appears.

Fragile Kashmir

Jammu and Kashmir, especially the Kashmir valley is a risky population for a varied set of reasons. Firstly, it has a huge floating population. Slightly less than half a million seasonal workers get into the valley to manage its workforce demand. They have already started arriving as the new season has started. Being a conflict spot, it has a massive presence of the security grid. Though absolute numbers are not available, military and paramilitary personnel move out and get in, in thousands on daily basis – some going on leave, some on training and many returning after spending time with their families.

Washing hands with soap for more than 30 seconds is termed to be the key protection from coronavirus infection

Kashmir being a tourist spot, it was crowded in spring of 2019. The situation, however, changed after August 2019 and there are not visitors visible anywhere in Kashmir, especially after the virus scare.

The same, however, is untrue about Ladakh and Jammu. Tens of thousands of pilgrims are driving to Katra on daily basis to pay their respects to the Vaishno Devi shrine. The footfalls to Leh have reduced to a trickle, unlike the armed forces.

There is another facet to the floating population triggered by weather, trade and education. Tens of thousands of people routinely migrate outside Kashmir for winter. Even handicraft traders spend most of their winters in the plains. Conservative estimate suggests that around a million-odd residents spend their winters outside Kashmir.

Off late, thousands of students are pursuing their studies in the plains. A huge section is abroad also. In fact, China, Iran, Italy and other places where the virus has spread links Kashmir because of the students. Many batches from China have flown home and many more are awaiting evacuation from Iran. Some from Italy have reached home already.

Secondly, Kashmir is dangerously placed. Though at the far end, it is surrounded by Pakistan and Tibet. Unlike Pakistan, Tibet has not reported any case so far. Tibet can have some impact in Ladakh though remote, but Pakistan can have a direct and quick impact. There are villages on the Line of Control and the International Border (IB) which are breathing the same air and quenching their thirst from the same streams. The rival armies at various places are very close to each other.

Thirdly, Kashmir is proverbial rumour republic. This can run riot with the society as has happened in history when people took the superstitious route to fight logic. Indications are already there as some people have started using social media to “sell” their own “prescriptions” and the police are looking the other way.

Fourthly, albeit a positive one is that the health sector is very strong. It has traditionally remained lukewarm to situations but when the crisis was around, it has fought ferociously. However, a major tension is that the ruling set up is exhibiting a sort of disconnect. At a time when the central government literally banned mass gathering, the Prime Minister cancelled offshore visits and the Holi interactions, the UT administration in Kashmir is flying 1000-odd kids to Gulmarg for a winter sports tournament!

Authorities Say

While the world scrambles to control the Coronavirus outbreak, health authorities in Kashmir claim to be prepared for an outbreak. Commoners seem oblivious and the awareness of the severity of Coronavirus seems hazy. This ignorance has been reinforced by the availability of only a slow-speed internet and up until March 5 lack of social media. There has not been a conscious and seriously campaign so far.

Chief Secretary reviews preparations to deal with the evolving situation of Coronavirus in Jammu and Kashmir

Last week, the government felt the requirement of a campaign. “We were literally pulled out of our homes slightly before midnight to ensure the publication of the advertisement in local media,” an employee in the information department said. But the issue is how many people read newspapers in Jammu and Kashmir? With one advertisement, is the job done?

Kashmiri health authorities seem to have positive answers to all the questions that WHO posed to the world’s health authorities in the wake of a pandemic:

Are we ready for the first case?

Do we have enough medical oxygen, ventilators and other vital equipment?

How will we know if there are cases in other areas of the country?

Do our health workers have the training and equipment they need to stay safe?

Do we have the right measures at airports and border crossing to test people who are sick?

Do our labs have the right chemicals that allow them to test samples?

Are we ready to treat outpatients with severe or critical disease?

Do our hospitals and clinics have the right procedures to prevent and control infections?

Do our people have the right information? Do they know what the disease looks like?

Dr Shafqat Khan, Nodal Officer for Coronavirus for J&K said that the J&K continues to be far from the outbreak.

“About 196 people arrived in J&K from Coronavirus hit countries, and all are asymptomatic, 161 in Kashmir and 35 in Jammu,” Khan said. “Out of 21 samples taken 20 are negative and one of that of a patient in Jammu is awaited.” The government, he said, is engaged in screening and monitoring the arrivals in Kashmir.

Health authorities in Kashmir have trained doctors, paramedics who are called RRT’S (Rapid Response Teams) besides procuring PPEs (Personal Protective Equipment), triple-layer masks, and N-95 masks. There is close monitoring of ARI’s (acute respiratory infections).

“We are giving our best to ensure J&K remains free of the virus,” said the nodal officer.

Khan said there was enough material and logistical support with the health authorities to tackle the outbreak, if any. Jammu and Kashmir, he said, is also in the process of designating more hospitals as tertiary care centres if Coronavirus hits Kashmir. “There is no dearth of human resources in the health sector to tackle a potential crisis,” he added.

Limited Cases

Fortunately, the Coronavirus hasn’t marked its presence in Kashmir, so the health care set up is dealing with a handful of cases, mostly the individuals who flew home from infected regions. However, the recent discovery of a case in the US with no evidence of being infected by anyone has caused concern. This has even raised a concern that a similar emergence in a country like India which is geographically much closer to China and densely populated could quickly overwhelm the chronically underfunded health care system. By now, the USA has lost 12 of its citizens to Covid-19.

People wearing masks to protect from Coronavirus. KL Image by Bilal Bahadur

“The action plan has been framed for it by the directorate of health services,” said epidemiologist, Dr Manzoor Qadri. “Government is establishing control room with helpline numbers”.

The health department has issued health advisories through various media outlets especially in local daily newspapers for awareness. Five surveillance desks with doctors and paramedics have been established at Srinagar Airport for the screening of arrivals from directly or indirectly infected countries.

The government has also established isolation wards at, SMHS, SKIMS, Sanat Nagar, Chanpora, Ompora and Jawahar Lal Nehru Memorial Hospital at Rainawari.

Outside Hospitals

These wards are required in case of the outbreak. With no vaccine coming for next one year, the entire focus across the world is on precaution. That is what is missing in Kashmir. There is no instance in which the authorities had engaged the society. So far, there is no interaction at any level in which the school administrators were involved in transmitting the basic knowledge.

“As the schools opened for seven months, nobody knows which student was where for all these months,” Mohammad Inayat, a concerned citizen, who contracted flu from her daughter, who in turn, was infected in school. “This is the basic things that the authorities could have done to screen the students.” He said that while nothing much happened to Kashmir in the absence of schools and internet for all these months, why do not authorities considering the closure of the primary schools as was done by Delhi. Kashmir alone has 1.6 million students enrolled in the entire educational set-up.

There has not been a single instance indicating that the authorities tried to engage the community leaders either. As is obvious that Saudi authorities have closed Umrah pilgrimage from virus impacted regions, the arrivals have gone for a toss in Mecca, the home to Kaaba. Was any mosque Imam involved in spreading the message?

“How could they?” asked an Imam, who wishes not to be named. “They have already arrested dozens of Imam’s who had the potential of fighting this menace as a movement.”

Lax Screening

Qadri said they were assessing only those passengers at the airport who were coming from affected countries. “For the last three days, we are assessing everybody,” Qadri said. “Srinagar gets 28 flights a day with almost 180 passengers in every aircraft.” He said the 20-odd personnel manning the five desks have all the personal protection system and they use handheld infra-red thermometers.

“Within the department, we have enough masks (N95),” Qadri said. “But people need not to panic and they do not require masks. These are required in isolation wards and at the centres where samples are to be taken.” Medical personnel managing the patients require Personal Protection Equipment (PPE) which is already available.

Qadri said they have also set up a desk at Zig Mode near the Lower Munda where the doctors are assessing the incoming passengers. He, however, lacked any data to give an idea about how many were screened so far.

However, there are reports that the screened system is weak and lax. One newspaper reported that 70 foreigners, some from the virus impacted countries, visited Kashmir since January without any screening.

Why is Covid-19 dangerous than other infections?

Even Kashmiri passengers mocked at the “careless screening” systems at the airport. One of the students who returned Kashmir from the Coronavirus impacted Italy came via road from Delhi said the systems are lax. He was screened at Delhi International Airport, where he was declared asymptomatic and made to fill the form of health and family welfare. “There and then, they issued my clearance,” he said. He had flown from Southern Italy that was far from the virus mess. Once out from Delhi airport, he drove home and was not stopped anywhere. The virus has an incubation period of 14 days.

Explaining the screening at the Srinagar airport, a traveller, Abrar Ali while mocking the screening arrangements at Srinagar wrote on his Facebook wall about how he and 200 others on board were screened at the Airport. “A person at the desk asked for my boarding card, noted name and mobile number on a notebook that looked exactly like 5th class notebook; four lines copy and said go,” he wrote. “Another friend travelling with me who had unintentionally left his boarding card in-flight got worried what to do. But not to my surprise, he just passed quietly even without getting his name noted on a 4-line copy.”

Businesses Impacted

The virus appeared at a time when the Kashmir business was attempting to hunt for an opening to revive after seven months of a crisis. Tourism is unlikely to revive given the closing of borders and a fall in the per capita income across India. Now, the education sector and the retail are expected to take a hit including the transport.

Authorities in Delhi and in the UT of Jammu and Kashmir have not drafted any policy about how to keep the show going. Ideally, the government should increase spending so that the situation does not get worse. Instead, the system is still busy in the wrangles it created to squeeze the trade, trade leaders believe.

Closure of Wuhan has impacted most of the manufacturing sector in the world. It is expected to increase in coming days as the virus gets into newer geographies. Certain basics required to fight the menace are sourced from China and the pharmaceutical sector has already made it public.

Note: This report was featured on the cover page of Kashmir LIfe that went to the market on March 7, 2020.

About Author

A Mass Communication and Journalism postgraduate from the University of Kashmir, Khalid is a writer by choice and a journalist by chance.

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