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Covid-19

Knee-deep in Covid-19, our hospitals need steady supplies of PPEs, sanitisers and adequate staff

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We don’t want your salutes,” says Dr Hamid Mehmood, consultant anesthesiologist at the Dow University of Health Sciences. “What we desperately need right now are the PPEs (personal protective equipment).”

“Walking out of my home at 7:30 in the morning, leaving the kids asleep, I ask myself every day — ‘Do I really have to walk in that isolation ward of patients with Covid-19? Am I safe… the worst thought is am I bringing that virus to my home, to my kids, wife, and parents? What if I become a carrier?'”.

The anesthesiologist adds: “My only survival in these desperate times is via the PPE because I cannot distance myself from my patients. My arsenal, scarce though, is my trustworthy PPE.”

Helping Covid-19 patients in increasingly harrowing circumstances, Dr Mehmood says if healthcare workers get sick, then there isn’t going to be anyone to treat the patients.

Ensuring a smooth supply of the very basic PPEs, sanitisers, and bleach is taking up precious time of the Jinnah Postgraduate Medical Centre’s executive director Dr Seemi Jamali in her battle with this virus.

“We have PPEs for now, but we will require a lot more,” she says.

Dr Shobha Luxmi, who heads the isolation ward at the DUHS, says she has enough PPEs “at least for now”, but what her hospital needs immediately and urgently are sanitisers. At the moment, they are rationing on PPEs and diluting sanitisers to make them last longer.

The ration has extended to the N95 masks as well.

“Our N95 masks are our lifesavers, but in short supply. We use them very carefully and after each use put them in brown bags marked with our names to be re-used, till these wilt away,” says Dr Muneeba Ahsan Sayeed, infectious diseases physician at the DUHS.

“And can you please tell your readers, these masks are not for them, so do not cause shortage for us?” she asks, her voice filled with sadness. She says these masks are worn by healthcare workers so they can protect themselves while treating contagious patients.

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Doctors in PPE carry out tests on a patient at a hospital in Muzaffargarh. — Photo courtesy: GoP.
Doctors in PPE carry out tests on a patient at a hospital in Muzaffargarh. — Photo courtesy: GoP.

At the Indus Hospital (IH), they have found a solution to make their PPEs last longer as well as to double their protection. “We wear another disposable gown on top of the one that comes with the PPE,” says Dr Fivzia Farooq Herekar, consultant internist and infectious disease specialist at the IH.

At the DUHS, they wear another pair of lower quality gloves over their latex ones and shed it after seeing a patient.

Doctors getting sick, hospitals short-staffed

Already, it has been reported that six doctors, some very senior ones, in Karachi have contracted the virus.

“I think if doctors and paramedical staff elsewhere in the country are protesting and are hesitant to report to work, if not provided proper PPE, then it’s justified,” points out Dr Herekar. “Their panic is genuine.”

“But the situation is going to get worse,” anticipates Dr Mehmood. “We just don’t have enough manpower even if we have the PPEs for them. Our janitorial staff, even our nurses are too scared to go near a Covid-19 patient for fear of catching the virus,” he says.

Most hospitals, including private ones, had always been short of ancillary staff. “Some patients on ventilators who cannot move at all, need to be turned every couple of hours, some need to get their soiled pampers changed, or a patient’s room needs clearing and cleaning, which involves moving his/her stuff.”

At a minimum, Dr Mehmood says, a hospital taking care of 10 elderly patients infected with Covid-19 (and some on ventilators) needs 35 people for the duration of 24 hours — with each doing a six hour shift. “These include ward boys, sweepers, porters, phlebotomists, radiographers, on-floor duty doctors, nursing incharge, shift incharge, and the most important person, the consultant doing the rounds,” counts the anesthetist.

With Pakistan sitting on a ticking “time bomb” of Covid-19 patients, Dr Mehmood anticipates the virus will hit the elderly whose health condition is already compromised, especially those who are diabetic and those who are suffering from hypertension.

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“We will need assistance for taking them to the washroom, help them with eating, you know little chores that do not require any special medical skill,” he says.

So what they will need, soon, says Dr Mehmood, is a brigade of young, energetic educated people who can, once provided a crash course in biosafety, quickly understand instructions on how to wear the PPE properly and store and doff it off carefully as well to avoid contamination.

Willing to volunteer, but not without proper SOPs

Twenty-five-year-old Mohammad Ismail, who founded a virtual group of science students, called Scientists Against Covid-19 Pakistan (SACP-19), and which today has over 3,500 young and eager Pakistanis from across the country, agrees with Dr Mehmood.

He says: “Even we would prefer that the most trained/most experienced people from among us go first as they are more likely to be careful compared to an eager undergrad who could make mistakes in their excitement.”

Ismail adds that the only reason SACP-19 has not connected its young volunteers to the authorities so far has been the lack of availability of proper PPEs.

The SACP-19 is working to arm its members with a set of standard operating procedures (SOPs) in the Covid-19 context to ask of local authorities and hospitals as to whether these are being followed, before the group forwards its list of available volunteers.

The SOPs also require the availability of “isolated accommodation as it is not advisable for these volunteers to go back home for at least three weeks,” points out Ismail.

What it’s like to wear the PPE and the N95 mask

Not quite a hazmat suit, the basic personal protective equipment that healthcare workers in Pakistan are asking for includes a coverall made of an impermeable material, latex gloves, a face shield, goggles and masks (both N95 and the three-layered surgical mask).

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It takes about 10 minutes to get into scrubs, wash up and wear the PPE. “Do not rush to wear the PPE as it needs to be donned on properly,” advises Dr Herekar.

But it is not the most comfortable of equipment everyone agrees and “adhering to the PPE protocols is quite a challenge” says Dr Sayeed.

“You sweat profusely,” she says, adding that one cannot remain in it for more than four to six hours. That is probably because DUHS is not air-conditioned.

However, most doctors prefer and feel safer to not be in an air-conditioned isolation room which may not have a negative pressure when a hepa filter is used, increasing manifold the chances of catching an infection.

“The infection is air-borne and without a hepa filter that controls the spread of particulate matter through ducts, those inside the wards can catch the disease,” says Dr Mehmood.

In addition, Dr Sayeed says: “You cannot drink, eat, go to the washroom,” once you’ve donned it. But the IH has a room next to the isolation ward where doctors can go sip some water if they need to.

An N95 mask. — Reuters
An N95 mask. — Reuters

But more than the coverall, it is the N95 mask that is terrifying.

“Breathing in and out takes a huge effort and your communication is impaired, and you need to speak louder to be heard,” says Dr Sayeed. “It saps my energy.”

“It needs getting acclimatised to,” agrees Dr Herekar, adding: “For those not used to it, or wearing it for the first time, it can cause dizziness.”

“And what a relief it is when you doff it,” she says, adding that “it does take both a physical and mental strain on you”.

A person wearing a PPE and working for 6-8 hours is the same as a doctor completing a duty that lasted 36 hours, she says.

Via_ DAWN.com

Covid-19

Consul General of Liberaland in Pakistan Faisal Butt hails Imran Khan’s strategy that reduced Covid-19 Cases in Pakistan .

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Lahore: Consul General of Liberland in Pakistan Faisal Butt has appreciated the strategy of the Pakistani government in view of the reduction of corona cases in Pakistan. In his statement, he said that Pakistan has taken better steps to control the spread of corona in comparison to the neighbouring countries .

As a result of these measures , Pakistan is rated amongst the lowest covid 19 cases reported countries . Not only the cases but also the death toll is much less than other countries.

He said that there was no doubt that Pakistan was making progress even in conditions like corona. All the credit goes to the government of Prime Minister Imran Khan.

Today, other Asian countries, including Europe, also appreciating Imran Khan’s strategy. He further said that the day is not far when the people of Pakistan will be vaccinated and declared a Corona free country.

Referring to the relations between Pakistan and Liberland, he said that Corona has enveloped the whole world, which has hampered relations, imports and exports with many countries. As soon as the situation improves, not only diplomatic but also trade relations between Pakistan and Liberals will be restored.

The Consul General said we are planing to sign the agreements between the Liberland Chamber of Commerce and the Lahore Chamber of Commerce. A plan of action will be announced soon.

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China

What will the post-COVID world look like?

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Although virologists have been warning of the risks of a global pandemic since the SARS outbreak in 2003, the world was still mostly unprepared when confronted with the COVID-19 crisis. However, it was also unlucky.

It was unfortunate that the pandemic came in the run-up to a US presidential election that has created an environment as politically polarized as any the country has experienced. As a result, much of the US media coverage of, and debate about, the virus and the global policies needed to deal with its effects have been more about the presidential race rather than the pandemic.

This has obviously had a clear effect on international politics because of the importance of the role of the US and its global leadership.

It was also bad luck that the health crisis came at a time of high tensions between the US and the second largest global power, China, where the virus originated. This further complicated any potential global unified response.

As a result of the global uncertainty, it is difficult to forecast how critical aspects of the crisis, which seems likely to continue for at least another 12 months, will play out in the Middle East, and also what a post-COVID world might look like.

One certainty is that most countries will be forced to shift their focus and resources to domestic matters rather than regional issues.

The virus and the resultant shutdowns imposed to “flatten the curve” of infections have had, and will continue to have, devastating consequences on economies and national budgets. It seems that despite the soft reopening of parts of economies around the world, the current health concerns will prevent a full restoration of business activities for some time, especially if the number of infections and deaths start to rise again after governments relax precautionary measures.

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In our increasingly interconnected world, it is difficult to determine whether any country will come out on top economically, and consequently geopolitically, especially given mounting levels of debt.

Countries able to borrow in their own currency seem to be at an advantage; this applies mainly to the US and the EU (if the European countries can unify their policies), and indirectly also explains the current debate in the Gulf about the unpegging of currencies.

Another certainty is that with less money available, wars and proxy wars will become prohibitively expensive and all parties will be forced to scale down their ambitions. As a result, aggression will be reduced and consensus and agreement might be more readily reached. Countries and their allies or proxies who have refused to sit at the negotiation table might now change their minds and mellow, or perhaps even be forced to completely withdraw from conflict zones.

Take Iran, for instance, which has been targeted recently by a successful US policy of maximum pressure. The country is facing problems domestically and, with the added pressure of low oil prices, it will be less able to maintain its financial support to the Houthis in Yemen, the militias in Iraq, and Hezbollah.

Does that mean Tehran will cease its meddling? Nothing is certain but domestic turmoil might force it to do so.

As Iran’s problems have grown, the region has witnessed during the COVID-19 pandemic the emergence of a more assertive Turkey. This has happened despite the fact the country is also suffering economically.

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It has been a long time in the making. Turkish involvement has spread to many regional issues beyond its normal national security zone. Its involvement in neighboring Syria is understandable, given that the conflict there directly threatens Turkey’s security. More interesting is the Turkish interest in Libya, where Ankara is pushing for a continued presence with no apparent direct threat or rationale to explain this. This is happening while it also increases political rhetoric that promises continued interference in the domestic affairs of Arab countries in the years to come.

A closer look at the issues reveals that Turkey is focusing its involvement on key points on Europe’s energy routes. This is not surprising, as Europe remains Ankara’s main and constant focus. So, Turkey is now directly competing with Russia — the biggest supplier of gas to Europe — in Syria, where Iran is also strongly entrenched as the country is a key Mediterranean access point for its gas and energy deliveries to Europe.

Turkey is challenging Russia for control of the tap that provides Europe with its energy stability, and this explains its involvement in Libya and other countries. The same logic explains Ankara’s negative reaction to the Israeli-Greek-Cypriot gas-pipeline project, EastMed. This motivates its strategy, as it hopes to leverage it to make more gains in the region.

Therefore, we can expect an increased Turkish focus on the Mediterranean and on supply-chain routes and access points for energy, as well as merchandise being shipped from the East to Europe.

On that point, the land routes of China’s Belt and Road Initiative include one that goes through Russia and another that passes through Turkey. This massive project is also something Turkey is well aware of, and Ankara is striving to ensure it has a presence on key points along the BRI’s Maritime Silk Road. Once again, it is being guided not by national security concerns but a desire to increase its regional clout.

It is difficult to forecast how critical aspects of the corona crisis will play out in the Middle East. 

Khaled Abou Zahr

While Russia and Turkey face off on the ground over an increasing number of issues, it is interesting to note the apparent lack of any direct involvement by the US or China, the two biggest global powers, and, surprisingly, the total absence of European nations, which should be the most concerned about what is happening.

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In weighing how global and regional powers will direct their foreign policies and manage existing conflict zones, their own domestic political, economic and social stability will play an important role.

Yet, apparent weaknesses might invite bold moves and dangerous power-grab attempts. This delicate balance will be the key driver for international policies in the coming years. One might say that uncertainty and volatility have spread from the stock-markets to the geopolitical arena.

  • Khaled Abou Zahr is the CEO of Eurabia, a media and tech company. He is also the editor of Al-Watan Al-Arabi.

Courtesy : Arabnews.pk

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China

US warns of ‘consequences’ if China abandons trade deal

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US Treasury Secretary Steven Mnuchin said on Monday he expects China to uphold a trade deal reached with Washington this year, and warned of “consequences” if the country did not.

The comments come amid a sharp drop in global trade caused by the coronavirus pandemic as well as a dispute between the two powers over fault for the spread of the virus, which first broke out in Wuhan, China.

The US and China in January signed an agreement to end a nearly two year-long trade war, that included a commitment by Beijing to buy an additional $200 billion in American goods over the next two years.

“I’m expecting them to meet their obligations,” Mnuchin said on Fox Business Network.

“I have every reason to expect that they honour this agreement and if they don’t, there would be very significant consequences in the relationship and in the global economy as to how people would do business with them.”

Ties strained

However, relations between Washington and Beijing have soured in recent weeks, with US President Donald Trump blaming China for the pandemic, and threatening tariffs.

The US has been hit with tens of millions of layoffs as the virus has spread, significantly weakening the previously solid economy, which Trump was counting on to win re-election in November.

The trade agreement signed in January includes $77.7 billion in additional purchases from the manufacturing sector, $52.4 billion from the energy sector and $32 billion in agricultural products.

The US currently runs a trade deficit with China, and the objective is to realign the trade balance between the two countries.

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