Sindh govt response to COVID-19 exposes loopholes at the micro-level

HYDERABAD: The Sindh government’s response at the micro level has exposed some loopholes as the total number of suspected samples so far tested positive for Covid-19 in the province crossed the 1,000 mark on Wednesday, showing an alarmingly rising trend in local transmission.

Given the official statistics, Hyderabad ranks the second with 156 active Covid-19 patients after Karachi’s 444. Sukkur, which faced a difficult situation with the arrival of pilgrims from Taftan earlier, has now 91 active cases as 183 out of the 244 have recovered.

A provincial task force headed by the chief minister (CM) analyses situation daily before taking any decision. There seems to be something missing in the rest of Sindh and more local transmission cases are being reported.

Tando Mohammad Khan in lower Sindh and Larkana in upper Sindh have reported 12 and 13 cases, respectively. WHO has classified such “transmissions” as local for Pakistan.

Some points merit attention of the CM who cannot visit every district now. He relies, rightly so, on video conferencing for situation analysis. Hyderabad, Sindh’s second largest city, has its own demographic issues.

The city could be taken as a model to introduce a paradigm shift in the current strategy for anti-coronavirus fight. It might lead to better management of the present situation.

It was, so far, managed without a well-thought-out plan to respond to the pandemic, leading to a spike in cases by the end of March. Admittedly, one could not single-handedly cope with such a massive task. Only a sincerely coordinated effort could make things easier to emerge victorious in this battle amidst governmental and administrative oversight.

A provincial task force format, for instance, could be replicated in Hyderabad followed by other districts with the representation of health officials, Liaquat University of Medical and Health Sciences (LUMHS) faculty, revenue officers, police personnel, elected representatives and members of municipal bodies. LUMHS could play a lead role as far as positive patients’ care is concerned.

A central control room at the commissioner’s or deputy commissioner’s office could lessen the pressure of work on all sectors. But such a room should not be a one telephone operator-type set-up seen in rain emergencies. Its modalities could be worked out once all stakeholders sit together for strategy’s review afresh. Responsibilities must be clearly defined at the senior level.

It must have a 24-hour presence of representatives from above areas. Ration distribution is under way and administrations should keep a critical eye on the situation as disbursement of financial assistance is about to begin perhaps from April 9 in Sindh.

“So far decisions were thrust on us. If a suspected patient with travel history is reported to a revenue officer by police, then he or police locate him. The officer starts calling the district health officer to know about jurisdiction/area. After wasting time, something is achieved, but by then plenty of energy is gone. We can figure out the entire plan easily and all stakeholders will have to be in the loop if we need results and defeat coronavirus,” one official shares his ordeal.

Civil administration, health experts, police etc, apparently have worked in isolation, thus creating a chaos. Authorities have struggled to manage facilities in and around Hyderabad, utilising a lot of manpower, fuel and logistics, and bearing with tremendous psychological pressure.

Isolation facilities are widely scattered. While Labour Colony flats — otherwise a perfect location for quarantine — is on one extreme on the Tando Mohammad Khan road while Wali Bhai Rajputana or Isra hospitals on the other extreme. Then comes Kohsar Latifabad Hospital which is in another direction.

One then must not lose sight of the fact that health services available in these hospitals have either come to a naught or are being undermined to a great disadvantage of patients with other ailments from lower Sindh, who need day-to-day consultancy, surgical procedures and dialysis.

Sindh’s healthcare system is already fragile, therefore, doors of those services must not be shut on those patients in this situation as it could endanger their lives. “Where will they turn to now?”, comments a doctor.

Spaces like Hyderabad Club’s spacious hall could be used as an isolation ward. It has separate rooms as quarantine for suspected patients. Then there is option of Sindh Sports Board hostel’s rooms, a gymnasium and a badminton court, all in a compound wall in midst of the city, which is not yet considered. It may save logistical cost of administrative work if health experts approve of it.

Currently, population of suspected and confirmed patients in Labour Colony flats alone is 71 and 90, respectively. These 1,504 two-room flats could be fully used for quarantine and isolation to optimise achievements with limited resource.

Liaquat University of Medical and Health Sciences (LUMHS) Vice Chancellor Prof Dr Bikha Ram is supportive of it and believes that more such spaces like Expo Centre could be discussed.

To quote a professor of medicine, Dr Imran Shaikh, LUH’s Jamshoro branch is the best option where many wards, currently vacant, could be segregated that fulfils social distancing aspect in hospital environment.

“We need to see co-morbidity and mortality aspect also. LUH Jamshoro ensures multidisciplinary approach as elderly patients also have multiple ailments,” he opines.

Besides a tertiary hospital, Hyderabad luckily also has a well-equipped Diagnostic and Research Laboratory (DRL) of LUMHS in the LUH city branch. In few cases, it initially charged fee for the Covid-19 test, but now all such cases are attended free of charge, denying a known private lab a major chunk of revenue, but saving poor patients’ money.

The private lab charges Rs7,900 for Covid-19 test. So, if 1,000 tests are done in the university lab, it means government’s Rs7.9m are saved. And these lab reports are to be repeated for positive patients, which increases the lab expenses.

Even Sukkur administration got its patients’ tests done at DRL. Only two DRL reports varied from those of the private laboratory, one of a Hyderabad deceased Covid-19 victim and other from Kohsar. “Flawed sample collection technique of the same [Hyderabad] patient is possible,” said a doctor, expressing concern.

Another chips in: “Then LUH has just witnessed an end to a tug of war between the MS and his administrative colleague who was now relieved, and the MS got his drawing and disbursing powers back from him.”

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