The 1st case of killer Coronavirus in Peshawar, Pakistan

AC Peshawar Sara Rehman is sealing the house of coronavirus patientPolicemen are present on the spot from where corona patient has been recovered

Coronavirus in Peshawar

The first case of Coronavirus infected patient has been identified in Peshawar on 18th April 2020 in the academy town area. It is reported that the patient reached Peshawar from Dubai. Commissioner Peshawar raided the area and sealed the premises. The 1st case of suspected coronavirus was reported in Peshawar on 25 Feb 2020.

The infected person was of Chinese origin and was admitted in the Intensive Care Unit (ICU) of Khyber Teaching Hospital (KTH). The health authorities were tight-lipped about the case and become successful in hiding the issue from the media.

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A senior registrar working in the said hospital, on the condition of anonymity, has informed one of our team member about it. The infected person was working on a CPEC project and was returned from China. The infected person was discharged from the hospital after recovery. It should be noted here that the non-cooperative attitude of the people of Pakistan in general and KP in particular, with the health authorities, is of great concern.

The non-serious attitude of the people may lead to the spread of the disease further. A suspected coronavirus patient, Ashraf Khan S/O Musafir, resident of Dalazak road has disappeared from the khyber teaching hospital on 19th March. The said person was admitted in the room no 21 of the hospital and his specimen had been sent to the laboratory for confirmation. This issue has been reported by the security officer of KTH. He has informed the local police to arrest the person and bring him back to the hospital because he will spread the virus to many other people.

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Similarly in other parts of the country, the people are not taking the directives of administration seriously. They are attending the gathering regularly, shaking hands and participating in the events without any fear. Although the govt has imposed a complete ban on all types of gatherings and the marriage halls are being closed down, but the people are now arranging these events in homes and private places.

The second case of coronavirus patient has been identified on 21 March 2020 in Bara gate near Bacha Khan international airport. This is a highly populated area which is also near to university town and right road Hayatabad Peshawar. Thousands of people travelled through this road, daily to reach their destinations in Peshawar Saddar Bazar, Hyatatabad, University town etc.

Several densely populated villages are also located on Bara Road Peshawar. This district administration of Peshawar has issued orders of sealing the areas. The locals are informed through mosques about the severity of the issue. Police have been deployed and the district administration has completely cordoned off the area.

The second case of coronavirus in Peshawar on Bara Road.

Coronavirus infected person has also been identified in Sindh province by the health department. Yahya Jaffari, a 22 years old young boy recently arrived in Karachi from Iran by air. Jaffari, a resident of B42, Gulshan society, scheme 33 was admitted in the intensive care unit of Agha Khan Hospital Karachi. His family also accompanied him during the journey. He has been discharged from the hospital after his recovery.

Coronavirus has created panic in the official circles because its cases are being reported in Afghanistan, Iran and India. Pakistan shares borders with all these countries and thousands of people, from all the sides, visit these countries daily. There are maximum chances that the people may get infected while visiting these countries because there are no proper checking facilities on the border.

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Apart from it, Pakistan shares a very long border with Afghanistan (2500 kilometre) and Iran (99 kilometres). There is no proper fencing on most of the border areas where people case be stopped from entering another country. These areas are also used by human and drugs smugglers. The people can easily slip between Pakistan, Iran and Afghanistan which further increases the chances of caring infection from other sides. Keeping in view the severity of situation Pakistan government is considering to impose a complete ban on travelling to these countries.

Ban on travelling to China has also been imposed by the govt to protect its people from the pandemic of coronavirus. Its merit to mention here that Pakistan also important hundreds of dollars of items from Afghanistan and Iran. These items include candies, biscuits, dry fruits, vegetable, honey, tiles, vehicles, spare parts and a large number of other edible products. 

Pakistan also exports various items worth billions of dollar to these neighbouring countries due to which the movement of the people among these countries also increases. In such a situation, if a ban on travelling is imposed the economies all these bordering countries will suffer billions of dollars in revenue. In the months of Ramadan, Pakistan imports date from Iran, which will not be possible this year Ramadan if there will be a ban on travelling between two countries.

The total number of Coronavirus infected, Dead and recovered people in Pakistan.

(Table updated on 6th April 2020 at 05:00 pm)

Province Number of Coronavirus positive case Number of Deaths Number of recovered people
Punjab including Islamabad 1784 16 84
Sindh 990 1 91
Khyber Pukhtoonkhwa (KP) 423 12 52
Baluchistan 201 4 25
Gilgit Baltistan 213 5 17
Azad Kashmir 17 1 6
Total 3628 55 275

The federal and provincial governments have initiated several steps to mitigate the suffering of the people. Quarantine facilities have been established through the country in the designated hospital. One of the biggest hospital of KP, Lady Reading Hospital (LRH) has been closed for other patients and from 17 April it would only look after the patients suffering from coronavirus.

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All other major hospitals of KP ie Khyber teaching hospital (KTH), Hayatabad Medical complex and district headquarters hospitals have been directed to establish separate wards for the corona infected people. In addition to these efforts, private hospitals have also reserved more than 400 beds for the patients suffering from the devastating pandemic of 2020.

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Coronavirus isolation wards have been established in the far-flung areas of KP. More than 1000 health workers have been given special training to cope with the situation effectively. Schools, colleges and universities have been closed down. Ban has been imposed on marriages and all types of gatherings. Section 144 imposed throughout KP.

Helplines at federal and provincial levels have been established which will provide information regarding coronavirus round the clock.  A provincial task force has been launched under the direct supervision of Mehmood Khan, CM KP.

Helplines providing information to the public regarding Coronavirus.

Govts/Hospital Helpline
Federal 1166
Punjab 0800 99 000
KP 1700
Sindh 021-99203443 021-99204405
Baluchistan 081-9241133-22 WhatsApp: 0334-9241133
Deputy Commissioner Peshawar Helpline 1052
CM KP Emergency Control Room 091-111-712-713 091-9222561 Fax: 091-9210707 Whatapp: 0347-3666849

Coronavirus score sheet

The below-mentioned sheet can be utilized to determine the susceptibility of coronavirus infection in individuals.

Travel history to any Coronavirus infected place or country eg China, Italy, Middle East, Iran, Sindh province in Pakistan etc. 02
Exposure to corona patient 03
Cough 01
Flu 01
Fever (Temperature) 01
People at home, friends, relatives and coworkers having a history of cough, fever, flu and inhalation problems. 01
Health professionals (Doctors, Nurse, Pharmacists, Paramedical staff etc. 01
Total score 10
   

If the score is less than 3 then it is better to isolate at home for 14 days. (There are limited chances of acquiring the infection but as a precautionary measure, one should isolate him/herself from the general public) If the score is 5 then the confirmatory test is required. In this case, also confine yourself at home and consult a doctor. If the score is above 5 then you should be quarantined at the hospital.

Coronavirus testing facility throughout Pakistan

KHYBER PUKHTOONKHWA:

  1. Public Health Laboratory, Khyber Medical University, Peshawar, F1 Phase-6 Hayatabad, Peshawar, (091) 6217703.
  2. Police Services Hospital, police Road, Peshawar, (091) 9223472.

SINDH:

  1. Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi, Sindh. (021) 111911911
  2. Civil Hospital Karachi, DOW University campus، Mission Rd, Near Nanakwara, Karachi, (021) 99215740

PUNJAB:

  1. Armed Forces Institute of Pathology, Rawalpindi Road, Punjab. (051) 5176419
  2. Punjab Aids Lab, 6 Birdwood Road, Jubilee Town, Lahore, (042) 37802425.
  3. Shoukat Khanum Hospital, 7A Block R-3 M.A. Johar Town, Lahore 92 42 3590 5000.
  4. National Institute of Health, Park Rd, Chak Shahzad, Islamabad, (051)9255881.
  5. Nishtar Medical College, Nishtar Rd, Gillani Colony, Multan, (061) 9200383.

QUETTA:

  1. Fatima Jinnah Hospital, Bahadurabad, Wahdat Colony, Quetta, Balochistan, (081) 2853849.
  2. Mobile Diagnostic Unit, Taftan.

GILGIT BALTISTAN:

  1. DHQ Hospital Gilgit, Hospital Rd, Gilgit-Baltistan, (058119) 20253.

AZAD JAMMU AND KASHMIR:

  1. Abbas Institute of Medical Science, Muzaffarabad,  (058224) 39306

 

What is Coronavirus:

This name is derived from a Latin word Corona and a Greek word Korone which means a crown. This name is given to it due to the reason that it appears like a crown in the electron microscope. In was identified in 1960.

Coronavirus Transmission

There is uncertainty about the transmission of coronavirus but it is thought that this virus is transmitted from animals to human. The first case in the present crises was reported on 31st December 2019 in the Wuhan city of China, which was confirmed on 7th January 2020. It is believed to be transmitted from bats and snakes into human beings but, expert says there is no scientific evidence in this regard which can prove this claim.

A seafood market in china which is believed to have played a major role in spreading this virus which has been closed down by the authorities. The present crises of coronavirus, in the year 2020 is believed to be its transmission from bats and snakes into human beings but there is no scientific evidence in this regard which can prove this claim.

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In the past, SARS (severer acute respiratory syndrome) and MERS (Middle Eastern respiratory syndrome) were caused by the viruses of the same family and these viruses were transmitted from animals to human beings.

SARS associated coronavirus (SARS-CoV) was transmitted into a human from Civet cats (China 2003).

The MARS associated coronavirus (MARS-CoV) was transmitted into human beings from camels. SARS had a history of killing 774 people out of more than 8000 infected cases worldwide in the years 2002 to 2003. Majority of these cases reported in Hong Kong and China.

Diseases caused by a coronavirus

There are many viruses in corona virus’s family. These viruses are responsible for many diseases and they affect animals and human beings as well.

Coronavirus signs and symptoms

In humans:

It causes severe respiratory infection (infection of the nose, upper throat, sore throat, cough, the common cold), which if not treated on time may lead to death in a short period.

The sign and symptoms of this virus appeared within 2-14 days of infection. It is very fetal for old age people and those affected by other diseases. It signs and symptoms are similar to pneumonia infection.

In animals:

It can also cause severe diarrhoea and respiratory infection in animals (chicken, pigs and cows) which could be lethal for them.

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Coronavirus Treatment: 

  • The most dangerous aspect of this virus is that there is no drug and vaccine available for its prevention and treatment.
  • We have to rely on symptomatic treatment and there is no alternative without it. The traditional remedies used to treat cough, sore throat and runny nose can be used to treat it.
  • They should avoid overexertion and the patients shall be on bed rest.
  • Take fresh juices, fluidized meal and water.
  • In case of severe infection, the patient shall be shifted on a ventilator.
  • Paracetamol shall be used to reduce the severity of the disease. Earlier it was stated that NSAIDS shall not be given to COVID-19 infected patients but this claim has been refuted by WHO as no scientific evidence has been presented in this regard.

Coronavirus Precautions: 

  • The person infected by the said virus shall be kept in isolation i.e. away from the general public. It should be done because this virus spread from the infected person very easily. It spreads through coughing and sneezing.
  • The healthy people can easily acquire if from the infected person by touching his body parts (hands, face etc). It can also be acquired by using the utensils of coronavirus infected person. Therefore, all the items used by the infected person shall not be used by anyone and all such items shall be burned to ashes after its use.
  • The medical worker shall repeatedly and properly sterilize all the products used in hospitals. Special care shall be taken in medical wards where patients suffering from various seasonal diseases are admitted.
  • Children are more prone to this virus therefore special attention shall be given to their protection.
  • Repeated and Proper washing of hands with medicated soap.
  • Avoid hotelling during the pandemic.
  • Avoid public places and gatherings.
  • Avoid contact with domestic and wild animals because a human can also acquire it from infected animals.
  • All food products shall be properly cooked especially meat and eggs. Pressure cooker shall be used to cook meat and other edible products.
  • One of the words renowned scientific journal Lancet has recently published a report in which it is stated that this infection could be spread even from the people who do not have symptoms of it. This could further aggravate the situation, to an alarming level because the people could only protect themselves from the infected people, who are confined to hospitals or those who have clear symptoms of it.

Coronavirus in dogs and cats:

Earlier it was thought that the Coronavirus can infect the household animals, livestock and pets like dogs and cats. The WHO has now stated that no evidence of such things has been reported yet. It has also been denied, by WHO that Covid 19 can be transmitted from dogs and cats to human beings.

It was reported earlier that a dog has acquired the coronavirus from his infected owner in Hong Kong. Upon extensive examination, the dog showed no sign and symptoms inspite of the fact that the dog was tested positive. Scottish govt also refuted the claim of transmission of Coronavirus from pets to human.

The govt-issued guidelines for pet owner about keeping their pets in this difficult time. As the dogs and other pets required a regular exercise, walk and care, therefore the owner must think about their pets in this time of social isolation.

The govt has asked the pet owners to take regular guidelines and advice from the Scottish SPCA animal helpline  (03000 999 99) if you are helpless and don’t know what to do. Similarly, in the US no case of coronavirus infection from household animals including livestock and pet has been reported during this pandemic.

Precautions need to be taken while handling Dogs and cats during COVID-19 pandemic.

  • As there is no reported transmission of the Covid-19 from dogs and cats to humans, however extensive research needs to perform in this regard to prove the above-mentioned claim.
  • Regular hand washing is the most important step in the prevention of coronavirus, therefore hand must be properly washed before and after while handling a pet.
  • Good hygiene practices must be adopted while preparing food for pets.
  • Frequent check-up of your pets is mandatory during the pandemic.
  • If any signs and symptoms have been observed in the pet, it shall be reported to the veterinary officer and regular advice must be taken in this regard.  and any sign and symptoms
  • It is in the interest of both the owner and a pet as well to keep a distance from one another if anyone of them is found to be the carrier of the virus.

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Role of pharmacists during COVID-19 pandemic

In 2019 the word has seen the rise of one of the deadliest viruses in human history called as Coronavirus, which has also been named as COVID-19 (Coronavirus disease 2019). This lethal creature of GOD has tightened his grip on all the countries of the world and infected millions of people irrespective of their caste, creed and religion. Thousands of healthcare professionals are providing their services during this pandemic and pharmacists, as the most accessible healthcare providers are also playing their active role in this situation.

Responsibilities and duties of a Pharmacist during Coronavirus infection

  1. A professionally competent and legally qualified pharmacist has the complete knowledge of microbes including viruses. It is due to the reason that he/she has studied the subjects of Microbiology, Pharmacology, Clinical pharmacy and Pathology etc during his studies. Due to his extensive background in these subjects a pharmacist can affectively guide and create awareness in the general public and health care professionals regarding various issues on coronavirus.
  2. A pharmacist can easily spread the knowledge about its mode of transmission, means of protection and precautions (frequent hand washing, using masks, avoid gatherings and close contacts with one another, self-isolation etc). A pharmacist can aware of the general public regarding the safe use of different kind of medications during the pandemic.
  3. A pharmacist can be the best liaison between the doctors, nurses and laboratory staff and can inform them about the latest trends to be followed. A pharmacist must update himself about the latest research and follow the guidelines, issued by the concerned authorities (FDA, WHO) from time to time
  4. A competent pharmacist is also an expert on drug-drug and drug-food interaction. At a time of panic people usually resort to self-medication which can be lethal and can cause severe side effects. The same situation has been observed during the COVID-19 pandemic where people started using antimalarial drugs for prophylaxis and treatment of the disease. Many doctors have also prescribed chloroquine and hydroxychloroquine to patients without considering the adverse effect. As it can cause severe problems in cardiac patients (arrhythmias) and in those patients who are using antihypertensive drugs which may be fatal and can lead to deaths in some case. It inhibits the enzyme CYP2D2, causes potassium deficiency and can prolong QT interval. Lungs fibrosis is an additional side effect in a limited number of people. These antimalarial drugs are also contraindicated in many conditions which include G6PD deficiency, psoriasis and porphyria. It should be with caution in hepatic, retinal and haematological diseases. As there is no scientific evidence regarding the contraindication of NSAIDs in patients infected by COVID-19 but it should also be given with caution. However, these drugs have recently shown some promising results in, a limited number of studies against the COVID-19 infection. It is suggested is some research articles that Chloroquine also seems to act as a zinc ionophore, that allows extracellular zinc to enter the cell and inhibit viral RNA-dependent RNA polymerase. Keeping in view all of the above-mentioned points these antimalarial drugs should only be used with great caution and after consultation with doctors. In such a situation a pharmacist can be acted as a source of information for both the doctors, clinicians, nurses and patients as well.
  5. Chloroquine and hydroxychloroquine are easily available in countries where malaria is common. In countries where there are no or fewer cases of malaria, the availability of these drugs may be a problem. Therefore, it the prime responsibility of a retail, community, clinical and hospital pharmacists to ensure the availability of these antimalarial drugs in large quantities in their pharmacies.
  6. Another controversy is also generated regarding the use of chloroquine and azithromycin for the treatment of Coronavirus. Technically speaking cholo is antiprotozoal drug and azithro is a cell wall inhibitor while corona is an RNA based capsid and scientifically there is no relation between chloro, azithro and corona. The pros and cons of cholo have been discussed earlier.
  7. A pharmacist must keep himself update as the coronavirus mutates and changes its composition very quickly. He must acquire the latest knowledge of disease from the authentic resources/reference material and share it with the general public and doctors. Consulting a large number of authentic materials is also mandatory because there is very limited literature available on the coronavirus because it appeared for the first time and it did not challenge the world before. Scientists throughout the world are compiling information and it will take some time to conclude, therefore relying on few resources would not be a wise decision in the present situation.
  8. The last but not the least is the preparation of sanitizers. As this pandemic has infected millions of people in almost every country in the world. In such a situation the shortage of necessary items, related to COVID -19 is natural. There is a big gap between the demand and supply of hand sanitizers throughout the world as it is one of the most commonly used product in this situation. A pharmacist must prepare sanitizers for his local community, customers and hospital where he/she is performing duties. In this way, he can help his community, manufacturer and governments to cope with the situation effectively.

World Health Organization (WHO) concerns regarding Coronavirus

Though the WHO has not raised severe concern regarding the issue of Coronavirus since China has taken strict measures, so far to control the epidemic but they have warned the number of infected people could rise further. The Chinese government has imposed travel restrictions on the cities which are infected by the virus.

The number of such cities is said to be 18 where more than 56 million people will be affected by the travel restrictions. The people are directed to wear face masks while doing their routine work. A ban has also been imposed on several festivals that are to be held in coming days as this is the most important month of celebrations according to the Chinese calendar.

Several cases of coronavirus infected people have also been surfaced in other countries including the US, Singapore, Japan, Australia and South Korea but the situation, in these countries is in control according to WHO.

Coronavirus outbreak in China

There is an outbreak of coronavirus in China at the start of the year 2020. According to the reports thousands of people have been infected by the virus in different Chinese cities. The Hubei and Wuhan cities of China are the worst affected. By 25th of January 2020, more than 1200 confirmed cases have been reported by the Chinese health authorities. About 51 infected people are also killed so far.

It has also been reported that said virus has also spread to other cities of China including Beijing and Shanghai. This fast-spreading epidemic has forced the Chinese authorities to seal the routes leading to the cities infected by the epidemic. No one is allowed to leave the infected cities to protect the spread of this deadliest virus and to protect the lives of other non-infected people.

Coronavirus affected countries (Latest updates 25th Feb 2020)

S.NO Affected Country No of affected people No of people killed
1 China 90345 3114
2 USA 5
3 UK 5 (suspected)
4 Japan 2
5 Mexico 1 (unconfirmed)
6 Thailand 4
7 S. Korea 2
8 Taiwan 2
9 Hong Kong 2
10 Australia 2 (suspected)
11 Pakistan 3
12 Canada 1
13 Iran 227 64
14 Afghanistan 3
15 Bahrain 3
16 Kuwait 3
17 South Korea 835 31

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