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Medical

Organize the Medical Profession

Jinnah's Ideals

“I have learned with great interest that the Pakistan Medical Association has been formed and is going to be inaugurated on Saturday, 27 March 1948, in Dacca. This Association, I hope, will serve earnestly to organize the medical profession in Pakistan on a high level befitting our State. It can render many services if it is well-organized and efficient. For example, it can help to speed up medical relief of which we stand in very great need indeed at present. It will also keep medical and social contact with similar interests in other parts of the world for the exchange of views and ideas from time to time, and thereby establish a better understanding in solving medical problems peculiar to various countries and Pakistan. 

I wish Pakistan Medical Association all success.” 

- Mr. Jinnah / Quaid-e-Azam

- Speech:  On Need of Medical Relief | 26th March 1948

- Context: Message to the Pakistan Medical Association, Daca 

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Deeper reflections

Pakistan’s national response to the coronavirus emergency has been one of the best in the world. We must further continue in this direction by: 

 

  • Containing the spread of the disease by building local awareness 

  • Building a stronger health-care system that can withstand a sudden and high influx of patients  

  • Developing the vaccine by collaborating with global partners 

  • Prioritizing health and safety over profit 

  • Supporting businesses to adapt to the crisis that’ll retain consumer confidence 

We’ll get through this but there are challenges ahead of us that we must face head-on. 

Contain the spread of the disease / Building Local Awareness

It’s mission-critical to have a well-informed, medically literate and scientifically aware population. 

 

Here are the latest facts (as of March 13th*) on Coronavirus that Pakistanis should be aware of:  

 

Origins of the Virus 

Researchers have found that three-quarters of new diseases come from animals. Experts believe the novel coronavirus likely came from bats or pangolins. This is because every time a virus replicates, its genes can mutate and make it possible to spread from animals to people. There are various other diseases that spread via animals such as Rabies, Blastomycosis, and Psittacosis, etc. 

Source: Federation of American Scientists 

 

How it spreads 

COVID-19 spreads when a person with the virus cough or sneezes. Small droplets from coughing or sneezing land on the skin and enter the body when one touches their face around their nose or mouth. Breathing in these droplets can transmit the virus; however, this can be prevented by keeping your distance from a person who is sick. Beyond droplets, it is good to be cautious and recognize that the disease can be airborne because droplet trajectories can be accelerated by the gust of air that is released when a person coughs or sneezes. 

Source: Federation of American Scientists | They Say Coronavirus Isn't Airborne—but It's Definitely Borne By Air

[Qualitative real-time schlieren and shadowgraph imaging of human exhaled airflows: an aid to aerosol infection control. Tang JW, et al. PLoS One. 2011.VIDEO: JWTANG, A NICOLLE (NATIONAL UNIVERSITY HOSPITAL), J PANTELIC (NATIONAL UNIVERSITY OF SINGAPORE)]

Spreading through fluids 

It is not yet known whether other non-respiratory body fluids from an infected person including vomit, urine, breast milk, or semen can contain viable, infectious SARS-CoV-2.

Source: Federation of American Scientists 


 

Severity of Symptoms

On 6 March the World Health Organization reported that 80% of infections were mild or showed no symptoms, about 15% were severe infections, and 5% were critical infections. Those who have severe symptoms are often older or have preexisting conditions such as diabetes, hypertension, or cardiovascular disease. Children do not seem to catch COVID-19 as frequently as adults and often have mild flu-like symptoms.

 

Globally, about 3.4% of reported COVID-19 cases have died. In Italy, the mortality rate is 5%. By comparison, seasonal flu generally kills about 0.1% of those infected on average. The current mortality rate for known cases of COVID-19 is about 0.6% in South Korea, where there has been widespread testing, and 0.7% in China outside of Wuhan. 

Source: World Health Organization | Situation Report | Wall Street Journal | Vox | ABC news 

 

Does it infect Fruits or Vegetables 

No, coronaviruses are not known to infect fruits or vegetables. Plant cells are built differently than animal cells, with the former having very tough cell walls. Viruses that infect animals or humans are not adapted to get into plant cells. However, the coronavirus can be present on surfaces for at least a few hours so proper food preparation techniques are advised.

Source: Federation of American Scientists 

 

Survivability of the COVID-19 Virus on Surfaces

While it is difficult to determine exactly how long viruses can stay intact outside the body, since it is so dependent on environmental conditions, different viruses do appear to have different levels of resiliency. Flu viruses, for example, are generally rendered harmless after nine hours on hard surfaces and four hours on soft surfaces. The Middle East Respiratory Syndrome (MERS), which is in the same virus family as COVID-19 virus, lasts for two days on hard surfaces. A recent study concluded that human coronaviruses can last on surfaces at room temperature for up to 9 days. The World Health Organization’s early estimates suggest that COVID-19 virus can survive on hard surfaces for a few hours, or up to several days.

Source: Federation of American Scientists 

Was the virus created in a Lab 

The COVID-19 virus was not designed in a laboratory. The COVID-19 virus is most closely related (96% identical) to a coronavirus that was previously identified in bats. Scientists are working around the clock to determine which animal was the original host of COVID-19 and which mutations the virus obtained that enabled it to infect humans. The suggestion that the virus was created in a lab has been debunked and retracted.

Source: Federation of American Scientists 

 

Coronavirus vs. Common Cold 

Unlike the four strains of coronavirus behind about 20% of the cases of common cold, COVID-19 virus can cause severe illness, and even death. This is because while coronaviruses causing the common cold infect the nose and throat, which comprise the upper respiratory tract, COVID-19 virus infects the lungs, which is the lower respiratory tract. That can bring on pneumonia.

Source: Scientific American 


 

Treatment 

There's no specific drug that kills Coronavirus yet -- but doctors have ways to treat It. Doctors provide supportive care in the intensive care unit environment. The strategy of supportive care is to do whatever's possible to keep vital organ systems functioning. That means monitoring vitals such as temperature, blood pressure, and oxygen levels and trying to keep those as normal as possible. Providing oxygen can be critical, particularly for a lung ailment. The method can range from a simple tube in the nostrils (a nasal cannula) to much more aggressive approaches, such as a mechanical ventilator, which involves a breathing tube threaded into a person's airways. We're just trying to support their bodies through it while they deal with the infection themselves.

Source: There's No Specific Drug That Kills Coronavirus. But Doctors Have Ways To Treat It

 

People who recover 

The immune response to COVID-19 is not yet understood. Patients with MERS-CoV infection are unlikely to be re-infected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19.

*if any of this information gets outdated as new data surfaces, please email us at team@jinnahspakistan.com and we’ll immediately update it.

 

 

Here’s a brief history of Pandemic:  

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Here are the actions you can take: 

 

1. Limit leaving home: Stay home during the coronavirus pandemic is the most effective means of prevention.

  • It reduces your chance of infection and quickly contains the disease’s spread. A recent study in Science found, for example, that this kind of distancing is even better than widespread travel bans or restrictions. Source: China’s travel lockdown sharply slowed the global spread of Covid-19

  • However, being outdoors, in fresh air exposed to UV light, is healthy. We encourage Pakistanis to continue executing the functional things that need to be done with the right precautions in place - cities and societies need to run undeterred. We just need to avoid crowds and groups to stop the spread of the disease.   

2. Maintain Healthy Lifestyle: Keep your immune system strong by actively exercising, eating a good diet with supplements, sleeping 8 hours and maintaining a positive mental and emotional health.

What to do when traveling 

 

 

1. Stagger Commute times: If you can’t drive or walk where you need to go, consider commuting by public transit during off-peak hours. Spreading out commute times, even by a small amount, can help reduce transmission risk from overcrowded subways and buses. 

2. Avoid surfaces: While in transit, avoid touching poles and handles. Some recent research in a pre-print paper suggests that the virus can survive on hard surfaces for up to three days, although there is still no evidence that it is transmitted in this way. You can also wear gloves or create other makeshift barriers to stay protected, but they should be removed as soon as you are back indoors.

3. Stay six feet away from people (as much as possible): The six-feet rule might not be possible if you’re waiting in line to get to your seat, but there’s no need to rush to your boarding-area queue or crowd around a coffee shop.

4. Wear a makeshift mask (if it gives you peace of mind): It’s still unclear how much a mask will reduce a healthy person’s risk of contracting coronavirus but the extra protection doesn’t hurt. The caveat is if you’re not used to masks, you might fidget with it and thereby break a cardinal rule of coronavirus prevention: don’t touch your face.

5. Take a shower after you arrive: When you get to your destination, take a warm soap-and-water shower before interacting with people or lounging around too long in common spaces. Soap and water is one of the best disinfectants. A bath is more comprehensive than hand-washing when you’ve been in contact with a lot of different surfaces. Avoid rewearing your travel clothes again until you’ve washed them.

What to do when you are sick 

1. Stay at home: If you are sick (with something other than the coronavirus), reconsider whether you need to be out and about. The coronavirus is most threatening and more likely to result in complications when contracted along with another disease. With a weaker immune system, you will be more vulnerable. Exposing others to whatever you have, especially if they are immunocompromised, will make them more susceptible as well. 

 

2. Wear a makeshift mask: But for essential trips, such as to go to the doctor, wear a mask or other makeshift barrier across your nose and mouth to protect others. Even a scarf or other cloth is better than nothing for reducing the spray of droplets when you cough or sneeze. Of course, the tighter the barrier the better. Do not, however, hoard surgical masks, which need to be reserved for front-line health-care responders. That backfires for everyone.

 

3. Call an ambulance: If you suspect you have coronavirus, call for an ambulance instead. Traveling on public transit puts fellow passengers at too much risk. You could also contract another infection.

What to do when you need food 

1. Get it delivered: Always opt for grocery or restaurant delivery if you have access to those services. It will reduce the flow of people circulating in-store and the chance of community spread. When the food arrives, wait for the delivery person to leave before you pick the package up. (Many delivery apps give you the option of specifying such instructions.) This minimizes delivery workers’—and the community’s—exposure to potential germs as they go from one home to another. 

 

2. Opt for cooked over raw foods: Cooking produce is the safest way to guarantee decontamination. But diligent washing with can also be a good defense.

 

What to do when you work out 

 

1. Opt for in-home workout (avoid gyms): Forgoing regular exercise can be challenging for mental health, especially during high-stress times such as this one. So consider developing routines that avoid the gym. Gyms are breeding grounds for many types of germs, which could weaken your immune system, but the heavy breathing and confined spaces also heighten the risk of coronavirus spread. Jog outside; do yoga in your bedroom; find in-home, equipment-free alternatives. 

 

2. Avoid peak hours: If you do need to go to the gym, try to shift your workout schedule. Just as you should avoid peak hours on the subway, staggering workout times can help reduce risk of transmission. 

 

3. Avoid high-contact equipment: Also avoid gym equipment that requires long periods of handling, like weights, and opt for things that don’t, like treadmills. Disinfect the equipment before and after use, and don’t wipe the sweat from your face with your hands during your workout. 

 

4. Shower immediately after: A generally good rule regardless, but particularly important for disinfecting your body. You want to minimize the time you spend with potential contaminants on your clothes and skin.

What to do when you leave and come back home

 

1. Run errands together and during off-peak hours: Try to get as much done as possible in one fell swoop. You want to minimize the number of trips, then stay home for as long a period of time as you can. Also, try to avoid crowds by going to stores and public places early before work or late at night. In general, reduce the amount of time you spend in locations where you don’t know the level of infection. 

 

2. Don’t mix “outside” and “inside” clothes: Every time you get home, change your clothes—and shoes—and wash them as soon as possible. If you have the option, you can also leave coats and other hard-to-wash items outside to disinfect in the sunlight. This is especially true for people that are in areas of high risk. 

 

3. Create a dedicated reentry zone: That staging area for packages is good for humans too: in addition to changing clothes and taking off shoes, use this space to disinfect your phone and keys. Phones, in particular, can be hard to disinfect, so consider putting yours in a thin plastic bag when you leave home. Wipe it down with soap and water or alcohol once you take it back out.

4. Take a shower after every outing: Of course, jump in the shower right away if you can. Children especially have a tendency to touch their faces, so bathe them with soap and water. If you don’t have time, at a bare minimum wash your and their face and hands. 

What to do when you have kids

 

1. Don't exaggerate or panic: Explain coronavirus in an age-appropriate manner - but maintaining a sense of perspective becomes critically important. Don't freak out if your kid coughs or dwell for hours on coronavirus coverage. Your kids want to feel secure.

 

2. Demonstrate good habits: Teach kids how to cough and sneeze into the crook of their arm and thoroughly wash their face and hands while singing to make it a fun experience. 

 

3. Get creative if schools have closed: Kids are prone to quickly develop cabin fever and feelings of isolation. Use technology creatively: give them permission to FaceTime or play video games with friends. Online social activities can help maintain and foster friendships. You can also opt for no-tech solutions like board games and crafts with the family. 

Source: How to practice social distancing during the coronavirus pandemic

 

Here’s why controlling the spread of the disease is so important: 

 

 

  • What does that mean? By staying inside our homes, we’ll limit the probability of the disease spreading and as a result, decrease the risk of sudden surges in patient influx. 

 

  • Objective: Control the spread of the disease to avoid reaching the maximum healthcare system capacity. 

 

  • If the spread of the disease is not contained and Pakistan experiences a sudden explosion of illness -- people will die because there won’t be enough hospital beds or ventilators to keep them alive. The total number of cases confirmed in Pakistan is currently 31 (that’s 0.019% of total global cases confirmed). We can contain this. 

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Here’s how we’ll build greater awareness through data: 

The Johns Hopkins University Center for Systems Science and Engineering created a dashboard for tracking the COVID-19 pandemic.

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Note: Pakistan has 31 confirmed cases with 2 recovered 

The World Health Organization is also tracking the COVID-19 pandemic with its dashboard

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 South Korea has provided COVID-19 testing widely to their citizens, and a comprehensive dataset of COVID-19 cases in South Korea is available on Kaggle.​
 

Pakistan will build its data infrastructure that will a.) integrate with each local COVID-19 diagnostic lab and b.) connect to our national dashboard. The dashboard will be available to the public 24/7 and empower them to learn which Pakistani tehsil, sub-tehsil, and neighborhood has the highest volume of cases. This knowledge through data will inform and influence our movement and social distancing behavior.  

Building a stronger health-care system that can withstand a sudden and high influx of patients
 

Play the long-game: 

  • Capital allocation: At the moment, Pakistan has seven diagnostic labs that are capable of conducting 15,000 tests. While Pakistan has been keeping the virus at bay -- we’ll start injecting capital in the health-care system to increase capacity. Pakistan’s a country home to +200MM people and would need to have more than 7 diagnostic labs. 

    • Pakistan needs to innovate and partner with startups using Crispr-based Diagnostics that could deliver a diagnosis in less than two hours without any complex instrumentation. (Think paper swabs + paper strip, like a pregnancy test for coronavirus.) 

 

  • Disrupt ICUs:

  • Cost of ICUs:  In Pakistan, the conservative median cost per admission is ~PKR 300,000 and the mean cost per day was PKR 60,000. The pricing structure excludes a vast majority of the population which means that the lack of affordability risks the spread of the disease. 

  • Scale Shaukat Khanum’s model: 

    • Prime Minister Imran Khan’s Shaukat Khanum is a unique profitable cancer facility that provides treatment regardless of ability-to-pay and financially supports 75% of patients. 

 

  • Pakistan will scale SK’s business model and make ICU supportive care more affordable across every province, division, district, and tehsil of Pakistan in a very short period of time. 

 

  • Disrupt mechanical ventilators:  

  • In Pakistan, this machinery is already undersupplied and is imported at a high cost of ~PKR 3 million. 

     Source: Developing a Low-cost Ventilator for Ill-equipped Hospitals
 

  • In the US,  790,257 hospitalizations involving mechanical ventilation in 2005, representing 2.7 episodes of mechanical ventilation per 1000 population; estimated national costs were 27 billion representing 12% of all hospital costs. 

  • Source: mechanical ventilation in the intensive care unit 

  • Ventilators are expensive machines costing us lives. Not only do we need to manufacture them locally in Pakistan but we also need to completely re-design this machine to become simpler, less expensive and more reliable. It’s a disruption waiting to happen that’ll unlock tremendous market value.  

Developing the vaccine by collaborating with global partners

Vaccine development takes a long time because there are many steps in the process. Researchers must ensure the vaccine is safe and causes the correct immune response without causing other problems. There are many stages of tests both in the lab and then clinical trials that must be completed before wide-scale production can begin. In the past, this process has taken years, but it is estimated that a COVID-19 virus vaccine will be ready in 12 to 18 months.

 

Towards vaccine development - Pakistan needs to advance in synthetic biology and build open-source protein-design algorithms that build nanoparticles out of proteins and attach viral molecules in a repetitive array so that, when the whole thing is packed into a vaccine, it can make people resistant to the new coronavirus. Now is the time for Pakistan to reach out to global partners, in particular to Bill and Melinda Gates Foundation, and have local labs set up in Pakistan with world-class capabilities. 

Prioritizing health and safety over profit 

 

The health of employees and customers is more important than the short-term losses that businesses may have to incur. Workers in Pakistan will be encouraged to work from home. We will need to increase investment in more workplace communications software to deal with a sharp rise in remote work.  

 

Businesses can create positive externalities by sharing disinfectant wipes, gloves, masks, hand sanitizers with not only employees but also customers. Travel related companies can cancel reservations and provide refunds to customers to build good-will.

Supporting businesses to adapt to the crisis that’ll retain consumer confidence 

 

For society to function, we need businesses to operate and workers from all sectors to continue to execute. This is not a time to panic but a moment for every Pakistani business to responsibly play their part. 

 

It’s not business as usual and therefore, companies would need to institute rigorous cleaning & sanitation processes and practices that will ensure they’re containing the spread of the disease. This will build consumer confidence.  

 

Consumers are most likely to buy from businesses that are: 

  • Constantly cleaning surfaces

  • Providing wipes/hand sanitizers/masks 

  • Communicating their policy and initiatives to build a safe and healthy environment 

 

We’ll weather the storm and manage this crisis. During the partition and birth of Pakistan -- 15MM people were uprooted and 2MM died. The story of the millions of refugees who had to flee from their homes across our borders and seek asylum in Pakistan is well known to you all. 

 

During our first year of existence, it was prophesized that Pakistan would be left bankrupt but our first budget was a surplus one, there was a favorable balance of trade, and a steady and an all-around improvement in the economic field. 

 

We are a resilient nation - we will always face our challenges with courage, determination, and imagination. 

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Update July'2021

Pakistan scored top 3rd spot in the Economists normalcy index list that ranks countries that have implemented effective measures against the coronavirus and suffered relatively few deaths. Important for Citizens of Pakistan to continue to wear masks during the upcoming Eid and practice social distancing and other SOPs to prevent lockdowns. This will protect our nation and economy.

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