Can Pakistan Effectively Respond to Coronavirus Pandemic?

Pakistani public health system's ability to deal with Covid19 pandemic is increasingly being questioned with the number of confirmed coronavirus cases spiking in the country. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan. Hydroxycholroquine (HCQ), made by Getz Pakistan, is also reportedly effective in treating Covid19.

Coronavirus Global Pandemic

Is Pakistan Ready?

Pakistan is among only 6 countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The 6 countries named in the report are: Eritrea, Finland, Pakistan, Saudi Arabia, Tanzania and the United States.

Covid19 Coronavirus. Source: US CDC

Pakistan's ability to deal with a pandemic is now being tested by the coronavirus. The current hotspot for it is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes.

Pakistan is ramping up coronavirus testing and setting up isolation wards at many hospitals in Sindh and across the country. More testing accounts for the spike in confirmed cases. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.

In response to a recent request by Pakistan's Express Tribune newspaper staff, World Health Organization Executive Director Dr. Michael J. Ryan said Pakistan has great capacity in public health but he also talked of challenges posed by the Coronavirus pandemic. “Pakistan has a highly mobile population with mega cities and undeserved people,” he said.  “So there is a great challenge facing Pakistan. But Pakistan has also demonstrated time and again with dengue, polio and other diseases how all of the government and society’s approaches can be made to work.”

Dr. Palitha Gunarathna Mahipala, World Health Organization (WHO) representative in Pakistan, also lauded Pakistan's response to Covid19 pandemic, according to The News. He said,  “Pakistan has timely come up with one of the world’s best National Response Program against COVID-19 and it is being implemented very effectively. Authorities are doing their job and now it is the responsibility of the people to follow the instructions and take preventive and precautionary measures to avoid contracting the viral disease.”

The World Bank report titled "From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level" was written by experts from the World Bank,  the World Health Organization, the International Monetary Fund, the African and Asian development banks, and finance officials from various governments. The report included estimates of the economic damage various epidemics had done. For example, the viral pneumonia SARS — which ultimately killed only 774 people — shrank China’s gross domestic product by 0.5 percent in 2003. The report also broke down costs on a per capita basis. A major flu pandemic, for example, would cost Afghanistan only $12 per citizen, India $31, Pakistan $28 and the United States $248.

Social Distancing:


The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.

Italian experience with coronavirus has shown that even a well-developed public health system in a rich European country can be overwhelmed by rapidly growing pandemic such as Covid19.  The best way to handle the situation is to cut the infection rate by keeping people about 6 feet apart. This is being called "social distancing".

Social Distancing to Limit Infection Rates 

Based on what the United States has learned from what is happening in Italy, major cities and states in America are taking steps to reduce large gatherings of people. Offices, schools, restaurants and shopping centers are closed with shelter-in-place orders in Silicon Valley and the larger 6-county San Francisco Bay Area.

Herd Immunity:

Herd immunity develops when a large percentage of population is infected or vaccinated. Dr. Arindam Basu, Associate Professor of Epidemiology and Environmental Health at University of Canterbury, has recently written an article in The Conversation arguing that it is "unethical and potentially dangerous" to wait for herd immunity to develop in the absence of a vaccine.  It could result in hundreds of thousands or even millions of deaths among the most vulnerable segments of the population such as the elderly and the immune-compromised.

Pakistan's Assistance to China:

Chinese President Xi Jinping has thanked Pakistan for its support during coronabirus outbreak in his country. "China is deeply grateful for Pakistan's support. Facts have proved once again that China and Pakistan are true friends who share weal and woe and good brothers who share each other's joys and sorrows. The special friendship is a historical choice, and is deeply rooted in the hearts of the two peoples," said Xi.

Resochin (Chloroquine) Produced by Bayer Pakistan 

At the peak of the outbreak in February, Bayer Pakistan exported to China 300,000 tablets of Resochin (Chloroquine) that proved effective in treating coronavirus infections and saving lives in Wuhan. Resochin is an antiviral drug used for treating malaria. Chloroquine is manufactured by not just Bayer but several other drug companies as well.  China and many other countries discontinued its production years ago.   Several Pakistani pharmaceutical companies also manufacture HydroxyChloroquine which has lower toxicity and fewer side effects. The United Kingdom has banned hoarding and export of both of these drugs. In addition, Pakistan donated 7,000 surgical masks to China at the peak of the coronavirus outbreak.  A recent paper titled "An Effective Treatment for Coronavirus (COVID-19)"  by James M. Todaro, MD and and Gregory J. Rigano, Esq. has published data showing the efficacy of familiar anti-malaria drugs Chloroquine and Hydroxychloroquine for treatment of and as prophylactic against COVID-19.

In Vitro Efficacy of Chloroquine(CQ) vs Hydroxychloroquine (HCQ) Ag...

Recently, Chinese research (reported in Clinical Trials Arena) reported that “data from the drug’s [chloroquine] studies showed ‘certain curative effect’ with ‘fairly good efficacy’ … patients treated with chloroquine demonstrated a better drop in fever, improvement of lung CT images, and required a shorter time to recover compared to parallel groups. The percentage of patients with negative viral nucleic acid tests was also higher with the anti-malarial drug… Chloroquine has so far shown no obvious serious adverse reactions in more than 100 participants in the trials… Chloroquine was selected after several screening rounds of thousands of existing drugs. Chloroquine is undergoing further trials in more than ten hospitals in Beijing, Guangdong province and Hunnan province.”

A small French study found only 25% of COVID19 patients who took it for 6 days still had the virus while 90% of those who had not taken it still had Covid-19.

HCQ (Hydroxychloroquine) Manufactured by Getz Pakistan

Economic Impact of Coronavirus Pandemic:

Service sector accounts for  50% of the world GDP and 54% of Pakistan's GDP.  Social distancing will significantly impact the services, particularly retail, restaurants, travel, transport and education sectors. Imran Khan has expressed fear that the pandemic will devastate the economies of developing countries.

“My worry is poverty and hunger," Khan said. "The world community has to think of some sort of a debt write-off for countries like us, which are very vulnerable, at least that will help us in coping with (the coronavirus).”

Summary:

Pakistan is among only six countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.  The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.  Dr. Michael Ryan and Dr. Palitha Gunarathna Mahipala of the World Health Organization (WHO) have talked of challenges Pakistan faces but also praised the steps it has taken to fight coronavirus pandemic.

Here's the latest Coronavirus Pandemic Update:

https://youtu.be/vE4_LsftNKM

Related Links:

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Comment by Riaz Haq on April 11, 2020 at 8:14am

#Pakistani fashion designer Muhammad Asim Jofa is currently making full-body suits to be used as personal protective equipment (#PPE) by #healthcare professionals. #COVIDー19 #Coronavirus https://www.usatoday.com/videos/news/nation/2020/04/06/pakistan-bas...

blob:https://www.usatoday.com/5f9e8270-0014-4d62-99df-c8c84ee44cad

Comment by Riaz Haq on April 11, 2020 at 4:29pm

#Pakistan bans #export of anti-malaria drugs. International demand for #chloroquine and #hydroxychloroquine has jumped in the last fortnight. Both have been identified by the #US #FDA as possible treatments for #coronavirus. #COVID19 https://economictimes.indiatimes.com/news/international/world-news/...

Islamabad: Pakistan has banned the export of anti-malaria drugs after several countries, including the US, started using the medicines to treat coronavirus patients, according to a media report.

The ban, which has been imposed with immediate effect, will remain till the National Coordination Committee (NCC) on COVID-19 deems necessary, according to a notification released by the Commerce Ministry on Friday amidst a spike  ..

Comment by Riaz Haq on April 11, 2020 at 6:59pm

Crises, #technology and social protection. #Pakistan's National Database & Registration Authority NADRA with its database of 122 million citizens plays a pivotal role in dealing with disasters such as #coronavirus. #EhsaasEmergencyCash #COVID19 #Ehsaas https://www.dawn.com/news/1548208

NATURAL disasters or crises expose state fragility, but also present a valuable opportunity for change. They are creative moments to transform governance through testing innovative technical solutions. Today’s ‘Ehsaas’ programme is built on the platform of the Benazir Income Support Programme (BISP), which was established in 2008 but went through a learning curve by incorporating the lessons learnt in the IDP crisis in 2009 and flash floods in 2010. If handled well, Covid-19 could allow us to radically transform and upgrade our social protection regime.

The National Database and Registration Authority (Nadra) can play a pivotal role in any such transformation as it has been dealing with disasters in the past. It houses the real and unique sets of biometric as well as biographical data of its 122 million citizens.

Nadra’s inclusive and robust database had proven time and again that it can increase access to critical services and benefits. The authority has been in the technology frontline in all disasters. Identity authentication and credential verification of the victims of disaster, performed by Nadra, are the key steps for any kind of relief or benefit in kind or cash transfer.

The massive flash floods in 2010 affected about 20 million people across the country. There was already a trust deficit between the donors and the previous government, triggered by mismanagement of donor funds for the 2005 earthquake.

Despite bureaucratic resistance, Nadra’s technical team used this moment to pioneer an ID-based solution that devised a secure and accurate way of identifying the affected population and ensuring transparent disbursements. Using the citizens’ database, Nadra teamed up with commercial banks to issue an ATM card, known as the ‘Watan Card’. The cash that was uploaded on these cards could be drawn by the targeted beneficiaries without any hassle.

Previously, a similar solution was rolled out to people internally displaced by the Army operation against terrorists in Swat and Malakand in 2009. This experience strengthened Nadra’s response in the wake of floods because, by this time, we had learnt to implement more stringent validation checks for ensuring the eligibility of targeted beneficiaries.

With the support of World Bank and other donors, an amount of Rs77 billion was distributed among 2.84 million families, an average of over Rs27,000 per family.

Eligible families were given ATM cards loaded with cash that were activated upon registration. The money spent by these families supported the local economy. The benefits even spread to neighbouring districts not directly affected.

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Eligible BISP beneficiaries are identified through proxy means testing. Households receiving a score of 16 and below are deemed eligible for the BISP or Ehsaas cash transfer. The same platform can be used to devise a social protection scheme for daily wagers.

The data can be refined further by reconciling it with data analytics from Nadra’s citizen database. The database contains a dedicated field that classifies the profession of ID card holders, which can be used to identify, to the best approximation, the segment of daily wagers. Complimentary databases from the Pakistan Bureau of Statistics, the State Bank and FBR could also be used to define a precise categorisation.

Once such a database has been developed, it can be used to roll out different schemes in future, such as vocational training, health insurance, and the like. In short, while Covid-19 has exposed our unpreparedness for dealing with a health calamity, we have at hand a valuable opportunity to develop a state-of-the-art platform for social service delivery to the most vulnerable and shock-prone segments of our society.

Comment by Riaz Haq on April 12, 2020 at 7:39am

#Coronavirus Fans #Islamophobia in #India after health ministry repeatedly blamed #Tablighis for spreading #COVID19 — and ruling #BJP officials spoke of “human bombs” and “corona jihad” — a spree of anti-#Muslim attacks has broken out across the country. https://nyti.ms/2VjtOu8

Here in India, no other group has been demonized more than the country’s 200 million Muslims, minorities in a Hindu-dominated land of 1.3 billion people.

From the crackdown on Kashmir, a Muslim majority area, to a new citizenship law that blatantly discriminates against Muslims, this past year has been one low point after another for Indian Muslims living under an increasingly bold Hindu nationalist government led by Prime Minister Narendra Modi and propelled by majoritarian policies.

In this case, what’s making things worse is that there’s an element of truth behind the government’s claims. A single Muslim religious movement has been identified as being responsible for a large share of India’s 8,000-plus coronavirus cases. Indian officials estimated last week that more than a third of the country’s cases were connected to the group, Tablighi Jamaat, which held a huge gathering of preachers in India in March. Similar meetings in Malaysia and Pakistan also led to outbreaks.

“The government was compelled to call out this congregation,” said Vikas Swarup, a senior official at India’s foreign ministry.

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The virus and the new wave of hatred have changed everything. Mohammed Haider, who runs a milk stall, one of the few businesses allowed to stay open under India’s coronavirus lockdown, said, “Fear is staring at us, from everywhere.’’

“People need only a small reason to beat us or to lynch us,’’ he said. “Because of corona.’’

Muslim leaders are afraid. They see the intensifying attacks against Muslims and remember what happened in February, when Hindu mobs rampaged in a working-class neighborhood in Delhi, killing dozens, and the police mostly stood aside — or sometimes even helped the Hindu mobs. In many villages now, Muslim traders are barred from entering simply because of their faith.

“The government should not have played the blame game,” said Khalid Rasheed, the chairman of Islamic Center of India. “If you present the cases based on somebody’s religion in your media briefings,’’ he said, “it creates a big divide.”

“Coronavirus may die,” he added, “but the virus of communal disharmony will be hard to kill when this is over.”

Tahir Iqbal, a recent university graduate from Kashmir, was among the 4,000 or so gathered at the Tablighi Jamaat headquarters in early March for missionary training. He said people slept, ate and prayed in close quarters, with little fear of the coronavirus. “We didn’t take it seriously at the time,” he said.

On March 16, the Delhi government banned gatherings of more than 50 people. Several days later, Mr. Modi announced a nationwide lockdown.

But instead of dispersing, more than 1,000 people stayed put at the center. During a March 19 sermon, Maulana Saad Kandhalvi, a Tablighi Jamaat leader, told followers that coronavirus was “God’s punishment’’ and not to fear it.

About a week later, health inspectors found around 1,300 people still sheltering at the center without masks or other protective gear. Many Muslim leaders criticized the group’s center for not closing down.

But by that point, hundreds of congregants had already left. They wended their way across India by car, bus, train and plane, spreading the coronavirus to more than half of India’s states, from beach towns in the Andaman Islands to the hot, farming cities in the country’s northern plains.

On March 31, the Delhi authorities filed a criminal case against Maulana Kandhalvi for “deliberately, willfully, negligently and malignantly” putting the public’s health at risk. Tablighi Jamaat’s center was sealed. The maulana, a title for a Muslim scholar, disappeared.

Comment by Riaz Haq on April 12, 2020 at 3:57pm

The number of confirmed COVID-19 cases in Pakistan has risen to 5,038 as of 10 April. Increase of 250 new cases in the last 24 hours.
The most affected province due to COVID-19 virus is Punjab 2,425, followed by Sindh 1,318.
The National Disaster Management Authority is dispatching additional Personal Protection Equipment for doctors and health workers of 202 hospitals of Sindh.

https://reliefweb.int/report/pakistan/pakistan-covid-19-situation-u...

More than 1.5 million families will get severely affected if the lockdown continues for two months in Balochistan.
The public sector hospitals of the Islamabad city are again considering extending the closure of Outdoor Patient Departments for one month due to possible high risk of novel coronavirus spread from the facilities, The Nation learnt on Saturday.
The district administration of Rawalpindi has established a 120-bed quarantine facility at Shahbaz Sharif Sports Complex located on Sixth Road.
Minister for Aviation Ghulam Sarwar Khan on Saturday said the government would bring back 4,000 Pakistanis stranded across the world following Covid-19outbreak through special flights.
Chairman National Disaster Management Authority (NDMA) Lieutenant General Muhammad Afzal said Pakistan has the testing facility available for 75-days to diagnose Coronavirus or COVID-19 pandemic disease.
Prime Minister Imran Khan on Saturday said the incentives announced by the central bank for the business community would prevent massive unemployment in the county because of the economic downturn caused by the coronavirus pandemic as the health minister warned against easing restrictions at the current stage of the outbreak.

Comment by Riaz Haq on April 13, 2020 at 12:58pm

Is #India #coronavirus #lockdown working? The need to leave one’s home to go to the #bathroom and collect #water at crowded communal taps hamper #SocialDistancing. #Modi #BJP #poverty #hygiene #sanitation - The Washington Post

https://www.washingtonpost.com/politics/2020/04/13/millions-people-...

India’s lockdown to slow the spread of the coronavirus is laying bare immense social inequalities in the country’s sprawling cities. The plight of migrant laborers has been especially alarming. Following Prime Minister Narendra Modi’s sudden announcement of a 21-day lockdown on March 24, migrant laborers have scrambled to return to their villages of origin in search of food and shelter, in many cases on foot.

Residents of India’s urban slums represent another population whose vulnerabilities have intensified during the lockdown. According to India’s 2011 census, 65 million people, or 17 percent of the country’s urban population, live in slum settlements. Broadly, these are low-income neighborhoods, with dense and unplanned housing, often weak or absent formal property rights, and marginalized access to basic public services, including public health systems. Most residents work in a vast, largely unregulated informal economy and depend on daily wages to support their families.

How India plans to put 1.3 billion people on a coronavirus lockdown

What does social distancing — and the suspension of movement — mean for residents of India’s slum settlements? Here are some of the central challenges facing this segment of India’s population.


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India’s slum settlements are highly congested spaces, leaving little or no room among neighbors. Take, for example, Kathputli Nagar, a settlement in central Jaipur. About 4,000 people live in Kathputli Nagar, on a small, 28,000-square-meter plot of land. One- and two-room jhuggies (shanties) are tightly packed and linked by narrow alleyways that allow just a few people to stand shoulder to shoulder.

Slum settlements often house residents who have migrated from various states in India. The community leader in Jaipur, Rajasthan quoted above pointed out that his settlement has about 5,000 residents, most of whom have migrated from villages in Bihar and Uttar Pradesh. He noted that many returned to their villages after the announcement of the lockdown, joining other vulnerable migrants in India who have struggled to return to their villages of origin in the past few weeks.

Comment by Riaz Haq on April 13, 2020 at 6:55pm

#Pakistan awaits clinical trials for #COVID19 treatment. #Scientists at #Karachi’s Dow University of Health Sciences say they have prepared potential treatment with plasma obtained from recovered patients of #coronavirus

https://www.aa.com.tr/en/asia-pacific/pakistan-awaits-clinical-tria...

Pakistani scientists are awaiting approval to start clinical trials for a treatment they claim can cure coronavirus.

A research team from Dow University of Medical Sciences, the country’s leading health institution, has devised intravenous immunoglobulin (IVIG) with plasma obtained from the blood of patients recovered from coronavirus, according to a statement.

The plasma teeming with anti-bodies was donated by patients after recovering from the illness.

Lab tests and animal trials were successful. The next step is to initiate clinical trials.

"This is a very important breakthrough in the war against COVID-19," professor Shaukat Ali, the head of the research team, told Anadolu Agency.

This way of treatment is safe, low risk and highly effective against coronavirus, Ali said.

He urged recovered coronavirus patients to donate blood as their plasma is the vital "raw material" for this treatment.

So far, over 1,000 coronavirus patients have recovered out of more than 5,000 reported cases in the country.

This method is also a type of passive immunization, he added.

Many countries across the world including Turkey, France and the U.S. are holding clinical trials for plasma therapy or transfusion to fight the novel virus.

However, the Pakistani doctor said, the treatment they have devised is safer and more effective than plasma transfusion as it does not carry the undesired component of blood like plasma proteins, potential bacterial and viral pathogens.

These treatments have globally been effectively used to curb other viral epidemics like MERS, SARS and Ebola, he said.

Scientists world over are grappling to find a cure for COVID-19 which has claimed over 114,000 lives globally after it appeared China last December.

More than 1.85 million people have been infected worldwide, while an upward of 434,000 have made a recovery, according to U.S.-based John Hopkins University.

Comment by Riaz Haq on April 13, 2020 at 6:57pm
Comment by Riaz Haq on April 14, 2020 at 10:52am

The #coronavirus is empowering Islamophobes — but exposing the idiocy of Islamophobia. #Hindutva claim the pandemic is a conspiracy by #Muslims to infect and poison #Hindus. https://interc.pt/2VnVGgM by @mehdirhasan

IF ANTI-SEMITISM is the world’s oldest hatred, perhaps Islamophobia is the world’s weirdest.
How else to explain the fact that a pandemic of global and historic proportions, a novel coronavirus that is infecting people in almost every country and territory on Earth, has been weaponized by the far right to attack … Islam and Muslims?

Take India, where the spread of the virus has been dubbed a “corona jihad” by supporters of the far-right BJP government; they claim the pandemic is a conspiracy by Muslims to infect and poison Hindus. The government itself has blamed around a third of India’s confirmed Covid-19 cases on a gathering held in Delhi by a conservative Muslim missionary group called the Tablighi Jamaat; one BJP minister called it a “Talibani crime.” As The Guardian reports, “Muslims have now seen their businesses across India boycotted, volunteers distributing rations called ‘coronavirus terrorists’, and others accused of spitting in food and infecting water supplies with the virus. Posters have appeared barring Muslims from entering certain neighbourhoods in states as far apart as Delhi, Karnataka, Telangana and Madhya Pradesh.” There have even been reports of Indian Muslims being attacked, beaten, and lynched.

Did members of the Tablighi Jamaat behave recklessly? Yes. Do all of India’s 200 million Muslims bear responsibility for their behavior? No. “Virtually overnight,” wrote investigative journalist Rana Ayyub in the Washington Post, “Muslims became the sole culprits responsible for the spread of the coronavirus in India.”

But it isn’t just Hindu nationalist politicians or mobs. The country’s respectable press have joined in too. The left-leaning newspaper The Hindu published a cartoon showing the world being held hostage by the coronavirus — with the virus itself depicted wearing clothing associated with Muslims. (The paper later apologized for its “completely unintentional” decision to link the crisis to Muslim terrorists, and replaced it with a more neutral image.)

Comment by Riaz Haq on April 14, 2020 at 7:47pm

BBC News - #Coronavirus: The children struggling to survive #India's #lockdown. Tens of thousands are calling helplines daily while thousands are going to bed hungry as the country shuts down to battle the pandemic. #Modi #BJP #poverty #hunger https://www.bbc.com/news/world-asia-india-52210888

The sudden imposition of a 21-day lockdown in India to stop the spread of the coronavirus has thrown the lives of millions of children into chaos.

Tens of thousands are calling helplines daily while thousands are going to bed hungry as the country shuts down to battle the pandemic.

With 472 million children, India has the largest child population in the world and campaigners say the lockdown has impacted around 40 million children from poor families.

These include those working in farms and fields in rural areas, as well as children who work as ragpickers in cities or sell balloons, pens and other knick-knacks at traffic lights.

Sanjay Gupta, director of Chetna, a Delhi-based charity that works with child labourers and street children, says the worst affected are the millions of homeless children who live in cities - on streets, under flyovers, or in narrow lanes and bylanes.

"During the lockdown everyone has been told to stay home. But what about the street children? Where do they go?" he asks.

According to one estimate, Delhi has more than 70,000 street children. But Mr Gupta says that number is really much higher.

And these children, he says, are usually very independent.

"They look for their own means of survival. This is the first time they need assistance.

"But they are not in the system and they are not easy to reach out to, especially in the present circumstances. Our charity workers cannot move around unless they have curfew passes," he says.

And passes are hard to obtain, because charities like Chetna are not considered essential services.

So, Mr Gupta says, they have been using innovative ways to keep in touch with the children.

"Many of these children have mobile phones, and because they generally stay in groups, we send them messages or TikTok videos about how to keep safe and what precautions they must take."

In return, he's also been receiving video messages from the children, some of which he's forwarded to me. They give a sense of the dread and uncertainty that has taken hold of their lives.

There are testimonies from worried children talking about their parents losing their jobs, wondering how they will pay the rent now or where would they find the money to buy rations?

Then, there are videos from children who have to fend for themselves.

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