Note: Since this story was reported, two more persons were detected positive for COVID-19 in Kashmir. More details here.
In Srinagar, gardens and joggers’ park are empty; cafes and restaurants are shuttered; all educational institutes are closed; business units shut; and the population is panicked after it had its first positive case of the novel coronavirus last week.
Bandipora district in the north was shut too. So was Pulwama in the south. The Srinagar administration has invoked Disaster Management Act 2005 and imposed section 144 in the city, which disallows the assembly of more than five men, to avoid the spread of the virus.
The novel coronavirus, SARS-CoV-2, i.e. severe acute respiratory syndrome coronavirus 2, has infected more than 3,00,000 people in 183 countries. While about 80,000 have recovered – more than 13,000 have died. As China claims to have been recovering from the epidemic, central Europe has become the continental epicenter of the pandemic. In Iran, the epicenter in middle-east, one person is dying in every ten minutes due to COVID-19 – the disease caused by the novel virus.
The photographs from across the globe show empty public squares as the governments ask people for social distancing and self-isolation. Kashmir has become one of the initial regions in the country to observe a lockdown to prevent the spread of the virus – but the scene is entirely different at Srinagar International Airport.
“We might get infected in quarantine”
The official statements claim that the airport is suited-up to tackle the inflow of the patients with four designated desks to fill-up self-declaration form and proceed for a thermal screening test – leading to an exit door. Easy and smooth. But for Asrar Khan, a 20-year-old studying in the United Kingdom whose name has been changed, the experience was: “ill-management, humiliation, and betrayal.”
Before landing in Srinagar on 19 March, Mr. Khan was screened at airports in the UK and New Delhi. “But here the experience was different,” he says. “After clearing the [thermal] screening, we were stopped inside the airport and our parents waited for us outside.”
Mr. Khan wasn’t alone; there were about a hundred more students, who flew in from Ladakh and Bangladesh, and a few more from the US, France, and elsewhere. “We all, about 300, were made to wait together at the arrival gate with foreign tourists,” he says. “If they had to prevent the spread of the virus, why did they keep us together?”
They have to be kept separate – that’s what quarantine is about. They are asymptomatic but we are keeping them away from society and family for everyone’s wellness.
The uncertain nature and authorities’ indecisiveness led to a ruckus outside the airport and the government forces ended up baton-charging the parents to clear the area.
A few days, on 16 March, Kashmir’s Patient One also arrived at the airport with seventy-eight Umrah pilgrims – but cleared the screening and went home.
Later, stationed doctors and forces’ personnel told Mr. Khan’s group that the quarantine for anyone with a travel history of a foreign country has to be kept under essential quarantine for fourteen days. “They asked us to cooperate and promised better accommodation,” says Mr. Khan. “For the greater good, we agreed.”
The official handle of Srinagar District administration tweeted that the citizens arrived at Srinagar airport from Bangladesh and other countries have been isolated to undergo quarantine as a preventive measure. “It’s notable that 50 well-equipped quarantine facilities have been set up in the district,” it read.
At about 5 pm, Mr. Khan with a small group of students was made to board a van, which drove him to Haj House, Srinagar. Inside the Haj House, his fears became a reality: “there was no hygiene. It looked like the building was shut since 2014 floods. And there were ten to fifteen students in a room. Shared washrooms had no flush working. Water in taps was stinking and black.”
The initial lag in the proper measures taken can have severe spillover impact down the line. Dr. SM Qadri, nodal officer for coronavirus in Kashmir, agrees that it is problematic. “They have to be kept separate – that’s what quarantine is about,” he says, adding that all these decisions lie with the civil administration. “They are asymptomatic but we are keeping them away from society and family for everyone’s wellness.”
We don’t have mask and sanitizers here. If not quarantined, we might get infected here.
Dr. Qadri added that medical teams are deputed at these quarantine facilities. But Mr. Khan rebutted the claim. Moreover, he is afraid that the unhygienic conditions in the facility and forced-mingling with other students from travel history to affected countries put him at risk of getting infected.
“We don’t have mask and sanitizers here,” he says, “if not quarantined, we might get infected here.”
On the night of 21 March, Mr. Khan and other students were shifted to different hotels in Rajbagh, Srinagar.
The World Health Organisation (WHO) guidelines advise to quarantine suspects in single rooms. However, it permits multiple beds in isolation wards – given they are kept at least a meter away, with no contact; these students are kept in shared rooms and forced to sleep under a shared quilt.
Mayor of Srinagar, Junaid Mattu, also tweeted: “STOP this UTTER MADNESS please! WHY are we putting these kids in these shabby, unkempt and shoddy “quarantine” centers when they have to be HOME QUARANTINED as per EVERY single guideline INCLUDING those by WHO and Union Govt?”
A number of doctors also tweeted on similar lines, suggesting that the students, as per the guidelines, need not be shifted to a quarantine facility but to self-isolation in home-quarantine.
That’s not it. Another cause of frustration among these students and travelers is the alleged VIP-treatment to a few commuters by the airport authority. A recent report claimed that Patient One also escaped the essential quarantine and exited from VIP-gate at the airport when an influential relative of hers intervened. Mr. Khan and other students The Kashmir Walla spoke to shared first-hand accounts of similar incidents.
But the administration is also facing an issue – travelers are lying, and hiding, about their travel history. “One of my friends – I won’t name him – lied about his travel history and left the airport,” recalls Mr. Khan.
Srinagar District Development Commissioner, Shahid Choudhary, called such actions “unfortunate” on his Twitter account. He wrote that “anyone hiding travel history/avoiding screening/facilitating exits could be guilty of culpable homicide.”
Short on resources “but using them optimally” – is that enough?
What happens when anyone, who has been tested positive for COVID-19, gets critical? As per doctors fighting against the pandemic on frontlines, the last stage is acute respiratory distress syndrome; it is caused by widespread inflammation in the lungs that stops the body getting enough oxygen it needs to survive. Data shows that only 6 per cent of the positive cases reach the critical range – 3.1 per cent of total identified positive cases die due to multiple organ failure.
In Kashmir Valley, for a population of about 7 million, there are less than a hundred ventilators, with thirty in Sher-e-Kashmir Institute of Medical Science (SKIMS).
We are trying to use the available resources optimally.
The doctors in the Valley are vigilant, although not unnerved as they say the dangerous part, i.e. community transmission phase is not here yet. In community transmission, the number of infected people rises dramatically (as seen in Italy and the US). However, critics, including health experts, counter that India is not conducting enough tests.
Currently, there are only two functional testing labs in the Valley – SKIMS and GMC in Srinagar. The SKIMS has conducted about sixty-three tests by 20 March and, Dr. Jan says, is left with about a hundred more.
3611 travelers and people are kept under surveillance in the Valley, says Dr. Qadri, while samples of 213 persons have been collected so far.
Twitter feed of Srinagar’s Mayor is flooded with pictures of Srinagar Municipal Corporation (SMC) workers sterilizing and fumigating the city’s landmarks and lanes. The social media spaces have been hailing these workers and doctors as heroes. However, the heroes in white-coats are complaining of being ill-equipped.
In a letter to the principle of Government Medical College (GMC), Srinagar, Dr. Samia Rashid, Resident Doctor’s Association highlighted the grossly inadequate quantity of Personal Protection Equipment (PPE) and masks for the number of residents working here: “…dire dearth of personal protection equipment for all doctors working in the hospital.”
Dr. Qadri, the nodal officer, says, “The supplies are short, of course. They are nationally short. And there are limitations but doctors are being provided with triple-layer masks.”
However, Dr. Rashid, Principal of the GMC, tweeted on 21 March that the hospital is equipped with more than 13,000 N95 masks, 3,300 PPE kits, and 22,000 triple layered masks. Later, following a meeting with Minister of State, Jitendra Singh, the hospital received 1,00,000 triple-layer masks.
Dr. Farooq Jan, Medical Superintendent at SKIMS, says, “We are trying to use the available resources optimally.” At the hospital, Dr. Jan says, they have created levels like COVID-ward, emergency ward, and others and are using the equipment accordingly.
The letter adds that research indicates that about eighty per cent of persons infected with the novel coronavirus are asymptomatic and undetectable – but are capable of transmitting the infection to others. This makes any suspected patient a threat to the health officials – if they do not have proper protective gear.
It further highlights the fatal face the delay and lags can take – wherein whole “department or even entire hospital staff [can end up] being infected and quarantined”.
The statistics of the healthcare department in Kashmir, and the country as a whole, are alarming. If – if – the outbreak happens in the Valley, the public health system will struggle to cope up with a dramatic rise in the inflow of patients. And one thing to learn from the COVID-19’s spillover in abroad is how the extra burden on the public health care can result in losses of life that could be saved. Kashmir is still in the phase of containing the virus – so, stay home and stay safe.
Yashraj Sharma is an assistant editor and features writer at The Kashmir Walla.
The story also appeared in our 23 – 29 March 2020 print edition.