Dr Nisar warns catastrophe, stresses for strict lockdown in Kashmir

‘Virus takes dangerous turn due to possible mutation’

Fayaz Bukhari

SRINAGAR, July 13: Leading influenza expert and Associate Professor Medicine at Government Medical College Srinagar, Dr Nisar-ul-Hassan, today said that the Novel Coronavirus has taken a dangerous turn in Kashmir and warned of catastrophe if strict lockdown is not imposed across Kashmir to prevent spread of the virus.
Speaking exclusively to Excelsior, Dr Nisar said that for the last few weeks the COVID-19 has taken a dangerous turn in the Valley with hospitals reporting more sick patients and there has been spike in COVID-19 deaths.
“For the last few weeks large number of people are reporting to the SMHS hospital in Srinagar in severe condition with bilateral pneumonia. It is not only old but young and middle aged too are reporting. When I inquired about the other hospitals, there is a similar situation”, he said.
Dr Nisar who is also president of the Doctors Association Kashmir said that the trend is quite disturbing. “This is quite disturbing. The cases are rising and so are the COVID-19 deaths. There are many unreported deaths as well. The pregnant women and children have been least affected by the virus in other parts of the world but here even pregnant women are dying”, he added.
The influenza expert said that, of late, its behaviour towards children and pregnant women suggests that it has possibly changed its strain and is more virulent. “Most of the patients we are seeing are seriously ill. The virus needs immediate genetic testing to find out whether it has mutated or not”, he said.
The DAK president said that since its outbreak in Kashmir virus was behaving very mildly in comparison to other parts of the world and country. “90 percent of patients were asymptomatic or had mild disease. Only a few people with underlying medical conditions died here. Very few among those who had chronic illnesses, co-morbidity and weak immunity systems died. Basically they didn’t die of COVID-19 but other causes”, he said.
“Now for the last few weeks as a Consultant Medicine in SMHS hospital for many years, we are seeing a lot of people with large number of them with bilateral severe pneumonia. All needing oxygen and even ventilator support”, he said.
“Thursday night I was on call at SMHS. In my unit there were 40 admissions and among them 32 had bilateral pneumonia and many needed ventilation. It is more than 90 percent. It is horrific. If the patients increase, there will be no oxygen points, ICU beds and ventilators available”, he added.
Dr Nisar said that the immunity against COVID-19 infection is not long lasting and patients are at the risk of re-infection. “We hoped that people would get herd immunity but that didn’t happen. The antibodies developed in the majority of the COVID-19 positive patients is very less. The persons who develop antibodies are at the risk of re-infection and immunity against the virus does not last longer”, he said.
Another cause of the spike, Dr Nisar said, is easing of restrictions by the Government when Coronavirus cases and deaths were rising. “They eased it in one go, in a jiffy. You have a pandemic and you have a new virus. You don’t have a vaccine and the only tool is lockdown or restrictions or containment but you lifted it at the wrong time” he said.
“Initially we had miniscule death and cases were few and we didn’t allow travellers to return home. When cases started rising, the travellers were allowed. Unfortunately, it was a wrong time and they should have been brought at an earlier stage. They got all travellers all of sudden. They got the virus along. Till then we were fine but when they came cases increased”, he said.
The influenza expert said that surge in positive cases is due to travellers and spike in deaths is due to possible mutation.
The easing of restrictions or imposing restrictions should be purely based on behaviour of the virus here. “We should not copy others. We should purely do it based on how the virus is behaving in your society. Virus was mild here and in Europe its behaviour was aggressive. It behaves differently in different places and response should not be copy paste”, he said.
Dr Nisar said that the easing of the restrictions by administration was not scientific.  ”The easing should have been done keeping in view of local conditions. Here the policy makers and experts should have come and discussed before taking any decision. They eased restrictions when cases were rising. The decision should have been taken based on our own assessment”, he said.
The removal of restrictions was done when study showed very less Kashmiris have immunity. “ICMR study was carried here with Pulwama as a case study. It shows that only 2 percent of people are immune and 98 are vulnerable. It is catastrophic. Huge lot of people are vulnerable and can get infected in a jiffy”, he said.
Dr Nisar said that there is no other choice but to impose strict lockdown to arrest the trend and prevent deaths. “This is the only way out. But this period should be utilized to make people aware about the unpredictability of virus”, he said.
The influenza expert said that Coronavirus has to be tackled in Kashmir before winter as other winter flu viruses can complicate the situation. “We are still in the first wave and we are yet to achieve peak, then there will be flattening of the cure and then decline. These few months are very crucial. If it goes to winter where we have the flu virus, then there will be mixtures of virus and it will be very difficult to handle”, he said.
He said that Kashmir should be prepared for a dangerous second wave. “We should not go in patches. We should go for strict lockdown in the entire Valley. And let us hope that its potency may go. There may be a resurgence and we should be prepared for the second wave. Second wave will be more dangerous as is the past practice of viruses”, he said.
“I can understand there are issues with lockdown as people get exhausted and they want to resume economic activities. But I don’t think the economy should get precedence over life”, he said.
Dr Nisar said that people are being blamed for the spread of Coronavirus by not following guidelines of social distancing, wearing masks and maintaining hygiene which is wrong.
“It is the Government which initially created so much fear that a son did not bury his father or mother. Government resorted to mixed messaging as everybody was allowed to give messages on Coronavirus. It was not left experts and even some doctors who were advising were not having knowledge of the subject”, he said.
He blamed administration for lack of creating proper awareness among people. “Those guidelines which are for West or other countries or other States in the country may not be applicable here. There was mixed messaging, chaos and confusion. People were not made aware properly. I don’t entirely blame people for not following the guidelines”, he said.
“Only experts can tell how a virus behaves. There is a difference between creating fear and awareness. It should be left to experts to frame the guidelines. What for they are? When people are not made aware properly, then comes mistrust”, he said.
Dr Nisar said that every hospital has to be prepared for the coronavirus surge and complicated cases. “We need to enhance ventilator support and oxygen beds. We need to increase capacity of ventilators, and ICUs”, he said.
The influenza expert said that doctors should also be trained as those patients with respiratory illness can’t be the only COVID patients but those with strokes, heart attacks, hematology issues could also be COVID-19 patients. “Doctors need to be sanitized for this”, he said.
He said that the plasma therapy has been started but it is not in an organized manner. “Bank should be created where it is safe to donate plasma. There is no awareness among COVID-19 recovered patients and they have not also been tested for antibodies”, he added.
Dr Nisar said that clinical trials about treatment modalities have to be conducted and they can’t be copied from other places.