The coronavirus is spreading in Pakistan at one of the fastest rates in the world, and its overwhelmed hospitals are turning away patients. But the government is pushing ahead with opening up the country, trying to salvage a near-collapsed economy where millions have already slid into poverty from pandemic restrictions.
Further complicating the dilemma, many people are ignoring government calls to wear masks or obey social distancing rules.
Millions crowd markets and mosques. Hard-line clerics tell followers to trust that faith will protect them. Many call the virus a hoax. Even some government officials dismiss warnings, saying traffic accidents kill more people.
"I am nervous when I go out because I see our people are still not taking it seriously," said Diya Rahman, a broadcaster at Radio Pakistan in the capital, Islamabad. Two of her colleagues have died of the virus and more than 20 others have tested positive.
She fears that "until they see their families are dying they won't understand that we can save ourselves if we adhere to the guidelines, to wear masks."
Pakistan is a prime example of fragile developing countries that say they'll just have to live with rising infections and deaths because their economies cannot withstand an open-ended strict lockdown.
But the rapid acceleration in infections in Pakistan this month could be an indicator of what other countries in Asia, Africa and Latin America might face.
New cases in Pakistan leaped from around 2,000-3,000 a day in late May to up to 6,800 a day in mid-June. Deaths are nearing 150 a day. So far, more than 180,000 people have been infected in the country of 220 million, and the government said Sunday the number could reach 1.2 million people in August. Authorities have reported 3,590 deaths.
Infections have soared a spectacular 257% in the last month, the International Rescue Committee said Monday, calling for international support "for local communities displaced by violence and natural disasters, as well as Afghan refugees as they face the health and economic impacts of the pandemic amidst deteriorating living conditions."
More than 1.5 million Afghan refugees live in Pakistan.
Earlier this month, the World Health Organization warned Pakistan in a letter that it was among the top 10 countries in the speed of the virus's spread and faced devastating effects from opening prematurely. It urged the government to alternate between two weeks of lockdown and two weeks of opening. The Associated Press acquired a copy of the letter, some of which was reported in the press.
The government rejected the proposal. One lawmaker even accused the WHO of "imperialism."
Prime Minister Imran Khan said the refusal to impose a complete lockdown saved the country from economic collapse. In televised speeches, he has pleaded with the public to wear masks, ignore conspiracy theories and take the virus seriously.
A survey by Gallup Pakistan released Monday said 55% of Pakistanis believe the virus threat is exaggerated. The survey of 1,050 people has a margin of error of 2-3 percentage points.
As cases spiraled, the government last week shut down some districts in Islamabad and other cities where fresh outbreaks have been identified. But otherwise it has largely kept lifting restrictions.
The restrictions were imposed in mid-March, but within weeks were lifted bit by bit. Now, most businesses have reopened, including markets and malls, as is public transportation. Schools, restaurants and wedding halls remain closed, gyms had to be shut again, but mosques never closed because clerics refused to do so. Last week, the border with Iran — blamed as the source of the first infections — was reopened for trade only.
At the same time, hospital beds have been filling up.
Zeeshan Hassan said his uncle was turned away from three hospitals in the southern city of Multan, a virus hot spot. Administrators said they had neither a bed nor the drugs to treat him, Hassan said. His uncle was finally admitted to a government hospital, where he died within 15 hours.
A few family members dressed in protective equipment were allowed to bury him.
"Now we are all afraid we will get this COVID-19," Hassan said.
Health professionals are being infected at an alarming rate, with over 3,000 testing positive and more reported each day, said Dr. Qaiser Sajjad, secretary-general of the Pakistan Medical Association.
Even before the pandemic, Pakistan lacked enough trained health personnel to administer equipment like ventilators. With fewer than 3,000 acute care beds for the whole country, Sajjad warned that the system was teetering on collapse.
"People are now starting to get scared and the government is now taking it seriously, but I think we are too late because COVID-19 has already spread massively everywhere in the country," he told the AP.
Misinformation is rampant, he said, and many Pakistanis believe doctors made up the coronavirus to explain deaths in an inept and failing health care system. It also doesn't help that some government officials have gone on TV to downplay the impact of the virus, Sajjad said.
"The poor people and ignorant people, they absolutely don't believe the virus exists. They think it is some conspiracy, all between the government and doctors," he said.
Pakistan is dealing with serious economic issues. Economic growth has been slowing since 2018 but the virus has sent it into contraction for the first time: This month, the country recorded negative growth of 0.38.
"Pakistan is officially in a recession," said Haroon Sharif, a former economic adviser who still counsels the prime minister.
The number of people living in poverty has risen to 40% from 30% since the pandemic began, and massive job losses could spark unrest, Sharif warned.
Sharif said the prime minister is trying to help the poorest Pakistanis, while his Cabinet ministers — many of whom are wealthy industrialists and landowners — focus on the elite. Middle-income earners and small businesses that employ 15 people or fewer are largely ignored, he said.
They have little savings, and much of their business is in cash and so they have little to no support from the banking system.
"I know examples of teachers who are selling fruit," said Sharif.
