Increase in respiratory infections

It starts with a cough, a cold and strong shivering, but the results can be deadly. Sitting on a bed at the Abbas Institute for Medical Sciences (AIMS) in Muzaffarabad, capital of Pakistan-administered Kashmir, Faraz Lalkhan, 28, has no idea what’s wrong with her daughter Zarana, although doctors are already convinced. The two-year-old has pneumonia. “Everyone is coughing,” said Dr Irum Gilani of AIMS, the only functioning public hospital in the Kashmiri city, citing a significant rise in acute respiratory infections (ARI) over recent days. Her colleague at the PIMA (Pakistan Islamic Medical Association) field hospital, located on the banks of the Neelum River in Muzaffarabad, agrees, citing colder temperatures, dust and air pollution as contributing factors. “The number of acute respiratory cases is definitely increasing,” Dr Reyaz Shaikh, head physician at the PIMA facility, maintained. The people have no proper protection from the elements, with most of the patients coming from around Muzaffarabad, as well as remote quake-devastated areas of the Neelum and Jelum valleys, Shaikh explained. “We advise them to use masks and provide them with medication. We do the best we can with the limited resources we have,” the Pakistani doctor said. Although such infectious diseases are endemic, the numbers suffering from them have increased sharply following the quake that hit northern Pakistan on 8 October, according to the World Health Organization (WHO). From 15 to 21 October, one week following the disaster, the cumulative number of cases of ARI reported by Pakistani Ministry of Health/WHO surveillance teams was 1,639. By the week ending 28 October, that figure stood at almost 8,500. More than 73,000 people are known to have been killed when the quake measuring 7.6 on the Richter scale ripped though Pakistan’s North West Frontier Province (NWFP) and Pakistan-administered Kashmir, rendering over 3 million people homeless. “In this situation, the risk factors are greater for acute lower respiratory infections,” Dr John Watson, WHO medical officer for disease control in humanitarian emergencies, said in Muzaffarabad, noting there were bacterial and viral infections being transmitted back and forth when people lived in crowded living conditions. “As the weather gets colder, with inadequate shelter and people closer together, the risk factors for lower respiratory infections increase,” Watson repeated, noting the contributing role poor nutrition also played. However, ARI is one of the most commonly reported infectious diseases in disasters such as this. Such a scenario had been expected, with less and less injury and trauma cases to be reported and a general shift towards infectious diseases. “We’re seeing more cases. We’re also looking for more cases now,” he said, noting that in Muzaffarabad alone hundreds of ARI cases had already been reported. But according to the WHO, the incidence of ARIs is a particular source of concern, with the onset of winter and so many people living outdoors. A major cause of mortality and morbidity in emergencies, about 20 percent of all deaths in children under five years of age are due to acute lower respiratory infections (ALRIs –pneumonia, bronchitis); 90 percent of these deaths are due to pneumonia, making early recognition and treatment imperative, the world health body said. The big increase in ARI cases may just be the tip of the iceberg, with known numbers only partially representing the reality on the ground. The region’s previously existing surveillance system had all but collapsed following the devastating quake and was only now slowly being restored. “I would expect thousands over time,” Watson warned, referring to an expected wintertime increase in respiratory infections.