After Pakistani health authorities confirmed on Wednesday that two Pakistanis travelling from Iran had tested positive for the COVID-19 or novel coronavirus, many in the country think the world is coming to an end.

With images from around the world of healthcare providers in oversized space suits, masks and goggles showing up in news feeds along with scores of new cases on a daily basis — so far 83,000 people have been infected and over 2,800 have died in 55 countries — it is but natural for people to equate getting infected with a death sentence.

The fear is also playing up in people’s minds in Pakistan.

Fictional accounts

“Isn't it quite uncanny and even scary that I picked up to read this book titled Severance, by an American-Chinese, just a week before coronavirus entered Pakistan,” says a Karachi-based bookworm.

“The book talks about a disease that originated in China and from which people get the fever like you do in coronavirus, but they become zombies and just a handful remain unscathed,” she adds.

Pages from the novel The Eyes of Darkness by Dean Koontz, published in 1981, with specific paras highlighted are doing the rounds on WhatsApp where the writer talks about a “severe pneumonia-like illness” that will spread across the globe in 2020.

“It's not God’s wrath and it’s not the Plague – two of the most devastating pandemics in human history that wiped out a third of the population in Europe and Asia,” says Dr Naseem Salahuddin, senior infectious diseases specialist at Karachi's Indus Hospital, assuaging fears associated with the coronavirus outbreak.

“Today we are in better health, are better nourished and armed with more knowledge on how to fight the virus,” she adds, saying there’s “no need to panic” since the survival rate from the disease is around 98 per cent.

Panic mode

But world over, panic continues with World Health Organisation (WHO) chief Dr Tedros Ghebreyesus saying the disease has reached a “decisive point” with a “pandemic potential”.

Schools in Japan and Iraq have been closed down (they had already been closed in China and Hong Kong); Saudi Arabia has put a ban on pilgrims from countries where the virus has reached — Pakistan being one of them.

It is still too early to say what the country’s Haj policy would be for foreign pilgrims as we near July. Iran and Saudi Arabia have cancelled Friday prayers; Australia is not letting in people from China; Italy has quarantined 11 towns and Greece is cancelling all carnival activities.

Following suit, in Pakistan, the Sindh government first sounded the alarm bells when it announced closure of schools soon after the confirmation of the first case in Karachi on Feb 26.

“There was no need for taking this extreme measure,” according to Dr Salahuddin.

A resident wears a face mask at a market in Karachi on February 28. — AFP

“If there was an outbreak, one would understand, but creating this hype is not the right way to deal with this situation when people are already nervous,” says Dr Bushra Jamil, professor of infectious diseases at the Agha Khan University (AKU) in Karachi.

"All these deaths that one reads about daily does not mean the virus is lethal as the mortality from the disease is just between 2pc to 4pc, and spreads through sneezing and coughing, explains Dr Jamil, who is also the president of the Medical Microbiology and Infectious Diseases Society of Pakistan.

"The denominator is important. If 70,000 people are infected, 2,000 may die."

In some places, she adds, mortality rates may appear high because there's a lack of official surveilance, which means there is no data on the number of infected individuals.

And, says Dr Salahuddin, it's the few people who suffer from "lungs damaged by smoking, tuberculosis, the already sick and weak" who will be impacted the most by this virus and may "need to be hospitalised and even put on ventilator for a while" as there are no prior antibodies in their bodies or even developed clinically through a vaccine, to fight it.

"But if ordinary people get it, they will probably suffer a mild bout of influenza-like symptoms and bounce back," she says.

Health officials have said the condition of both the Pakistani patients is stable.

“And as far as the history of influenzas go, it's not even the most dangerous of them. In 1914, the Spanish flu devastated 40-100 million people around the world and people were less healthy then than they are now," Dr Salahuddin points out.

But the perception both nationally and internationally is quite the opposite.

If it were like any other influenza, and not that dangerous, some may question why patients are isolated and those suspected put in quarantine. It is giving the general public the perception that the disease is extremely dangerous. Just yesterday the government announced it will trace 8,000 pilgrims (1,500 of whom are from Sindh), who recently returned to the country from Iran, where more than two dozen people have been reported dead from the virus.

According to Dr Jamil, the reason is simple.

"To contain the virus from spreading as it can easily do that, we need to do the investigation by taking the travel and medical history through which it can be detected if a person is suffering from any symptoms that are similar to coronavirus and then do a screening before the person can be allowed to mingle with the general population," she says.

"Designating isolation areas in hospitals and measures for triage is something we should have done weeks ago," adds Dr Zulfiqar Bhutta, founding director of the Centre of Excellence in Women and Child Health at the AKU.

And if the disease is not contained at this stage, the likelihood of it having a snowball effect would be real.

The port city of Karachi, with a population of over 15 million (60pc of whom live in informal settlements) suffers from huge governance problems, collapsing civic infrastructure, dilapidated public transport and healthcare systems.

"It's overcrowded, the air is highly polluted, there is congestion with people sharing smaller spaces with poor ventilation. The chances of cross infection are much higher, " says Dr Salahuddin.

A resident wears a face mask at a market in Karachi on February 28. — AFP

Conspiracy theories abound

While people scramble for answers, conspiracy theorists are having a field day spreading rumours and misinformation. There is talk of the beginning of a biological war; that it happened when an experiment in a petri dish in a lab in Wuhan went awry where a covert biological weapons research programme was in progress. Dr Bhutta terms these stories as "disinformation" and dangerous to even propagate.

Dismissing them as "highly unlikely", Dr Jamil wonders how human beings could be given so much credit for "developing a tricky and highly complex genome" that comes once every other decade, and has included killers such as SARS and MERS. In all probability, she says, it could be a result of climate or environmental changes and human behaviour.

Interestingly, these fringe theories and books are not a point of discussion in the more densely populated Shirin Jinnah neighbourhood of the megapolis, where 25-year-old Aasia, mother of two, lives.

Working as a domestic helper in one of the private homes in the Clifton area adjacent to her neighbourhood, she says her neighbours are more worried about the practical side of battling the "Chinese flu".

"All that people are talking about is to switch over from chicken and 'chota' and 'bara' meat and turn to vegetables and daal, because animals are carriers of this disease and once you get it you die."

"We have yet to find animal to human transmission," says Dr Jamil.

"The transmission is human-to-human," she emphasises.

"People won't get COVID-19 by eating any kind of meat, there is no connection of the virus to the animal produce."

But she does recommend well cooked meat to "prevent many other infections which may be transmitted through improperly or partially cooked animal products."

Commuters wear face masks on a street in Karachi on February 28. — AFP

There are other remedies floating around like having lemon juice or garlic, but there are "no grounds" to support them, says Fayza Khan, dietitian/nutritionist at Kidney Centre, as there is no research to prove them.

Instead, she says, "a healthy, balanced diet builds strong immunity, helps in combating all kinds of illness."

She adds: "Lemons and oranges are rich in vitamin C and it is generally advised to include at least one citrus fruit to one's diet on a daily basis."

She further suggests washing hands often, sanitising and avoiding overly crowded places these days as more sensible ways of avoiding catching the virus.

With Saudi Arabia and Iran stopping Friday congregations, people are worried about going to mosques in Pakistan as well.

Dr Jamil says if the mosque is well ventilated and there is some distance between people praying in a jamat, "it is perfectly fine to go for prayers."

But if you want to take further precaution, she suggests taking along your own prayer mat to the mosque.

"It's all common sense and no rocket science really!"

In the wake of the virus, experts say it brings a "huge opportunity" for civil society to play a role. "We need a massive public awareness campaign on hand hygiene, improved sanitation and practices to clean up our living environments; pretty fundamental preventive measures which are far more effective than buying ventilators," says Dr Bhutta.

This was endorsed by executive director of the National Institute of Health, Major General Dr Aamer Ikram.

"The virus does not respect any border or anyone. Everyone has to play a part in stemming it. We need to bring about a change in our attitudes, within ourselves to adopt hygienic practices, be clean and keep our environment clean. In this, I think the media can play a huge role in educating the public."