After the plague

As Covid-19 appears to have receded a bit, most of us have rushed to put it out of our minds choosing to ignore the threat that still exists

There have been as many plagues as wars in history; yet always, plagues and wars take people equally by surprise.

The Plague by Albert Camus

December 31, 2022. It’s New Year Night in Lahore and while the poor huddle around small fires made from tree branches and discarded cardboard boxes, in the affluent neighbourhoods of Lahore expensive cars are pulling up into large driveways. Cases of bootlegged drinks are being unloaded by armies of servants, the caterers are warming up their grills and preparing skewers of kebabs and tikkas and heating up the huge tandoors assembled expressly for the night. The guests start arriving, wrapped in their coats, scarves and shawls but as they move towards the huge bonfires built in the lawns, something is different. They are all wearing surgical masks and the easy chairs arranged around the bonfires are all at a distance from one another with dainty hand sanitiser bottles tucked into their armrests. Those who find the outside chill too much move indoors to the enormous drawing room lined with Persian carpets and expensive wall hangings but there too, sofas and easy chairs are discreetly arranged at a distance and hand sanitiser bottles are placed within easy reach of all. As the evening warms up and some of the guests find the masks cumbersome (while others strain to hear), many pull the masks down over their chins while they talk or take a drink. Invariably, a uniformed waiter appears at their side and gently reminds them to pull their mask up. Everyone complies, some willingly, others less so. Not wearing masks is no longer an option after the carnage the city has gone through the previous two years.

The ‘first’ wave of Covid-19 (perhaps the name should now be changed to Covid19-20, and the years added on as the infection lingers) has mostly subsided and the denizens of Lahore appear to have already forgotten about it. But in many countries including Spain, the illness is resurging leading to another spike of cases. The United States is grappling with the highest number of cases in the world (and the highest number of deaths); China is watching warily as cases appear in some cities.

“The world has changed” is heard often, and for those who lost a loved one to Covid-19, the world will actually never be the same again. I had these thoughts at the peak of the surge in Lahore a month or two ago. My elderly parents have weathered the storm nicely without getting sick but when the place where I work, Mayo Hospital Lahore – the main referral centre for Covid patients in Lahore – was packed to capacity with the sick and dying (at one time, we had 430 critically ill Covid patients in Mayo on 400 specially designated beds), I had my doubts about any of us making it through.

And while a doctor has the luxury of distancing himself from the pain of his patients, when my own mother and father were involved, it was very different. Fortunately for me, I was, during that time, deeply involved with helping a colleague who had just lost his father (not because of Covid-19). He was mired deep in his grief and agony. I was in touch with him in person at our hospital, on phone and on text, and it kept my mind off the very real threat to my own parents and family.

Now that Covid-19 appears to have receded a bit, most of us have rushed to put it out of our minds choosing to ignore the very real threat that still exists (but can be controlled by simple measures such as wearing masks, hand washing and social distancing). Part of this ‘voluntary forgetting’ is a coping mechanism, of course. We do not want to remember a terrible Ramazan and Eid from 2020 when we, along with the rest of the world’s population, were scared out of our minds. But we are now posing a very real danger to ourselves and those around us by not following simple preventive measures.

Our young people are facing challenges of their own. Schools, colleges and universities have been closed for over five months now and may not open for a while longer. There has been a push towards online learning but in a haphazard and disorganised way. A low income country like Pakistan faces multiple additional challenges: steady electricity supplies, internet connectivity and availability of computer devices, to name a few without which online education will remain a distant dream. In addition, while Covid-19 has given a forceful push to everyone to move their activities online, it will take time for people, especially those in middle age or older to catch up. In all likelihood, learning, teaching and working in the future will likely be a blend of ‘in-person’ and ‘on-line’ with the ‘on-line’ component complementing and enhancing the rest.

And what about the jobs lost, the extreme financial stress and resulting social dislocation from Covid-19? That too, is simply an acceleration of the process which has been going on across the world but especially in Pakistan for decades. Covid has simply unmasked the horrendous social and economic disparities in Pakistan and the rest of the world and made them headline news for all to see. This brief article is not the place to analyse social and political processes, suffice it to say that the miniscule space for governments like Pakistan’s to do anything in the spheres of health, education and social welfare for their populations has all but disappeared with no indication of when things will change. As usual though, the people of Pakistan have stepped into the void to lend a hand and while private charity is no replacement for government policies, the stories of people helping those less fortunate are too numerous to be recounted here.

As we go forward, hopefully the impetus being provided to new online ventures will result in some economic benefits ‘trickling down’ although the poor level of education and awareness of technology among most of our population means that ‘tech resurgence’ may also pass them by. The good thing is that going online for our tech-savvy people means that they can now ‘sell their wares’ (products, services, skills etc) to a national as well as a global market. This should help bring home some much needed money.

This is true for mental health services as well which were already being delivered and utilised online. Most mental health professionals (including myself) have gone completely ‘virtual’, and thus can help people all over Pakistan and across the world. The demand for mental health services is skyrocketing and online work (which is more burdensome in a lot of ways compared to in-person work) is consuming a lot more of our time. The solution is to work on developing and implementing mental health services which can be provided to a large mass of people in the country rather than only the few who can afford ‘boutique therapy’ at expensive rates. Fortunately, the government of Pakistan, in collaboration with the World Health Organisation, is working actively to make this happen and mental health professionals are at the forefront of this effort.

So what will New Year’s celebrations in 2023, 2024 and 2025 look like? Probably the same as 2022 if the situation continues ‘as-is’ but hopefully, this pandemic will have taught us some useful lessons on how to better handle the next one.

The writer is a psychiatrist and faculty member at King Edward Medical University and a member of the Government of Pakistan’s HEC National COVID19 Committee for Psychosocial Wellbeing. He taught and practiced psychiatry in the United States for 16 years. He tweets @Ali_Madeeh

After the plague