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Tajikistan: transparency is needed to effectively fight the coronavirus [interview]

Mirzo Hojimuhammad, a top Tajik doctor, notes that the authorities were late in recognizing the existence of the coronavirus.

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Cabar.asia: Tajik authorities have finally admitted that COVID-19 is present in the country. Earlier they have stated that mysterious deaths occur from pneumonia. Does this mean that Tajikistan now has both pneumonia and COVID-19?

Mirzo Hojimuhammad: The position of authorities and healthcare bodies is still unclear. Despite the recognition of COVID-19 in the country, patients with atypical pneumonia also known as severe acute respiratory syndrome (SARS) are not yet included in the statistics. However, the treatment of such patients, their relatives, and the treatment of their bodies in the event of death is the same as if they would have died from COVID-19.  

Mirzo Hojimuhammad. Photo from personal archive
Mirzo Hojimuhammad. Photo from personal archive

It is impossible to conceal the facts of COVID-19 infection. Representatives of the World Health Organization, who visited Tajikistan, will inform about the real state of the country’s healthcare. It cannot be stated that pneumonia in Tajikistan has disappeared with the arrival of coronavirus in the country. However, the current situation is such that it is the coronavirus that kills people.

No one has yet commented, whether there is only one coronavirus epidemic in the country, or whether there is also an epidemic of unusual infectious pneumonia?

If that is the case, then what is it – a dangerous microbe or virus? If no, why not to register such people as patients with suspected coronavirus? For me, as a doctor, there questions remain unanswered to this day, not to mention ordinary people.

What is pneumonia and how does it occur?

Pneumonia is a disease caused by various microbes (pneumococcus, staphylococcus, and streptococcus), viruses or fungi. With this disease part of the main unit of the lungs – alveoli – fills with fluid and gas exchange stops in them. Usually, the exchange of oxygen and carbon dioxide between blood and air occurs through the alveoli.

The x-ray usually shows blackening or flattening of the part of the lung on the left or the right side, and sometimes there are bilateral lesions.

The condition of the patient depends on the size of the affected surface of the lungs, which can comprise from 1 to 40-50 percent of the total number of alveoli. Symptoms of the disease: high fever, cough, rapid fatigue, shortness of breath, rapid breathing, chest pain. This usually occurs when a person’s immune system is weakened, the person catches a cold or gets the flu. These patients are not contagious and are treated in the general departments of hospitals in the same room as patients with different diagnoses.

How contagious is pneumonia? Can it turn into a pandemic?

Ordinary pneumonia is not transmitted from a patient to a healthy person. Contagious is only the pneumonia, that is caused by tuberculosis bacillus (tuberculosis microbe) and it is treated in specialized tuberculosis hospitals.

In recent years, cases of atypical pneumonia also known as severe acute respiratory syndrome (SARS) have been reported in China, Africa and the United States, caused by emerging viruses such as coronaviruses, which are highly contagious.

The disease also passes in a more severe form, and the mortality from them is higher. The pandemic of this year, which erupted in China, is one of such diseases that has affected more than 3 million people in most regions of the world and killed more than 240,000 people, and it is not yet clear when it will end.

What is the difference between coronavirus (COVID-19) and pneumonia?

COVID-19 is a rapidly spreading disease such as flu, which is transmitted through the respiratory system, and which causes acute pneumonia in 15% of people with a mortality rate of 10 times higher than that of ordinary pneumonia. Due to the large number of infected people and acute nature of the disease, the need for hospital beds, doctors and medical equipment significantly increases.  

Therefore, the World Health Organization declared a pandemic on March 11 and urgently issued recommendations for the heads of the state and health authorities to conduct anti-epidemic measures and prepare for the possible admission of a large number of patients. Similar recommendations were also made to our country in March of the current year.

In particular, it was recommended to refrain from organizing mass events, such as Nowruz. Financial aid, anti-inflammatory, diagnostic and medical materials were also provided.

What measures should be taken during the funeral of a person deceased from pneumonia? Do they have to be different from the funeral of a person who has died, for example, of cancer, heart attack or stroke?

The bodies of those who died of pneumonia as well as those who died from other diseases, are washed and buried without any special clothing. Usually the relatives and doctors are not quarantined. 

Central hospital of Jabbor Rasulov district. Photo: CABAR.asia
Central hospital of Jabbor Rasulov district. Photo: CABAR.asia           

The quarantine of several families and hospitals was on its own an unofficial confirmation of the existence of coronavirus in Tajikistan.

According to the laws of the country, rules and regulation of the healthcare system, no one has the right to place and bury the bodies of the deceased in closed coffins without permission of the relatives, unless there is coronavirus or other infectious disease in the country.

Unfortunately, neither the health authorities nor the law enforcement bodies have not commented on anything to the public and the relatives of the sick and dead, which caused panic, suspicion and rumors among the population.

The majority of the population of Tajikistan, more than half, lives in mountainous and rural areas, where access to doctors and hospitals is difficult. What can be done to fight coronavirus, for example, at home?

Patients with COVID-19 symptoms in mountainous villages can be treated in their own homes or in separate departments of the rural hospitals. However, patients in serious or potentially serious condition should be directed to city and district hospitals, because at any time there may arise a need to take special medical measures, such as oxygen therapy and mechanical ventilation.

The elderly and people with chronic illnesses, who have weak immune system, usually die, thus be twice as careful not to infect them. The immune system of children and young people can also be weakened sometimes, although they do not notice it, so all precautionary measures should be observed by everyone, and which ones exactly, we will explain below.

Quarantine at home is carried out as follows:

A separate room should be allocated, where the quarantined person is isolated from the rest of the family members. The person under the quarantine and other family members must be provided with personal protective equipment (at least, with a mask and gloves), while preventive and precautionary measures such as coughing etiquette and refusal to shake hands during greeting should be fully observed. Quarantine at home cannot be applied in cases, where there are family members at high risk of becoming infected with COVID-19, that is, people over 65 years old, children under 5 years old, pregnant women, people with chronic diseases of the lungs, kidneys and blood vessels. This requirement should be strictly adhered to.

A person quarantined at home must:

  • do not leave the house, live in a separate room with a closed door, ventilate the room through a window or artificial ventilation device, cover mouth and nose with a towel or an elbow when coughing or sneezing, so that the virus does not spread to the surrounding environment;
  • wash hands frequently with soap and disinfect them with an alcohol-based sanitizer;
  • wash hands with soap and water or disinfect them with alcohol-based sanitizer before cooking, eating and after using the toilet;
  • use only disposable towels for drying hands;
  • use a separate toilet, if possible.

What do you think would have happened if the existence of coronavirus in Tajikistan had been announced earlier? Could it have been prevented from spreading in Tajikistan?

The reality is that we have lost a crucial milestone in the prevention of coronavirus, and recognition of this fact is unavoidable. Unfortunately, the authorities of the country did not take seriously the warning of the World Health Organization, and thousands of students continued to participate in the marches in Khujand to celebrate Nowruz, while football, goat racing and horse racing competitions were held in the capital and in the South.

Public transport was still overcrowded, and schools, universities and businesses were not closed, leading to the spread of the deadly virus in many parts of the country.

However, when the first cases of patients with unusual pneumonia appeared and their relatives and doctors became infected with it, some quarantine measures were taken. But official recognition of the existence of coronavirus was too late.

Are the measures undertaken by Tajik authorities sufficient to fight and prevent this disease or not?

If the authorities had listened to the recommendations of WHO and refrained from holding mass events, as well as not solely relying on tests, would have diagnosed COVID-19 based on clinical signs, it would have been possible to curb the spread of the epidemic in the country. With the adoption of more severe anti-epidemic measures, which were adopted in many country around the world, such as school and university holidays, quarantine in some individual regions, a ban on holding mass events, etc., certainly, would have helped to prevent such rapid and extensive spread of the coronavirus.

What do you think needs to be done now? Does it make sense to declare a quarantine?

I think it would be useful to introduce quarantine in certain cities and districts, ban the use of public transport in some cities and regions, and ban the travel between individual cities and districts.

It is also necessary to identify the possible number of infected people in all cities and districts and depending on this, take urgent anti-epidemic measures.  

It is necessary to identify the possible number of infected people. Photo: CABAR.asia
It is necessary to identify the possible number of infected people. Photo: CABAR.asia

Transparency is needed when publishing statistics and informing about the conditions of the hospitals. Unfortunately, we do not know much about all this, either the performance is not enough or the information is not provided to us. 

In any case, the decision to close the markets and shops with the exception of grocery stores, is the right one. Without such measures, it is impossible to prevent the spread of coronavirus. Unfortunately, no accurate information is available about how many cases of COVID-19 have been registered and in which cities, districts and villages of the country and which regions the virus has not affected yet. It is pointless to suggest specific measures without knowing these figures.

For instance, if I knew about the number of people infected with the coronavirus in Dushanbe, but Rasht and Kanibadam are still virus-free, then I would recommend that students from these districts who are in Dushanbe do not return home. Or allow them to return home after two weeks of supervised isolation and only after their safety to other is proved by testing.

This article was prepared as part of the Giving Voice, Driving Change – from the Borderland to the Steppes Project.

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