— By Zubaeer Akhtar, Maryam Haltam, Amber Hashmi and Fatima Khan—
Introduction
Environmental issues in Pakistan have been disturbing the balance between economic development and environmental protection. With the rise of the novel COVID-19 viral pandemic, governmental priorities have been necessarily realigned in order to minimize possible catastrophe. Nevertheless, the Ministry of Environment continues to take responsibility to protect and conserve the environment.
The World Health Organization discloses information on the high level of air pollution in the country. As the novel coronavirus is a respiratory illness, poor air quality magnifies the risk of infected persons suffering from viral symptoms that are more severe in nature and have the potential to become life threatening. In addition to concerns regarding air quality, water pollution from raw sewage, agricultural runoff, and industrial wastes is also a problem to be addressed, as the CDC has issued a notice stating that the risk of transmission of the COVID-19 virus through sewage systems is low, but still may be possible [1].
Water
The World Bank has recognized Pakistan’s struggle to boost productivity and sanitation in its water sector. Irrigation for rice, wheat, sugarcane, cotton dominates water use in the country at 80%, but suffers from lack of productivity as it accounts for a mere five percent of gross domestic product, with losses due to poor water management amounting up to $12 billion dollars annually [2].
In addition to the economic impacts of water sector issues, the private lives of individuals and families are also negatively affected by the water crisis. 22 million people (10 percent of the population) live without basic sanitation [3], and water-borne illnesses kill nearly 40,000 children each year [2]. Access to soap and handwashing facilities in the cities is limited, and this problem is exacerbated in rural areas where each village has only one toilet so most people have no choice but to defecate in fields [3].
The novel coronavirus is a magnified problem among those who live in urban, yet informal settlements, which accounts for 45.5% of Pakistan according to statements made by the United Nations in 2017 [4]. While the usual instructions for combating the spread of the virus include washing hands and socially distancing, this is simply not easily doable for people living in these settlements. 60 percent of Karachi, a city of over 16 million, live with limited or no access to clean water and sanitation. People have to rely on buying water from water tankers, which take up a significant amount of their earnings despite the fact that those who live in the informal settlements have been living with the threat of eviction over the last 18 months, and 40 percent of the families in these settlements have at least one person in need of special medical or social care with chronic illnesses that could raise the risk of contracting the virus. A necessary truth to face is that psychological stresses due to food and water insecurity and healthcare needs have reached unprecedented levels in the past few months, but officials do not have data on the slum areas so it is difficult to come up with helpful policies.
According to the World Health Organization, there is not much evidence suggesting that transmission of COVID-19 through contaminated drinking water, whether it be surface water or groundwater sources. A study found that a surrogate human coronavirus only survived two days in dechlorinated tap water.
However, if the water is already contaminated, it is a different story. In addition to personal stresses, hospital and industrial waste in urban areas are thrown into streams and channels along with household liquid waste [5], which is a dire problem that increases the risk of viral contagion. Health care facilities connected to sewers should have a risk assessment to confirm if the wastewater is contained before reaching the disposal site. Fecal contamination can cause the virus to be contagious from anywhere between a few days to a few weeks.
According to the WHO, people suspected of having or confirmed with the virus should be provided their own properly operating toilet separate from others in the patient’s room, disinfected at least twice daily by a trained cleaner with PPE. Well maintained plumbing with sealed bathroom drains would also be necessary to prevent aerosolized fecal matter from entering the plumbing or ventilation systems. During the time of the SARS virus, poorly designed air ventilation systems could have contributed to the spread in a high rise apartment building in Hong Kong, so today, concerns of the spread of COVID-19 linger because of faulty toilets in high rise apartment buildings.
The Taftan quarantine camp at the border of Iran and Pakistan holds a large number of people due to falling along an important trade route and also being on an important religious site for Shia Muslims. Unfortunately, although the camp was supposed to be a sanitary quarantine location to prevent the outbreak from Iran (which had one of the largest number of cases) from reaching Pakistan, it has exceedingly unhygienic conditions that do not allow for compliance with COVID-19 protection measures [6]. Tents are set up for families with no real bathrooms, towels, or blankets. At one point, six thousand people were staying in these tents with no real medical facilities closeby. Those who displayed symptoms did not get tested for three weeks, so self-isolation was not enforced during that time period. There is a shortage of doctors and nurses and medical facilities, and many doctors have been paying for necessary medicines and technology themselves. Eventually, protests actually broke out among the quarantined due to the inadequate living conditions.
In regards to what should be done to combat these problems, municipalities should fund improved water supply and waste disposal infrastructure, regularly monitor the water supplies so that there is no contamination, and provide wastewater treatment and management. On a smaller scale, rather than focusing on running water for handwashing properly, people should focus on scrubbing properly with soap [5].
Water and sanitation workers often work without protective gear and for very little money. Ditches are filled with human waste, blades, broken glass, needles, and chemicals, and harmful gases like methane and hydrogen sulfide. Exposure to dangerous chemicals and gases can cause cardiovascular degeneration, musculoskeletal disorders such as osteoarthritic changes and intervertebral disc herniation, hepatitis, leptospirosis, helicobacter infection, skin problems, and respiratory system problems, altered pulmonary function parameters [7].
Air
Pakistan is a large importer of both exhaustible and renewable energy, and, according to the World Bank, its fossil fuel energy consumption accounts for 61.6% of the total as of 2014 [8]. The consumption of fossil fuels has a detrimental impact on the ambient air quality in large cities, with the transportation system in particular greatly contributing to high levels of smog [9].
Air quality is indicated according to the concentration and size of particulate matter. Fine particles have a diameter of 2.5 µm or less, and coarse particles typically have a diameter of less than 10 µm [10]. The former size category is more dangerous than the latter as fine particulate matter can make its way down the cardiopulmonary system and interfere with bodily health. Prolonged exposure to fine particulate matter in the long-term can cause lung cancer, cardiovascular disease, chronic respiratory illness, allergies, associated with heart attacks and strokes. Short term effects include upper respiratory illnesses like pneumonia and bronchitis.
Karachi, Lahore-Johar Town, Peshawar, and Rawalpindi have specifically reported high levels of particulate matter. On an hourly basis, the United States Embassy and Consulates in Pakistan provides updates on air quality data from Pakistan’s major cities, using the air quality index on a seven-category scale from good to hazardous, with good being satisfactory with little to no risk, and hazardous being an emergency situation in which the air poses serious health risks. As of Apr 13, 2020 at 9:00 AM (LT), Lahore is in the fourth highest category on the scale, one below emergency conditions, with hazardous air quality of PM 2.5 causing members of sensitive groups to experience negative health effects [11]. For example, an analysis of the 2003 SARS virus said that people who live in air pollution were twice as likely to die from the virus.
NASA recently released images from space stations showing a dramatic decrease in emissions released into the atmosphere since the start of the pandemic, although this may be impacted by seasonal or other natural changes in the environment. Italy and China have already seen great decreases in air pollution. While it is too early to tell whether Pakistan will experience lasting reductions in toxic emissions, an optimistic outlook on the environmental policies that could be set in place following the pandemic is not out of reach.
Solutions to Build a Sustainable Future
The novel coronavirus is rapidly changing the healthcare situation across the globe. The scope of the impact it has had on Pakistan is still not known, but its ramifications will be seen as time passes. It, and the implications of climate change, will alter policies, healthcare, and the economy, affecting the more than 200 million people of Pakistan. This pandemic is a red flag for policymakers, planners, and government officials. Priority attention should be given to equalizing access to urban infrastructure services [4].
Urgent solutions are needed to address long term issues. First recommendation is to restore local government systems in Pakistan. Having local governments at each level ensures a reliable network of governance leadership. Second recommendation calls for the immediate establishment of committees composed of representatives from local government, NGOs, and community leaders. The third recommendation calls for the accounting of those with healthcare needs. The fourth recommendation calls for the documentation generation of data on different population groups, with special care given to those of informal groups.
References
- Guidance for Reopening Buildings After Prolonged Shutdown or Reduced Operation. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html. Published May 7, 2020. Accessed June 12, 2020.
- Altaf MS. Pakistan’s Scarce Water Can Bring More Value to People and Economy. World Bank. https://www.worldbank.org/en/news/press-release/2019/02/04/pakistans-scarce-water-can-bring-more-value-to-people-and-economy. Published February 4, 2019. Accessed June 13, 2020.
- Fatima F. Open defecation: How are 22 million Pakistanis living without basic sanitation? Eco-Business. https://www.eco-business.com/news/open-defecation-how-are-22-million-pakistanis-living-without-basic-sanitation/. Published April 9, 2020. Accessed June 13, 2020.
- Abdullah A, Arif M, Macktoom S, et al. Why the Covid-19 crisis is an urban crisis. DAWN.COM. https://www.dawn.com/news/1544933. Published April 14, 2020. Accessed June 13, 2020.
- Proper wash facilities to contain faecal-oral route transmission of COVID-19. The Nation. https://nation.com.pk/06-Apr-2020/proper-wash-facilities-to-contain-faecal-oral-route-transmission-of-covid-19. Published April 6, 2020. Accessed June 13, 2020.
- AlJazeera; 2020. https://www.aljazeera.com/programmes/newsfeed/2020/03/coronavirus-pakistan-taftan-quarantine-camp-200323110255493.html. Accessed June 13, 2020.
- Ghani F. Sanitary workers risk their lives despite spread of coronavirus. AlJazeera. https://www.aljazeera.com/news/2020/03/sanitary-workers-risk-lives-spread-coronavirus-200325051916407.html. Published March 25, 2020. Accessed June 13, 2020.
- https://data.worldbank.org/indicator/EG.USE.COMM.FO.ZS?end=2014&locations=PK&start=2014&view=map&year_high_desc=. Accessed June 12, 2020.
- Ali M, Athar M. Air pollution due to traffic, air quality monitoring along three sections of National Highway N-5, Pakistan. Environmental Monitoring and Assessment. 2007;136(1-3):219-226. doi:10.1007/s10661-007-9677-3
- Pakistan General Health Risks: Air Pollution. IAMAT. https://www.iamat.org/country/pakistan/risk/air-pollution. Published April 16, 2020. Accessed June 13, 2020.
- Air Quality Data. U.S. Embassy & Consulates in Pakistan. https://pk.usembassy.gov/embassy-consulates/air-quality-data/. Published April 22, 2020. Accessed June 13, 2020.