Quetta: Hayatullah had had fever and muscle cramps for some time before his condition deteriorated alarmingly on October 2nd.
His family rushed him to a hospital in Quetta, the provincial capital of southwestern Balochistan province, where after a week of intensive treatment, he died. A doctor at the Fatima Jinnah General and Chest Hospital said Hayatullah, 27, had all the symptoms of Congo virus infection.
“It’s a deadly virus about which there is little awareness,” Dr. Naseer Mohammad, in-charge of the isolation ward in Fatima Jinnah General and Chest Hospital, told News Lens. “Families bring patients at the last stage of the disease when there is little we can do to save them.”
For a province with high prevalence of the virus, equipment and expertise for pathology tests to diagnose the virus are not locally available. Dr. Mohammad said the “PCR (polymerase Chain Reaction) test” for Congo virus detection was not available in Fatima Jinnah hospital and blood specimen had to be sent to Karachi and Islamabad, with reports taking as many as four to six days to arrive, whereas patients need immediate attention.
“The government should arrange for medical tests here in Quetta so we can diagnose the virus immediately and start treatment,” said Dr. Mohammad. “Laboratory reports arrive late and the delay poses a serious threat to patients.”
He said Hayatullah was brought to hospital in a critical condition on October 2nd. “He was the fifth person in less than three weeks to die of Congo virus,” said Dr. Mohammad. “We have lost 15 patients to Congo virus in the past ten months.”
Health authorities say incidence of infection with Congo virus that spreads from animals to people is rising in the largely pastoral Balochistan where people breed sheep and goats. While the province is known for high prevalence of the virus, it is around the time of Eid-ul-Azha – the Muslim feast of sacrifice – that the incidence of infection increases as people come in contact with cattle not treated for ticks that transfer Congo virus to humans. According to Dr. Mohammad, at least sixteen patients with Congo fever were brought for treatment to Fatima Jinnah General and Chest Hospital since Eid, celebrated on September 24.
The symptoms of the Crimean Congo Hemorrhagic (CCHF) can be sudden, says the US based Center for Disease Control (CDC) fact sheet on the disease available on center’s website. Initial signs and symptoms include headache, high fever, back pain, joint pain, stomach pain, and vomiting. These can be accompanied by other common symptoms such as blood-shot eyes, a flushed face, raw throat, and petechiae (red or purple spots) on the palate. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.
According to the CDC fact sheet, as the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.
The 16 patients treated at the Fatima Jinnah General and Chest Hospital were brought there within a week of Eid. “The tick carrying the virus transfers from animals to people if they are not careful during handling or slaughtering cattle and removing animal hides,” said Dr Mohammad. “Most of these patients were butchers.”
The record at the hospital shows that 86 patients of Congo virus have been admitted to the hospital this year. Of these, only 45 cases were diagnosed and fifteen died due to complications. The hospital provides free medical support to patients with assistance from the World Health Organization (WHO).
According to the health authorities, Congo Virus is found in ticks feeding on the blood of infected animals. Dr. Naseebullah, a general practitioner, told News Lens the virus was found in sick animals from where it spread to humans. “People should stay away from sick animals,” he said.
Dr. Naseebullah said that Quetta was vulnerable to the virus because cattle and sheep freely moved across the border from Afghanistan all year around, especially during Eid. “Absence of screening facility for animals brought in from Afghanistan and other parts of Balochistan is the main reason behind increase in spread of Congo virus,” he said.
Livestock Secretary Siddiq Mandokhel said they had limited budget to disinfect. “We asked the provincial government for 50 million rupees to disinfect areas affected by Congo virus but it has yet to be approved by the chief minister,” he said.
Mandokhel said the Livestock Department had appointed two member committees in every district to monitor spray of animals with disinfectants and monitoring their health. “The virus is coming from Afghanistan and affecting the Pashtun areas like Zhob, Killa Abdullah and Killah Saifullah that border Afghanistan.”
Patients infected with Congo virus require special attention and care in the course of treatment. However, hospital staff is generally reluctant to stay close to patients due to the highly infectious nature of the virus. Patients have to be quarantined. Due to lack of facilities in hospitals to treat Congo fever and the risk of contracting the virus while interacting with patients, doctors and paramedics feel hesitant to visit patients
Provincial president of All Pakistan Paramedic Staff Association, Mohammad Iqbal Sheikh, told News Lens hospitals in Balochistan lacked safety mechanisms for the health staff.
“Can you imagine our doctors and paramedic staff using the torchlight of their mobile phones to examine patients in the emergency ward,” he said. “There are no power generators in hospitals despite long and frequent power outages.”
Sheikh said the medics just wore gloves to protect themselves from contracting Congo virus. “We have not been provided any facilities to protect ourselves from Congo virus and hepatitis,” he said. “We have lost several staff members to contagious diseases.”
Sheik said the association had lost Laboratory Assistant Abdul Malik at Bolan Medical Complex, Surgeon Mohammad Ayaz Mandohkhil, Surgeon Habib ur Rehman, Laboratory Assistant Hafiz Kareem Baksh and Laboratory Assistants Hidayatullah to infectious diseases transferred from patients.
Dr. Naseebullah told News Lens that one of the doctors died after contracting Congo virus in 2013 while treating a patient.
