Senior doctors in Karachi warned authorities on Wednesday that introducing relaxations in the lockdown will cause a spike in COVID-19 cases that would in turn cripple the country’s already fragile healthcare system. Addressing a press conference at the Karachi Press Club, Pakistan Medical Association Secretary General Dr Qaiser Sajjad regretted that the strict lockdown in Sindh, which was enforced by the provincial government effectively earlier, had “now become a joke just like in the rest of the country”. “I have to say, with all due respect, that our government has made a very wrong decision and our ulema have demonstrated extreme insensitivity [akin to] playing with human lives. “This fight is between the coronavirus and doctors, so please listen to us […] You (government and scholars) have held a meeting without including any technical person. You have drafted 20 SOPs (standard operating procedures). Please tell me, will these SOPs be followed in Pakistan’s mosques? The prime minister has said that the mosques where SOPs are not followed will be closed. Mr prime minister, by then, it will be too late.” Dr Atif Hafeez Siddiqui also urged religious scholars to “review their decision” to keep mosques open. “We want to say that congregations like these would lead to exponential growth […] and if we don’t stop that and this [virus] spreads, then everyone will forget markets and supermarkets. Fingers will only be pointed at mosques.” “Religious scholars from all sectors should please understand that saving lives is of foremost importance in the epidemic. They should endorse the need to keep common people away from congregations in mosques. The different innovations suggested are unlikely to be followed. Dr Siddiqui insisted that a strict lockdown needed to be imposed in order to curb the spread of the virus. He acknowledged that a lockdown “will hurt”, but added that Pakistan was “declared the fourth most philanthropic nation” and with the help of charitable individuals and organisations, the vulnerable people could be taken care of. “We doctors are also bearing the economic impact, we earn through clinics but we have closed them. No one is spared from the economic brunt, the entire world is affected,” Dr Siddiqui said. He pointed out that it took a month for Pakistan to reach 1,000 cases but after relaxations in the lockdown, the number had spiked. Dr Siddiqui cautioned that if proper measures were not taken, a time may come where doctors will have to choose which patient to save and which to abandon. He explained that for a COVID-19 patient, an intensive care unit with a ventilator of negative pressure was required, which was extremely expensive. “Is the government willing to support these ICUs? I don’t think so. Because we don’t even have money for PPEs. When we ask for PPEs, we are told that if you want to protect your life, quit your job. We are not quitting our job or our field, we are standing right here. We have seen our junior and senior doctors fighting against coronavirus without PPEs.” He highlighted the risks the health staff was exposed to, saying that the virus was an “unseen enemy”. “Every doctor that is fighting against [this virus] is eligible for Hilal-i-Jurat because they have not seen this enemy [that they are up against],” he said. Indus Hospital’s Chief Executive Officer Dr Abdul Bari, who was also present, said that “nearly all facilities in Karachi are full” and added that the government’s decision to introduce relaxations in the lockdown had “angered and stressed doctors”. Dr Bari and Dr Saad Niazi pointed out that doctors were the “experts” in the current scenario. Referring to the lack of precautionary measures being taken by the public, Dr Niazi said that the notion that the virus will not affect Pakistanis was not true as the number of cases was increasing every day. “Like Dr Bari just said, with the current number [of cases], the facilities available to deal with coronavirus in Karachi have almost been used up. And this disease has not yet peaked, the numbers are still on the left side of the graph,” Dr Niazi warned. He revealed that in Pakistan, the number of patients under the age of 60 was higher compared to countries in the West. He further said that in Sindh alone, 162 health professionals had tested positive which was problematic as health facilities, including doctors, technical staff and expertise, are already limited. He said that while medical professionals were fighting against the disease, they needed the public to cooperate. Dr Niazi warned that if appropriate measures to curb the disease were not taken, hospitals will not have enough beds for sick people. “The bottom line is that this problem is more severe than [people] realise and all experts believe that this [disease] will spread in the next two to four weeks and might peak.” Dr Niazi said that the reason that Pakistan’s healthcare system was still able to accommodate COVID-19 patients was that they were “trickling in”. The spread of the infection so far, he said, had been contained due to the lockdown. “We only have one way left, which is prevention. We don’t have the capacity, and quite frankly, the expertise to deal with this [disease],” he declared. He urged the people “not to take this lightly”. “This jo hoga dekha jaye ga (we’ll see what happens) approach is very depressing. We will fight to an extent but a time will come when we will also be exhausted,” he said. The press conference comes a day after the emergence of a letter, written by senior doctors to the government, urging it to review its decision to allow congregational prayers to be held in mosques and limit the congregations to 3-5 persons as it had done previously in view of the coronavirus outbreak.