In the last five weeks I have only stepped out of the house four times and each time for important non-recreational reasons. Personally, I am sort of a loner and do get overwhelmed by what is best described as a sensory overload. But even so the present need for self-isolation is getting to me even though that is probably the best way to avoid getting infected.

However, I do wonder how most people are able to withstand an enforced isolation along with their families. As has been pointed out from different perspectives, the well-to-do are able to isolate much more easily than the ones not so lucky.

A family of four or more people living in a two-room home is going to feel greatstress having to live in that environment without any respite. Sociologists and mental health workers are worried about increase in domestic violence under these circumstances.

And poverty does add fuel to this particular fire.Whether the social problems are being considered at all while decisions are being made about lockdown, its form, and continuation is debatable. But it is an important consideration.

I have seen four or five people, including children loaded on a motorbike going around during the day. At first I just thought that these people were too ignorant or else did not care about getting infected that they were out and about. And that too at a time when schools were closed, most shops were closed and most places for public gathering were closed. Obviously, they were being driven ‘stir crazy’ and just had to get out and about for their mental health.

The disease is bad enough but the semi-lockdown in Pakistan is having a rather adverse effect that is difficult to measure. Statistics about new cases and those that died and the ones that recovered are all important. But what happened within the homes of those that had barely enough to eat or were just packed in together in small spaces will unfold in months and years after this pandemic is over.

As I read the ‘learned’ articles being published in western newspapers and journals, it would seem that the pandemic will have major effects, either very good or very bad in the long run. Xenophobia, anti-immigration sentiment, racism and political polarisation are all being presented as one possible outcome.

There is even talk of the rise of political autocrats with mentions madeof the rise of the Nazis in Germany in the early 1930s in response to the great depression. The optimists point out that, on the other hand, a new American president came at the same time and the historic ‘New Deal’ that empowered the poor and the disadvantaged also happened.

One of the major risk factors that can destabilise modern societies is the sudden loss of earning power combined with a major disruption in the healthcare delivery system. Having lived and worked in the United States (US) for more than three decades I can understand how a major economic downturn combined with major loss of life from disease is just not what most Americans ever expected to happen at the same time.

Here a side point. The US healthcare system is heavily criticised by many on the left in the political spectrum. But before the meddling by President Trump, the system was good enough to provide subsidised healthcare to most US citizens. The system is variable in quality but still pretty effective.

What is needed is better public relations about the isolation centres. Air-conditioned accommodation, free food, proper medical care and perhaps a daily stipend of a thousand rupees might make more people volunteer for getting tested.

Coming now to Pakistan, the two major factors I have mentioned above, loss of earning and loss of life from disease are not all that unusual. Most Pakistanis live at or below the poverty level and few Pakistanis have access to adequate health care. And death from disease is an expected part of life for many.

Considering these ‘ground realities’ it is hard to predict any major long-term results of this pandemic. Interestingly, the loss of life from Covid-19 in Pakistan has not been too high. Just because it is early or there is more to it, remains to be seen.

That said, relaxing a poorly observed lockdown in my opinion is quite justifiable. Even in the US and Europe, lockdowns are being relaxed even though the pandemic still has not been controlled. The important consideration seems to be that the medical system is not overwhelmed.

To whatever level the lockdowns are relaxed in Pakistan remains to be seen but I do have a few suggestions.

First, a little bit about the masks. A couple of weeks ago I visited a local bank where customers without masks were being turned away. I thought that banks, and restaurants and shopping malls as they open up, they should provide customers with free cloth masks with a company logo.

Masks must be worn in public because they decrease the chance of infection. Cloth masks are as good as paper masks and have the advantage that they can be washed and re-used. The reason why ordinary masks help is because a majority of the corona virus infection is passed on through saliva or mucus ‘droplets’ released while coughing, sneezing or even talking. And ordinary masks will cut such transmission down, but these masks must cover the mouth and the nose.

However, in hospital settings where Covid-19 patients are being treated, the virus is ‘aerosolized’ so more effective closely fitting masks are needed. The tightly fitting, 99 percent filtering masks to be used by healthcare workers taking care of Covid-19 patients are ineffective in the presence of facial hair that prevents a proper seal.

The social distancing of six feet is based on the fact that most of the droplets released during coughing or sneezing will drop to the ground in about three feet. So six feet is a safe distance. Unfortunately, social distancing is the most difficult thing to enforce.

The next point is about testing. Most ordinary people are afraid of being tested for fear of being carted off to some isolation centre. Evidently testing vans have been going around but with little response from the people.

What is clearly needed is better public relations about the isolation centres. Clean and air-conditioned accommodation, clean clothes, free food, proper medical care and perhaps even a daily stipend of a thousand rupees might make more people volunteer for getting tested. Testing should be for active disease as well as antibodies.

Then there is the question of checking people entering shopping malls or department stores. A few weeks ago as I entered a local department store to buy groceries, a young lady in full battle regalia checked my temperature with a temperature gun and a young man next to her gave me spritz of a hand sanitizer.

Fortunately, my temperature was normal. But I do wonder what happens if a customer does have a fever. Perhaps those wandering testing vans should be placed near such temperature check points for immediate testing.

Finally, keep wearing masks in public;maintainingsome social distancing and frequent checking are the most important ways to loosen the grip of Covid-19 on Pakistan. And yes, keep washing those hands.

The writer has served as Professor and Chairman at the Department of Cardiac Surgery, King Edward Medical University