Subh-e-Nau Magazine

Nurturing your environment as a natural defense against a global pandemic

The COVID-19 is a serious threat to our everyday lives. How can we save ourselves by minimizing risks? Keeping yourself and surrounding healthy is an implementable and sustainable strategy which can help build natural defenses against the coronavirus and other upcoming threats.      

The COVID-19 pandemic is a rapidly evolving global threat with more than 365,000 deaths to date and an ongoing rapid increase in cases. These resulting tragedies combined with the social, health, and economic impacts of mitigation efforts to slow disease transmission through shifting human relations to limit exposure using preventive practices, such as social distancing, wearing masks, washing hands, and minimizing contact are yielding good results, however, cases are still rising and this is so for the case of Pakistan.
Prior to this crisis, environmental and social factors have been shown to be associated with occurrence and mortality due to influenza and other respiratory viruses. SARS-CoV-2, the virus causing COVID-19, is still new, but recent reports and studies suggest that environmental variables might also contribute to its transmission and the severity of the disease. While there are plenty of social measures, there is little discussion on how to keep your environment and related interactions healthy against this potentially deadly threat. In what follows, I outline three basic avenues for enhancing your defenses in daily, practical steps by nurturing your immediate environment. This will not only yield safety for you and those under your care but will also benefit our natural environment as each meaningful action matters in this fight against this global pandemic. 

Saving water

As a start let us begin by saving our previous water and other resources by local practices as rains are hard to come by these days especially during the upcoming monsoon season. With regular handwashing a key requirement, saving water will be useful due to this increased demand by the COVID-19 pandemic. As is the case, much of the water is lost and to add insult to injury it is oftentimes allowed in the monsoon season to flood and kill people! A great amount of this precious being can be saved if each rain season is literally turned into a “rainwater harvesting season” and saving this will help at all levels, especially for ensuring health in the time of the pandemic. All food production rests on water, and since life is dependent on water, we do a favor to ourselves and others by switching to water conservation (See “Tips for public usage of water” for some tips).
If conservation is followed with conviction, it means managing through periods of pandemics that Pakistan now is experiencing along with other impacts such as droughts on a regular basis. Unfortunately, as trite as the whole idea of conservation of water has been made out to be, the time is nigh and now that such a philosophy guides all efforts in solving our current and impending water shortages. This includes water recycling and rain harvesting, which as the words imply, is a most elegant and practical means to save especially in the time of this crisis. On the other hand, given that rains are now scarce and erratic, we can also extensively employ such practices in times of epidemics and pandemics.

Tips for public usage of water

Individual responsibility needed in solving water crisis
  • Use a pan for dish cleaning, instead of a running sink tap
  • Avoid using a running shower; use a bucket instead
  • Use recycled water for gardening, such as saved ‘Wudu’ water
  • Monitor and repair, in a timely manner of leaking taps and pipes
  • Clean cars with a bucket instead of using a pipe
  • Employ smaller flush tanks for saving water
  • Consider dietary changes towards less meat consumption, which takes twice as much water to cook than vegetable dishes.
  • Save water via rainwater harvesting.

Rainwater harvesting

To start, rainwater harvesting is the gathering and storage of rain from roofs or from a surface catchment for various uses. This notion of is well documented from pre-Roman times and on all the major continents, although in industrialized countries, until recently, the practice had largely expired away with the introduction of reliable mains-supplied water. The water is generally stored in rainwater tanks or directed into mechanisms, which recharge ground water. Rainwater harvesting can provide lifeline water for human consumption, lessen economic burdens and the need to build reservoirs, which oftentimes require the use of valuable and fertile regions.
Traditionally, rainwater harvesting has been practiced in arid and semi-arid areas, and has provided drinking water, domestic water, water for livestock, water for small irrigation and a way to replenish ground water levels. However, this can easily be extended towards urban areas where similar benefits can be achieved. Rainwater harvesting in urban and rural areas can have manifold reasons. To provide supplemental water for the populations’ requirements, to add to soil moisture levels, to augment the ground water table through artificial recharge, to mitigate flooding and to improve the quality of groundwater are some of the reasons why rainwater harvesting can be adopted both in cities and rural areas, especially during the time of this pandemic.

Keeping the air clean

One of the great dangers by the coronavirus infection is impact on lungs, hence air quality is a great concern. Due to the pandemic, there is reduction of air pollution levels globally. However, prior to this pandemic, air quality in Pakistan is deteriorating with every passing day, especially in North-Eastern areas and urban parts of Punjab. Big cities, such as Lahore, Faisalabad, Rawalpindi, Peshawar, have very bad air quality. These cities are experiencing smog from the last three years with the smog episodes starting in early October and November. Smog is mainly triggered by less or no rainfall in the region. This is not only limited to Pakistan, but Delhi, closest major city in India, is also heavily affected by smog during the same months of the year. To make sure that your air quality is clean, use air filters, avoid smoky environments including cigarette smoking and second or third-hand smoke. Ensure that the garbage in your surroundings and indoor environments is not burned and disposed in a proper manner. Also, stay away from air pollution from outside environments. This way, you will ensure that you are not comprising your lungs from either indoor or ambient pollution sources.
Indoor and outdoor plantation can also control and improve air quality and is a good long-term solution. However, for improving air quality of urban areas, small hubs of trees count a lot. The Billion tree project is a very good effort of forestation in this regard and needs to be extended to urban centers.  Afforestation contributes positively towards minimizing climate change impacts in Pakistan and towards cleaning air. Since urban air quality is more related to indigenous activities, what happens within the city or the surrounding areas, such as the industrial estates inside and around the cities, and the vehicle population on the road, is important.

Greening your space

Regarding forestation, we must have vegetation within our surroundings and especially the cities as well. We should preserve vegetation and should plant trees in this pandemic, as thousands of trees have been cut, especially in cities in the last ten years. This has led to the loss of a healthy environment and as such by restoring them, we also build defenses against pandemics like COVID-19 and ongoing dengue fever.
Indigenous tree species should form the key components of any of the plantation you do, not as there are scientific and health reasons for doing so. As is unanimously voiced by experts, this may take time; however, is the only way to ensure a long-term stability of our environment.
Bringing in exotic or “alien species” oftentimes creates unpredictable damage to not only the growth of our forest ecosystems and the environment, but also affects all living things. Take the example of the infamous Paper Mulberry in Islamabad which literally wreaks asthmatic havoc on us each summer, when there are record levels of pollen released by this foreign species. In addition, this tree is rendering our existing species extinct due to so-called “allelopathic effects” – these effects inhibit the growth of local plants by secreting chemicals in the soil.
Which species should you choose for greening your gardens and community?
In Karachi and Baluchistan, what are commonly known as wilayati keeker (Mesquite) and beli were planted for the very reason that they grew fast, but this has restricted or even wiped out other indigenous trees and shrubs like Acacia senegal – local name Khor, Acacia nilotica – local name Kikar or Bhabar, Prosopis cineraria – local name kandi or jandi. These species must be replanted, and slow replacement of exotics must happen alongside.
The Northern forests in the earthquake affected areas mostly consist of Cheer (Long Needle Pine), Fir, Deodar and Kail (Blue Pine) varieties which should form the basis of reforestation efforts in the affected areas.
In the case of Islamabad, there are many beautiful trees in the area that are naturally part of the landscape, e.g. Shirin. Similarly, Sumbul trees should be encouraged as they also have economic value if the seeds are harvested as they are used to fill pillows. CDA should encourage harvesting of seeds of this tree as well. Banyan tree or Bur as is commonly known was planted for centuries. Sher Shah Suri planted these trees at regular intervals on the GT Road in sets of three with water ponds for horses. People also used to rest under these. Peepal is also a very good native tree for the purpose.
Further recommendations are: Pine – local name Cheer, Sukh Chain, and Kachnar. Local Mulberry that produces black colored fruit is a very good choice, since the fruit has medicinal qualities of healing sore throats and infections, and hence will be valuable for natural preventative defenses against pandemics and epidemics.
In summary, we can all improve and build natural defenses against the coronavirus and other such dangers, by making sure that by improving your immediate environment. I have outlined some sustainable measures, but for following conservation, reducing exposure to pollutants and restoring greenery which will not only prove beneficial now but also for upcoming threats, while also improving our natural environment.
Writer: Dr. Farrukh Chishtie

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Rampant waste mismanagement: more fuel to the COVID-19 fire

The improper treatment of solid waste is rapidly destroying quality of health in Pakistan, and for COVID-19 this presents additional threats. Recent it has been witnessed that air masks are thrown in the streets and in hospital waste are indicative of the potential impact of this mismanagement. With dengue already as an additional complication, the issue of waste management must be addressed at a top priority.        

The threat of an airborne threat from COVID-19 pandemic is multiplied with a degraded environment and waste on the streets is of great concern. Pakistan is already facing the additional and deadly threat of dengue in this season.
Almost half of solid waste generated in urban areas of Pakistan is not collected whatsoever, while collected waste is typically dumped on low-lying land without following standard procedures. The collection of waste is normally confined to posh localities and the settlements of lower-middle class and slums are literally littered with the waste. Lack of a proper Solid Waste Management (SWM) is the call of the hour, especially with the ongoing COVID-18 pandemic.
The burning of collected waste at streets or the legal and illegal dumping sites produces clouds of smoke that can be seen from miles away, which smells bad and emits carbon dioxide along with other hazardous gases. The danger attached to these practices enhances when dangerous hospital and industrial waste is also treated like domestic waste. Heaps of garbage in and around the urban localities are a common scene in all the cities of the country. These heaps of waste provide a perfect breeding ground to mosquitoes and flies putting the health of inhabitants at stake, and with the coronaviruses in the air, the situation is furthermore compounded.
The situation has worsened to the extent that these heaps and emissions of toxic gases are killing people across the country, and with the COVID-19 lurking in the mix, the situation can become far worse. Worker die of toxic gases regularly when trying to incinerate collected waste in Karachi. Newspapers report similar incidents quite often in which people are killed with direct contact of waste, let alone the death toll of toxic emissions. Solid waste causes choking in drainages and sanitary workers keep dying of the toxic emissions while trying to open the drainage lines.
Pollution in river Ravi is not only affecting inhabitants living along the river but animals especially cows are also getting physiological disorders transmittable to human bodies through milk. Pollution in this river is the highest compared to all the rivers in Pakistan. The river presently receives 47 per cent of the total municipal and industrial pollution load discharged into all the rivers of Pakistan. Drinking polluted water and the interaction with the coronaviruses is still being studied, however, even if no transmission is no found, the reduced immunity from water-borne diseases such as diarrhea can again enhance risk and number of cases from the pandemic.  
The collected solid waste spills out of uncovered containers, which are mostly transported from one place to another. A lot of garbage falls in the streets and roads before reaching the dumping facility. Similarly, in certain areas bull and donkey carts are used to collect municipal waste, which go from street to street picking up the waste and this again is not proper arrangement for waste collection. In this regard, it has been witnessed that air masks are thrown on our streets much like the litter that is carelessly thrown or is spilled from collection facilities. These masks and related garbage must be treated with care and disposed with international best practices.
The number of dustbins and constructed filth depots are far less when compared with urban sprawl and population. One of the most serious problems is air pollution. The wind carries waste, dust and gases caused by decomposition. Putrefaction of waste in sunlight, during daytime, results in bad smells and reduced visibility, and could also facilitate the dangerous spread of the coronavirus spread.
Industrial solid waste is perhaps most dangerous type of waste, which affects the inhabitants of the localities, situated near factories. In the absence of effluent treatment plants and proper care for the waste, industrial waste is thrown away as domestic waste, exposure to which causes serious injuries and even deaths. In all industrial cities of Pakistan, inappropriately designed industrial planning and programs are perceived to be notorious for generating water and land pollution due to heavy discharges of untreated wastewater and solid wastes. In Pakistan, only 3 percent of the total industrial units treat their wastes, while the rest discharges untreated effluent into rivers, lakes and sea. Dumping of untreated industrial wastes have caused contamination of surface and ground water resources and threatened the aquatic life to an endangered level.
The second most hazardous waste is hospital waste. In recent years, hospital waste disposal has posed even more difficulties with the use of disposable instruments such as needles, syringes, and other similar items. Around 250,000 tons of medical waste is annually produced from all sorts of health facilities in Pakistan. In Lahore alone, major public and private hospitals and laboratories in the city produce 3 tons of waste every day. Most of this comes from government hospitals and is dumped into city government containers, already putting citizens at risk of diseases such as diarrhea, dysentery, cholera, typhoid, hepatitis, malaria, the plague, skin diseases and HIV (AIDS), according to a recent report on hospital waste management. With the additional risks due to COVID-19 pandemic actions to curb hospital waste including proper handling of equipment is paramount. On an average, a Pakistani uses five disposable syringes per year, making a demand of about 750 million syringes.
This type of waste has a crippling effect on the environment by contaminating land, air and water resources. Some hospitals and municipalities burn their wastes, which results in production of large amount of highly toxic gases. It is quite unfortunate that no monitoring measures are taken, or assessments made to measure the levels of these emissions, which cause air pollution and is another risk to adding to the COVID-19 pandemic impact.
Another kind of toxic waste is electronic waste. The electronics industry is the fastest growing manufacturing industry in the world, and it undergoes rapid product obsolescence, therefore frequent discard of electronics takes place (or E-waste). E-waste has now become the fastest growing waste stream in the industrialized world. The growing quantity of E-waste is beginning to reach disastrous proportions and industrialized countries, all over the world, are just now beginning to grapple with the problem.
Countries from which the computer waste/scrap comes include Australia, Japan, England, the United States, Kuwait, Saudi Arabia, Singapore, and the United Arab Emirates. The disposing and recycling of E-waste has serious environmental implications, including COVID-19 pandemic as the virus survives on surfaces for 2 to 3 days on plastics, which makes these a threat as well.
When computer waste is landfilled or incinerated, it poses significant contamination problems. Landfills or dumping sites leach toxins into groundwater and incinerators emit toxic air pollutants including dioxins. Likewise, the recycling of computers has serious occupational and environmental implications, particularly when the recycling industry is often marginally profitable at best and often cannot afford to take necessary precautions to protect the environment and worker health.
It is hard to calculate exactly the financial, environment and public health cost of an improper solid waste management system in the country; however, it can be safely said that this cost runs into billions in monetary terms while the health of hundreds of thousands of people is at serious risk. With the COVID-19 pandemic this can multiply, so we have to get effective solid waste management and disposal systems in place, especially in densely populated cities of our country.
Many new technologies have been developed to solve solid waste problems, but due to lack of political will and initiatives, remain out of our possible future. Frequent outbreaks of diarrhea, dengue and other diseases in urban centers could be taken as wake-up call by the authorities and the public. The glaring question in relation to all these dangers are: Where is the Ministry of Health and Environment Ministry or provincial-EPA in all this? When will they wake up and smell the stench?
Here is a message to them and all concerned: lack of attention to an effective solid waste management has dangerous and deadly consequences, and with the COVID-19 crisis, things are becoming worse with environmental conditions a key consideration. Without a proper SWM system in place, our lives as well as our coming generations, run the risk of being wasted by waste itself, and with epidemics and pandemics on the rise. Our authorities have routinely avoided this issue, to the point that it literally stinks in all our faces. This issue must be taken up at all levels so that the mess is cleared up once and for all, and for the well-being of our citizens in the immediate and long-term.

How does waste affect us even more negatively with the COVID-19 pandemic?

Improper disposal of solid waste has serious results for the environment and human health problems. Disposal of waste into nallahs, canals and rivers can pollute the water supply along the whole length of the watercourse. Infections and diseases can rapidly spread from dumpsites into the general population. The coronaviruses responsible for COVID-19 can easily settle on surfaces besides can be transmitted via air.
The open dumping and burning of waste can cause skin and eye infections and dust in the air at dumpsites or kachra kundis can cause breathing problems in children and adults. Flies breed on uncovered piles of rotting garbage and spread diseases like diarrhea, dysentery, typhoid, hepatitis, and cholera. Mosquitoes transmit many types of diseases like malaria and yellow fever. Similarly, dogs, cats and rats living around refuse carry a variety of diseases including plague and flea born fever. Intestinal, parasitic and skin diseases are found in workers engaged in collecting refuse. As is the case, the coronavirus is in some sense more dangerous than these types
The most serious problem related to improper SWM is groundwater contamination. As water filters through any material, chemicals in the material may dissolve in the water, a process called leaching. The resulting mixture is called leachate. As water percolates through solid waste, it makes a leachate that consists of decomposing organic matter combined with iron, mercury, lead, zinc, and other metals from rusting cans, discarded batteries and appliances. It may also contain paints, pesticides, cleaning fluids, newspaper inks, and other chemicals. Contaminated water can have a serious impact on all living creatures, including humans, in an ecosystem.
When waste is burnt, heavy metals like lead, toxic gases and smoke spreads over residential areas. The wind also carries waste, dust and gases caused by decomposition. Putrefaction of waste in sunlight during daytime results in bad smells and reduced visibility.
Writer: Dr. Farrukh Chishtie


Staying Safe while Saving Lives

Healthcare professionals work day and night to save lives. Nonetheless, they have to deal with multiple occupational safety and health hazards every day. This safety article is quite general and covers some of the basic precautions to stay protected at work. For more specific comprehensive measures, follow referenced guidelines by established medical and professional authorities.            

Neglecting safety protocols can put your entire healthcare team at risk. It may also increase the spread of transmittable diseases in the community. Other than properly wearing Personal Protective Equipment (PPE) to prevent Novel Coronavirus COVID-19, you should follow these general safety rules year-round to keep yourself safe and healthy while serving humanity.

1. (Ergonomic) Repetitive Strain Injuries:

Ambulance officers and those working at hospitals regularly move immobile patients from stretcher to bed and wheelchair etc. Excessive heavy lifting could cause Repetitive Strain Injuries to those workers required to lift patients as well as large medical supplies every day. The injuries, also known as musculoskeletal disorders, could severely damage their bones, muscles, nerves, joints, tendons, or blood vessels making them unable to work for weeks and may require hospitalization.
To protect yourself from debilitating RSI ergonomic injuries, make sure to follow these instructions:
  • Learn proper lifting techniques to avoid unnecessarily straining your body muscles. Hospital administration should provide adequate patient moving training and equipment to their staff.
  • Keeping your feet apart and knees bent when lifting an immobile patient can significantly reduce the risk of ergonomic injuries. Always wear appropriate slip-resistant shoes.
  • Use mechanical devices, whenever possible, e.g. slip sheets and electronic hoists, etc.
    Remember! You should use one of those devices only if you know how to safely operate them. Improper usage could result in serious injury or death.
  • When there is no such device available, do not hesitate to ask your co-worker for help.
  • Do not overwork; take frequent breaks at work. Managers should make sure the workers are given at least one day (24 hours) off every week to help them relax and ease off fatigue. Hospital and ambulance staff are often required to work on annual festivals including Eid, Independence Day and Christmas, etc. They should also be granted fully paid compensatory holidays. Making exhausted staff work is not only dangerous for their health but it may also put the patients’ lives at risk.

2. Biomedical Hazards

Managing biohazards in hospitals, ambulances and diagnostic laboratories is a very important job to prevent healthcare services from becoming the sources of contagious diseases. Blood, urine and other body fluid are known to transmit deadly diseases like HIV, Congo fever, Hepatitis and Tuberculosis, etc. Some of the several highly contagious viral infections, including COVID-19, spread through the air. They are more dangerous than bloodborne pathogens. These safety practices could minimize your risk of catching an infectious disease at work:
  • PPEs are the last line of defense. Therefore, healthcare workers should regularly be vaccinated against common contagious diseases.
  • Always wear approved disposable gloves, head cover, mask, shoes and safety goggles. Splash resistant face shield should also be worn while performing high-risk tasks involving the risk of blood splash.
  • Make sure to properly dispose of your single-use PPE e.g. contaminated gloves.
  • Do not forget to wash your hands with antibacterial soap and water for 20 seconds even if you are wearing a pair of gloves during the job.
  • Hospital beds, ambulance stretcher and wheelchairs, etc. should frequently be cleaned with disinfectant.
  • Be extra careful with needles; medical professionals have lost their lives after catching deadly blood-borne diseases as a result of needlestick injuries. Immediately and cautiously dispose of used syringes in the biohazard waste bin.

3. Hazardous Chemicals

Cleaning hospital premises is the best way to keep everyone safe. However, chlorine-based cleaners are known to cause respiratory and eye irritation. Sanitary workers are the most vulnerable individuals, but other hospital staff, patients and visitors may also get affected by these harmful chemicals used for cleaning purposes.
  • Explore the safer alternative to conventional antibacterial cleaners which are just as effective but less harmful for health and environment.
  • Open all the windows to create a fresh airflow through the building while the floor is being disinfected by strong chemicals.
  • Sanitation staff should wear proper PPE.
  • Sensitive individuals should limit their exposure to those chemicals. 

4. Risk of Fire and Burn Injuries

Fire hazards are everywhere, and healthcare facilities are no exception. In December 2019, a cancer patient died after being set on fire during surgery in Romania. This tragic mishap happened at Floreasca Hospital (Bucharest) when alcohol-based disinfectant was accidentally ignited by a spark from an electric scalpel. Flammable disinfectants and poorly maintained electronic equipment are the leading cause of hospital fires. In June 2012, at least 6 innocent children perished after a fire broke out in the nursery ward of Services hospital Lahore. A 4-days old baby girl was burned alive in another incident on January 9th, 2020 after her incubator burst into flames at NICH Karachi. Fire safety should never be overlooked. Here are some basic safety tips to prevent such horrific accidents:
  • Intensive Care Nurseries should never be left unattended. The burning rubber-like smell could be the early warning sign of an electrical fire. Your quick reaction could prevent a major disaster from happening.
  • Hospital administrators should pay attention to the electrical wiring. Worn out wires and poorly maintained electrical devices are like a disaster waiting to happen.
  • Install smoke detectors and fire extinguishers and train the staff how to use them. They might be a little expensive but help minimize the risk of huge life and property loss.
  • Good quality circuit breakers of appropriate rating should be installed to prevent short-circuits.
  • Never use any (alcohol-based) flammable disinfectant during a surgical procedure with an electrical scalpel/laser beam.
  • Medical oxygen cylinders should be used and stored away from flammable chemicals and sources of ignition. Pure oxygen is not flammable in nature, but its leakage could cause any fire to burn hotter and faster than usual making it difficult to extinguish.
  • Improper usage of autoclave (to sterilize surgical equipment) and laser machines may also cause serious burn injuries to hospital workers. Always follow the instructions on the user manual and keep the machines well-maintained.

5. Physical Attacks

Violence against healthcare workers is a condemnable act. Unfortunately, such incidents are on the rise. Some mentally disturbed patients attack medical professionals who are treating them in hospitals. Medical staff at a coronavirus isolation ward had to run for cover as a deceased patient’s family members began to smash hospital equipment and windowpanes in a recent attack that happened on May 15th, 2020 at JPMC Karachi. Altercations between the patient’s attendants and healthcare workers are not so unknown. In some extreme cases, armed mobsters had attacked hospitals resulting in life and property loss. A charged mob of lawyers attacked Punjab Institute of Cardiology in Lahore a few months ago which is one of the worst examples of physical assault on medical professionals. Here is what hospitals administration and medical professionals can do to avert such violent attacks in the future:
  • Provide enough security by installing CCTV surveillance system and employing well-trained security guards.
  • No weapons should be allowed inside the medical treatment facility.
  • Try to maintain friendly relations with patients and their attendants by providing them the adequate medical care they deserve.
  • Learn effective techniques to calm down angry and mentally disturbed patients.
  • Train yourself to deescalate conflicts to stay focused on your main job which is to stay safe while saving lives!
Hospitals administration should conduct safety drills to be emergency-ready for different kinds of disasters including fire, earthquake and terrorist attacks, etc.
Writer: Sultan Kiani
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