Throughout April 2020, deaths of patients exhibiting symptoms that medical doctors insist are consistent with COVID-19 have increased with alarming rapidity although, until today, the Tajikistani government appeared to be in denial. The bearers of bad news – doctors and independent journalists – have been at risk of harassment and intimidation as officials urged doctors not to refer patients for testing. Dozens of medical doctors are reported to have died and many hospitals are filled with quarantined medical personnel and patients. A pattern of illnesses with prisoners suffering from fever and respiratory problems has been reported from penitentiary institutions. Until today, state television channels informed the public repeatedly that Tajikistan is a country free of COVID-19 and citizens were caught between trusting the authorities and fearing they were being misled.
Before today, Tajikistan had not officially registered one single case of coronavirus, but an announcement on 30 April – on the eve of a visit from a delegation of the World Health Organization — confirmed that there have been 15 positive tests for coronavirus in the country, 10 in the northern region of Soghd and 5 in the captial city Dushanbe. At the same time, media and other reports indicate that the situation is far more serious.
Until Tajikistan closed its borders (at least the official check points) and halted most air travel (since 23 January for flights from China and from 20 March for all other international flights), labour migrants regularly commuted to and from Russia and other Central Asian states. China, where the virus originated, is an important trade partner and there used to be lively interaction with European and other countries that are now severely affected by the pandemic.
On 1 February 2020 the authorities began putting people who arrived in Tajikistan on international flights in “quarantine“ in public medical facilities for 14 days. In the period from 1 February to 20 April, over 8200 individuals were placed in shared rooms in these institutions. They were not tested for coronavirus and many of them reported that no preventative measures such as practicing social distancing or wearing masks were implemented. Medical and service personnel who were in contact with them also did not take protective measures in most cases. In addition, there were cases of returning travellers who used their contacts or paid bribes to avoid going into quarantine.
First cases with COVID-19-like symptoms
According to reliable sources, the first known cases with symptoms consistent with COVID-19 were detected in the northern city of Khujand before the Navruz (spring) celebrations in the second half of March. Reliable sources reported the case of a family who were quarantined in their home and received medical treatment until they recovered; one family member has still not regained senses of taste and smell, symptoms that are often associated with the coronavirus.
As the virus was spreading fast around the world, Navruz was celebrated across Tajikistan, and an especially big event took place in Khujand in the northern Soghd region on 22 March, where President Rahmon oversaw a celebration in a stadium together with some 12 000 people. The first reports about diseases with alarming symptoms are believed to have originated from Soghd region.
The first case reported in the media was that of Habibullo Shodiev, who died on 1 April in the central hospital in Jabbor Rasulov district of Soghd region. He was officially diagnosed as having died from bilateral pneumonia. His relative, Abduhalil Juraboev, who attended Habibullo Shodiev’s ablution, a burial rite, was admitted to Soghd Regional Hospital in Khujand around two weeks later and died on 21 April, with the same diagnosis.
Hospitals: hot spots of outbreak and spread
Hospitals appear to have become hot spots for the outbreak and spread of illnesses with COVID-19-like symptoms. Outpatient clinics and medical personnel in ambulances do not examine patients with respiratory symptoms, but refer them to hospitals where they are quarantined for 14 days. There they are not actually isolated and remain in contact with other patients.
In recent weeks there have been reports of the deaths of several medical doctors who were in contact with patients under quarantine in hospitals in Dushanbe, in Soghd region and the southern Khatlon region; and of many other doctors developing respiratory problems.
Medical doctors complain about the absence of clear medical procedures to protect against the virus and the lack of sufficient protective equipment and clothing. Many report having had to buy protective equipment with their own wages. Doctors treating quarantine patients in hospitals reportedly receive one set of protective clothing which they have to disinfect themselves overnight while doctors working in other medical institutions are instructed not to wear protective gear in order not to scare their patients.
In different parts of the country hospital doctors report seeing mounting numbers of patients with pneumonia-like symptoms every day. Reliable sources in Tajikistan estimate that over a thousand patients have been admitted to hospitals with respiratory problems in the second half of April. According to official figures, 300 individuals have recently been hospitalized in Medical Centre No. 1 in Dushanbe with pneumonia symptoms; 136 of them were medical personnel.
Currently, hospitals across the country are filled with patients suffering from respiratory illnesses and persons with whom they have been in contact. The Medical Centre No. 1 in Dushanbe is now closed to any new patients and patients are reportedly being transferred to hospitals in Gissar.
Respiratory illnesses in the penitentiary system
In recent days there has been an increasing number of reports about prisoners suffering from respiratory illnesses. Among them are journalist Daler Sharipov, who was recently convicted to one year’s imprisonment on fabricated charges, and lawyer Buzurgmehr Yorov, who is serving a long prison sentence after being convicted on politically motivated charges. On 31 March 2020 the authorities suspended visits to prisoners with the exception of lawyers’ visits, but lawyers are often hesitant to see detainees in pre-trial detention for fear of infection. Reportedly, a lawyer recently died of pneumonia in Soghd region.
Doubting the official line
Until today the Ministry of Health and Social Protection of the Population (further Ministry of Health) repeatedly insisted that all tests for coronavirus conducted so far have come back negative. According to Galina Perfilyeva, the head of the Office of the World Health Organization in Tajikistan, as of 16 April the country had conducted 2317 tests, 440 of which were repeat tests. This appears to be a very small number for a population of around eight million.
On 18 April, Jamshed Shohidon, the Deputy Health Minister, explained the spike in pneumonia cases as being caused by the exceptionally rainy weather conditions.
Medical doctors report that officials of the Ministry of Health put pressure on medical personnel not to refer cases for testing to the Dushanbe-based laboratory – the only one in the country equipped to test for coronavirus. According to the Ministry of Health, the laboratory’s test results used to be double-checked by laboratories in London, Moscow and Novosibirsk, but this practice ended when the borders were closed and air travel stopped.
Doctors also claim that the symptoms they are now seeing in patients, and on x-rays and CT scans of the lungs are different from those associated with ordinary pneumonia. Patients deteriorate very quickly and many are dying of oxygen deficiency even when connected to a ventilator.
Doctors from one hospital reported that out of a total of approximately 100 pneumonia patients at least 40 exhibited COVID-19-like symptoms. In some of these cases tests for coronavirus were conducted, but the Dushanbe laboratory returned negative results, raising doubts about their accuracy among medical experts.
Hope that the virus has not yet reached Tajikistan – as the authorities insisted before today – lead to many citizens continuing life without taking precautionary measures. Until today food markets were crowded with people who, in many cases, did not wear masks. Preventative measures imposed by the authorities in recent weeks include the closure of mosques, the suspension of the domestic football league on 26 April, and “forced holidays“ in kindergartens and schools starting on 27 April. On 29 April students were informed that universities would be closed until September. When the first cases of coronavirus were confirmed on 30 April, the authorities made the wearing of masks obligatory.
While it is a positive sign that the authorities have finally admitted that there are cases of coronavirus in the country, the virus has already spread alarmingly across the country, affected large numbers of people and put considerable strain on the health system.
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