According to PMD (Pakistan Meteorological department), many cities in Pakistan have hit record-breaking heat in the summer of 2021. Data collected shows that almost every city in Pakistan has recorded over 40 degrees Celsius with areas like Jacobabad reaching 48 degrees while KPK and surrounding areas recorded the temperatures to be between 46 degrees to 48 degrees Celsius. Specifically, Karachi’s temperature soared to 46.6 degrees Celsius, the highest temperature recorded in over 70 years. The last time Karachi was this hot was back in April of the year 1947.
Due to this intense heat, a mammoth of the population has either packed up their bags and traveled north to avoid the heatwave or have taken to activities involving water bodies like waterparks, country club swimming pools, or farmhouses.
Due to the hordes of people making their way towards the water activities, especially in Karachi, one would expect there to be no compromise on the upkeep and cleanliness of these places. However, that has not been the case, as on June 27th, 2021, 19-year-old Rana Sharjeel lost his life to Naegleria fowleri, a brain-eating bacteria, which infected him while he was out swimming with his friends in a lake on a farmhouse in Malir, Karachi.
Naegleria is an ameba (a single-celled organism) that is commonly found in warm freshwater. There are only one species of Naegleria, known as Naegleria Fowleri, which infects people. This particular strain was discovered in the year 1965. Although it was first discovered and identified in Australia, it is believed to have evolved in the United States.
It is this species of Ameba that is responsible for the disease called Primary amoebic meningoencephalitis (PAM), or otherwise more commonly known as the brain-eating bacteria. They are normally found in geothermal waterbodies like hot springs, warm freshwater bodies for example lakes and rivers poorly maintained swimming pools, and soil.
It is next to impossible to get PMA by drinking contaminated water. The only way it can infect a person’s brain is if the ameba travels up through the nose. Therefore, activities like water skiing or diving in contaminated water bodies comparatively have a higher probability of getting a person infected.
Rana Sharjeel’s demise marks the sixth life taken by N. fowleri since the beginning of the year 2021. According to The Lancelet, only 2, out of the six people who died, were known to have recreational activities involving waterbodies.
It is also reported that some of these deaths were caused by people getting infected at home while performing Wudu (religious ablution that involves cleaning the nose using water). This, therefore, points to the suspicion that Karachi’s water supply might have become contaminated. This particular concern was also raised by Pakistan Medical Association’s (PMA) representatives Dr Qaiser Sajjad, Dr. Samreen Sarfaraz, and Dr. Abdul Ghafoor Shoro who have openly stated, “The filtration and chlorination of potable water provided in the city is questionable. The water distribution system was faulty, allowing seepage of sewage in the domestic water supply, which got contaminated and caused harmful diseases like Hepatitis A and E, Typhoid, Cholera etc.”
Dr Mirza Ali Azhar, heading PMA-Sindh Chapter, went as far as to say, ““The chief justice should take Suo Motu notice on this matter. It’s criminal negligence and responsible officials should be punished. We know that water has not been chlorinated at all for many years,”.
This begs the question of the possibility of N. fowleri, which is normally found in warm freshwater, surviving in Karachi’s briny and contaminated with sewage water supply. The only viable variable is that the strain of N. fowleri found in Karachi has somehow become resistant and immune to the saline seawater and is now, possibly, present in the water that is being supplied all over the city.
Studies suggest that it takes anywhere between 6 to 15 days for the physical symptoms of PAM to start showing. Some of the symptoms of this disease are fairly common and can be easily mistaken for a cold or flu. Other serious symptoms of the disease might also look like bacterial meningitis. The more common symptoms include:
However, the more critical symptoms are rather severe and can include:
According to the Centers for Disease Control and Prevention (CDC), there is no definite cure for this condition. Once a person gets infected, there is a 98% chance that they will not be able to survive the disease. This fatal disease causes death within two weeks after the initial infection.
The one and the only way to absolutely make sure that this bacterium does not survive is to ensure that an appropriate chlorination process is conducted. Several investigations conducted on numerous water activity sites all concluded that there was little to no chlorination process carried out by the respective organizations responsible for the maintenance. The PMA prescribed process involves using 1 tablet of chlorine for about 1,000 gallons of water.
For our part, it is strongly suggested by the Medical Association to make sure the pools for the amusement activities are properly disinfected and chlorinated. PMA also urges people to personally clean the water tanks at least once a year, including those of schools, malls, personal residences, hospitals, and offices.
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