It’s hard to know the true extent of the outbreak in Afghanistan, which has documented more than 36,000 confirmed cases and nearly 1,300 deaths but has carried out only 87,000 tests nationwide. An overwhelmed health system, public fear of crowded hospitals and reliance on traditional treatments are probably obscuring the true toll.
Thousands of people who fell ill and later recovered never knew whether they had contracted the virus. Many described experiencing headaches and fevers, sometimes with other signs associated with the coronavirus, such as losing their sense of smell. But without being tested, they could not be sure.
“Our whole family got sick with headaches and fever, even the kids, but we all got through it,” said Mir Ahmad, a lawyer in his 40s whose family did not get tested for the virus. “We stayed together in the house for more than a month. We made juice with lemons and oranges. I drank five pots of tea a day. We stayed away from sweets and oily food, as the doctors recommended. Now we are all fine.”
Zamin Modabber, an employee at a technology company, felt sick after going to a large dinner in June. Other guests also fell ill, and the one who ventured to a clinic for testing got a positive result. Modabber, 30, said he refused to seek hospital treatment even though he was in “excruciating pain,” because he feared it would make him sicker.
“The environment of the corona hospital is worse than the virus itself,” he said, because it “weakens morale” and risks contamination. Worried that he might infect his ailing in-laws, he said, he camped at his office for weeks, preparing vegetable dinners and drinking “a lot of honey, lemon and ginger tea.” He said he has fully recovered.
The World Health Organization said Sunday that limited health resources and testing, plus the lack of a national death register, have made confirmed cases and deaths in Afghanistan “likely to be underreported.” It suggested that “the peak has not yet passed and cases may still accelerate.”
Afghan health officials have said the numbers of coronavirus cases and deaths may turn out to be considerably higher in rural areas, where both testing and hospital facilities are lacking and public access to information is limited. Some villagers, they said, are still unaware that the coronavirus exists.
In urban areas, however, health officials said that people had responded well to an early and consistent campaign on radio and TV advising them to stay home if they felt sick, eat only nutritious food and seek medical treatment if they had difficulty breathing or developed other serious symptoms.
Religious leaders endorsed the messages, announcing that people should not crowd into mosques and should pray at home if sick. To reduce the stigma of the disease, the national council of Islamic clerics declared that anyone who died of it would be considered “shaheed,” or a martyr to Islam.
“People have followed the advice of medical authorities. No one has challenged it,” Health Minister Ahmad Jawad Osmani said Monday. In Kabul and other urban centers, he said, the situation is close to achieving minimum standards for herd immunity, but some rural pockets are “still at risk.” But herd immunity requires people who have recovered from the coronavirus to be immune from future infection, and whether coronavirus survivors develop a lasting immunity is unknown, according to medical experts.
Even urban dwellers, though, have been tempted by promises of a miracle cure. In June, thousands flocked to an herbal-medicine dispenser in Kabul named Hakim Alokozai, who offered a curative potion. After officials found it contained a dangerous mix of narcotics, they shut down his clinic amid angry street protests.
By this week, though, the capital had returned to normal. A commercial shutdown and traffic ban had been lifted, the virus seemed to be in recession and spirits were high with the four-day Muslim festival of Eid al-Adha due to start Friday. In an informal survey of people across Kabul, more than a dozen said they or their loved ones had survived a flu-like illness they assumed to be the coronavirus.
Asked how they had recovered, most said they had followed advice from doctors on TV or, in some cases, in their own families. Mohammad Elyas Rahmani, 23, an engineering student, said almost everyone in his family came down with the virus. One uncle, a physician living in Germany, called daily with advice, recommending fresh juice and beef broth.
“He told us what to do, step by step,” said Rahmani, who is now recovered. He said he suffered from a severe headache but never got tested or went to a hospital. His uncle said that going to a crowded, poorly equipped facility “could weaken the body’s immune system” and should only be a last resort.
There was only one downside to the high-vitamin, low-fat regimen prescribed by the experts: It cost a lot more than the typical Afghan meal of rice, meat and bread. Oranges are imported from Pakistan, lemons from Iran and kiwis from Tajikistan. Before the virus arrived, lemons cost less than 50 cents a pound; by June the price had shot up tenfold.
“I never sold so many oranges before. People couldn’t afford it, but they had no choice,” said Esmatullah, 30, a produce seller in Kabul who uses one name. He said he wore a mask and gloves at his stall each day, then took leftover fruit home at night.
“Thanks to God, nobody in my family got too sick,” he said. His only regret was also welcome proof that the virus has subsided: The price of lemons is back to 50 cents a pound.