Since coronavirus first emerged in February 2020, there have been a series of lockdown. From parks to cinema halls and from restaurants to travel restrictions, people have adjusted themselves with almost everything but the most worrisome thing around these times have been health conditions and precautions to avoid going to hospitals as hospitals are the hub of the virus.
Since the easing of lockdowns last year, many doctors and health practitioners have suggested that Gastrointestinal (GI) disorders will increase as people will go out and eat unhygienic foods which they were avoiding due to lockdown and restrictions on restaurants.
What doctors have to say?
With the situation of the virus getting better in the country with each passing day, the restrictions are also lifting and lockdown is also easing as comparable to last year however, it is important to note that GI-related disorders are also the second-highest symptoms of Covid-19 and not just due to unhygienic eating habits. “Among 8-10 patients who come with complaints of diarrhea and stomach aches almost 30 to 40 per cent are Covid-19 positive and have mild or no other symptoms such as cough, flu, and fever,” said Associate professor and Director Gastroenterology Liaqat National Hospital Dr Lubna Kamani.
Stomach aches, vomiting, diarrhea and nausea – are all second most prominent symptoms of the virus and many hospitals consider conducting Covid-19 PCR or antibodies tests before examining any patient. “Just because there is very little to no awareness of these symptoms, it is mandatory to conduct the test as on average 2 to 4 patients daily test positive for Covid-19 who have no fever, cough or flu but just GI disorders. There are many patients who come for the endoscopy but even they are Covid-19 positive,” said Dr Kamani, who is also a consultant at the Aga Khan University Hospital.
As far as the correlation of easing lockdowns and eating of unhygienic foods is concerned, many people who have the access to online ordering never stopped eating food prepared outside their homes, and in fact, some people were ordering more than ever during that time. “In the beginning of the lockdown for a month or so the restaurants were closed even for delivery but once deliveries were allowed, people ordered in record numbers as they were just staying at their place working from home and ordering food,” she said, adding that the number of people who can order food online is different than the ones who opt for roadside food stalls which are unhygienic in comparison.
The deadly virus is not just a condition but a viral infection which affects muscles and causes several symptoms which can vary from person to person. “People also complain about headaches in Covid-19 but people need to be vigilant about what they eat as eating spices and unhealthy food can cause a problem which can directly affect the liver,” said Dr Kamani, pointing out that the government also needs to add these second-highest symptoms in the awareness messages so that people should be aware that it is not only cough, fever and cold that are symptoms but that GI disorders should also be taken seriously.
Keeping in view that the socio-economic condition of the country and the quality of the food which is available for the people’s consumption, Dr Shahid Ahmed thought that nothing was different in the one and a half years of on and off lockdown and closure of restaurants as people of each financial slab chose restaurants and food according to their socio-economic conditions, which clearly define the quality of the food people are consuming. “We are not receiving any extraordinary cases but the normal routine number of cases of abdominal pain or diarrhea, which we treat by keeping them under observation and treating through antibiotics,” said Dr Ahmed who is a professor and head of department Gastroenterology at the Dar-ul-Sehat hospital.
People complaining about GI disorders due to eating out especially street food or roadside food is nothing new but has been a regular complaint of the patients who are avid foodies, mostly office going people who usually eat street food once a day. “The trend of eating out is nothing new since last few years the capacity of eating out has increased drastically. One of the main reasons is there are many options available in different price ranges for every financial class and the reason for increased cases is the same because everything available in the market is not up to the standard,” he said.
Testing of every patient who is coming to the hospital complaining about abdominal pain is not mandatory by the government but few hospitals have made PCR or rapid antigen test mandatory for the protection of the doctors. “Few hospitals conduct tests before treating any patients or admitting them but we do not follow this as it can cause extra burden on the patient in terms of money and also this isn’t the government’s orders,” he said.
How foodies are taking it?
Even with the food delivery applications and restaurants saw an eager increase in numbers of orders during lockdown when people couldn’t go out to dine-out still the enthusiasm to step out and dine-out was seen in many avid foodies. “It’s not that we didn’t order anything in last few months since the indoor dine-out was closed but coming out of the house and eating here was something I was missing badly,” said Iqra Khan, who was in the waiting area of a restaurant with her family while waiting for her turn for half an hour. She also said that she and her sisters were tired of sitting at home and ordering food as the food doesn’t taste the same at home as it does at restaurants.
Another consumer who regularly dines out with his friends said that since restaurants in the city were closed they have been choosing to eat out on the highway mostly as almost every restaurant at the highway was open and with no time restrictions. “Highway was open even when restaurants were closed for even outdoor dine-in, but yes after eating hygienic food at home for so many months eating out was different and two of my friends got diarrhea,” said Ishan Ahmed.
How patients take it?
No matter how hygienic or expensive food one eats at any restaurant, after a long break from eating out to sudden ease in dining out has caused a frenzy amongst dining out customers, which itself is an open invitation to the GI disorders. Similar is the case of ten-year-old Muskan who went to eat out with her family on a weekend and ended up becoming hospitalised for two days after having severe diarrhea. “As soon as the indoor dine-out opened a few weeks ago we decided to go out to celebrate our elder son’s result. Little did we know that almost everyone in the family of six will start complaining about stomach aches from the very next day,” said Muskan’s mother Seemi Khan, who was getting her discharged from the hospital.
Khan and her family are not just ones suffering from eating out but several people have been facing the same situation, “My daughter started vomiting which I thought was due to the fact that we were traveling and she had heavy breakfast but then the vomiting kept continuing to the point where she was even vomiting water. It was then that we rushed to the hospital but luckily it was nothing serious,” said another worried mother who has been traveling for a week and has only been eating street food. She also said that quality and hygiene is the main reason why her four-year-old daughter kept complaining about abdominal pain.
Research on harmful spices
The correlation of market available spices being harmful to the health and causing GI disorders are nothing new but several researchers and studies have been conducted on the subject now and then. One such research was conducted by the professors of the Environmental Studies department at the University of Karachi by Dr Moazzam Ali Khan and Dr Amir Alamgir back in 2016 where their research proved that the quality of the ready-made spices which are easily available in the markets may cause liver damage and even cancer.
The samples for the study were taken from not one place but in fact 40 different samples were collected from different parts of the city mainly where the consumers are high.The six-month-long research concluded that the spices contain heavy metal mixes are a health risk. The metal and their high concentration can cause liver ailments, stomach aches, fat issues, and much more life-threatening diseases.
The research not only collected samples but shared the findings that market-based spices which are mostly used in every household and mostly in outside food had the presence of mercury, arsenal, lead, nickel, chromium, and cadmium. All such metals are toxic even if they are used in micro concentration and all are mostly used in biryani, nihari, tikka, chapli kebab and karahi gosht which are usually in demand when people go out to eat. The research not only concluded that the metals are found in locally sold and made spices but also in branded ones but concentration might be mess comparatively. However, the locally made spices are sold more in the market.
What restaurant owners have to say?
With the lockdown lifting and restricting, again and again, the restaurant business has been affected badly, with dine-out being restricted and even outdoor seating capacity to be specified and distance should be maintained has changed the parameters of the whole restaurant industry. “In last year and a half it was hardly four months that dine-in was allowed and even with delivery allowed, the time restriction made it difficult for us to manage our expense and even pay salaries of our employees,” said a restaurant owner, who runs a local burgers restaurant in Nazimabad.
The situation of lockdown at eateries is different for restaurants, as many rely on a local variety of ingredients and are providing the same quality which is available at home. “There are two things which are important here that the ingredients we use are similar to the ones people use themselves at their homes and secondly the rush in dine-in is not because the people didn’t get anything to eat in these times but the exhaustion they feel when they can’t go out and eat,” shared Chef Asad who is also an owner of a restaurant named Urban Tarka. He also pointed out that the main reason for rising number of diseases and Covid-19 rates might be due to customers not following SOPs and not due to hygiene issues at the restaurants. “People are advised to keep wearing masks the entire time they are waiting for food or their turn outside the restaurant but they don’t follow this rule and even not accept wearing masks which the restaurant provides and don’t sanitize their hands despite the fact that we have placed hand sanitizers on every table that we serve on,” he explained.
The main reason for the increasing rush at eateries was due to restrictions in wedding halls when people opted for parties and small gatherings at restaurants where they can arrange parties in the open air. “People were coming to restaurants and eating even in their cars when dine-in was closed but the number of people started increasing when we started offering space for small parties but the irony is that even in the party of 50 to 60 guests hardly 10 per cent are there who are wearing masks while others don’t even listen to the instructions,” said Chef Asad, while adding that they have even hosted nikkah, reception and rukhsati events when halls were closed with upto 100 guests.
What associations are doing to curb it?
The future for restaurants and their owners has been in limbo since the lockdown began and now as the country is moving towards the fourth wave and another lockdown on dine-in is expected as the city’s Covid-19 positive ratio is increasing day by day. Restaurants owners and the quality of maintaining hygiene is what matters here. “After the lockdown was eased after the first wave on August 10, 2020, indoor dine-in was opened only for two months while in all of this scenario outdoor dine-in was also closed for more than five months in total but the sales of online food delivery shot up to record-breaking numbers, with at least 200,000 orders per day. So it means people were eating restaurant foods and have been consuming more than before,” said former Chairman All Pakistan Restaurant Association Waqas Azeem.
People who have complained after eating out can have many other factors attached to their condition as well. “Customers who were eating in their safe and healthy environment at home and are now suddenly eating out might have some change in diet and also can be seasonal change which is affecting their overall eating habits,” he explained, adding that most of the common customers do not rely on upon indoors especially at night because they want to enjoy the cool breeze of Karachi and that is the reason why restaurants at Do Darya and Highway are the most revenue-generating places in the city.
With the specific gentry which the restaurants cater who are assured to strictly follow the rules and regulations, most of their customers are already vaccinated but the main issue is the customer who is consuming food from roadside dhabas, hotels and street vendors. “It is still a challenge to make that customer believe that we are in the middle of the pandemic and eating out unhealthy can cause them GI diseases when that customer is not even ready for vaccination yet,” he added, who has more than 100,000 restaurants under the organisation with around 2.5 million employees.