Smog! A New Threat Emerging in India and Pakistan

Smog: A Growing Hazard in India and Pakistan 

The competition for the world's most polluted city is being run in between Lahore and New Delhi.

Pakistan ranks 179 & India ranks 176 out of 180 countries on the Environmental Performance Index. 

According to the World Health Organisation, air pollution in Pakistan is expected to increase by 50% by 2030.

In recent years, smog has emerged as a significant environmental and public health threat in South Asia, especially in India and Pakistan. This hazardous mixture of smoke and fog, scientifically known as “photochemical smog,” results from complex reactions between pollutants like nitrogen oxides and sunlight. The issue has garnered increasing concern due to its profound health impacts, economic costs, and detrimental effects on regional ecosystems.

What is SMOG!

Smog is essentially a cocktail of smoke and fog, intensified in colder weather when emissions from vehicles, industries, and burning biomass combine with cooler air and sunlight. Known as photochemical smog, it forms primarily when nitrogen oxides, volatile organic compounds, and other pollutants react under sunlight. The resultant particulate matter, particularly PM 2.5 (particulate matter with a diameter of 2.5 micrometers or smaller), can easily penetrate the respiratory system and bloodstream, posing severe health risks.

Definition of Smog

The term "smog" is a portmanteau of the words "smoke" and "fog". It's a particulate cloud that's often seen over urban areas. The term "smog" was first used in the early 1900s to describe a mix of smoke and fog. In 1909, more than 1,000 people died from smog in Glasgow and Edinburgh alone. 

What is Air Quality Index

Air quality is measured by the Air Quality Index (AQI) in particulate matter (PM) units. Recently, Lahore’s AQI levels for smog and pollution surpassed 700 for the first time in recorded history. According to NASA, between 15,000 and 18,000 fires were lit across India and Pakistan to clear fields. Farmers commonly burn rice stubble after harvesting, especially toward the end of October, resulting in massive amounts of airborne pollutants. Reports indicate that in India alone, approximately 32 million tons of rice stubble were burned.

The Air Quality Index (AQI) is typically categorized into six levels, each representing a different level of air quality and its impact on health. Here’s the standard AQI scale used by many countries, including the U.S. Environmental Protection Agency (EPA): 

Types of Smog

There are two main types of smog:  

• Photochemical smog: This type of smog is most common in urban areas. It's created when sunlight reacts with nitrogen oxides (NOx) and volatile organic compounds (VOCs) from car exhaust, coal power plants, and factory emissions.  

• Sulphurous smog: Also known as "London smog", this type of smog is caused by high concentrations of sulfur oxides (SOx) in the air from fossil fuels like coal. It's made worse by dampness and particulate matter (PM).

Smog Situation in Region

On November 10, 2024, NASA released an image showing Pakistan’s Punjab province shrouded in thick smog, visible even from space. This image was circulated widely by global media outlets.

The contest for the world's most polluted city is currently between Lahore and New Delhi. Sometimes one is ahead, sometimes the other. Annually, Lahore ranks as the 5th most polluted city globally, 

Faisalabad ranks 12th, 

and Peshawar ranks 34th.

Out of the world's 50 most polluted cities, 42 are in India and 3 in Pakistan. This makes our region the epicenter of global pollution. Among the most polluted countries, Bangladesh ranks first, Pakistan second, and India third.

Multan AQI crosses 2,000 Mark

In Multan, the air quality index (AQI) hit a staggering 2,135, a level far beyond safe limits. This AQI reading is more than six times the "hazardous" threshold of 300.

Why Doesn’t Smog Form in Karachi or Mumbai?

Smog, a pressing environmental challenge, is a common phenomenon in cities like Lahore and Delhi but is notably absent in coastal cities such as Karachi and Mumbai. Understanding why this disparity exists requires a look at weather patterns, geographical features, and pollution dynamics.  

Smog formation relies heavily on two conditions: high pollution levels and specific atmospheric factors. In regions like Lahore and Delhi, cooler weather during winter leads to fog—a collection of water droplets suspended in the air. When pollution particles mix with fog, they create the dense, hazardous haze we call smog.  

In contrast, Karachi and Mumbai, being coastal cities, benefit from steady sea breezes. These winds disperse pollutants, preventing fog and smog from forming. The absence of stagnant air conditions means that pollution particles don’t settle in one place, unlike in landlocked regions prone to still weather. 

Who is Responsible for Smog?  

In Punjab, transportation contributes the most to smog at 43%. The industrial sector follows with 25%, agriculture at 20%, and emissions from coal-fired power plants and generators at 12%. If we focus solely on Lahore, 83% of its smog is due to vehicle emissions. In Pakistan, motorcycles alone consume 40% of the total fuel.

While weather plays a significant role in smog formation, human activities remain the primary driver. In Pakistan, 83% of air pollution comes from vehicles. The sheer volume of automobiles and motorcycles on the road contributes significantly to the problem:  

• Over 4 million cars and 24 million motorcycles operate in Pakistan.  
• In the past five years alone, Pakistan imported petroleum products worth $73 billion. Of this, $15 billion worth of fuel was consumed by motorcycles, which account for 69% of vehicular emissions. Cars and jeeps contribute an additional 23%.  

These staggering figures highlight the scale of pollution stemming from the transportation sector.  

Why Is Pakistan Lagging in Cleaner Fuel Technology?  

Globally, countries have shifted to cleaner fuel standards like Euro 5, which significantly reduces vehicular emissions. This advanced fuel, also known as "high-octane," produces up to 60% less toxic emissions compared to regular fuel.  

However, Pakistan continues to use Euro 2, a far less efficient and more polluting grade of fuel. The reliance on outdated standards exacerbates the air quality crisis, as vehicles emit higher concentrations of harmful gases.  

If Pakistan transitioned to Euro 5 fuel and mandated its use across all vehicles, it would drastically reduce the severity of air pollution, especially in smog-prone regions.  

Health Impacts of Smog Exposure  

The adverse health effects of smog are well-documented. PM 2.5, which is especially prevalent in smog, is small enough to bypass natural body defenses and enter deep into the lungs and bloodstream, leading to respiratory and cardiovascular diseases, aggravation of asthma, and, in some cases, premature death. In Pakistan alone, pollution-related illnesses claim over 125,000 lives annually. The World Health Organization (WHO) estimates that nearly 22% of deaths in Pakistan are linked to pollution, with a substantial portion attributed to air quality.

Smog exposure has also been shown to decrease life expectancy. A recent study found that long-term exposure to air pollution can reduce the average life expectancy by up to four years in Punjab, the hardest-hit region.

Environmental Factors: The Role of Agriculture and Industry 

Smog severely damages crops and ecosystems. 

Agricultural practices contribute significantly to seasonal smog, with crop residue burning a major factor. Each autumn, farmers in both India and Pakistan burn leftover stubble after the rice harvest. According to NASA, between 15,000 and 18,000 fires are ignited across the region during this time. A 2023 report highlighted that around 32 million tons of rice stubble were burned in India alone, releasing substantial pollutants into the atmosphere.

Urban sources also exacerbate the problem. Lahore’s transportation sector, for example, with around 5 million motorcycles, is a major contributor to smog. Converting these vehicles to electric power could markedly reduce emissions. Industrial emissions, especially from coal-fired plants and kilns, are significant contributors, as they release particulate matter and sulfur dioxide into the atmosphere. 

This escalating pollution poses a dire threat to public health and the environment. Immediate measures are needed to control emissions from key contributors, particularly the transportation and industrial sectors. Enhancing public transportation, adopting cleaner energy sources, and enforcing stringent environmental regulations can help mitigate this crisis.

Investing in green technologies, promoting awareness about the adverse effects of pollution, and international cooperation are crucial steps to safeguard our future. The time to act is now if we wish to breathe cleaner air and protect our planet for generations to come.

 

Comparative Lessons from The Great Smog of London  

The Great Smog of London in 1952 is an instructive historical precedent. The event, which resulted in nearly 10,000 deaths, led the United Kingdom to enact the Clean Air Act, restricting coal burning and imposing controls on industrial and vehicular emissions. Similar policies could be adapted for South Asia to address smog and pollution-related challenges.

Economic Costs of Smog 

Beyond health impacts, the economic toll of smog is immense. A 2022 World Bank report estimated that air pollution cost the Indian economy approximately $95 billion annually, or around 3% of its GDP, due to productivity losses, healthcare costs, and premature deaths. Pakistan, too, faces significant economic strain from pollution, with healthcare costs rising in proportion to the increasing air quality index (AQI).

Protective Measures for Individuals 

In the face of persistent smog, personal protection is also crucial. Reducing outdoor activities during high-smog days, using air purifiers indoors, and wearing protective masks outdoors can help mitigate individual exposure to harmful particles.

Solutions: A Call for Regional Cooperation 

Given the trans-boundary nature of air pollution, regional collaboration is essential. Both India and Pakistan need to coordinate a comprehensive action plan. Introducing stricter emissions standards, promoting cleaner technologies in agriculture and transportation, and educating farmers on alternatives to crop burning could all make a substantial impact. Incentives for sustainable farming methods, along with penalties for burning practices, might encourage wider adoption. Encouraging farmers to adopt alternative methods could help curb this smoke.

Moreover, bikes and transport should be shifted from fossil fuels to electric energy.

Fossil-fuelled plants should be converted to other resources like renewable energy.

Tackling the smog crisis in South Asia requires immediate, well-coordinated action. While smog is not a new phenomenon, the scale and severity it has reached in India and Pakistan are unprecedented. As other countries have shown, policy reforms, technological solutions, and community involvement can make a difference. Collaborative efforts between India and Pakistan, driven by a shared action plan, could transform smog from a perpetual threat to a managed challenge, benefiting the health, economy, and environment of the entire region.

The Path Forward  

To address smog effectively, a multipronged approach is necessary:  

1. Upgrade Fuel Standards: Transitioning to Euro 5 fuel is critical for reducing toxic emissions.  

2. Promote Public Transport: Reducing the reliance on personal vehicles can significantly cut down emissions. Investments in efficient and affordable public transit systems are essential.  

3. Encourage Electric Vehicles: A shift toward electric and hybrid vehicles can alleviate the environmental burden caused by traditional fuel consumption.  

4. Adopt Urban Greenery: Planting trees and creating green belts can absorb pollutants and improve air quality.  

5. Strengthen Regulation: Enforcing stricter emission standards for vehicles and industries will ensure accountability and compliance.  

Smog is a reminder of the environmental toll of unchecked human activity. While Karachi and Mumbai escape its grip due to their coastal climates, cities like Lahore and Delhi suffer its full impact. Addressing this challenge requires not only technological upgrades but also a collective commitment to sustainable practices.  

The solution lies in proactive measures—transitioning to cleaner fuels, adopting greener transportation options, and enforcing robust environmental regulations. Only through such initiatives can we breathe cleaner air and pave the way for a healthier future. 

Polio and Pakistan

Polio Virus in Pakistan

One of the most widespread myths about the polio vaccine is that it causes infertility, despite Pakistan’s population growth rate being the highest in South Asia. Countries like India, Bangladesh, and China have significantly lower growth rates, and while Bangladesh once had a larger population than Pakistan, Pakistan has since surpassed it. It’s ironic that even those with large families believe these rumors—where do they think all these children are coming from? Areas most affected by these false beliefs include Khyber Pakhtunkhwa (KP) and major cities like Karachi.

The polio virus attacks the human body by first replicating itself in the intestines, after which it travels through the bloodstream to the brain and spinal cord, causing paralysis, weakened bones, and often lifelong disability. Polio has been affecting humans for millennia, but it wasn’t until the 1900s that the wild polio virus became particularly virulent, spreading as a pandemic. In the 1950s, Dr. Jonas Salk and Dr. Albert Sabin developed vaccines that successfully combated this crippling virus and nearly eradicated it from the globe.

In 1988, the World Health Organization (WHO) launched a worldwide campaign across 125 countries, which led to a 99% reduction in polio cases. In 1988, there were approximately 350,000 cases, which dropped to just 223 cases by 2012.

Pakistan started its polio eradication campaign in 1994 when the country had over 30,000 cases. By 2004, this number had dropped to around 30. However, due to disruptions in polio campaigns in conflict-affected regions, cases surged past 300.

Today, Pakistan is the only country where vaccination efforts are sometimes enforced at gunpoint to protect people’s health.

 

Along with Afghanistan, Pakistan is now one of only two countries where polio remains endemic. The primary reason? Unfounded rumors and misinformation.

What to Eat in Morning Empty Stomach

What to Eat on an Empty Stomach for Breakfast

In the morning, an empty stomach triggers hunger hormones, increases stomach acidity, and may cause mild discomfort. Blood sugar is lower after fasting overnight, so breakfast helps restore energy, rehydrate, and kick-start metabolism for the day.

Benefits of Honey and Lemon Water on an Empty Stomach 

Drinking honey and lemon water on an empty stomach offers many health benefits. To prepare, warm a cup of water, let it cool slightly, then add a spoonful of honey and the juice of half a lemon. Stir and drink immediately. This mixture helps balance stomach acids and enhances their quality, aiding in digestion and cleansing the intestines by removing undigested particles that could cause inflammation. Additionally, this drink acts as a diuretic, clearing the bladder and urinary tract, relieving constipation, and even cleansing the kidneys, which can help prevent kidney stones. The combination of honey and lemon makes this drink a powerful detoxifier, flushing out toxins from the body. It also helps burn excess fat, and when consumed for two to three weeks, it can significantly reduce acne, boils, and skin impurities. This drink can help protect against seasonal allergies and infections like colds, as well as soothe a sore throat and reduce irritation.

 

Benefits of Almonds on an Empty Stomach 

Soak five to ten almonds overnight, peel them in the morning, and eat them on an empty stomach. The peel is hard to digest, so it’s best to remove it. Drinking milk with almonds provides even more benefits. Almonds enhance brain function, lower cholesterol, and support heart health. They also help manage blood pressure and regulate blood sugar levels. Rich in fiber, almonds aid in relieving constipation. Vitamin E in almonds is excellent for skin and hair health.

 

Benefits of Dates on an Empty Stomach 

Dates are nutrient-dense and energizing. Egypt is the largest producer of dates worldwide. A 100-gram serving of dates provides around 300 calories and 75 grams of energy. Vitamin B6 in dates strengthens the brain, while the fiber content helps prevent constipation and reduces the risk of colon cancer. The protein in dates boosts physical strength and supports healthy weight gain, while potassium helps control blood pressure. Magnesium in dates strengthens bones, reduces inflammation, alleviates joint pain, and further lowers blood pressure. Dates also contain iron and other essential vitamins, providing an immediate energy boost to the body.

 

Foods to Avoid on an Empty Stomach 

Avoid eating tomatoes, bananas, yogurt, alcohol, tea, coffee, or sugary foods on an empty stomach. Sugary foods can spike blood sugar levels, which puts additional strain on the pancreas.

What is H.Pylori

Treatment of H. pylori 

Helicobacter pylori (H. pylori) is a type of bacteria that infects the stomach lining and is a common cause of stomach-related problems, including ulcers and chronic gastritis. It is estimated that around half of the world’s population is infected with H. pylori, though not everyone develops symptoms. It is usually contracted during childhood and can persist into adulthood if untreated.

Causes of H. pylori Infection

H. pylori is primarily spread through:

• Contaminated food and water: Ingesting food or water that has been contaminated by the bacteria can lead to infection.
• Person-to-person contact: The bacteria can be transmitted through saliva, which may happen when sharing utensils, kissing, or through direct contact with contaminated surfaces.
• Poor hygiene: Lack of proper hand-washing practices, especially after using the bathroom, can increase the risk of transmission.

Impact of H. pylori on Health

H. pylori can lead to several digestive disorders, including:

1. Peptic Ulcers: It is the most common cause of ulcers in the stomach (gastric ulcers) and the upper part of the small intestine (duodenal ulcers). The bacteria damage the stomach’s mucous layer, making it more vulnerable to acidic digestive juices, leading to sores.

2. Chronic Gastritis: H. pylori causes chronic inflammation of the stomach lining, leading to gastritis. Long-term infection may result in stomach pain, nausea, bloating, and other gastrointestinal discomforts.

3. Increased Risk of Stomach Cancer: In some cases, chronic H. pylori infection may contribute to the development of gastric cancer. However, this is relatively rare and usually occurs in individuals with long-standing untreated infections.

4. Dyspepsia (Indigestion): Symptoms such as bloating, heartburn, and general stomach discomfort may result from H. pylori infection.

5. Other Health Impacts: Some research suggests H. pylori may also be linked to iron deficiency anemia and certain vitamin B12 deficiencies, as it can impair nutrient absorption.

To diagnose an H. pylori infection, several tests are available, and they vary in accuracy and invasiveness. Each test has its own way of determining the presence of the bacteria, and the ranges for results typically indicate whether or not the infection is present. Here's an overview of the common tests used for diagnosing H. pylori:

1. Urea Breath Test (UBT)

This is one of the most accurate non-invasive tests for detecting H. pylori. It works by measuring carbon dioxide in your breath after ingesting a urea solution. H. pylori bacteria produce an enzyme called urease that breaks down the urea, releasing carbon dioxide, which is then detected.

• Procedure: The patient swallows a urea solution that contains a special carbon isotope. After a short time, they breathe into a container, and the level of carbon dioxide is measured.
• Results:
  • Negative: If the level of carbon dioxide is normal, it indicates no active H. pylori infection.
  • Positive: If higher levels of carbon dioxide are detected, it indicates an active H. pylori infection.
  The normal range for the carbon isotope (C13 or C14) detected in the breath is typically low or absent. A significant increase in carbon dioxide suggests an infection.

2. Stool Antigen Test

This test detects H. pylori proteins (antigens) in a stool sample. It is widely used because of its accuracy and non-invasive nature.

• Procedure: A stool sample is collected and tested in a laboratory for the presence of H. pylori antigens.
• Results:
  • Negative: No H. pylori antigens are detected, meaning no infection.
  • Positive: H. pylori antigens are present, indicating an infection.
  The standard range is negative, meaning no H. pylori is detected in the stool. A positive result indicates the bacteria's presence.

3. Blood Antibody Test

This test checks for antibodies that the immune system produces in response to H. pylori infection. However, this test is less accurate because it cannot distinguish between a current or past infection.

• Procedure: A blood sample is taken, and the laboratory tests for the presence of H. pylori antibodies.
• Results:
  • Negative: No antibodies are found, suggesting no infection.
  • Positive: Antibodies are present, indicating exposure to H. pylori. However, this might reflect a past infection, as antibodies can remain in the blood long after the infection is cleared.
  This test does not indicate the severity or activity of an infection.

4. Endoscopy with Biopsy (Invasive)

This is an invasive test that provides a direct examination of the stomach lining. During an endoscopy, a small sample (biopsy) of the stomach lining is taken and tested for H. pylori using either histology (microscopic examination), a rapid urease test, or culture.

• Procedure: A thin, flexible tube with a camera (endoscope) is inserted through the mouth into the stomach. A tissue sample is collected during the procedure.
• Results:
  • Negative: No H. pylori bacteria are found in the biopsy sample.
  • Positive: H. pylori bacteria are detected, indicating an active infection.
  Biopsies allow for direct observation of the stomach lining and provide the most definitive diagnosis, but this is generally reserved for cases where other tests are inconclusive or complications like ulcers are suspected.

5. Rapid Urease Test (CLO Test)

This is often done during an endoscopy and involves testing the stomach tissue sample for urease, the enzyme produced by H. pylori.

• Procedure: A biopsy sample is placed in a urea solution containing a pH indicator. If urease is present, the solution changes color, indicating H. pylori infection.
• Results:
  • Negative: No color change, indicating no urease activity and, therefore, no H. pylori.
  • Positive: A color change suggests urease activity and confirms the presence of H. pylori.

Severity and Treatment Implications

• Standard Ranges: The standard for most tests (breath, stool, biopsy) is a negative result, meaning no detectable H. pylori bacteria or its markers.
• Severe Ranges: The tests do not usually measure the severity of the infection directly. However, a positive result, especially with associated symptoms (such as ulcers or gastric distress), indicates the need for treatment. In severe cases, further evaluation via endoscopy may be needed to assess damage to the stomach lining.

Follow-up Testing

After treatment, follow-up testing is often required (usually with a Urea Breath Test or Stool Antigen Test) to confirm that the infection has been successfully eradicated.

Regular monitoring and retesting may be necessary if symptoms persist or recur after treatment.

Remedies and Treatments for H. pylori

1. Antibiotic Therapy:

   • Combination Therapy: Treating H. pylori usually requires a combination of two different antibiotics to ensure the bacteria are eradicated. Common combinations include amoxicillin, clarithromycin, metronidazole, or tetracycline.
   • Proton Pump Inhibitors (PPIs): Medications such as omeprazole or lansoprazole reduce stomach acid production, creating an environment less favorable for H. pylori and aiding in ulcer healing.
   • Bismuth Subsalicylate: Sometimes prescribed with antibiotics, this can help protect the stomach lining and kill the bacteria.

2. Dietary Adjustments: While diet alone can’t treat H. pylori, certain foods and habits can support the treatment and alleviate symptoms.

   • Probiotics: Foods like yogurt, kefir, or supplements containing Lactobacillus and Bifidobacterium can support gut health and potentially help counteract some of the side effects of antibiotic treatment.
   • Anti-inflammatory foods: Incorporating foods rich in antioxidants, such as fruits, vegetables, and green tea, may help reduce inflammation and support healing.
   • Avoiding irritants: Spicy foods, alcohol, caffeine, and fatty meals can aggravate the stomach lining, so it’s important to avoid them during treatment.

3. Lifestyle Changes:

   • Good hygiene practices: Wash hands thoroughly and avoid sharing utensils to prevent the spread of the bacteria.
   • Stress management: Reducing stress can lower stomach acid production and prevent further irritation to the stomach lining.
   • Quit smoking: Smoking increases the risk of developing ulcers and interferes with ulcer healing.

4. Surgical Intervention: In rare cases where ulcers have caused significant damage (like bleeding or perforation), surgery may be required. However, this is uncommon with timely antibiotic treatment.

Additional Tips for Managing H. pylori

• Stick to the full course of treatment: Even if symptoms improve, it’s crucial to complete the prescribed course of antibiotics to ensure the bacteria are completely eradicated.
• Follow-up testing: After treatment, your doctor may recommend a breath or stool test to confirm that H. pylori has been fully eradicated.
• Prevent reinfection: Maintain good hygiene practices and be cautious about food and water safety, especially when traveling to areas with poor sanitation.

By following the right treatment plan and adopting preventive measures, the risk of complications from H. pylori can be minimized, leading to better long-term gastrointestinal health.دن میں تین دفعہ