KABUL, Afghanistan – For 23-year-old Mohammad Wakil, social distancing is an abstract concept. Every working day he shakes hands with dozens of customers in the teeming bazaar where he sells used shoes. He takes care of dirty Afghan banknotes. He despises hand sanitizer. A mask? Forget it.
"There is no coronavirus," Wakil said in late October as shoppers flooded his rickety booth. "It's a lie told by the government."
When the coronavirus pandemic first hit Afghanistan in March, the government made efforts to shut down cities and convince Afghans to wear masks, wash their hands and practice social distancing. The measures were arbitrarily enforced for several weeks before citizens began to rub under the restrictions.
Today, despite public health officials confirming a second deadly virus wave, Covid-19 is an afterthought. Afghans have adopted a culture of denial in which personal priorities triumph over public health experts whose appeals are drowned out by public apathy, skepticism, and an ongoing belief that Allah will determine the fate of a believer.
"The mentality that Trump and his supporters have is exactly the same for the Afghan people," said Dr. Tariq Ahmad Akbari, until recently chief physician at Kabul's only infectious disease hospital. "They think Covid is western propaganda."
But unlike the United States, there is no political party or anti-government movement that downplays the virus by spreading misinformation. Even the Taliban have distributed personal protective equipment and conducted public health information programs. They have allowed government health workers into areas they control, the Department of Health said.
In cities across the country, people go about their daily lives as if Covid-19 never existed. While the virus is most transmitted indoors, scientists say it can also be transmitted through close personal encounters outdoors. Yet Afghans crowd into buses and taxis, eat shoulder to shoulder inside restaurants, pray in mosques, embrace traditional Afghan greetings, and gather in sprawling bazaars.
Few people wear masks on crowded city streets. Ubiquitous public health posters warning of Covid-19 are routinely derided as relics of a not-too-distant past when the coronavirus seemed terrifying and invincible.
"We know people are fed up with the virus and the health messages they keep hearing," said Akmal Samsor, a health ministry spokesman. “We live in a country with serious threats from war and poverty. Covid can't keep up. "
Afghans continue to contract the virus and die, but the scale of the epidemic is difficult to measure. The coronavirus death toll reported by the Ministry of Health is 2,074 with 50,677 positive cases, but Afghanistan's testing capacity is severely limited – only 180,000 tests have been performed since March. Its ailing health system cannot always distinguish Covid-19 from other causes of death in a country where disease and violence are endemic.
Health officials acknowledge that the real death toll in Afghanistan is exponentially higher. An estimated 32 percent of the approximately 34 million people in Afghanistan may have already contracted the virus, the Ministry of Health said. A May World Health Organization model estimated half of the population could become infected.
"The virus is orbiting the country," Samsor said, noting that the Covid-19 death rate rose 47 percent in the first week of December. "If 95 percent of people only wore masks for two weeks, we could get the virus under control."
However, the local news media have lost interest in the virus and are instead focusing on peace talks, the worsening war and targeted killings in the capital.
Last spring, the pharmacies were overwhelmed by inquiries about alleged virus treatments. But some pharmacists are now saying that customers have convinced themselves the virus isn't worth a second thought, even though some continue to search for miracle cures.
Dec. 20, 2020, 2:37 p.m. ET
"People now think Covid is not a fatal disease so they are not worried about it at all," said Faizullah Faizbakhsh, a pharmacist from Kabul.
At domestic airport terminals, passengers ignore faded circles on the floor to keep them six feet apart. Only a few airport employees wear masks. Flight attendants are masked, but not all passengers wear the free masks. People casually cavort in cinemas and shopping malls.
Even heartbreaking stories of Afghans dying from the virus after infecting loved ones have not sparked widespread fears.
Zalmay Rahman, a resident of Mazar-e-Sharif in northern Afghanistan, said his entire family wore masks and used hand sanitizer. However, his mother died of Covid-19, and he and several other relatives were also infected with the virus.
"We just hope that we can survive this second wave," Rahman said.
The feeling of apathy towards the virus seems to trickle downwards. In October, the Ministry of Health ordered government officials to wear masks and reinstated a policy that was disregarded in early summer. But in the presidential palace complex in Kabul, almost all of the staff that reporters recently encountered were maskless. In a palace cafeteria, workers ate side by side, hugged and shook hands.
The Ministry of Health recently proposed mandatory masks for banks, shops and buses. Suggestions have also been made to close wedding halls, sports clubs and funeral homes, and to temporarily remove vehicles with more than five passengers. The proposals are still pending.
The government has not been able to shut down cities because most Afghans have to travel daily to earn a living. Eighty percent of the population live near the poverty line in a country that is supported by foreign aid and a subsistence economy.
The Afghan health system relies on international support and spends around $ 5 per person annually – compared to $ 11,000 per person in the US.
Even before Covid-19, 3.7 million Afghans needed emergency services, according to the World Health Organization. This year, at least 30 health facilities were attacked, suffering from widespread food insecurity and the world's highest child mortality rate.
In Kabul, the Afghan-Japanese Communicable Diseases Hospital takes 40 more Covid-19 cases a day than it did two weeks ago, said Ramin Hamid, the hospital's health information director.
Since the pandemic began, the hospital has admitted 32,000 suspicious Covid-19 patients, more than 500 of whom have died.
But even hospital workers sometimes neglect to wear masks or robes, said Dr. Meranay Baratzay, the hospital's infection prevention doctor. While he was speaking, a man emerged exposed after visiting a family member's room with Covid-19.
"They don't understand Covid is real," said Dr. Niaz Ahmad, an ambulance, talks about companions and visitors. "Only the people who lost someone to the virus believe it."
One day among the patients in the Covid-19 ward was a student, Nazif Rezayi , who was coughing and panting in his bed. In a scratchy voice, he said he had not taken any precautions, even when he lived in a crowded dormitory.
"I didn't take it seriously," said Rezayi. "I'm doing now. Everyone should."
The hospital with 120 beds has only 31 patient monitors, three X-ray machines, two ultrasound machines and no CT scanner. When the second virus wave intensifies, Dr. Akbari, the hospital cannot care for every Covid-19 patient.
Dr. Ahmad shook his head in frustration. The doctor said he faithfully wore a surgical mask, washed his hands, and practiced social distancing as he spent his everyday life outside the hospital.
"But what's the use," he asked, "if no one else follows the rules?"
The reporting was contributed by Fatima Faizi and Najim Rahim from Kabul and Asadullah Timory from Herat, Afghanistan.