The AQI index reached a daily average of 243, still “very unhealthy” but below the highest level of 300 considered “hazardous”.

The level of PM2.5 particles was also more than 10 times higher than the level deemed acceptable by the World Health Organization.

The city of 14 million people close to the border with India peaked at a record AQI of 1,110 on November 14.

Punjab, home to more than half of Pakistan’s 240 million people, closed schools in its major cities on November 6, and on Friday extended the closure to November 24.

It has also banned all outdoor sports in schools until January, and cracked down on polluting tuk-tuks, barbecues and construction sites in pollution hot spots across Lahore.

Seasonal crop burn-off by farmers on the outskirts of the city also contributes to toxic air the WHO says can cause strokes, heart disease, lung cancer and respiratory diseases.

Over 1.93m seek hospital care for respiratory diseases

Smog has severely impacted the health of sensitive citizens across Punjab, with approximately 1.93 million people visiting hospitals over the past 30 days for respiratory and related illnesses, state-run APP reported on Sunday.

Hospitals in Punjab received 124,660 asthma patients, 62,908 cases of ischemic heart disease, 5,953 stroke patients, and 12,694 cases of conjunctivitis, according to the Punjab Primary and Secondary Healthcare Department, in the last month.

The department further reported that 452,567 respiratory disease cases, 31,707 asthma cases, 13,768 ischemic heart disease cases, 1,695 strokes, and 47,224 conjunctivitis cases were treated in the past seven days alone.

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Over the last 24 hours, hospitals handled 53,377 respiratory disease cases, 3,509 asthma cases, 883 ischemic heart disease cases, 104 strokes, and 656 conjunctivitis cases.

Lahore, the city most impacted by smog, reported 132,558 respiratory disease cases, 5,954 asthma cases, 14,869 ischemic heart disease cases, 583 strokes, and 2,395 conjunctivitis cases over the past month.

In the last seven days, the city saw 34,168 respiratory disease cases, 2,321 asthma cases, 1,835 ischemic heart disease cases, 331 strokes, and 1,602 conjunctivitis cases. During the last 24 hours, 4,108 respiratory disease cases, 393 asthma cases, 129 ischemic heart disease cases, 47 strokes, and 293 conjunctivitis cases were recorded in the city.