Observations, Lamentations, Suggestions
Despite having a host of examples to learn from and clear head start to plan an effective response, Pakistan’s actions to contain the spread of dangerous COVID-19 disease have raised a lot of questions. But the big question is: Does Pakistan realize the gravity of the situation the world is in and is it itself ready?
RAO, RS1, Haggenmachr, JA2, Rao, S3
In the interest of the matter under discussion and keeping in view the enormity of this situation, we will not indulge in repeating history by reiterating where the first case of nCOVID-19 coronavirus was identified (1) and how and when it progressed to be characterized by the Word Health Organization as a global pandemic (2). Social media (particularly WhatsApp) has been a rather rich source of obfuscating information that has left some with genuine apprehension and concern but has also served as a referenced source for defiance particularly for people in the younger age group (3, 4).
At the time of writing this manuscript (5), there were 328,800 confirmed cases of nCOVID-19 around the globe in 189 countries and territories and one international conveyance (6). Data from Pakistan and its neighboring countries (7) is provided in the table below as an illustration that by the time you will read this article, these numbers would have changed drastically:
In Pakistan, majority of these cases have been reported in the province of Sindh (333) followed by Punjab (225) and Balochistan (104). This table depicts the enormity of public health calamity that we are facing in Pakistan, which sits in a landmass surrounded by countries with active nCOVID-19 crisis. Of greater concern is that Pakistan has active bi-lateral economic ties with most of these countries which necessitates constant travel of people and goods across the border. It was not until February 23, 2020, that Pakistan closed its borders with Iran (8) and on March 01, 2020 with Afghanistan (9).
Even more disconcerting was the fact that Pakistan did not suspend incoming international flights until March 21, 2020 (10). It is confounding that against all logical arguments, Pakistan proceeded to reverse its decision and open its borders with Afghanistan on March 22, 2020 (11).
A Series Of Errors
Pakistan has made a set of serious errors in judgment and overt vacillation in taking decisive decisions has amplified this crisis. First, we are not taking seriously the magnitude of this catastrophe. Given that the spread of this virus has entered into the “community” phase of dissemination, our response to this emerging public health crisis continues to be dominated by politics rather than serious and informed strategy. We did not learn from global experience nor did we totally appreciate the potency of coronavirus and its colossal impact on our community.
Pakistan has made a set of serious errors in judgment and overt vacillation in taking decisive decisions has amplified this crisis. First, we are not taking seriously the magnitude of this catastrophe
To this day, the responses of our political establishment are at best myopic, indiscriminate and abominable, largely reflective of our culture which is dominated by management of crisis rather than implementing a set of policies that are informed by the experience and expertise of national and international experts and could potentially result in curtailing the damaging impact of the impending calamity. There is an absolute pandemonium in governments’ response with catastrophic downstream outcome.
It is a fact that there is an acute shortage of nCOVID-19 testing that is available to suspected cases in Pakistan. As in the United States, we believe that this single factor is responsible for the relatively low number of positive cases in Pakistan – a datum that may also be valid in some of our neighboring countries. Equally alarming is the fact that the healthcare infrastructure in Pakistan is most rudimentary and it acutely lacks the capacity to deal with the impending cataclysmic events. The critical paucity of skilled and committed workforce coalesced with severe shortage of medical supplies and lack of adequate isolation facilities to manage patients with suspected or confirmed nCOVID-19 infections have collectively created a very precarious situation in Pakistan. Further compounding these verities is the bewildering observation of the absolute privation of any element of seriousness in our community. While one could impugn our culture and the way of life in Pakistan for this dangerous insolence, our government by not taking this burgeoning crisis seriously, is equally culpable.
One could continue this blame-game at the peril of our community. The need of the moment is to take tough decisions to contain the spread of this virus and prevent its rapid dissemination. This would require resilience, sacrifices of monumental proportions and modification of behavior that individually and collectively would be critical for a successful outcome.
As communities, institutions and individuals, we need to switch from reacting to what has happened to instead taking bold action in anticipation of what is coming.
As communities, institutions and individuals, we need to switch from reacting to what has happened to instead take bold action in anticipation of what is coming. Our biggest fear at the present time in Pakistan is people dying due to lack of access to medical care. With limited available resources, hospitals and healthcare facilities in Pakistan are implementing perfunctory pandemic preparedness plans. However, despite these token preparations, hospitals alone cannot solve this problem. It’s up to all of us to decrease the demand for hospital care by reducing the rate of disease transmission…the so-called “flattening the curve”.
Figure: Goals of Community Mitigation – Flattening the Curve: 1: Delay Outbreak Peak; 2: Decompress Peak Burden of Healthcare Facilities; 3: Reduce Overall Cases and Health Impact
We acknowledge the fact that we cannot stop transmission altogether, but if we work together, we can potentially slow it down. That way, we can reduce the number of acutely ill patients and lessen the likelihood that patients who need medical attention will be deprived of the same.
How does one accomplish this outcome? Do we have to adopt an Italy-style lock down in the country? How will it impact our fragile economy? What financial and material resources can be garnished to tide us over this crisis? These and many more commonsensical questions are circulating in the minds of people in the community and with seemingly lack of decisive leadership, the crisis is bound to amplify. After rebuffing calls for a long time, the Government of Sindh finally succumbed to the reality and decided to implement a state-wide “care for you” lockdown (12), an action that the Punjab government will follow. Unfortunately, this is not a provincial problem but one that requires informed and decisive intervention at the national level. This federated model of managing crisis not only flares panic in the community but is also a very poor use of limited resources that we need to conserve and redirect in areas of identified need.
Our biggest fear at the present time in Pakistan is people dying due to lack of access to medical care
Let us remind ourselves that the most important and precious asset any country has is its citizens and it is incumbent upon all those who have the privilege of serving in leadership positions to preserve this resource to the best of our capabilities.
Derelict Decision Making
Functioning as servant-leaders is the call of the moment and unfortunately the rationale proffered by the Government of Pakistan to castoff the idea of a national lockdown in face of this emergency is an overt example of dereliction of one’s responsibility. Serious decisions of this gravity should not be influenced entirely by anticipated hindrances. The predictable financial hardships many of our fellow citizens will face in light of a much-needed national lockdown does not supplant the value of human life. This is a call for people with financial resources in Pakistan and for Pakistani’s living abroad to donate generously to this cause and assist the government in implementing a national lockdown which is the only tool currently at our disposal to avert an outcome of cataclysmic proportion.
This is also the right moment in our history for bolstering public-private partnerships that are of consequential value…words alone will not resolve the impending crisis. Philanthropists and private institutions should step-up their support for local and regional healthcare facilities which are inundated with sick patients and are in desperate need of financial and material support to overcome inadequate medical supplies and equipment.
The services of doctors, nurses, and support staff in healthcare facilities who are taking care of suspected cases and nCOVID-19 positive patients without adequate protective gear need our most sincere appreciation.
Let us also remember that the population that is most exposed to this virus are the frontline healthcare workers. The services of doctors, nurses, and support staff in healthcare facilities who are taking care of suspected cases and nCOVID-19 positive patients without adequate protective gear need our most sincere appreciation. They are the heroes that need our individual and collective support and the best mechanism by which we can display our gratitude is to modify our comportment and practice social distancing thus decompressing their burgeoning workload. Additionally, terminating elective surgical and non-surgical procedures and non-emergency clinic visits should be considered on a priority basis to protect all involved and to allow healthcare workers to provide much needed clinical care of the patients infected with coronavirus. Immediate implementation at a national level of telemedicine must be considered as a priority as well as the establishment of drive-thru testing facilities to increase the number of suspected cases who have been tested. We are locked in a “war” against nCOVID-19, thus necessitating the deployment of Pakistan Army to manage law and order in the country and to offer access to the expansive network of military hospitals for the sick and the vulnerable.
There remains no doubt that in Pakistan, we have moved from containment to mitigation phase of nCOVID-19 infection. The existing crisis has blurred the socioeconomic and geographical boundaries and has created a “virtual” global community that has to act in unison to assuage the impending calamity. The crisis in Pakistan has as yet not reached an irredeemable stage but is fast approaching that ominous outcome. This is a moment of truth for the extant human race and how we act today will not only shape our way of life in the future but will also impact our long-term survival as species.
1Rameez Sohail Rao, 4th Year Medical Student, School of Medicine, St. Georges University, Grenada
2Joshua Andreas Haggenmacher, 3rd Year Medical Student, School of Medicine, St. Georges University, Grenada
3Corresponding Author: Sohail Rao, MD, MA, DPhil., President and Chief Operating Officer, DHR Health Institute for Research & Development, 5323 S. McColl Road, Edinburg, TX 78539. www.dhrresearch.org
1: Coronavirus: China’s first confirmed COVID-19 case traced back to November 17. https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back
2: WHO Director General’s Opening Remarks at the Media Briefing on March 19-20, 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—20-march-2020
3: Fake Cures and Other Coronavirus Conspiracy Theories are Flooding WhatsApp, Leaving Governments and Users with a Sense of Panic. https://www.washingtonpost.com/technology/2020/03/02/whatsapp-coronavirus-misinformation/
4: WHO Health Alerts Brings COVID-19 Facts to Billions via WhatsApp.
5: March 22, 2020; 14:17 Central Standard Time
6: Confirmed Cases and Deaths by Country, Territory and Conveyance. https://www.worldometers.info/coronavirus/
7: Coronavirus in Pakistan. http://covid.gov.pk/
8: Turkey and Pakistan Close Borders with Iran Over Coronavirus Deaths. https://www.theguardian.com/world/2020/feb/23/turkey-and-pakistan-close-borders-with-iran-over-coronavirus-deaths
9: Pakistan to Close Borders with Afghanistan for 7 Days Amid Coronavirus Scare. https://www.news18.com/news/world/pakistan-to-close-border-with-afghanistan-for-7-days-amid-coronavirus-scare-2521185.html
10: Pakistan Suspends Incoming International Flights for 2 Weeks. https://www.dawn.com/news/1542658
11: Pakistan Opens Borders with Afghanistan. https://pakobserver.net/pakistan-opens-border-with-afghanistan/
12: Lockdown Imposed in Sindh for Next 15 Days; Movement Restricted to Need-Only Basis. https://www.dawn.com/news/1542901