According to a report prepared by public health officials in Karachi, Pakistan saw 50 per cent increase in the number of positive cases every week in April. Such cases were likely to reach 100,000 with some 2,000 deaths by end-May, if cases continued to rise at the same pace. It noted: “Going by the assumption that 20 per cent patients in confirmed cases would need hospital admission, it is estimated that some 6,000 patients may require hospital admission each week by end of May.
By Tilak Devasher
While the entire world is grappling with the COVID-19 pandemic, Pakistan’s handling of the crisis raises fears that if it does not get its act together quickly, it may be at risk of losing the battle.
The numbers of positive cases as of 20 May were close to 47,000 and fatalities over 1000. Analysts suspect that there could be major inconsistencies between the reported cases and the reality given low testing during most of April of just about 3,000 persons per day. A Chinese medical team that was in Pakistan in April told the media that the outbreak in Pakistan could be far bigger than the confirmed numbers showed due to lack of testing. The testing capacity was supposed to have been enhanced to 25,000 per day by end April but even in mid-May not even half of this had been achieved. Strangely, in the last week of April, barring Sindh, the other provinces reduced testing leading to suspicions that this was deliberately done to show fewer positive cases.
According to a report prepared by public health officials in Karachi, Pakistan saw 50 per cent increase in the number of positive cases every week in April. Such cases were likely to reach 100,000 with some 2,000 deaths by end-May, if cases continued to rise at the same pace. It noted: “Going by the assumption that 20 per cent patients in confirmed cases would need hospital admission, it is estimated that some 6,000 patients may require hospital admission each week by end of May.
In the case of Balochistan as of 11 May, according to official figures, 2,158 people had tested positive and 27 had died. However, as per a provincial government report, the active infections of coronavirus in Balochistan as of 04 May were approximately 20,000 i.e. at least 10 times higher than official reported infections. The report forecasted infections in Balochistan till July based on the level of mitigation measures adopted. These ranged from 24,000 infections and 360 fatalities in the case of strong mitigation; 640,000 infections and 7,600 deaths in the case of moderate mitigation and a staggering 8.39 million infections and 100,000 deaths in the case of weak mitigation. If this is the situation in a sparsely populated province like Balochistan, the situation in the rest of the country, especially the heavily populated urban areas of Punjab and Sindh, can well be imagined.
A major spread of the virus, as doctors in Karachi and Lahore have warned, would lead to the collapse of the already shaky health system. One doctor was quoted in the media complaining, “We don’t even have anti-rabies vaccines. How can we deal with thousands of people who will come here for coronavirus treatment.’
In times of crisis, the people look to a leader who can act decisively and sink internal differences so that the country can unitedly overcome it. Imran Khan, however, has failed to come up to the mark. His understanding of the crisis has been limited as evidenced by his initial assertions that 97 percent of those infected would recover and only the old and sick were in danger even though 84% of the confirmed cases were found to be between the ages of 20 and 64 years.6 He failed to act decisively and instead vacillated between not imposing a lockdown and imposing a ‘partial’ or smart’ lockdown.
He has also failed to build national consensus and even declined to listen to the opposition let alone work with them. This was amply demonstrated during the special session of the National Assembly that was called to exclusively discuss the COVID-19 situation. During the session, instead of formulating a united response, the opposition and treasury hurled charges at each other. Not surprisingly, the country remains bitterly divided at a time when unity is critical. The onus for intensifying political polarisation must lie squarely with the government.
Imran Khan’s failure to build a consensus was also manifested in the confusion between the centre and the provinces over policy. First Sindh and later the other provinces went in for a lockdown of differing degrees,disregarding the PM. The army decided that it would enforce the lockdown. Thus, rather than a national policy and a collective response, the ‘locking’ down of different provinces was clumsy and chaotic.
Another indicator of his inadequate leadership has been evident in the timing of the decision to further relax the lockdowneven though by his own assertions there was no lockdown to begin with. Though Pakistan has not yet suffered from a massive spread, there is consensus that the peak has yet to come. Thus, the relaxation is being done at a time when the number of cases and fatalities are rising, there is very little testing and it is against the advice of medical professionals. Moreover, while social distancing has been prescribed, there is very little enforcement. The SOPs are being honoured only in the breach and the scenes at markets and in mosques are like the pre-COVID-19 days.
As has been pointed out, the comparison with the US is instructive. When the US had 42,000 confirmed cases, as did Pakistan a few days ago, it had 522 deaths compared to Pakistan’s 900. The US now has 80,000-plus deaths. Moreover, Pakistan has more confirmed cases and deaths per million than neighbours like India, Sri Lanka and Bangladesh. These states had stricter lockdowns despite the similar socioeconomic issues.
In an important but strange development, a full bench of the Supreme Court on 18 May ordered the provincial governments to open all shopping malls. It also set aside the federal government’s decision to close shops, markets and businesses on Saturdays and Sundays, saying it reflected no justifiable rationale. The court held that the virus “apparently is not a pandemic in Pakistan” and questioned why fighting it was “swallowing so much money”.8 Though impinging on executive authority, the PTI has seen this as a vindication of its position that a lockdown was not needed.
The court’s strange observation about there being no pandemic in Pakistan is contrary to the WHO’s declaration of COVID-19 being a global pandemic and the reality of hundreds of thousands who have already died and millions who have been infected. Pakistan now has the unique but dubious distinction of being perhaps the only country that is in denial about the pandemic.
Capping it all is Pakistan’s belief that it is the last bastion of Islam. While most Islamic countries, including Saudi Arabia and Iran, have banned religious congregations during Ramzan, Pakistan has allowed daily and special prayers. It is not only the power of the clergy and their financial interests but it is also weak leadership that has been unable to confront the clergy. In practice, the social distancing measures that were to be implemented during congregational prayers have been violated across tens of thousands of mosques all over Pakistan. This could potentially lead to an exponential increase in infections and casualties in the days ahead.
Other ominous developments include the increasing number of doctors and medical workers falling victim to the infection. As of 11 May, 440 doctors, 215 paramedics and 111 nurses had been infected with the last 257 cases coming between 05 May and 09 May 9. 11 health professionals have so far lost their lives largely due to lack of or sub-standard PPEs. Doctors in several parts of the country have staged protests and hunger strikes on this issue. There is also the danger of public hospitals running out of ventilators for seriously ill patients if positive cases increase exponentially – a senior medical practitioner died in Karachi because no ventilator was available at any of the hospitals he was taken to. If all this was not bad enough, Pakistan is battling a major locust menace that is devastating crops in Balochistan, Sindh and Punjab and if not controlled could seriously impact food security in the country. There is a likelihood of Pakistan running out of petrol and diesel from the second half of May due to pandemic-driven supply chain disruptions. Finally, the pharma industry is facing serious raw material shortages for life-saving drugs since bulk of the supply that came from India has been stopped.
Worse news is from the economic front. The World Bank has warned that Pakistan’s economy could show negative growth of 1.3% to 2.2% in the current fiscal year whereas the IMF’s has projected a negative growth of 1.5%. A recent UNDP report states that Pakistan has one of the lowest levels of preparedness because of its limited human development, poor health infrastructure, and related issues. According to the Federal Minister for Planning, as a result of the crisis,20 to 70 million people could fall below the poverty line, 18 million people could become unemployed due to the lockdown and around one million small entities may close down permanently.
It is quite likely that Pakistan is entering a very dangerous phase, literally standing at the edge of a coronavirus abyss. Given its poor medical infrastructure, poorer social distancing measures, lack of leadership, an economy on the brink and a polarized polity, Pakistan could potentially be faced with a public health disaster. Pakistani leadership will have to pull up its socks or be in danger of losing the coronavirus battle.
The author is a consultant with VIF.
The article was first published in VIF India and belongs to them
