From rethinking health care systems to the redefining of global movement and migration, the coronavirus has undoubtedly changed the world – Pakistan being no exception. However, Pakistan, one of the highest populated countries in the world and a developing nation, somehow weathered the storm far better than most countries in the world – leaving many international experts and doctors questioning how.
A state of panic and chaos gripped Pakistan when the first two cases of the novel coronavirus were registered near the Iranian border, back in February of 2020. With flimsy healthcare infrastructure, insufficient public awareness and overcrowded urban spaces succumbing to grisly sanitation system, Pakistan was globally perceived to be a misfit for this kind of war, and also thought to be amongst the brutally hit ones. The notable trust deficit between the government and public, and the ignorance of both could make matters even worse.
The concept of social distancing, not new to the modern world, was alien to a mighty chunk of the masses. Pakistan, one of the only two countries still battling polio, was forecasted by prominent experts to fall deep into a quagmire, if timely actions were not taken. During May the cases began rising and in June, they peaked – hospitals were put on high alert and fear enveloped the populace. Pakistan’s already frail economy also struggled due to the coronavirus – specifically due to the nationwide lockdown that began in March 2020.However, soon after the country hit its peak, the plans finally started to kick off well; active cases began dropping by the end of June. Miraculously, Pakistan has accelerated its recovery rate to 96% in a matter of 6 months, which is surprising, given the current economic and demographic situation of the country.
Out of the 307,000+ active cases registered, more than 6,400 infected have fell victim to this disease so far, according to the Government of Pakistan. Pakistan’s surprising comeback from the pandemic has prompted World Health Organization (WHO) to declare Pakistan as an influential player in the fight against Covid-19.But how was Pakistan able to avert this public health crisis with a handful of resources and poor health infrastructure?
Graphical Analysis: The trend shows that the country witnessed the peak of the epidemic by mid-June as a result of direct or indirect violations of SOPs by the general public, especially during the Islamic month of Ramadan and Eid ul Fitr. However, the country observed a decline in daily cases by the end of June.
|CLOSED CASES*(Recovered/Discharged +Deaths)||298,719|
*As of 21st September Source: Worldometer
Amidst the national outcry for straining financial capacity, Pakistan’s healthcare infrastructure stood tall like a “Jenga” tower, with the government’s sensitive decision-making on one hand against the public’s negligence. The opposition politically capitalized on the public’s doubt about the government’s capability in dealing with a catastrophe of this scale initially, given the past experiences in dealing with natural disasters, like floods and earthquakes. Under such pressure and insecurity, PM Khan came up with a different solution.
After imposing a complete lockdown in March, a popular containment strategy, Pakistan pursued partial lockdown by closing down vicinities. The ruling party in consensus with other major elements also decided to keep crucial sectors of the economy, the livelihood of millions of wagers, open for economic activity. The government’s take on the countrywide lockdown seemed like a catalyst for an economic, social and political collapse, especially for a developing country like Pakistan.
Despite so many fingers raised at the government’s approach, PM Khan staunchly defended his position by explaining how it could give birth to greater problems like unemployment and eventually push the country into mass starvation. Reports about recession and market crashes from the neighboring India further emboldened the government on its anticipated approach – the smart lockdown.
While many believe that the policy was successful in slowing the spread of the disease in the country, notable health experts believe that the lockdown policy has only saved the country from an economic crisis, and not the disease itself yet. They believe other factors, like demography, have a bigger role to play in the country’s defense so far.
The major factor to consider is the demographic structure of Pakistan. Pakistan stands in the list of the countries with the highest number of independent population (youth, adults) against its dependent population (children, old-aged). In other words, Pakistan is home to a large number of youth or working age population; the number of old-aged individuals is significantly less.
Although COVID-19 can fatally affect people of all ages, analysis of the global death figures from the virus in the developed countries in light of the data of median age from the developed countries taken from Global health observatory data (WHO), specifically Italy, UK, France, suggests that the virus has caused more deaths in countries with the average age above 40. According to the above mentioned source, average age in Pakistan is 22; which means that the number of people with stronger physiological immunity is high, and the virus eventually dies down when the transmission occurs between large communities of young people. Thus, it can be said that the youth aspect of Pakistan’s demography might have a key role to play in the apparent success so far.
The Reporting Conspiracy
Pakistan’s testing capacity has also been subject to criticism, with claims that the health system is not sufficiently testing its population on a daily basis. Despite the Prime Minister’s sole credit to the government’s micro-lockdown policy, the data reveals an evident relationship between the decline in testing and reduction in new cases. The statistics released by Our World in Data indicate that Pakistan’s daily tests per thousand people, by July 16, was 0.1. The above source also shows that figure was estimated to be 0.13 back in June, the peak-month; the figures reveal a notable decline in overall testing from June to July.
Misreporting at the district level might have understated the official figures, but the notable thing is that even if we consider the fact that the country’s general testing has declined, it has still managed to show a positive rate less than 5%, according to Al Jazeera. According to the World Health Organization, any country with a positive rate less than 5% is in control of the disease outbreak.
Vulnerability to the Virus
By June, the disease spiraled out of control and started spreading at a very rapid pace. Due to religious gatherings in the month of Ramadan despite the lockdown restrictions, and the lifting of lockdown few weeks after Eid Ul Fitr, the country witnessed a boom in new cases. If we analyze the trend in the aforementioned graph, we can see that the number of cases almost tripled in a month. However, you can also see that after hitting a peak (6,825) in new cases, the rate of new infection steadily begin to decline over the next few days.
In an interview to Al-Jazeera, a health professional in Pakistan suggests that despite the highly contagious nature, the vulnerability to getting infected by the virus varies from individual to individual; a concept known as “population heterogeneity” in epidemiology.
Polio Response Force to the Rescue
With a big question mark on the healthcare’s capacity to accommodate sufficient ventilators for patients nearing respiratory breakdown, Pakistan defied all odds by deploying its polio eradication infrastructure to grapple the virus from spreading. The infrastructure, solely built to combat polio in rural and remote areas, has borne a great deal of innovation and research over the years due to immense pressure from the global health authorities to extirpate it.
Without the presence of a digital integrated health information system on a national level, Pakistan marched forward by integrating its polio eradication system with the COVID-19 monitoring system, an effort highlighted by the World Health Organization in a press conference. Highly trained health workers who were tasked to visit every door around the country for polio vaccination, were now directed to strategize exceptional practices that could effectively monitor, trace and contain the virus.
Even though the healthcare system does not have many epidemiologists in its infantry, Pakistan’s unique strategy has been able to considerably counter the virus than the countries widely accredited for their breakthroughs in the domain of disease control. Pakistan has received much deserved worldwide recognition in its unanticipated yet effective battle against the contagion.
The War Continues…
Pakistan might have pulled a narrow victory in what is considered as the first round of the pandemic, but the threat of the second wave still lurks around the corner. Health officials are continuously ringing bells for a potential disaster and advising the government to brace for it early on. They have also requested the government to pursue a total lockdown, if the country goes through a second wave, in the coming months as historical data suggests that second waves have usually taken a higher toll on the population as compared to the predecessor waves, like that of the Spanish influenza.