How Pakistan transformed Covid crisis into a success story

Pakistanis are known for their capacity to battle adversity. We have braved numerous crises over the last three decades that include terrorism and natural calamities

Pakistan surged to global spotlight for effectively controlling the Covid-19 pandemic. Notwithstanding a recent increase in the number of cases, the dramatic decline in new infections from June onwards have been widely acknowledged by international experts as an ‘amazing success story’. Pakistan’s most populous province, Punjab, has been under special focus of epidemiologists and researchers.

Punjab comprises 53 per cent of Pakistan’s total population, yet the province accounts for just over 31 per cent of Pakistan’s total reported cases with 21 deaths per million against country’s average of 31 deaths per million. Punjab’s cases stand at 950 per million against country’s average of 1,507. As these figures have intrigued a lot of people, it becomes important to share some key points of our response.

It may be mentioned that WHO chief Tedros Adhanom Ghebreyesus praised Pakistan’s response in his op-ed piece in The Independent recently saying the country has ‘suppressed the virus so that, as the country stabilises, the economy is also now picking up once again, reinforcing the lesson that the choice is not between controlling the virus or saving the economy; the two go hand-in-hand.’

Similarly, a study by Unicef and International Policy Centre for Inclusive Growth (IPC-IG) acknowledged Pakistan as one of the top-ranked countries in Asia with the highest number of responses to social protection amid the pandemic. Former US Treasury Secretary and economist Lawrence Larry Summers said recently that had his country handled the pandemic as well as Pakistan did, it could have saved trillions of dollars. Indian politician Shashi Tharoor said, “We look with envy across the border (Pakistan) because you chaps seem to be having a rather pleasant time of it in terms of being able to return to normalcy.”

Before we explore the impact of some strategically important interventions that defined our response, let us recall that an Imperial College Study had predicted a disaster for us by June 2020 projecting some 22 million cases by the end of the month. Although I have always had reservations with Artificial Intelligence-based Spatio temporal micro-simulation models, yet, I admit the projections had given me many a sleepless nights. Even for a potentially biased and exaggerated projection, half the figure meant a disaster we could ill afford. Luckily things did not turn that way.

Over the past two weeks, new cases have started emerging and there has been a steady increase. The second wave seems much stronger globally, but we hope that systems are in place and we are better prepared in terms of facilities and trained staff. Wards which were vacant earlier, are now being repopulated. New infections, which had slumped to a few dozen by end of September, have started to swell. I am greatly worried over an emerging perception that coronavirus is no longer a serious threat. As reported by recent Gallup Survey findings, close to 80 per cent Pakistanis feel that Covid-19 was now under control hence the need for continued precautions is superfluous. As the trappings of a second wave get stronger, we need to be circumspect and vigilant. Laxity may result in return of lockdowns as this recent increase may spiral into a strong second wave.

I have tried to enumerate some key interventions that were critical to controlling the pandemic. None of these factors worked in isolation; they all contributed towards the final outcome.

The first key factor was ownership and oversight by the highest offices from the state. The top-down model of governance worked to our advantage and enabled us to develop institutional framework for laying the foundation of a robust response machine. Starting from the National Command and Control Center, provincial response was led by the chief minister himself through Cabinet Committee that met daily in early days. This was followed by technical/advisory bodies i.e. Corona Experts Advisory Group (CEAG), Corona Monitoring Units in Department (s) translating into vertical and horizontal multi-sectoral collaborative mechanism synergising technical and administrative arms of the government. CEAG brought together experts from respective fields and provided insight on trends in clusters, incidence, severity, geographical vectors and trials for new therapies.

The second key factor was timeliness of response: All countries credited with successful control of the pandemic, such as China, Uruguay, Japan, and New Zealand, have one thing in common, timeliness of response. As we did not have a robust healthcare system at par with developed nations, our margin for error was already much limited. Even though the pandemic hit us a touch later, we were among the first to close down educational institutions and ban public events. Moving ahead of time and developing facilities for patients with no, mild and moderate to severe symptoms was the decisive factor.

Third was development of response platforms to organise patient registration and follow up. The Corona Monitoring Cell at Primary and Secondary Healthcare served as central platform. The Trace, Track and Quarantine Unit kept a strict follow up on registration, testing, admissions and home quarantine. The Patient Transfer System in collaboration with Rescue1122 facilitated transfers to nearest available facilities. The corona unit in the Specialized Healthcare & Medical Education Department consolidated daily hospitalisation status at private and private facilities. The Corona Unit at Mayo Hospital monitored status of HDU, Isolation Wards and ICU facilities.

Fourth was the development of mass isolation and quarantine arrangements in the early part the pandemic that helped us take the peak into the summer. The quarantine arrangements at Lahore, Multan. Faisalabad Dera Ghazi Khan were key to this and we placed all suspected and confirmed patients until they were cleared to move freely.

Fifth was the development of Sars-Cov-2 testing capacity at a large scale through setting up of BSL-3 labs across Punjab. We were terribly short of testing capacity until last week of March with cumulative capacity not exceeding 1,200 tests per day. Now we have had made functional 16 BSL-3 labs in public sector whereas cumulative capacity has exceeded 14,000 tests per day.

Sixth was reliance on evidence-based decision making. We continuously analysed data received from three platforms and devised strategies accordingly. We analysed that cities around GT road between Lahore and Rawalpindi were reporting most cases. Then we identified hotspots and went for smart lockdowns with an aggressive contact tracing program. We gave up on plasma and Hydroxychloroquine after trials and learnt that ventilators were not as effective as pressurised oxygen. There were regular Sero Prevalence Surveys and a regular analysis of burial data.

Seventh was resource provision and mobilisation to ensure uninterrupted supplies to frontline workers. This included arrangements for a wide range of necessary equipment from PPEs to ventilators, Oxygen supplies, disinfection and ancillary material along on fast-track basis with NDMA and the NCOC support.

Eighth is training and motivation of our doctors, nurses and paramedical staff serving on the frontline. Throughout the pandemic mortality among healthcare professionals continued to deliver shocks. This could be so demotivating yet the courage of our professionals stood out as exemplary.

Ninth is development of alternate platforms to replace conventional treatment. We developed telemedicine units on platforms like Zoom and Skype to provide prescriptions. Similarly, a psychological helpline was launched that provided counseling from expert psychologists to patients and families.

Tenth is the development of social safety net to support the marginalised population and daily wage earners. The government brought together philanthropists, NGOs, and public sector institutions on one platform to channelise contributory and non-contributory assistance to vulnerable families and individuals. The initiative incorporated national Ehsas program, Social Welfare Department, Baitul Mal and other partners to organise in-kind support and food transfers, conditional and unconditional cash transfers, fee waivers, school feeding programmes and a number of support initiatives.

Inevitably, the presence of a young population was an obvious advantage. Young people are known to be less severely affected or less likely to get critically ill. Regions and countries with younger populations have generally fared better. Africa’s daily new case count averaged around 16,000 compared to over 100,000 in Asia. Nearly 50 per cent of Punjab’s population is below 25 with 42.52 per cent less than 15 years of age. We have only 4 per cent population in the over-65 age group category, the most vulnerable age group. Africa, the youngest continent on the planet with 60 per cent of the population below 25, has seen very low rates of incidence and severity. Our incidence varied between 30 per cent to 34 per cent in the 31-45 years age group, between 21 per cent to 24 per cent in 45-60 and stayed around 10 per cent in 61-75 age group. Incidence remained around 30 per cent in 16-30 years age group from March onwards. Around 70 per cent infections are in below 45 age group where severity of symptoms is less likely. However, age group alone does not determine the course if not capitalised smartly.

Pakistanis are known for their capacity to battle adversity. We have braved numerous crises over the last three decades that include terrorism, earthquakes especially the one in 2005, floods and many more. We are a battle-hardened nation able to overcome challenges with our resilience and courage.

The pandemic has presented certain caveats that we as a nation need to learn.

Foremost is that health, economy and development are interwoven and integrated. The emerging concept of One Health is the pivot around which we need to develop our larger development edifice. A modest beginning will be to devise workplans with defined targets to achieve the larger UN Sustainable Developments Goals.

Yasmin Rashid is the Health Minister of Punjab, Pakistan