Can Pakistan Effectively Respond to Coronavirus Pandemic?

[Riaz Haq]

Pakistani public health system's ability to deal with Covid19 pandemic is increasingly being questioned with the number of confirmed coronavirus cases spiking in the country. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan. Hydroxycholroquine (HCQ), made by Getz Pakistan, is also reportedly effective in treating Covid19.

Coronavirus Global Pandemic

Is Pakistan Ready?

Pakistan is among only 6 countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The 6 countries named in the report are: Eritrea, Finland, Pakistan, Saudi Arabia, Tanzania and the United States.

Covid19 Coronavirus. Source: US CDC

Pakistan's ability to deal with a pandemic is now being tested by the coronavirus. The current hotspot for it is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes.

Pakistan is ramping up coronavirus testing and setting up isolation wards at many hospitals in Sindh and across the country. More testing accounts for the spike in confirmed cases. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.

In response to a recent request by Pakistan's Express Tribune newspaper staff, World Health Organization Executive Director Dr. Michael J. Ryan said Pakistan has great capacity in public health but he also talked of challenges posed by the Coronavirus pandemic. “Pakistan has a highly mobile population with mega cities and undeserved people,” he said.  “So there is a great challenge facing Pakistan. But Pakistan has also demonstrated time and again with dengue, polio and other diseases how all of the government and society’s approaches can be made to work.”

Dr. Palitha Gunarathna Mahipala, World Health Organization (WHO) representative in Pakistan, also lauded Pakistan's response to Covid19 pandemic, according to The News. He said,  “Pakistan has timely come up with one of the world’s best National Response Program against COVID-19 and it is being implemented very effectively. Authorities are doing their job and now it is the responsibility of the people to follow the instructions and take preventive and precautionary measures to avoid contracting the viral disease.”

The World Bank report titled "From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level" was written by experts from the World Bank,  the World Health Organization, the International Monetary Fund, the African and Asian development banks, and finance officials from various governments. The report included estimates of the economic damage various epidemics had done. For example, the viral pneumonia SARS — which ultimately killed only 774 people — shrank China’s gross domestic product by 0.5 percent in 2003. The report also broke down costs on a per capita basis. A major flu pandemic, for example, would cost Afghanistan only $12 per citizen, India $31, Pakistan $28 and the United States $248.

Social Distancing:

The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.

Italian experience with coronavirus has shown that even a well-developed public health system in a rich European country can be overwhelmed by rapidly growing pandemic such as Covid19.  The best way to handle the situation is to cut the infection rate by keeping people about 6 feet apart. This is being called "social distancing".

Social Distancing to Limit Infection Rates

Based on what the United States has learned from what is happening in Italy, major cities and states in America are taking steps to reduce large gatherings of people. Offices, schools, restaurants and shopping centers are closed with shelter-in-place orders in Silicon Valley and the larger 6-county San Francisco Bay Area.

Herd Immunity:

Herd immunity develops when a large percentage of population is infected or vaccinated. Dr. Arindam Basu, Associate Professor of Epidemiology and Environmental Health at University of Canterbury, has recently written an article in The Conversation arguing that it is "unethical and potentially dangerous" to wait for herd immunity to develop in the absence of a vaccine.  It could result in hundreds of thousands or even millions of deaths among the most vulnerable segments of the population such as the elderly and the immune-compromised.

Pakistan's Assistance to China:

Chinese President Xi Jinping has thanked Pakistan for its support during coronabirus outbreak in his country. "China is deeply grateful for Pakistan's support. Facts have proved once again that China and Pakistan are true friends who share weal and woe and good brothers who share each other's joys and sorrows. The special friendship is a historical choice, and is deeply rooted in the hearts of the two peoples," said Xi.

Resochin (Chloroquine) Produced by Bayer Pakistan

At the peak of the outbreak in February, Bayer Pakistan exported to China 300,000 tablets of Resochin (Chloroquine) that proved effective in treating coronavirus infections and saving lives in Wuhan. Resochin is an antiviral drug used for treating malaria. Chloroquine is manufactured by not just Bayer but several other drug companies as well.  China and many other countries discontinued its production years ago.   Several Pakistani pharmaceutical companies also manufacture HydroxyChloroquine which has lower toxicity and fewer side effects. The United Kingdom has banned hoarding and export of both of these drugs. In addition, Pakistan donated 7,000 surgical masks to China at the peak of the coronavirus outbreak.  A recent paper titled "An Effective Treatment for Coronavirus (COVID-19)"  by James M. Todaro, MD and and Gregory J. Rigano, Esq. has published data showing the efficacy of familiar anti-malaria drugs Chloroquine and Hydroxychloroquine for treatment of and as prophylactic against COVID-19.

In Vitro Efficacy of Chloroquine(CQ) vs Hydroxychloroquine (HCQ) Ag...

Recently, Chinese research (reported in Clinical Trials Arena) reported that “data from the drug’s [chloroquine] studies showed ‘certain curative effect’ with ‘fairly good efficacy’ … patients treated with chloroquine demonstrated a better drop in fever, improvement of lung CT images, and required a shorter time to recover compared to parallel groups. The percentage of patients with negative viral nucleic acid tests was also higher with the anti-malarial drug… Chloroquine has so far shown no obvious serious adverse reactions in more than 100 participants in the trials… Chloroquine was selected after several screening rounds of thousands of existing drugs. Chloroquine is undergoing further trials in more than ten hospitals in Beijing, Guangdong province and Hunnan province.”

A small French study found only 25% of COVID19 patients who took it for 6 days still had the virus while 90% of those who had not taken it still had Covid-19.

HCQ (Hydroxychloroquine) Manufactured by Getz Pakistan

Economic Impact of Coronavirus Pandemic:

Service sector accounts for  50% of the world GDP and 54% of Pakistan's GDP.  Social distancing will significantly impact the services, particularly retail, restaurants, travel, transport and education sectors. Imran Khan has expressed fear that the pandemic will devastate the economies of developing countries.

“My worry is poverty and hunger," Khan said. "The world community has to think of some sort of a debt write-off for countries like us, which are very vulnerable, at least that will help us in coping with (the coronavirus).”

Summary:

Pakistan is among only six countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.  The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.  Dr. Michael Ryan and Dr. Palitha Gunarathna Mahipala of the World Health Organization (WHO) have talked of challenges Pakistan faces but also praised the steps it has taken to fight coronavirus pandemic.

Here's the latest Coronavirus Pandemic Update:

https://youtu.be/vE4_LsftNKM

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[Riaz Haq]

#Pakistan locks down province, bans international flights as #coronavirus spreads. PM #ImranKhan is urging people to stay at home but remain calm, saying that “panicking is more dangerous for us than coronavirus.” #COVID19 https://www.washingtonpost.com/world/pakistan-locks-down-province-b...

With the number of coronavirus cases in Pakistan soaring to more than 700 in the past few days, officials there have banned all international flights and have requested that security forces help institute a full lockdown in Sindh province, where a majority of cases have been reported. A third death from the virus was reported Friday.

Most of those found to be infected are Shiite pilgrims from Sindh who returned from visiting shrines in neighboring Iran, where the virus has already killed more than 1,500. Most reentered Pakistan via a single border crossing in Baluchistan province. A similar problem is affecting next-door Afghanistan, where tens of thousands of refugees have recently flooded back from Iran.

Pakistani Prime Minister Imran Khan, facing public panic, has stopped short of declaring a nationwide lockdown but has asked all citizens to self-quarantine for two weeks. This past week, Khan came under strong criticism after playing down the threat in a nationwide address. He said that people should not “run to hospitals” to get tested and that 90 percent of those testing positive would “recover easily.”

On Friday, with several hundred new cases reported, Khan told a group of TV anchors that he hoped the coming of hot and dry weather would mitigate the outbreak. He urged people to stay at home but remain calm, saying that “panicking is more dangerous for us than coronavirus.” He said he was still reluctant to impose a nationwide lockdown because it would harm the working poor.

“We don’t want to try and save people from corona but they end up dying due to hunger and poverty,” Khan said. Pakistan, a Muslim-majority country of 210 million, has a high poverty rate, with about one-quarter of the populace earning less than $2 per day.

But in Sindh, a vast and impoverished region of close to 50 million, officials decided to impose a total lockdown beginning Sunday night. Chief Minister Murad Ali Shah was in discussions with army and police officials Sunday night and was expected to formally enlist their help to ensure public compliance with the lockdown.-----------------------------------------

As of this weekend, health officials said a 3,000-room quarantine center has been set up in Multan, a city in Punjab, for infected pilgrims who returned from Iran. They said it has 171 isolation rooms. After screening there, patients will be sent to a new general hospital for treatment, they said.

[Riaz Haq]

Mass Religious Gathering In Pakistan Leads To Fresh Concerns Over COVID-19 Spread

https://www.npr.org/sections/coronavirus-live-updates/2020/03/23/82...

The first two cases of coronavirus infection in the Gaza Strip, a war-shattered territory with a fragile health system, were confirmed over the weekend in Palestinian men who attended a mass religious gathering 10 days ago in Pakistan, according to an Islamabad-based Palestinian diplomat.

The diplomat, Ahmed Rabi, says the men were part of a two-day gathering that ended March 12 in eastern Pakistan. The gathering of the Tablighi Jamaat, a global conservative Muslim missionary group, brought together tens of thousands of Muslim preachers from some 80 countries and has raised concerns about the virus' spread in Pakistan and beyond.

The group, founded nearly a century ago in India, has millions of followers and proselytizes around the world. Preachers on missions sleep in mosques and make door-to-door visits.

A longtime Pakistani Tablighi Jamaat member, Arif Rana, said the gathering was canceled on March 12 because of rain — attendees sleep in the open. But Azhar Mashwani, on the Punjab chief minister's staff, said on Twitter that it ended because of coronavirus fears. Most attendees were Pakistani, but at least a few thousand came from other countries, Rana told NPR.

In Pakistan, four people in the southern province of Sindh who attended the gathering were infected with the virus, the provincial government reported. Other Pakistani provinces do not provide a detailed breakdown of coronavirus cases, so the national number may be higher.

Five preachers from Kyrgyzstan stayed in a mosque in Islamabad after attending the Tablighi Jamaat gathering and have also tested positive, said a senior health official who did not want to be named because he was not authorized to speak to the press.

On Twitter, Muhammad Hamza Shafqaat, the deputy commissioner of Islamabad, accused the Kyrgyz group of "criminal carelessness" because "they knew that one of them had symptoms and they kept on roaming around."

Concerns have also been raised in Southeast Asia about infection after a Tablighi Jamaat gathering outside Kuala Lumpur, Malaysia, in late February and early March. Malaysian media reported that more than half of the country's known coronavirus cases were traced to the gathering. Preachers who attended also spread the virus to Brunei and Thailand, the New York Times reported, saying the gathering created "the largest known viral vector in Southeast Asia."

Tablighi Jamaat leaders in Pakistan had dismissed earlier calls by the Punjab provincial government to cancel their event, saying they believed those calls were motivated by anti-religious bias.

"Every other year, something or other happens which makes people afraid of getting together," Rana said. "We just focus on action, on deeds, and Allah protects."

Now, he said, for the first time in the group's history, they were curtailing activities such as weekly meetings, "until thing[s get] better."

[Riaz Haq]

A group of volunteers from Pakistan, who call themselves Pakistan Against COVID-19 – Volunteers (PAC-V), have announced plans to use cutting edge 3D printing to produce affordable ventilators, respiratory valves and other essential equipment at a large scale.

According to a report in The News, the group of volunteers from across Pakistan had earlier this month come together to develop affordable solutions to combat COVID-19 and manufacture medical equipment using 3D printing technology in the country.

The volunteers are doctors, biomedical professionals, engineers, academics, diaspora, resource mobilisers and other smaller groups, who aim to make use of 3D printing to manufacture ventilators, valves and required equipment for the frontline response to the cornonavirus.

The group has announced that the first 3D ventilator prototype will be ready for testing within two weeks. The 3D printing process builds a three-dimensional object from a computer-aided design model (CAF), usually by successively adding material layer by layer, and is also called additive manufacturing.

The group has announced that it is seeking support from the nation to scale up the initiative for a larger impact on the health industry that requires resources and facilitation at different levels of the government.

https://www.thenews.com.pk/print/633189-volunteers-come-together-to...

[Riaz Haq]

Pakistan’s top hematologist and transplant surgeon says that the blood of recovered patients of COVID-19 – the mysterious respiratory illness caused by the novel coronavirus – could be used to slow the spread of the deadly contagion which has killed nearly 10,000 people and sickened tens of thousands others worldwide.

“The body of a COVID-19 patient creates antibodies to fight off the virus. These antibodies in the blood of a recovered patient could be used to boost the immunity of the newly infected people,” Dr Tahir Shamsi, the head of National Institute of Blood Diseases, told The Express Tribune in an interview.

In medical lexicon, this technique is called “passive immunisation” which was introduced in 1890, he added. This technique is used when there is a high risk of infection and insufficient time for the body to develop its own immune response, or to reduce the symptoms of ongoing or immunosuppressive diseases.


https://tribune.com.pk/story/2179772/1-passive-immunisation-can-sav...

[Riaz Haq]

The first National Center for Virology is being recently established as a part of the International Center for Chemical and Biological Sciences at the University of Karachi, in collaboration with the Wuhan Institute of Virology and three German institutions, Eberhard Karls-University of Tuebingen, Tuebingen University, and Medidiagnost. Wuhan is the very city in China from where the coronavirus first started. The Wuhan Institute of Virology is administered by the Chinese Academy of Sciences (CAS), the most powerful scientific organization in China, and it is the leading centre for virus research in China.

The need to set up a top class centre for virology was felt by the scientific leadership of the International Center for Chemical Biological Sciences several years ago, reflecting their foresight. The International Center for Chemical and Biological Sciences now houses some 17 buildings spread over about 70 acres of land with some 600 students enrolled for PhD. It has been internationally awarded many international prizes and awards and is now the Unesco Center of Excellence, providing training to many scientists from other countries, including Germany.

The centre has been built through a number of private-public partnerships starting with the Husein Ebrahim Jamal Foundation that has set up a number of research centers in the institution, including the now famous H E J Research Institute of Chemistry. The Panjwani Center for Molecular Medicine was later established by the Panjwani Foundation and has already established excellent standards. Other donors include the Searle company led by Rashid Abdullah saheb. I also donated funds to it for setting up the Jamil ur Rahman Center for Genomics Research established in my father’s name.

After returning from Cambridge University in 1973, I have spent all my life in its development. It is now led by Prof Iqbal Choudhary, a leading research scientist of Pakistan. The buildings of the Virology Center have been constructed and Special Biosafety level 3 (BSL-3) facilities are being established in it, needed for research where work is performed with viruses and other agents that may cause serious or potentially lethal diseases through inhalation and that may contaminate the environment. A non-lethal form of Covid-19 was imported by this Karachi Center earlier this year, and work started in earnest to find a cure for this lethal disease.

https://www.thenews.com.pk/print/630787-coronavirus-and-pakistan

[Riaz Haq]

“Currently, there are 1600 beds available in nine hospitals with three in Punjab, two in Sindh, two in Islamabad and Rawalpindi, one each in Quetta and Gwadar, one in Khyber Pakhtunkhwa, and two in Gilgit Baltistan.” Moreover, one ward in all the major hospitals had been specified as an isolation facility, he added.

The total number of ventilators available across the country for critically-ill coronavirus patients are 1,700. Amid the drastic shortage and advance booking of ventilators globally, Pakistan has managed to get around 800 ventilators with the help of China. But the government is contacting several companies to increase the number to 6,000, the chairman of NDMA said.

There are currently 12 million masks available in Islamabad, Lahore and Karachi, and another 12 million have been booked. Around 100,000 masks were available in Peshawar and 50,000 in Balochistan. About 12,500 suits are available for health workers. Nearly 2,000 laser thermometers are available at different entry points while another 30,000 would be imported from China. There are some 15,000 N-95 masks available in stock, mainly for medical staff while 50,000 more would be available shortly. Meanwhile, the Chinese tech company, Alibaba, has also donated 50,000 masks to Pakistan.

Pakistan has also established 1200 single bed-with separate bathroom accommodation at 3 entry points at the western border, which can be increased to 1,000 if needed. The total quarantine beds available in the country are 23,557 and some 2,942 isolation beds. There are 215 hospitals with isolation centres and 15 testing facilities.

https://gulfnews.com/world/asia/pakistan/pakistan-draws-up-continge...

[Riaz Haq]

#Pakistan Cuts Interest Rates, Sets $6 Billion To Offset #Economic Impact Of #CoronaVirus for Poor Households,100 $630 million tax rebate for #export sector & $600 million to aid small and midsize businesses (#SMEs) & #agriculture sector. #ImranKhan #PTI https://www.rferl.org/a/pakistan-cuts-interest-rates-sets-6-billion...

Prime Minister Imran Khan on March 24 said up to 200 billion rupees ($1.26 billion) of the aid would go as payments to laborers to help families to counter the adverse effects caused by COVID-19.

Funds will also go to food and energy subsidies and on measures to boost agriculture, Khan said.

Separately, the State Bank of Pakistan announced it was slashing its key interest rate from 12.5 percent to 11 percent, a week after the rate was reduced from 13.25 percent.

The moves come as countries around the world intensify measures to rescue their economics in the face of dramatically reduced demand due to the coronavirus epidemic.

Khan also told reporters that there would be a 15-rupee (about $0.10) decline per liter in the price of gasoline and diesel.

Other measures included a 100 billion-rupee ($630 million) tax rebate for the export sector, with a similar amount to be set aside to aid small and midsize businesses and the agriculture sector.

Low-income families will receive cash payments of 3,000 rupees ($19) a month for the next four months.

Taxes on items such as sugar and wheat will be reduced or eliminated, and the government will also provide assistance to users of electricity and to medical workers.

"We will have to protect poor and make sure they have food on the table," Khan told the news conference.

The prime minister said more than 1 trillion rupees ($6.3 billion) will be taken from the government's coffers to fund the aid and stimulus packages.

The government has confirmed 906 cases of coronavirus infection with seven deaths, although most experts caution that the true number of cases in any country is impossible to determine because of a lack of testing.

Hospitals in the capital and other cities have reported long lines of people attempting to get tested for the potentially deadly disease.

Pakistan has suspended all international flights to and from the country, while provincial governments have imposed lockdowns in several cities in a bid to stem the spread of the virus.

Even before the crisis, Pakistan's finances had been in a precarious situation.

In July 2019, Islamabad turned to the International Monetary Fund for a $6 billion bailout package and has since been attempting to exhibit more disciplined financial policies to satisfy the Washington-based lender's requirements.

[Riaz Haq]

Passenger train service halted in #Pakistan till March 31. Pakistan #Railways operates 142 trains daily on its 1,885-km-long tracks to ferry some 700 million passengers every year. #Coronavirus fears had already reduced ridership. #COVID19 #lockdown https://tribune.com.pk/story/2183068/1-pakistan-railways-suspend-pa...

The Pakistan Railways on Tuesday announced that all passenger train services would be suspended till March 31 to curb the spread of coronavirus infections.

Taking effect from midnight, all passenger trains will remain suspended owing to the growing number of COVID-19 cases in the country, while cargo trains will continue to function according to their schedule.

Passengers who have already booked seats will be accommodated in trains of their choice when the services resume, according to a statement issued by the Pakistan Railways.
In case tickets are unavailable, they will receive a full refund.

The move to suspend the services came after Prime Minister Imran Khan’s approval.

Earlier in the day, Railways Minister Sheikh Rashid told the media that the suspension of all passenger train services was on the cards but the final decision would be made by the prime minister.

He added that he had recommended to the prime minister to give a relief package to the railways and continue paying salaries of its employees while the services remained suspended.

On Saturday, the minister had announced the suspension of 42 trains by April 1 to restrict the spread of COVID-19 in the country.

The minister said trains would be suspended in phases, adding that the notification of the suspension would remain in effect till the first half of the holy month of Ramazan.

The trains suspended in the first and second phases included Khushhal Express, Akber Express, Sindh Express, Ravi Express, Shah Latif Express and Rohri Express. Jinnah Express, Bolan Express, Moinjo Daro Express, Thal Express, Marvi Express, Samman Shakir Express, Faisalabad Express, Musa Pak Express and Chenab Express.

The Pakistan Railways operates 142 trains on its 1,885-km-long tracks to ferry some 700 million passengers every year, which means that some 200,000 people travel by trains every day. However, because of the coronavirus spread, the number had declined.
“Due to the current situation the number has declined to 165,000 passengers per day,” the minister said.

[Riaz Haq]

#Pakistani #Coronavirous Survivor Returning From #Qom, #Iran: "My treatment in (#Karachi) isolation ward was excellent. The doctors and paramedical staff handled me in a highly professional way.... I made a swift recovery". #COVID2019 https://tribune.com.pk/story/2183876/1-tales-survival-became-pakist...

I went to Iran on February 6 on a pilgrimage along with three of my close friends and some other pilgrims. We visited the holy shrines in the cities of Qom, Mashhad and Tehran and returned to Pakistan on Feb 20.

By then, the coronavirus outbreak had hit Qom – and hit it hard. Back in Karachi, I didn’t have any symptoms associated with COVID-19 respiratory disease. No fever, no cough, no shortness of breath, absolutely nothing. Still, I visited a local hospital a day after my return for blood work on the recommendation of our family physician.

The CBC report came out normal – or perfect I should say. Since there was no abnormality, I rejoined the university and attended classes for the next couple of days. A doctor, in the meantime, told me that the novel coronavirus doesn’t show up in blood through simple CBC – and that I need to take a swab test for this purpose.

This is when I started feeling dizziness and weakness. On Feb 25, I had cold sensation in my hands and feet. I also started coughing and feeling nauseated. The symptoms raised a red flag. Interestingly, I didn’t feel shortness of breath until then.

The symptoms were tell-tale. And my dad advised me to consult a doctor immediately. However, the hospital where I have had my CBC didn’t have kits to test me for the novel coronavirus. So, my father took me to Aga Khan Hospital, one of the best hospitals in the city, where I was diagnosed with the COVID-19 disease. That’s how I became the first corona-positive case in Pakistan.

Immediately after my diagnosis, I was sent to the isolation ward where my treatment began. I was diagnosed at an initial stage which is why the mysterious pathogen had not infected my respiratory system.

Medics assuaged my fears. They said the COVID-19 mortality rate is less than 1% and that it causes complications only among the elderly or those with a compromised immune system. “Since the immune system of the young patients is strong, I’ve good chances to recover completely,” one of my doctors told me at the time.

My treatment in the isolation ward was excellent. The doctors and paramedical staff handled me in a highly professional way. I was, however, not allowed to see my family and relatives, which was understandable since the virus is highly contagious. Officials from the World Health Organization also enquired about my case.

I made a swift recovery. They tested me three times to make sure the virus is completely out of my system. And finally the hospital allowed me to go home. Now, I’m feeling very good. Or I shall say I’m feeling perfect.

The sad part of the entire episode was that my personal details were leaked to the media by God knows who, which created a lot of problems for me and my family. My photo was all over the social media and I became a pariah.

Soon after my diagnosis, my entire family was tested for the coronavirus and luckily all of them tested negative. The screening was then extended to my friends who accompanied me on the trip to Iran and also the people who I had interacted with after my return to Pakistan.

[Riaz Haq]

#Pakistan daily wagers struggle to survive in #coronavirus lockdown. #PTI govt giving Rs. 12,000 ($75) to low-income earners as part of $940m economic stimulus. Pak has 119,000 hospital beds in isolation wards & adding 162,000 beds for quarantine #COVID19 https://aje.io/zdbdr

Other provinces and regions are following a largely similar model, with Sindh province, which has the highest number of cases - at least 410, enforcing a stricter lockdown with full city shutdowns mandated between 8pm and 8am every night, starting on Wednesday.

"A lockdown is not a curfew," PM Khan reiterated in a news conference on Tuesday evening. "When you enforce a curfew, what will your poorest segment of society do?"

Shireen Khan, and more than a dozen others who were waiting for work beside him, however, say that the "lockdown" may as well be a curfew, because no one is offering them work.

"A lockdown is necessary [to control the virus outbreak]," he says. "But we need to be taken care of as well."

Rising number of cases
On Wednesday, Pakistan's countrywide tally of cases stood at 1,005, with 14 patients having recovered and seven fatalities, according to government data. The number of cases has more than tripled in a week.

Authorities have been scrambling to control the spread of the virus, although they do not yet appear to be at a level that could overwhelm Pakistan's fragile healthcare system.

On Wednesday, PM Khan reiterated that he has been delaying announcing a countrywide shutdown to safeguard the economic interests of the poorest Pakistanis, who he says need to work to earn a living.

Observers, however, say that work has already dried up with the current level of restrictions.

"The wider concern that a slowdown in economic activity would knock people's daily wages off, would evaporate the work that daily wagers do, that is already coming to fruition," says Mosharraf Zaidi, a senior fellow at the Tabadlab policy think-tank.

"Daily wage labourers require sites and opportunities that demand their skills or input. But when there is a lockdown, all economic activity, construction activity […] all of those activities have been suspended."

On Wednesday, however, the government announced it would be disbursing 12,000 rupees ($75) to low-income earners, affecting an estimating 67 million people, as part of a $940m economic stimulus package.

Healthcare specialists say there is cause for concern if the number of coronavirus cases spikes in the densely populated South Asian nation of more than 200 million.

"We're on a very low scale, in terms of infrastructure," says Dr Shamail Daud, a healthcare management specialist. "Healthcare is very disintegrated and not very high in terms of quality or dealing with high levels of critical care for patients, which is unfortunately an outcome of COVID-19."

While there are a limited number of ventilators available countrywide, Daud says a bigger problem could be a lack of enough doctors to operate them in the event of a spike in cases.

"Other than the functionality of the ventilators, the staff that actually works with it, the critical care staff [...] is very limited," he warns. "In every city, there is a shortage. […] The issue is not about the machines themselves, it is about the people who can make them work."

Earlier this week, several doctors told Al Jazeera that there are not enough personal protective equipment (PPE) kits to go around, leaving many front-line healthcare workers without adequate protection.

On Wednesday, Lieutenant General Muhammad Afzal, chairman of Pakistan's National Disaster Management Authority (NDMA), said the government was working on procuring more PPE and other medical equipment. The country needed more than 4,000 additional ventilators, Afzal told the press, but manufacturers were no longer taking additional orders.