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

Related Links:

Haq's Musings

South Asia Investor Review

Pakistan Covid Watch 

How Grim is Pakistan's Social Sector Progress?

Pakistan Fares Marginally Better Than India On Disease Burdens

Can Imran Khan Lead Pakistan to the Next Level?

Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

Conspiracy Theories About Pakistan Elections"

PTI Triumphs Over Corrupt Dynastic Political Parties

Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel

PakAlumni Social Network

[Riaz Haq]

Shen Shiwei沈诗伟
@shen_shiwei
·
5m

China state-affiliated media
So they've updated the joke?

https://twitter.com/shen_shiwei/status/1469165753031036931?s=20

(This tweet has maps of the best/worst prepared for pandemic....showing the West (US, Europe) best prepared, India & China less prepared and Pakistan least prepared)

[Riaz Haq]

#Pakistan has a big idea: Send 13,000 teams led by #women to vaccinate against #COVID19 . "We've got Pfizer. We've got Moderna. We've got Sinovac," says Dr. Kishwar Tanwir, who oversees vaccinations in the Pehlwan Goth district in #Karachi. #pandemic

https://www.npr.org/sections/goatsandsoda/2022/03/05/1084228017/pak...

KARACHI, Pakistan – A doctor gives a pep talk to some two dozen women sitting in a hall of a medical center. "We've got Pfizer. We've got Moderna. We've got Sinovac," says Dr. Kishwar Tanwir, who oversees vaccinations in the Pehlwan Goth district of the Pakistani city of Karachi.

The women were about to go door-to-door to offer COVID-19 jabs on a recent February day – part of some 13,000 teams led by women that were dispatched across the southern province of Sindh to vaccinate some 12 million people over the age of 12.

This dramatic intervention by the Sindh government aims to vaccinate a cohort they have struggled to reach: some 25% of residents who have not had their first dose, despite vaccines being widely available for the past year through supplies provided by the U.N.-backed COVAX program, the U.S. and China.

"The objective of the door-to-door campaign was basically to focus on these people," says Dr. Sohail Raza Shaikh, the government's point person for COVID-19. "People who are less literate, less aware about the COVID-19 vaccine."

It's not known how many countries have tried to bring the vaccine to people's doorsteps, but senior Pakistani health officials said they were not aware of any other effort this large anywhere else. If it works, it could be a model for other developing countries, struggling to boost their vaccination rates. Pakistan's eventual goal: bringing the Sindh province's first dose vaccine rate to 90 to 95%.

Transportation: Rickshaw. Cargo: Coolers full of vaccines
Pakistan dispatches female health workers for these sorts of public campaigns because they're more likely to get access to women in conservative households who don't speak to men. They have years of experience, frequently fanning out across Pakistan to administer the oral polio vaccine to millions of children.

At the medical center in Pehlwan Goth, Namra, a 21-year-old health worker waits for a medic to fill her blue cooler box with a mix of different vaccines stored in a deep freezer. She's only got one name, like many people here.

She jumps into a rickshaw to travel to her assigned area some five minutes away, accompanied by her team – two sisters: Sajeela and Sajida. One is a social mobilizer: Her job is to convince residents to get vaccinated. The other sister enters data about the people they're vaccinating.

They reach the Hindubasti, a ramshackle patch of huts dominated by Hindus and Sikhs, wedged between leafy nurseries and a college. They weave through narrow alleyways, stepping around garbage and puddles. The women turn a corner and enter the grounds of a Hindu temple.

Namra is meant to vaccinate door-to-door, but she says she'd rather do it in the temple. The Hindubasti is a small area, she says, and residents can easily find her here, adding "This is a very dirty area – this is the only clean place."

She respectfully takes off her shoes and enters the temple, where colorful statues of Gods and flowers adorn a shelf. Her gesture is striking in a Muslim-majority country where Hindus are often looked down upon.

[Riaz Haq]

Faisal Sultan
@fslsltn
Covid vaccine update. 75% of our eligible population (age 12 years and over) is now fully vaccinated.

https://twitter.com/fslsltn/status/1507634270252064775?s=20&t=F...

[Riaz Haq]

Pakistan’s Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic - PMC

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136406/


Go to:
Government’s Initiatives to Tackle the Pandemic
The government of Pakistan has been lauded by international organizations including the WHO (and rightly so) for taking the necessary precautions and measures against the COVID-19 pandemic to guarantee not only the containment of disease spread but also to fulfill its responsibility as a state toward its people and their safety [14].

Immediate Response to Contain Disease Spread
One of the first steps taken by the government was to develop functional emergency operations centers and to detect the route of disease spread in Pakistan. The origin of the virus was the first question; hence, detailed history-taking of patients was crucial not only in understanding the outbreak but also in determining the contacts of patients with other people in the community [15]. This helped in cordoning off areas or home-bounding people who came in close contact with a patient with COVID-19. In addition to this, patients with a recent international travel history were monitored closely. This made sense because many cases and massive spread was reported in the countries neighboring Pakistan [15-17].

Containment Measures
Once primary and secondary contact-tracing was delineated, the foremost step taken by the government was to control the borders [18]. This was a crucial decision, owing to the consideration of a large number of Pakistani students and pilgrims studying in and travelling from China, Iran, and Europe. The government gained the confidence of the affected individuals and their families. It was almost unfeasible to restrict such individuals outside the country because of the strong public response; nonetheless, it was necessary if the spread of the virus was to be controlled quickly. To tackle this problem, the government took the initiative of designating quarantine houses near borders and airports to isolate people entering Pakistan for a short period to make sure they were not infected before they moved out in the community [19,20].

Border Control
The WHO reported that the number of new cases increased by the minute, and disease spread was now not only limited to people who had a recent travel history in the regions highly affected by the pandemic. Disease spread within the community was alarming and called for drastic steps to be taken not only by local governments but also by countries and states at large. All necessary services and measures are still being used in maximum capacity till date to ensure the safety of people’s lives in the country. Since all cases initially had a history of recent travel, it was speculated that transmissions were imported from outside of the country. Therefore, travel restrictions were imposed to limit the spread of virus from other countries to Pakistan [21].

[Riaz Haq]

Pakistan’s Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic - PMC

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136406/



-----

Testing and Contact Tracing
The country’s testing capacity was limited during the early months of the pandemic, and while high-income countries were conducting large-scale randomized tests to estimate the actual number of confirmed cases, Pakistan was forced to carry out priority-based testing and rely on the enforcement of strict quarantine and isolation strategies to contain the pandemic [31]. Contact-tracing, however, was an effective strategy that not only helped limit the spread of the virus but also helped predict its route through different regions of the country and across different age groups. Nevertheless, since large-scale testing was crucial to assess the severity of the pandemic, the testing capacity of laboratories and the availability of testing kits was gradually increased by the government, and in June 2020 up to 30,000 tests were conducted daily to ascertain the pace of spread and to formulate future strategies accordingly [32]. Both these strategies provided valuable insights on the differences in the clinical manifestation of COVID-19 in people with different demographic and health backgrounds.

Field Epidemiology Laboratory Training Program
The Training Programs in Epidemiology and Public Health Interventions Network is a network of 75 field epidemiology training programs, which operate in >100 countries including Pakistan. After the WHO declared COVID-19 a public health emergency of international concern, alumni from the Field Epidemiology Training Program implemented standard operating procedures (SOPs) for COVID-19 screening at international airports in Pakistan. They also designed and implemented a real-time data entry system to screen travelers from high-risk countries [33].

Implementation of SOPs: Masks, Sanitization, and Social Distancing
SOPs were devised for the public and were meant to be strictly followed in public areas. These included guidelines on social distancing; that is, avoiding crowded areas, maintaining a physical distance of 3 feet, wearing masks, maintaining hand hygiene, sanitizing frequently touched surfaces and areas, and following general hygiene rules such as avoiding touching the face, nose, or eyes, and coughing, or sneezing in the elbow or a paper napkin instead of the hands. The authorities started taking disciplinary action against those who violated the SOPs at public places in various parts of the country in accordance with the recommendations of the National Command and Control Centre of Pakistan. The focus of the National Command and Control Centre was on SOPs, compliance, strict administrative actions being implemented, and enforcement of various strands of the track, trace, and quarantine strategy [34].

Initiation of Awareness Campaigns: Role of Community Health workers
Many campaigns were initiated by both local and federal governments in the interest of the general population to spread awareness about the risks, signs, and symptoms of COVID-19 [35]. Pakistan’s extensive polio vaccination program, consisting of more than 265,000 community health workers and vaccinators, was mobilized with the help of the WHO [36]. This not only helped provide infrastructure to track and trace cases early during the epidemic but also helped spread awareness in the remote, underdeveloped rural regions of Pakistan. Another vital step was taken to spread awareness to the masses, where text messages were sent by the government of Pakistan on all mobile networks [37]. The daily reminders on following SOPs helped tackle those who did not take the necessary precautions and were unaware of the aforementioned information, and the imposition of fines and charges for noncompliance made risk and awareness campaigns a nationwide success [35,37].