Ever since it became more apparent that the viral illness in China has the potential to become a pandemic, the world of economics went into panic. Stock markets crashed around the world. Millions of jobs lost in major economies. World growth predictions went negative. And along with the usual problems linked with economic distress there was bound to a health crisis and unfortunately the rising death toll became the norm of the day right across the globe. Like elsewhere Pakistan also faces challenges but Pakistan needs to look at those challenges in the light of its own demographic, social and economic realities.
Doing so might make Pakistan’s approach unique or somewhat different to the rest of the world and potentially transform those challenges into opportunities. With regards to health sector Pakistan should have the assurance that its young population demography is its advantage in this COVID crisis. 90% of Pakistani population is below 55 years of age and 60% below 30 years of age. We know from data obtained from China and elsewhere that risk of hospitalisation and death is considerably small in young people and rises sharply after 70years of age but above 55 years of age are also at significant risk particularly with medical conditions. For a population to achieve herd immunity about 60-70% of population should be immune and it may be Pakistan will get there with not many deaths. Any death is a tragedy and we should do whatever we can to stop that but in the bigger picture the economic crisis or slow down will lead to more deaths directly or indirectly.
One such example is the high infant mortality in Pakistan as compared to wealthy nations which is direct result of poverty in our country and those deaths or increase in similar deaths should not be discounted in the particular focus on COVID crisis. Pakistan’s policy regarding COVID is aggressive but directionless. Unfortunately, due to low testing figures Pakistan does not have enough data to build a representative picture on the spread of Corona virus. Putting aside the mistakes of Taftan and moving forwards it’s of paramount importance for Pakistan to establish at what stage of epidemic it is. I can see that Pakistan still remains focussed on containment measures like contact-tracing which is alright, but it does not know that there a tsunami of patients which will hit the health service for which I have seen little preparedness.
Pakistan needs to know that the disease has already spread across the country which is evident from the proportion of positive tests compared to the total number of tests. Moreover, a big proportion of domestic spread patients among the positive tested patient gives the same signal. Pakistan needs to put all this data to expert epidemiologists to ascertain the stage of epidemic. Focussing on containment when its not containable will be a waste of scarce resources. In UK here experts know that its not in the containment phase and hence it has stopped contact tracing or testing any COVID contacts. It only advises them to stay at home for 14 days. All its measures are to delay the peak of epidemic so all patients do not end up in the hospital at one time. Having worked in Pakistan and now in UK, I know that even tertiary care facilities had very limited oxygen supplies in Pakistan. Blood gases analysers were mostly non-functioning if at all present. There was very little understanding of non-invasive ventilation i.e. CPAP/BIPAP. We need to get the basics right.
Dr Usman Ali