Four key interventions are critical to keep daily cases low.
Pakistan’s Covid-19 tally have started showing a positive trend in the last couple of weeks, following a six weeks of explosive growth after Eid-ul-Fitr. This encouraging downward trend is more of due to a significant drop in test-positivity rates; Alhamdullilah, following a decline in hospitalizations and deaths. We all have witnessed how falling number of cases has been celebrated by our government, televising victory speeches.
This great aplomb has been met with a mix of caution and relief by Pakistanis, amid plummeting testing, and just some days before Eid-ul-Azha.
Though it did not have to be that way, we all know how the viral surged followed Ramazan – it was tragic and disastrous. To date, there are more than 40 countries with varying literacy rates, GDPs, and population densities, who have used diverse methods and precautionary measures to suppress the virus, never letting it reach the levels where Pakistan was in June.
Their daily cases are now somewhere within 50; it’s up to us that whether we have to follow the steps of these “winning” countries, or fall back into lockdown-release cycles and infection spikes, hinging on what we do next.
Rather than passing the baton of protecting their lives to the people, the state’s pandemic response should change course – they need to be more proactive, urgent, and aggressive. The absence of a science-backed containment plan always end up with loss of human lives.
To keep the daily-cases low, some key interventions are needed, urgently.
Limit Super-spreading Events
To control the virus, we all should identify all the Pakistan’s active infection clusters and super-spreading events – like, settings and conditions that have played an oversized role in increasing the country’s caseload.
According to a dozens of epidemiological studies, 80% of the infection is caused by 10 to 20% of carriers, especially at super- spreading events; it means that if we could stop these events, bending the pandemic curve gets easier. There are three Cs – crowds, close-contact settings, and close-range conversations – that lead to these clusters.
Identifying and strictly controlling these high-risk settings is so effective in controlling the spread of the virus; in this context, we have to look for a stream of global news about super-spreading events.
Trusting the science of Sars-Cov-2 transmission, we should limit or ban settings that are breeding grounds for the virus. The post-Ramazan viral explosion – a tsunami of clusters – can be traced in light of crowded malls, large religious congregations, Iftar and Eid parties, indoor family gatherings, and funerals that took more than a month to settle down.
If rules are not imposed to limit such events, and energies are not made in surveillance and tracing to identify clusters, it would take very less time to spike the cases again.
This is the most essential though misunderstood piece of the COVID puzzle, and in this case, debate about a state conspiracy to keep testing low is just a mere distraction — the real concern is tinkering around with less tests is a path to accelerate infection.
The fact is… even with declining cases, limited testing is not the right approach to manage the pandemic; lack of widespread testing cannot isolate new cases, especially the pre-symptomatic, asymptomatic, or mildly symptomatic ones. Testing is the right way to control the disease.
Sadly, Pakistan is neither testing enough relative to its rising outbreak, nor ready to ramp up testing in case of a new surge. In the last week, the average daily testing was 21,627 – for a population of 220 million. You know, it is less than half the minimum testing that WHO advised, and it is less than one-third of neighbouring India’s per-capita testing.
We are told, actually fooled, that testing has gone down because of its demand, while lab owners have confirmed that this decline is due to fall in voluntary testing, the key issue here is — waiting for people to show up for tests is not how surveillance and disease control works.
The “winning” countries, including those with low-income, all are practicing proactive search and detection of cases, ramping up testing so that the spread of the virus could be slowed down. This let them stay ahead of the curve, while we are lagging behind, trying to play catch-up with a fire.
So, instead of denying the need of testing, our public leaders should communicate it as an urgent state goal, so that we can understand the role of testing in controlling the pandemic, and yes, along with their self- enabling. The excess capacity should be deployed across high-risk populations such as prisons, crowded communities – to test suspected cases and contacts.
We were told Pakistan has the capacity for 80,000 daily tests, but actually it’s not the case; thanks to limited deficiency in staff, PPE, equipment and supplies. Scaling all of this infrastructure to deal with the future spikes – should be priority.
Testing should go hand-in-hand with quick turnaround times and assisted isolation — two key elements without which testing is ineffective in controlling spread. These were missing in Pakistan in June, when turnaround times surpassed a week, and fear and mistrust kept infected individuals away from isolation facilities.
Last, not least – Get them on Board
There is a dire need to bring the public on board, regain their lost trust and get the messaging across rightfully. Without which, there can be no compliance around tracing, testing, or containment; repeating the “strict SOPs” mantra only, is nothing but a false sense of security.
Pakistani leaders need to send a unified, promoting a science-informed message to the nation, while taking the responsibility of their words, and their role in motivating the public motivation as a whole. The most important factor is the honesty, both when trends are positive, and more critically, when they are negative. So far, our state’s response starts from denial in March and April when it was a real window to suppress the virus, to apathy and nihilism in May and June when cases spiraled out of control, and now, overblowing premature declarations of victory as trends improve.
How to get them? It’s simple, put richer data regularly in the public domain, so that they can be informed and motivated; and make daily, regional growth rates and trends – hospitalizations, test-positivity rates, testing turnaround times, ICU admissions, RO, and hospital capacities – easily accessible online.
Getting the public on board also requires simple science communication about topics such as asymptomatic spread, modes of transmission, immunity, and masking.
In short, Pakistan needs a solid containment plan that should…
- Identify and limit super-spreader events
- Widespread testing along with assisted isolation
- Get the public on board.
In the absence of these, the pandemic will keep putting our vulnerable and marginalised citizens at the highest risk, especially the disadvantaged ones.