Tuesday, June 9, 2020
Pakistan’s Confused COVID-19 Response
By Daud Khattak
Pakistan’s coronavirus fight needs clear public messaging to avert a public health crisis.
With over 108,000 COVID-19 cases, Pakistan has passed the official count in neighboring China, the country first hit by the novel coronavirus. Officially projected figures suggest positive cases in Pakistan could reach 125,000 by June 15. Yet thanks to the government’s contradictory public messaging, a majority of Pakistanis still haven’t registered the danger.
The pandemic, if it continues to be underplayed by the government, may pose a formidable challenge for Prime Minister Imran Khan’s leadership — along with causing a serious health crisis in a country of 220 million people with a weak healthcare system.
It has been 100 days since Pakistan registered its first coronavirus case. But the government has yet to come out with a unified statement and an orderly policy to inform, educate, and protect the masses. Instead, the public tends to follow dangerously fatalist and superstitious approaches rather than paying heed to science and health experts.
I have been closely covering the coronavirus outbreak in Pakistan by directly speaking to ordinary people, from the country’s tribal region bordering Afghanistan to the port city of Karachi. One common theme emerges: many people live in a state of denial and disbelief.
A section of society, mostly under the influence of religious propagandists, believe that COVID-19 is a conspiracy hatched by non-Muslims to keep believers from worshiping at mosques and following their religion. Similar misinformation surrounds the polio virus; propaganda that the polio vaccine is a ploy to make “Muslim men infertile” is one of the major reasons that polio still exists in Pakistan.
Maulana Tariq Jameel, a leading religious scholar in Pakistan and public face of the missionary Tablighi group, told a gathering that COVID-19 is the result of the “wrongdoing of women.”
“When a Muslim’s daughter practices immodesty and the youth indulges in immorality, then Allah’s torment is unto such a nation,” the highly acclaimed cleric said in a televised address while sitting side-by-side with the prime minister. Jameel later retracted his remarks, but the damage was done.Even among those who accept the existence of coronavirus, some are under the impression that the virus can not touch Muslims. There is a narrative that the disease is God’s wrath against the “infidels” for their “immorality.” This section of the society, again under influence from religious propaganda, believes that Muslims are immune to COVID-19 because they wash their hands and faces five times a day while performing ablution before each prayer.Yet another section of the society — mostly those coming from rural backgrounds and the lower middle class — presumes that reporting their symptoms to a hospital or a health worker means certain death. They believe that the government is trying to show more fatalities in order to collect money from international aid agencies and donor countries.
This is a rapidly spreading conspiracy theory with unclear origins. The most obvious reason for the spread of this conspiracy theory is the government’s unclear and ambiguous public messaging.
The public disbelief has its roots in the government’s unclear statements from the very beginning. Pakistan’s central leadership, instead of chalking out a unified strategy, tried to score political mileage by coming out with the usual bravado.
One of the first public messages was an Urdu language phrase that translates as “fight instead of fearing coronavirus.” This provided enough ground for the common people to respond frivolously to the deadly virus.
Prime Minister Khan’s speeches downplaying the nature of the menace, and his government’s flipflopping announcements – a lockdown, a smart lockdown and finally no lockdown, all without flattening the COVID-19 curve — further deepened the disbelief among the people.
The prime minister’s statements partly reflect his personal views about the global pandemic and partly emanate from his contempt for his political rivals. When the government of Sindh, the only province run by the opposition Pakistan People’s Party (PPP), started amassing praise in the local and international media for its strict COVID-19 measures while Khan’s central government was still dragging its feet on imposing a lockdown, Khan was quoted as saying that it was the “elites who locked down the country.”
At the outset of the outbreak in December 2019, Khan’s government remained unresponsive as the novel coronavirus started taking its toll in China, Pakistan’s northeastern neighbor and close economic and political partner. Later, dozens of returning Shiite pilgrims were quarantined at the Pakistan-Iran border in Balochistan when the virus was first detected in February 2020 among those returning from visits to the shrines in Iran. Many of the returnees, however, were released without a proper health check.
In March, the government of Punjab province allowed a congregation of devout Muslims, the Tablighis, in the city of Lahore. Over 100,000 people attended from across Pakistan, alongside devotees from around 40 countries.
Both the Shiite pilgrims who returned from Iran and the Tablighis later turned out to become the main agents of spreading the virus to other cities.
Health experts across Pakistan are the only segment ringing alarm bells about the threat and have been asking for a strict lockdown. But their voice was often drowned out by official confusion, the economic woes of the business community, and calls from clerics asking believers to return to mosques for congregational prayers.In the month of May, as doctors were issuing passionate appeals to the government and the public to pay heed to their warning calls, prominent religious scholars gathered to tell believers that the lockdown does not apply to mosques. It was the latter who prevailed.Khan, in his June 5 televised address to his so-called Corona Relief Tiger Force volunteers, said that “it is important to ensure people follow the SOPs [standard operating procedures, referring to precautionary measures] because we can’t go back to lockdown; this country cannot afford it.”
A few days later, on June 8, Pakistan recorded more than 4,500 coronavirus positive cases for a third straight day, raising the threat of an exponential growth in the number of cases.
Days before Khan’s speech, an official report of Pakistan’s Punjab government had suggested that “no workplace and residential area of any town is disease-free” in the city of Lahore. The same report estimated that total cases in the city at over 670,000.
Pakistan now has the 16th highest number of coronavirus cases in the world, but the government’s public messaging and decision making have yet to assume a clear direction.
One may sympathize with Khan while he speaks of the woes of the labor and daily wage class being hit by a complete lockdown, but, as health experts suggest, opting for the economy over people’s lives may result in serious health crisis for the country. The clarity in public messaging could limit, if not fully stop, the spread of the disease.
WHO says Pakistan meets no pre-requisites for easing restrictions, recommends 'intermittent lockdown'
The World Health Organisation (WHO) — in a letter addressed to Punjab Health Minister Dr Yasmin Rashid — has recommended that the country impose an "intermittent lockdown" to curb the spread of Covid-19, noting that the country doesn't meet any prerequisites for lifting restrictions as was done on May 1 and then on May 22
The letter dated June 7 has been penned by Dr Palitha Mahipala, WHO Country Head for Pakistan, and states that the coronavirus has spread to almost all districts in the country, with major cities making up a majority of national cases.
"Government intervention on April 12 detailing social distancing measures, including movement restrictions, closure of schools and businesses, international travel restrictions, and geographical area restrictions were instituted with the aim of limiting the spread of the disease."
However, the partial relaxation of restrictions on May 1, followed by a complete relaxation on May 22, has caused the rate of infection to increase, the letter noted.
According to WHO recommendations, any government that wishes to lift lockdown restrictions must meet a set of conditions. The letter noted that so far, Pakistan has not met any of the conditions which include:
- Disease transmission is under control
- Health systems can "detect, test, isolate and treat every case and trace every contact"
- Hot spot risks are minimised in vulnerable places
- Schools, workplaces and other essential places should have preventive measures
- The risk of importing new cases can be managed
- Communities are fully educated, engaged and empowered to live under a new normal
"The positivity rate is high, the surveillance system is weak, there is limited capacity to provide for critical patients and the population is not ready to adapt to change in behaviour," the letter stated, adding that Pakistan's reproductive number (R), which is an estimate for the number of individuals infected by each carrier, is also greater than 1.
The WHO recommended that strategic decisions should be taken to either tighten or loosen public health measures. "These difficult decisions will require the need to balance the response directly to Covid-19 which includes intermittent lockdowns of targeted areas."
Stressing the need for ramping up testing capacity beyond 50,000 tests per day and strengthening public health measures, the WHO recommended that the government enforce a "two weeks on, two weeks off strategy" as it offers the smallest infection curve.
Pakistan's coronavirus cases surpassed the 100,000 mark last week. As of June 9, more than 110,000 Covid-19 cases and 2,000 deaths have been reported.
'Need to ensure implementation of SOPs'
Commenting on the letter, Rashid said that it was important to remember that the recommendations were for the entire country, not just for Punjab.
She expressed these views while speaking at a press conference in Lahore earlier today. "I have been telling you since day one that the number of cases [in the province] are increasing, no data is being hidden.
"The main thing that they have said is to ensure implementation of standard operating procedures (SOPs). This discussion has already taken place. In his last meeting, the Punjab chief minister stressed on taking action in areas where there are violations.
"The current situation, whatever WHO says, right now we can also treat patients. The purpose of a lockdown is to prevent flooding of hospitals. We have a contingency plan [...] right now we have the capacity [to treat patients] and will increase it in the next 10 to 15 days."
She added that whatever the WHO had said was correct and that the government would "consider" it. It has already been proposed to lockdown areas where a large number of cases are being reported but this decision will be taken by the cabinet committee, she concluded.
ڈبلیو ایچ او کے خط میں درست تحفظات کا اظہار کیا گیا ہے، بلاول بھٹو
چیئرمین پیپلزپارٹی بلاول بھٹو زرداری نے کہا ہے کہ عالمی ادارہ صحت (ڈبلیو ایچ او) کے سندھ حکومت کو خط میں درست تحفظات کا اظہار اور تجاویز دی گئی ہیں۔
اپنے بیان میں بلاول بھٹو زرداری کا کہنا تھا کہ سندھ حکومت ڈبلیو ایچ او کے خط پر غور کے بعد وہ نکات قومی سطح پر اٹھائے گی۔
WHO letter to Sindh government raises valid concerns & suggestions. Will be discussed by Sindh govt before being taken up at national level. We’ve long called for national policy to be linked to facts & our own capacity. Unfortunately so far this hasn’t been national approach.
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انہوں نے کہا کہ سندھ نے ہمیشہ حقائق اور استعداد کے مطابق قومی پالیسی بنانے پر زور دیا ہے۔
بلاول بھٹو کا کہنا ہے کہ بدقسمتی سے کورونا کے معاملے پر قومی سطح کی حکمت عملی اختیار نہیں کی گئی ہے۔