How Pakistan managed to flatten its Covid curve despite a low testing rate

Earlier this month, Pakistan announced that it would allow restaurants and theatres to open up in the wake of the decreasing number of Covid cases.

A passenger wearing a mask has his temperature checked at Karachi Cantonment railway station, in Karachi Pakistan on 28 July 2020 | Asim Hafeez | Bloomberg File photo

New Delhi: As Covid-19 cases are rising everyday in India, something very striking is happening in our neighbourhood in Pakistan, which seems to have flattened the curve, that too with one of the lowest testing rates in the world.

According to data from Worldometer, at the peak of its Covid-19 curve on 14 June, Pakistan reported 6,825 new cases. On 15 June, the country recorded 5,248 cases and on 16 June 4,443 cases. The country then recorded just 331 Covid cases on 3 August, its lowest ever since the peak. On 9, 10 and 11 August, the country reported 634, 539 and 531 cases, respectively.

Data sourced from Worldometer | ThePrint team

In the last 24 hours, Pakistan reported 730 new cases and 17 deaths, taking its total disease burden to 28,5921 and total Covid toll to 6,129. All these, with a testing rate of just 9,878 tests per million. 

India is conducting 18,831 tests per million, the US is doing 20,2106 and the UAE, which has the world’s highest testing numbers, is conducting a mind-boggling 5,68,223 tests per million.

In a tweet on 4 August, Dr Faheem Younus, Chief of Infectious Diseases, University of Maryland Upper Chesapeake Health, wrote: “150 countries have done more Covid tests/million than Pakistan, Mexico, India, Indonesia, or Bangladesh. These 5 nations are now in a DATA FOG. They won’t know the REAL number of cases, hotspots, deaths or time to herd immunity. Drive carefully/humbly through this fog”.

~150 countries have done more COVID tests/million than Pakistan, Mexico, India, Indonesia, or Bangladesh

These 5 nations are now in a DATA FOG. They won’t know the REAL number of cases, hotspots, deaths or time to herd immunity

Drive carefully/humbly through this fog

— Faheem Younus, MD (@FaheemYounus) August 4, 2020

 

Pakistan, nevertheless, is earning rave reviews for its Covid control strategy. On 9 August, speaking to journalist Fareed Zakaria on CNN, philanthropist Bill Gates said: “Pakistan had a pretty bad peak in Karachi, but now they look like Europe. Those numbers have come down. India still sadly is in a growth phase as is lots of South America…”

The strategy

Pakistan’s principal weapon has been smart lockdowns, which were essentially localised lockdowns in hotspots to ensure that the disruption of livelihood is very limited and does not end up affecting the entire provinces given the current troubled economic situation in the country. 

Critics of the government, however, said that the Covid-19 testing rates are low and the death rates look impressive because of the demographics — a far younger population, like in India. 

Low testing is a criticism that Dr Abdul Bari, CEO Indus Hospital in Karachi and member of the Pakistan’s National Health Task Force, does not brush aside altogether. 

But he said it was the stigma of the Covid infection, visit by district administration officials and eventual isolation that made people reluctant to test in the initial days. He spoke about some of his own acquaintances who did not get tested, but simply isolated themselves when they developed symptoms.

“Initially people were not serious about it, they did not accept that this was a pandemic. Social media was the culprit in that as various conspiracy theories floated around. We eased the lockdown for 10 days ahead of Eid (in May) and our peak came just after Eid in the second week of June. That hit people. They realised that they need to be careful. This is a real problem,” said Dr Bari.

“On the government’s part here was a lot of focus on testing, tracing and quarantining. For every positive patient, we traced about 30 contacts on an average depending on the person’s level of mobility,” he recalled. 

Pakistan also never closed places of worship, but put in place SOPs such as maintenance of social distancing and wearing masks. 

The educated class did not visit the religious institutions “for months”, Dr Bari said, but other sections did. 

Pakistan also reaped benefits of its population demographics in terms of death rates, just “like India”, he added. The death rate per million population in Pakistan is 28. In India, it is 33.

Dr Bari, however, said most people aren’t wearing masks.

“People are not wearing masks all that much. The educated classes are following SOPs, but others not so much. But I suppose that has resulted in some amount of herd immunity to be developed,” he added.

Slowly opening up

Earlier this month, Pakistan announced that it would allow restaurants and theatres to open in the wake of the decreasing number of Covid cases. On 8 August, guidelines were issued both for the reopening of restaurants and of tourism. 

In a statement on 10 August, the Medical Microbiology and Infectious Diseases Society of Pakistan hailed the strategy of smart lockdowns. 

“Pakistan’s Covid-19 pandemic response is appropriate, with the decreasing case numbers reflecting the results of good decision making and advisory role of infectious disease specialists engaged by the federal and provincial authorities,” it said.

“The strategy of ‘smart lockdowns’ based on inputs from leading infectious diseases experts in the public and private sector has proved to be a practical way of handling Covid-19 infection in Pakistan.”

The statement also said that isolation centres in Karachi and Lahore, each with a capacity of 1,000 beds, had not worked to their capacity even at the peak of the disease.