In August 2019, I attended a session on ‘crisis as the new normal’ at the Bucerius Summer School in Germany, where the discussion was on the threat of new wars, on the battlefield and in cyberspace, without norms, treaties or frameworks. Who would have thought the a year later the world would be channeling its efforts, money and technology towards solving another crisis — the COVID-19 pandemic.
The journey of most countries’ experience with COVID-19 can be compared to the five stages of grief. It started with questions on the existence of the virus and the denial of its threat. Next came anger, mostly towards government inaction and policy delays. This was followed by the aggressive spread of the virus and a collective human bargaining; governments regretted the decision of not controlling the virus at infancy, import orders of ventilators were being placed on an urgent basis and people started praying and asking God for mercy. Then came depression; hospitals were choked, people were dying in the hundreds and the feeling of helplessness grew. Finally, people have entered a stage of acceptance, realising that COVID-19 is here to stay, at least until a vaccine is developed and deployed.
The journey of most countries’ experience with COVID-19 can be compared to the five stages of grief.
The virus has affected over 25 million people across 213 countries.
<1> Governments and citizens alike have had to adapt to the crisis. Pakistan’s story is no different. The first case recorded was on 26 February of a Pakistani who had traveled from Iran. At that time, although Iran had a substantial number of cases, the Pakistan-Iran border remained open to travelers and pilgrims without any quarantine procedures or testing mechanism in place. Over the next few weeks, as more pilgrims returned from Iran, the government set up camps along the border without adequate facilities to detain travelers for 14 days, which created plenty of bad press. While the government was struggling with improving facilities to control the spread of the virus spread from the border area, international passengers were free to enter the country through other land borders and airports. Travelers, including Pakistani migrant workers from the Middle East and Europe, returned to the country without restriction, triggering the spread of the virus in the provinces of Punjab and Khyber Pakhtunkhwa. Mismanagement and the inability to control the virus early on sparked harsh criticism of the federal government, which then decided to set up a dedicated office, the National Command and Operation Centre (NCOC), for the management of the virus and Pakistan’s response.
The NCOC is headquartered in the capital city of Islamabad and is headed by Prime Minister Imran Khan, with representatives from all provincial chief ministers, health ministers, district administration, disaster management authorities and the army. Khan assigned a senior minister and an army general to preside over daily meetings and update him on a weekly basis. The NCOC served as a nerve-centre for all COVID-19 related data and as a secretariat for coordinating and following-up national policy decisions. It also divided tasks among various government departments to assist in its tasks. The first responsibility assigned was to map the existing healthcare infrastructure, staff and equipment available across the country. This province-wide information — which included details on personal protective equipment, and the number of beds, oxygen tanks and ventilators available at each healthcare facility — helped the government channel resources to enhance capacity, including by importing what was required. Next, the NCOC tasked the top three private sector data analytics companies to run daily projections of cases. After studying the case forecast, the government decided to impose a strict countrywide lockdown from 23 March, when it had already reported 892 cases and six deaths.
<2>
While some appreciated the blanket lockdown, many cursed the government for this strategy.
A national lockdown meant that all educational institutions, private offices and public spaces such as malls, restaurants, parks and the transport were to remain shut. International flights were also halted, but the government arranged special flights to bring stranded Pakistanis back home. Provinces were allowed flexibility in deciding whether to impose the lockdown for a limited or an indefinite period. Over the next few weeks, the government, citizens and businesses all adapted to the new normal.
People were scared and roads were empty. Families and friends stopped meeting each other and hand sanitiser supplies ran out. Retail sector workers faced uncertainty regarding employment while others struggled with setting up home offices. Borders were closed and wedding gatherings banned. Industries were shut and the traditional economy suffered. On the other hand, startups focusing on digital service delivery emerged. Grocery stores and corner shops in larger cities moved towards developing websites and apps as demand skyrocketed. Most private schools started online classes, but those living in remote and unconnected areas had no access. Mosques were locked and hospital out-patient departments were closed, causing some pushback from people. While some appreciated the blanket lockdown, many cursed the government for this strategy. Khan himself expressed scepticism over the policy but consoled people by saying ‘
ghabrana nahi hai’ (do not worry).
<3> Yet, he also voiced fears of unemployment amongst daily labourers causing a rise in poverty levels and instructed his office to enhance its cash-transfer ‘Ehsaas’ programme for those affected by COVID-19. The people of Pakistan donated privately and to the government in abundance for purchase and distribution of grocery packs for the needy, in keeping with the country’s status as one of the most charitable nations in the world (contributing 1 percent of GDP annually
<4>), with the government raising PKR 4 billion through a fund-raising drive.
<5>
With technology providing data on virus clusters, the government moved to implement a smart lockdown in over 200 hotspots across 30 cities.
Even as the lockdown kept getting extended, the government enhanced its testing capacity and the NCOC coordinated the establishment of a central database for COVID-19 test results. The upgraded government and private labs started updating case results onto the single database. Each test conducted had the patient name, age, gender and address information, and with data pouring in, geographical clusters or case hotspots emerged.
As the month of Ramadan approached (May), religious scholars began pressurising the government to allow mosques to function, and the government caved. Soon after, industry and retail businesses demanded the lockdown be lifted and they too were allowed to open for limited hours each day by the end of May. However, schools and private offices remained shut. The government’s strategy to relax the lockdown coupled with Eid celebrations meant people started flocking to markets and other crowded common spaces. This caused an explosion in COVID-19 cases. By June, Pakistan was reporting approximately 6,800 new cases and 150 deaths a day, with the percentage of positives against tests conducted reaching a high of 24 percent. Soon hospitals reached their capacities, paramedics and doctors began to get infected, the plasma of COVID-19 survivors were being sold for exorbitant prices and the economy shrank. Despite the government working on developing new and strengthening existing systems to address the virus, Pakistan appeared to be losing the COVID-19 war.
While some wondered if the numbers fell due to reduced testing, data revealed that testing figures remained the same.
During this time, a trace, test and quarantine (TTQ) strategy was devised and implemented across the country. This TTQ strategy, applied to both local and imported cases, used technology to track COVID-19 positive people through their cellular network location and phone text alerts were sent to people they had been in close contact with. Contacts were advised to stay home while district administration arranged for home tests. Those who tested positive were placed under quarantine, either through home isolation or forced transfer to a government quarantine facility. The TTQ strategy was first tested by running a two-week pilot in the major cities of three provinces and the efficacy of controlling the spread of COVID-19 led to it being adopted across the country. The government faced criticism from citizens for monitoring their movement, but soon people accepted the move. However, the forced quarantine in government facilities meant people refused to get tested over fears of being sent to a government facility for two weeks. As a result, the NCOC decided to allow those infected to choose whether to isolate at home or at an official facility. Similarly, as flight operations partially reopened, all passengers were tested and transferred to hotels to isolate. This came at a high cost to the exchequer but prevented imported infection cases.
With technology providing data on virus clusters, the government moved to implement a smart lockdown in over 200 hotspots across 30 cities. Residents were informed in advance and advised to stock up on essentials as they would be barred from exiting the neighbourhood for two weeks. This strategy proved to be effective as only those areas that emerged as virus epicenters were placed under strict lockdown. The result were visible immediately — the number of cases declined sharply, halving in the first week of July and continuing to fall to an average of 1,200 a day by the end of the month. While some wondered if the numbers fell due to reduced testing, data revealed that testing figures remained the same. Others accused the government of underreporting cases to project its strategy as a success, but hospital data and anecdotal evidence suggests the opposite. COVID-19 wards began to empty, ventilators became available after months and government quarantine facilities began to shut down.
Despite the government adopting the right policies to tackle the virus, mixed messages regarding the severity of COVID-19 and the poor enforcement of measures like wearing masks and maintaining social distancing remains a weakness.
The number of new infections declined further in August, with daily cases and deaths reducing to an average of 650 and 12, respectively,
<6> and the positivity rate under one percent at the end of August.
The top three factors in the government’s approach that has led to these the low numbers are setting up a dedicated decision-making body with the right representation, using positive case location data efficiently to identify hotspots to enforce targeted lockdowns, and using its cash transfer programme to protect the economically vulnerable. Despite the government adopting the right policies to tackle the virus, mixed messages regarding the severity of COVID-19 and the poor enforcement of measures like wearing masks and maintaining social distancing remains a weakness. Pakistan no longer has lockdowns in any form and flights operate without passengers being tested. The virus has far from run its course, but Pakistanis’ attitudes show otherwise. Weddings have resumed, cinemas and restaurants are full, Independence Day celebrations resembled a crowded rock concert and Eid ul Azha was observed with fervour.
As fears of a second wave loom with educational institutes resuming, one can only hope that Pakistan’s lucky charm — hot and humid weather, BCG vaccinations, high immunity, a young population, or a combination of all — continues to work its magic.
This essay originally appeared in Rebooting the World.
References
<1> “
Coronavirus Cases”,
Worldometer.
<2> “
COVID-19 Health Advisory Platform by Ministry of National Health Services Regulations and Coordination".
<3> Rizwan Shehzad, “
PM Imran Vows to Win War against COVID-19.”
The Express Tribune, March 17, 2020.
<4> Shazia M. Amjad and Muhammad Ali. “
Philanthropy in Pakistan (SSIR)”,
Stanford Social Innovation Review: Informing and Inspiring Leaders of Social Change, March 19, 2018.
<5> Amir Wasim, “
PM's Corona Relief Fund Crosses Rs4bn Mark.”
Dawn, May 27, 2020.
<6> “
Pakistan”
Worldometer.
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