Can Pakistan Effectively Respond to Coronavirus Pandemic?

Pakistani public health system's ability to deal with Covid19 pandemic is increasingly being questioned with the number of confirmed coronavirus cases spiking in the country. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan. Hydroxycholroquine (HCQ), made by Getz Pakistan, is also reportedly effective in treating Covid19.

Coronavirus Global Pandemic

Is Pakistan Ready?

Pakistan is among only 6 countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The 6 countries named in the report are: Eritrea, Finland, Pakistan, Saudi Arabia, Tanzania and the United States.

Covid19 Coronavirus. Source: US CDC

Pakistan's ability to deal with a pandemic is now being tested by the coronavirus. The current hotspot for it is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes.

Pakistan is ramping up coronavirus testing and setting up isolation wards at many hospitals in Sindh and across the country. More testing accounts for the spike in confirmed cases. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.

In response to a recent request by Pakistan's Express Tribune newspaper staff, World Health Organization Executive Director Dr. Michael J. Ryan said Pakistan has great capacity in public health but he also talked of challenges posed by the Coronavirus pandemic. “Pakistan has a highly mobile population with mega cities and undeserved people,” he said.  “So there is a great challenge facing Pakistan. But Pakistan has also demonstrated time and again with dengue, polio and other diseases how all of the government and society’s approaches can be made to work.”

Dr. Palitha Gunarathna Mahipala, World Health Organization (WHO) representative in Pakistan, also lauded Pakistan's response to Covid19 pandemic, according to The News. He said,  “Pakistan has timely come up with one of the world’s best National Response Program against COVID-19 and it is being implemented very effectively. Authorities are doing their job and now it is the responsibility of the people to follow the instructions and take preventive and precautionary measures to avoid contracting the viral disease.”

The World Bank report titled "From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level" was written by experts from the World Bank,  the World Health Organization, the International Monetary Fund, the African and Asian development banks, and finance officials from various governments. The report included estimates of the economic damage various epidemics had done. For example, the viral pneumonia SARS — which ultimately killed only 774 people — shrank China’s gross domestic product by 0.5 percent in 2003. The report also broke down costs on a per capita basis. A major flu pandemic, for example, would cost Afghanistan only $12 per citizen, India $31, Pakistan $28 and the United States $248.

Social Distancing:


The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.

Italian experience with coronavirus has shown that even a well-developed public health system in a rich European country can be overwhelmed by rapidly growing pandemic such as Covid19.  The best way to handle the situation is to cut the infection rate by keeping people about 6 feet apart. This is being called "social distancing".

Social Distancing to Limit Infection Rates 

Based on what the United States has learned from what is happening in Italy, major cities and states in America are taking steps to reduce large gatherings of people. Offices, schools, restaurants and shopping centers are closed with shelter-in-place orders in Silicon Valley and the larger 6-county San Francisco Bay Area.

Herd Immunity:

Herd immunity develops when a large percentage of population is infected or vaccinated. Dr. Arindam Basu, Associate Professor of Epidemiology and Environmental Health at University of Canterbury, has recently written an article in The Conversation arguing that it is "unethical and potentially dangerous" to wait for herd immunity to develop in the absence of a vaccine.  It could result in hundreds of thousands or even millions of deaths among the most vulnerable segments of the population such as the elderly and the immune-compromised.

Pakistan's Assistance to China:

Chinese President Xi Jinping has thanked Pakistan for its support during coronabirus outbreak in his country. "China is deeply grateful for Pakistan's support. Facts have proved once again that China and Pakistan are true friends who share weal and woe and good brothers who share each other's joys and sorrows. The special friendship is a historical choice, and is deeply rooted in the hearts of the two peoples," said Xi.

Resochin (Chloroquine) Produced by Bayer Pakistan 

At the peak of the outbreak in February, Bayer Pakistan exported to China 300,000 tablets of Resochin (Chloroquine) that proved effective in treating coronavirus infections and saving lives in Wuhan. Resochin is an antiviral drug used for treating malaria. Chloroquine is manufactured by not just Bayer but several other drug companies as well.  China and many other countries discontinued its production years ago.   Several Pakistani pharmaceutical companies also manufacture HydroxyChloroquine which has lower toxicity and fewer side effects. The United Kingdom has banned hoarding and export of both of these drugs. In addition, Pakistan donated 7,000 surgical masks to China at the peak of the coronavirus outbreak.  A recent paper titled "An Effective Treatment for Coronavirus (COVID-19)"  by James M. Todaro, MD and and Gregory J. Rigano, Esq. has published data showing the efficacy of familiar anti-malaria drugs Chloroquine and Hydroxychloroquine for treatment of and as prophylactic against COVID-19.

In Vitro Efficacy of Chloroquine(CQ) vs Hydroxychloroquine (HCQ) Ag...

Recently, Chinese research (reported in Clinical Trials Arena) reported that “data from the drug’s [chloroquine] studies showed ‘certain curative effect’ with ‘fairly good efficacy’ … patients treated with chloroquine demonstrated a better drop in fever, improvement of lung CT images, and required a shorter time to recover compared to parallel groups. The percentage of patients with negative viral nucleic acid tests was also higher with the anti-malarial drug… Chloroquine has so far shown no obvious serious adverse reactions in more than 100 participants in the trials… Chloroquine was selected after several screening rounds of thousands of existing drugs. Chloroquine is undergoing further trials in more than ten hospitals in Beijing, Guangdong province and Hunnan province.”

A small French study found only 25% of COVID19 patients who took it for 6 days still had the virus while 90% of those who had not taken it still had Covid-19.

HCQ (Hydroxychloroquine) Manufactured by Getz Pakistan

Economic Impact of Coronavirus Pandemic:

Service sector accounts for  50% of the world GDP and 54% of Pakistan's GDP.  Social distancing will significantly impact the services, particularly retail, restaurants, travel, transport and education sectors. Imran Khan has expressed fear that the pandemic will devastate the economies of developing countries.

“My worry is poverty and hunger," Khan said. "The world community has to think of some sort of a debt write-off for countries like us, which are very vulnerable, at least that will help us in coping with (the coronavirus).”

Summary:

Pakistan is among only six countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.  The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.  Dr. Michael Ryan and Dr. Palitha Gunarathna Mahipala of the World Health Organization (WHO) have talked of challenges Pakistan faces but also praised the steps it has taken to fight coronavirus pandemic.

Here's the latest Coronavirus Pandemic Update:

https://youtu.be/vE4_LsftNKM

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Comment by Riaz Haq on March 25, 2020 at 4:35pm

An official handout released on the instruction of the minister of defense production said that the country’s ordinance factories had “attained the capability to produce 25,000 Face Masks and 10,000 liters of Hand Sanitizers on a daily basis.”
The official statement described its new production potential as “a landmark achievement and a proud moment for the entire nation.”
“Special cloth has been used in production of Face Masks, that makes it re-usable after wash,” the statement said, adding that in view of the current situation, wherein the country was fighting novel coronavirus, Pakistan’s defense related production capability “had been diverted toward mass production of Face Masks and Hand Sanitizers.”
“The laudable efforts by Pakistan Ordnance Factories will indeed complement the ongoing national drive to fight COVID-19,” it continued while promising “further breakthrough” in “the near future.”
Pakistan’s security forces have already been playing their role in preventing the spread of the dreaded virus in the country by activating the network of their hospitals across the country to deal with the problem.

https://www.arabnews.pk/node/1647331/pakistan

Comment by Riaz Haq on March 25, 2020 at 4:36pm

The newly- formed Corona Experts Advisory Group (CEAG) in its first meeting on Tuesday has warned the public against the unsupervised usage of Chloroquine and Hydroxichloro-quine, saying the drug could cause serious side effects/untoward reactions.”

https://www.dawn.com/news/1543479

The CEAG in its first meeting on Tuesday deliberated the opinion of using Chloroquine and Hydroxichloroquine for prophylaxis of COVID-19 based on current available evidence,” reads a meeting document.

An official said the CEAG issued the warning after numerous complaints that a majority of the people was using the drug for the prevention of the coornavirus disease and self-medication in this regard was going unchecked.

He added the CEAG also showed its utter displeasure on the unchecked usage of social media where self-proclaimed doctors suggest the self-medication. This may cause a new ‘ health disaster’ if not stopped immediately, the meeting said.

“The committee is of the opinion that there is insufficient scientific evidences to advise Chloroquine and Hydroxichloroquine for prophylaxis (prevention) of the COVID-19”, reads the document.

The CEAG also issued guidelines for the protection of the frontline health professionals attending coronavirus patients at the public hospitals across the Punjab province.

It issued three levels of the prevention - general pre-examination triage/OPDs, triage centres for corona general wards and isolation wards/ICUs, and HDUs to be adopted by health professionals during treatment of the patients.

The CEAG has declared mandatory use of surgical masks for the entire staff working at all healthcare facilities of Punjab.

It has directed the staff working at OPDs of infectious diseases and OPDs of respitary care, endoscopic examination rooms must upgrade their surgical masks to medical protective masks (N 95).

The CEAG has declared mandatory usage of the protective face screen based on level III protection while collecting respiratory specimens from suspected and confirmed patients.

It declared that the surgical masks are disposable and may be used for six hours provided it does not get wet.

“The life of N95 mask is eight days (eight hours duty per 24 hours with two hours break) provided if they do not get soiled and are used by the same user”, read the new guidelines.

They CEAG issued guidelines to disinfect the operation threathres, sample collection rooms and other areas where the suspected and confirmed patients are attended or kept.

The body has strictly directed the health professionals and heads of the teaching and other institutions to follow these guidelines strictly in letter and spirit to prevent them from the coronavirus.

Comment by Riaz Haq on March 25, 2020 at 4:38pm

Pakistan Reaches 1,000 Cases Faster Than Italy (4:32 p.m. HK)

https://business.financialpost.com/pmn/business-pmn/u-s-agrees-to-s...

The South Asian nation reached more than 1,000 cases in 29 days, two days before Italy, according to data compiled by Bloomberg. People who visited neighboring Iran for a pilgrimage make up most of Pakistan’s cases. Iran outpaced both nations to reach the 1,000 mark in 13 days.

Rush for Trump-Backed Drug Sparks India Export Ban (4:30 p.m. HK)

India banned exports of a malaria drug backed by U.S. President Donald Trump amid a run on supplies globally, even as scientists continue to search for conclusive evidence of the medicine’s effectiveness against the novel coronavirus. Exports of hydroxychloroquine will be limited to fulfilling fully paid existing contracts, while certain shipments on humanitarian grounds may also be allowed.

Separately, a small study found Hydroxychloroquine to be no more effective than conventional care. The report published by the Journal of Zhejiang University in China showed that patients who got the medicine didn’t fight off the new coronavirus more often than those who did not get the medicine.

Comment by Riaz Haq on March 25, 2020 at 8:18pm

#American editor of Washington Post:”We each underwent a temperature scan at the #Islamabad airport. We also had to fill out a form asking if we’d been in China or Iran, two countries hit hard by covid-19..Nobody checked us on arrival at #JFK” #coronavirus https://www.washingtonpost.com/outlook/2020/03/25/coronavirus-quara...

“Are you guys being quarantined?” asked one friend after another after my husband and I arrived back in Washington this past weekend from an eight-day trip to Pakistan.

In fact, while we’ve decided to self-quarantine for two weeks out of concern about the covid-19 pandemic, no government official ever told us to do so — it just seemed like the right thing to do. Nor did we receive any sort of screening at the airport when we returned to the United States, despite flying into New York — the epicenter of the U.S. outbreak, with over 25,000 reported cases and more than 200 deaths as I write this.

The disconnect between the illness’s mounting human toll and this seemingly lax approach to incoming international air passengers has opened our eyes to the federal government’s insufficient response to the coronavirus and caused us to ask why our country, with its vast resources, seemingly can’t — or won’t — take the coronavirus as seriously as it should.

When we arrived in Pakistan on March 13, we each underwent a temperature scan at the Islamabad airport. We also had to fill out a form asking if we’d been in China or Iran, two countries hit hard by covid-19, during the previous 14 days. We were asked to check boxes indicating if we had a fever, cough or shortness of breath. Though 2 a.m. was probably a low-traffic arrival time, it was a painless, organized process, not a major inconvenience.

So we were shocked when we arrived Saturday at New York’s John F. Kennedy International Airport to discover that no covid-19 screening measures or advisories about quarantining awaited us. We simply got off the plane and proceeded to the U.S. citizens’ line, as if returning from any normal overseas trip. We did our customs declaration (Are you bringing in any food?) at an electronic kiosk. The U.S. Customs and Border Protection officer who scanned our passports (and who was wearing gloves) asked us a couple of questions about where we’d been and what we’d done in Pakistan. My husband was kept back for a few minutes of additional questioning, which appeared to be motivated more by security concerns than health. No one said a word about quarantines.

Comment by Riaz Haq on March 25, 2020 at 8:19pm
Passengers arriving at #Toronto Airport comparing #coronavirus screening with airports in #Pakistan: #COVID2019 Screening in Pakistan much more thorough than in #Canada

https://www.facebook.com/ehtesham.a.nezami/videos/10218751232545222/
Comment by Riaz Haq on March 26, 2020 at 7:20am

Egypt's Al-Azhar Ulema issues fatwa permitting Friday prayers’ suspension in #Pakistan, amending Azaan (call to prayer) with words ‘Salaat Fi Buyut-e-kum’, meaning ‘pray in your homes’ instead of the usual ‘come to prayer’. #Coronavirus #SocialDistanacing https://www.dawn.com/news/1543801

Egypt’s Al-Azhar has issued a fatwa on the request of President Dr Arif Alvi permitting suspension of Friday prayers to control the spread of deadly coronavirus across Pakistan.

“I am thankful to Grand Imam Shaikh of Al-Azhar and Supreme Council for responding to my personal request to provide guidance to us with regard to Farz Jamaat and Juma prayers in mosques during coronavirus attack,” the president said in a tweet on Wednesday.

President Alvi through Egypt’s ambassador in Pakistan had sought guidance from Al-Azhar institution, an authority on Islamic injunctions, for a word on the suspension of congregational prayers at mosques amid spike in coronavirus cases.

Comment by Riaz Haq on March 27, 2020 at 10:05am

“A net increase of around 15% in internet usage was witnessed since last week as the country fights against coronavirus,” the Pakistan Telecommunication Authority (PTA) said in a press release. “The increase has been observed due to increased online activities by educational institutions and businesses and, ‘work from home’ policy adopted by individuals and organizations,” it added.

Seeking to allay concerns about internet speeds and bandwidth, the PTA said there was sufficient capacity to meet the growing demand. “There is sufficient internet capacity available in the country to meet the growing demands of the future. PTA has been closely monitoring the internet usage patterns so as to ensure that fast and efficient telecom services remain available to the consumers in this difficult time,” it said.

Part of this increase is no doubt attributable to government offices and politicians moving to video conferencing for meetings in a bid to encourage social distancing and avoid leaving their homes. Just this week, opposition parties held a conference call to discuss the strategies on how to deal with the COVID-19 outbreak. The State Bank of Pakistan has also encouraged the use of digital payments and e-banking to avoid unnecessary visits to banks.

Also on Thursday, media streaming website Netflix announced it had removed the highest bandwidth streams in Pakistan to reduce traffic so that more users can avail the service. In a statement, VP Content Delivery at Netflix Ken Florance said: “Given the crisis, we’ve developed a way to reduce Netflix’s traffic on telecommunications networks by 25 percent while also maintaining the quality of our service. So consumers should continue to get the quality that comes with their plan—whether it’s Ultra-High, High or Standard Definition. We believe that this will provide significant relief to congested networks and will be deploying it in Pakistan for the next 30 days.”

Comment by Riaz Haq on March 27, 2020 at 12:41pm

#China sends to #Pakistan 15,000 personal protective equipment (PPE) suits, 500,000 surgical masks, 50,000 N95 masks, 50,000 test kits and 20 ventilators to fight #coronavirus. #COVID2019. https://gulfnews.com/world/asia/pakistan/china-sends-tonnes-of-medi...

On Friday morning, trucks full of medical supplies were unloaded at the border as the teams from both sides braved the harsh weather and snow. Meanwhile, a plane carrying 50,000 coronavirus testing kits also arrived in Karachi on March 27. This was the second bulk consignment sent by China’s Alibaba and Jack Ma Foundation within days. On March 25, the foundation sent 500,000 surgical masks and 50,000 N95 respirators to Pakistan. Sindh Chief Minister Murad Ali Shah, Consul General of China Li Bijian and other officials received the supplies at Karachi airport.

---------------------

On March 26, Yan Chen, managing director of Challenge Group of Companies from China called on Prime Minister Imran Khan to donate 15,000 protection suits for Pakistani doctors and paramedical staff on the frontline battling the pandemic. To meet the increasing demand for protective gear, China will help produce the protection suit in Pakistan’s city of Lahore, said the Chinese Ambassador to Pakistan, Yao Jing. Chinese government and leadership is committed to support Pakistan in combating Covid-19 as their top priority, the ambassador added.

----------------
Pakistan will receive around 20 tonnes of medical goods and 20 ventilators on an urgent basis from China this week, said Chairman National Disaster Management Authority (NDMA), Lt. Gen. Mohammed Afzal, during March 27 media talk. Additionally, two more planes would bring 100 tonnes of urgently needed medical equipment from Beijing and Chengdu next week.

------------

Full gear for 30,000 ICU workers
There are currently 194,000 medical health practitioners in Pakistan, of which 30,000 work in ICUs. “These 30,000 medical practitioners working in ICUs will be equipped with complete medical kit by April,” he said. Each box will contain face-shields, goggles, two N95 and 30 surgical masks, hand wash kit.

The number of beds in the intensive care unit (ICUs) in Pakistan currently is 19,670. The capacity of quarantine facilities has also been enhanced from 500 beds to 162,000 now. Pakistan’s Covid-19 command and control centre has also booked 1,795 three-star and four-star hotels where 40,000 patients can be accommodated if required.

There are nearly 2200 ventilators available in public hospitals. The number of the imported ventilators will reach to 1,000 by April 10 to 15, the NDMA chief said. This number would rise to 2,000 to 3,000 by April 25 and the officials expect to enhance it to 8,000 and 10,000 by May.

Pakistan would have enough medical equipment, including personal protection kits, by April 5 to improve the safety of the health officials working on the frontline, said Health Minister Dr Zafar Mirza.

Top 3 priorities
Pakistan’s top three priorities under the Covid-19‬ strategy, according to NDMA chairman: ‬

1. Medical gear for doctors & health workers

2. Ventilators & supplies for treatment of patients

3. Coronavirus testing kits

Comment by Riaz Haq on March 28, 2020 at 8:40am

Coronavirus Testing in Pakistan (2,000) vs India (14,500) is about the same per capita as of March 19. Pakistan has ramped up testing and the latest figure from NIH Pakistan is over 13,000 tests (vs 27,000 in India) as of March 28, 2020.

https://ourworldindata.org/coronavirus-testing-source-data

https://www.nih.org.pk/wp-content/uploads/2020/03/COVID-19-Daily-Up...

https://icmr.nic.in/sites/default/files/whats_new/ICMR_website_upda...

Number of cases in Pakistan is probably higher than India because of large numbers of people traveling between Pakistan and Iran which is a coronavirus hotspot. Testing in Pakistan is mainly targeted at that group and their family members and contacts in Pakistan.

So far, vast majority of coronavirus infections are among people who came in from Iran. There are a lot fewer local transmissions in Pakistan.

Comment by Riaz Haq on March 28, 2020 at 11:06am

#Economic activities in #Pakistan continue as some retailers still buying. “Pakistan is expected to achieve some 50% export target this month (March)..US retail chain Costco is still taking supplies.." Govt trying to make sure #agriculture unhurt. #exports https://tribune.com.pk/story/2185785/2-economic-activities-continue...

The rice industry, whose exports are worth $2 billion a year, has also managed to operate. The government will not charge demurrages for delay in clearance of import and export containers at ports.

However, many other industries and services sector, except for the essential ones, will bear losses of billions of rupees due to lockdown in almost the entire country to contain the coronavirus pandemic. The Express Tribune tries to estimate damages to the national economy. “Pakistan is expected to achieve some 50% export target this month (March),” Pakistan Business Council (PBC) CEO Ehsan Malik said.

“The US retail chain Costco is still taking supplies from around the world. Besides, many Asian countries remain operational,” he said.

Pakistan’s average exports came in slightly lower than $2 billion a month in the first eight months (Jul-Feb) of the current fiscal year, according to the Pakistan Bureau of Statistics (PBS).

“We are trying to make sure, in collaboration with the government, that those export industries continue to operate whose orders have not been delayed and cancelled by the international buyers,” Malik said. The list of employees of the export industries and those which are considered essential industries and services have been provided to the government and the law enforcement agencies are letting them commute between factories and homes.

These industries include food, pharmaceutical, textile and fast moving consumer goods like soaps, shampoos and detergents, which also come under the essential goods category.

“Essential food and pharmaceutical industries cannot operate in isolation and that is why we have taken permission from the government to let the packaging and printing industry operate as well,” Federation of Pakistan Chambers of Commerce and Industry (FPCCI) President Anjum Nisar said.

“Soap and sanitiser manufacturing industries also come under essential goods manufacturers since we need the two products to protect people from coronavirus,” he said.

Malik voiced fear that exports may gradually drop to a very low level in the next three to four months, but stressed that they would gradually return to normal by December 2020. Besides, non-essential industries and services would be badly hit by the lockdown. Many big industrial units including the three Japanese car manufacturers (Toyota, Honda and Suzuki), big textile and cement-makers including Gul Ahmed, Interloop and Lucky Cement have stopped production, according to a private TV channel.

Giving a rough estimate as to how the lockdown would impact the overall economic activity, Malik said, “One-third of the industrial production may be impacted and the share of industrial production in the overall GDP (gross domestic product) stands at around 18%.”

The share of wholesale and retail stands at around 18-20% in GDP. “It may come down by around 20%.”

The share of services sector (like doctors, bankers, lawyers, barbers, tailors and cobblers) has increased to around half of GDP over a period of time. “A majority of them may feel the heat of the melting economy except for the financial sector,” he said. Malik said the agriculture sector, whose share in GDP stood at around 50%, would remain unhurt since the government was making sure that the ready-to-harvest wheat crop was procured to achieve food security.

The State Bank of Pakistan (SBP) revised down its projection for economic growth to 3% last week compared to 3.5% before January 2020.

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