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 April 2, 2020 at 11:41am

#Pakistan extends lockdown to stem #coronavirus spread. Nearly 80% of the confirmed cases in Pakistan had recently returned from #Iran and #Saudi Arabia. http://v.aa.com.tr/1788297

Pakistan on Wednesday announced a two-week extension in an ongoing lockdown in the wake of rising numbers of coronavirus cases in the country.

"The government has decided to continue the current restrictions on public movement until April 14," Federal Minister for Planning Asad Umar told a news conference in capital Islamabad after a meeting on dealing with the pandemic.

The lockdown, Umar observed, had significantly added to the government's efforts to stem the spread of the virus. " That's why, the government has decided to continue the restrictions, except for the goods transportation, for two more weeks."

Islamabad also announced partial resumption of international flights, mainly to bring nearly 2,000 Pakistanis stranded in different countries, from April 4. However, all the domestic flights will remain suspended until further order, according to the minister.

Initially, state-run Pakistan International Airlines (PIA) will be allowed to operate 17 flights from Islamabad airport to bring back the stranded Pakistanis from Turkey, U.K., Canada, Azerbaijan, and other countries from April 4 to April 11.

The decision, Umar said, to continue or suspend the international flights would be taken after reviewing the week-long operations.

The number of novel coronavirus cases in Pakistan has risen to 2,007 with more than 150 confirmed in the last 24 hours, officials said Wednesday.

The country’s death toll jumped to 27, while 12 patients are in critical condition.

Nearly 80% of the confirmed cases had recently returned from Iran and Saudi Arabia.

So far, 82 patients have recovered and were discharged from the hospital, the Health Ministry said.

After first appearing in Wuhan, China last December, the virus has spread to at least 180 countries and territories, according to U.S.-based Johns Hopkins University.

Its data shows the number of confirmed cases worldwide have surpassed 885,600, with the death toll over 44,200 and more than 185,400 recoveries.

Comment by Riaz Haq on April 3, 2020 at 6:25pm

Pakistan with a score of 35.5 ranks 105/195 countries on global health security index.

It is rated as more prepared on a scale from most to least prepared.

https://www.ghsindex.org/

https://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-Hea...

Comment by Riaz Haq on April 3, 2020 at 7:04pm

HERE ARE 6 CORONAVIRUS DASHBOARDS WHERE YOU CAN TRACK THE SPREAD OF COVID-19 LIVE ONLINE

https://www.newsweek.com/coronavirus-tracking-maps-1491705

COVID DATA TRACKERS

Johns Hopkins

https://coronavirus.jhu.edu/

Comment by Riaz Haq on April 4, 2020 at 11:27am

Testing facilities have been established in all the provinces, Azad Jammu and Kashmir and Gilgit-Baltistan, it said.

The National University of Science and Technology (NUST) indigenously developed COVID-19 testing kits which have been sent to DRAP Technical Assessment Committee for comprehensive checking.

It said 13,000 surveillance centres had been set up across the country with public awareness messages disseminated through all modes of media.

https://arynews.tv/en/covid-19-pakistan-cases-lower-sc/

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The government submitted on Saturday to the Supreme Court of Pakistan a report on its national action plan for combating the coronavirus epidemic spreading across the country.

In its report, the government detailed the situation arising in the wake of the pandemic and the severity of suspected cases.

“By April 25, the number of the coronavirus cases are feared to reach 50,000,” the report stated at one point.

According to the breakdown provided in the report, around 7,000 cases of the total are expected to be critical in nature while around 2,500 could be a cause for concern. The government estimates that a further 41,000 cases could be of a mild nature.

The report notes that confirmed cases are expected to be lower than that of countries in Europe, and assures that the government is trying to maximize its testing capacity.

The federal government has said that it has put in place an emergency plan costing $366 million and guidelines have been prepared in consultation from the medical experts.

“All the airports have special counters to monitor coronavirus,” it mentions in the report, adding that around 222 suspected patients have been traced thanks to entry and exit point checking at airports.

The areas adjacent to Iran and along the Balochistan border have declared an emergency to cope with incoming infected individuals, it says.

“Preparations were made to place patients in 154 districts under quarantine,” said the government report.

As of Saturday, Pakistan has recorded more than 2,700 cases and 40 deaths.

https://www.geo.tv/latest/280938-govt-submits-report-on-national-ac...

Comment by Riaz Haq on April 5, 2020 at 4:54pm

#Coronavirus: How #Pakistan is using #technology to transfer Rs. 150 billion ($900 million) cash to people in need. #COVID19 https://theconversation.com/coronavirus-how-pakistan-is-using-techn... via @ConversationUK


Cases of COVID-19, the disease associated with the new coronavirus are spreading quickly in Pakistan. Considering that the nation shares borders with two global epicentres of the pandemic – Iran and China – the situation could have been worse. There have been more than 2,000 infections from the virus in Pakistan and 26 deaths linked to it, according to the most recent data.

Provincial leaders, particularly in the Sindh province, have been relatively efficient in imposing lockdowns. But there has been a lack of clarity at federal level. Much of the uncertainty came from a comment made by the prime minister, Imran Khan, in late March:

If we shut down the cities … we will save them from corona at one end, but they will die from hunger on the other side.

A consensus on slowing down the number of cases has nevertheless emerged. While there is still no official national lockdown, provincial governments have imposed their own versions. In most parts of the country, public gatherings have been banned, schools closed, and all shops other than those selling groceries or medicines shut.

Tough choices
For Pakistan, the balancing act between averting a health crisis and keeping the economy afloat has been complicated by widespread poverty. Around 39% of Pakistani households live in poverty. Because of this, an economic shutdown could produce a humanitarian disaster when the incomes of poor daily wage workers vanish.

In an emergency relief package announced in late March, the government allocated Rs150 billion (£734 million) in cash support for the poorest 12.5 million households. The government says this will benefit some 67 million people. Some of this will be funded by support from the World Bank and Asian Development Bank and will be transferred to recipients by the Pakistani government over the next few months.

While more details on the initiative are expected to emerge in the coming weeks, statements from officials indicated the government would use the infrastructure of existing social assistance programmes to disperse the cash. Given that these are reliant on digital data, administrators must be transparent about the criteria for eligibility. And they must provide ways for people to challenge decisions for those who find themselves excluded.

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

The emergency cash transfer programme has been likened to a basic income scheme – even though the Rs12,000 lump sum amount is a fraction of the Rs17,500 minimum legal monthly wage for 2019.

The selection criteria for the new emergency measures are based on those for an ambitious programme called Ehsaas, which was launched in March 2019 as a set of initiatives to create social safety nets and reduce inequality. Many Ehsaas schemes rely heavily on digital data. One of the most prominent projects, known as Kafalaat uses data analytics to decide who can receive cash transfers from the government.

Comment by Riaz Haq on April 5, 2020 at 5:42pm

#Pakistan is leading the way with its #welfare state – the world can learn from its innovation. PM #ImranKhan's #Ehsaas initiative is one of the most comprehensive welfare programs ever by a national government. #EhsaasEmergencyCash
https://www.telegraph.co.uk/global-health/climate-and-people/pakist... via @Telegraph

This is why we should all be looking with particular interest at the work underway in Pakistan to build a sustainable welfare state. Called Ehsaas, which in Urdu literally means ‘empathy’, the new initiative is one of the most comprehensive welfare programmes ever undertaken by a national government, with an underlying ambition to create a social safety net for Pakistan that could transform the lives of millions. It is enormously wide-ranging and ambitious.

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

Despite some progress since the turn of the millennium, a quarter of people in Pakistan still live in poverty, with rates of rural poverty more than double those in urban areas. With one of the fastest growing populations in the world, Pakistan will have to create a million new jobs each year just to keep up with the number of young people entering the job market. Educational attainment is some of the worst in the region and health indicators are not promising, demonstrated by the fact that Pakistan is one of only two countries where the wild poliovirus remains endemic.

This is the context in which Ehsaas is seeking to end the cycle of poverty faced by many Pakistanis. Acknowledging that no single area will unlock this ambition alone, Ehsaas encompasses 134 policies that range from tackling corruption to creating educational opportunities to providing the elderly with decent homes.

The programme is led by Dr Sania Nishtar, Special Assistant to the Prime Minister of Pakistan on Poverty Alleviation and Social Protection, who has been mandated by Prime Minister Imran Khan to work in partnership across multiple federal ministries that these policies will be driven by, as well with provincial governments who have devolved powers including on education and health. Without a multisectoral approach, it would not be possible to create the welfare state envisioned by Ehsaas.

The launch of a countrywide public consultation was particularly important as it was the first time a public policy in Pakistan had been developed in this way and demonstrates a new level of openness and transparency. Ehsaas’s impact will hopefully go much further than the borders of Pakistan. It will provide many lessons for low-, middle- and high-income countries.

Comment by Riaz Haq on April 6, 2020 at 11:33am

#Pakistan reports death of 3rd doctor from #coronavirus. Dr. Abdul Qadir Soomro, 70, a veteran physician in #Karachi, managed a #charity #hospital for Jamaat-e-Islami's Al-khidmat Foundation -- among largest relief agencies in Pak. May his soul RIP. Amen. http://v.aa.com.tr/1794673

Pakistan on Monday reported the demise of another doctor from coronavirus, raising safety concerns among health professionals who have been complaining about lack of proper safety gears.

Dr. Abdul Qadir Soomro, a veteran physician, breathed his last at a local hospital in southern port city of Karachi, becoming the third doctor in the country who succumbed to the virus.

Soomro, 70 was the administrator of a charity hospital, run by Al-khidmat Foundation -- the country's one of the largest relief agencies -- in the eastern outskirts of Karachi, where he had established an isolation ward for suspected coronavirus patients, the Health Ministry said in a statement.

His death brought the number of casualties from COVID-19 to 52 in the country.

The number of infection cases in the country has risen to 3,277, as 397 news cases were reported over the past 24 hours.

A total of 257 patients, of them 130 on Monday, have recovered, while 17 are in critical condition.

So far, the northeastern Punjab province reported 1,493 cases, Sindh 881, Khyber Pakhtunkhwa 405, southwestern Balochistan 191, northern region of Gilgit Baltistan 210, the capital Islamabad 82 and Azad Jammu and Kashmir confirmed 15 cases of the coronavirus.

Meanwhile, the virus also spread into the country's jails, with 49 cases confirmed in jails of Punjab province alone.

"We have 1,493 confirmed cases in Punjab, among them 49 are prisoners who are currently under quarantine," Usman Buzdar, chief minister of Punjab, said on Twitter.

Since appearing in Wuhan, China last December, the novel coronavirus has spread to at least 183 countries and regions, according to figures compiled by U.S.-based Johns Hopkins University.

The data shows more than 1.29 million cases have been reported worldwide, with the global death toll nearing 70,800, and more than 270,300 recoveries.

Comment by Riaz Haq on April 7, 2020 at 7:42pm

#Trump leans on #India's #Modi to export his unproven #coronavirus drug of choice—but it’s #China that determines supply of active ingredients (API) in #choloroquine and #hydroxycholoroquine. #China is the source for over 90% of all #APIs for drugs. https://fortune.com/2020/04/07/coronavirus-hydroxychloroquine-trump...

The U.S. wants to import more hydroxychloroquine, a common antimalarial drug that’s emerged as an unproven coronavirus treatment, but to do so, it will have to rely on a precarious supply chain from India and—ultimately—China.

On Saturday, India banned all foreign exports of hydroxychloroquine, after previous export restrictions left some exemptions. Hours later, U.S. President Donald Trump called India Prime Minister Narendra Modi to request that India release the drug to the U.S., and Trump on Monday warned of retaliation if India upheld the ban.

On Tuesday, India announced that it would partially ease restrictions on exports of the drug for humanitarian purposes once domestic demand had been met. India also lifted restrictions on Tuesday of exports of 24 pharmaceutical ingredients and medicines first imposed in early March.

Comment by Riaz Haq on April 7, 2020 at 7:52pm
Momentum in #WashingtonDC grows to change #US #medical supply chain from #China. #Coronavirus pandemic has exposed just how vulnerable the country is as it leans on China and other nations to help provide the tools necessary to combat the pathogen.

Calls are growing for the U.S. to reduce its dependence on China for key medicines and supplies as Americans face widespread shortages in the midst of the coronavirus pandemic.

While the U.S. supply chain's heavy reliance on Beijing for medical manufacturing has been glaringly apparent for roughly two decades, both lawmakers and administration officials say the virus has exposed just how vulnerable the country is as it leans on China and other nations to help provide the tools necessary to combat the pathogen.

Peter Navarro, President Trump’s economic adviser, pledged this week that the United States would move away from its reliance on other nations and toward building up its own capabilities to produce drugs and medical supplies.

"One of the things that this crisis has taught us, sir, is that we are dangerously overdependent on a global supply chain," Navarro said during a White House press briefing, standing next to Trump. "Never again should we rely on the rest of the world for our essential medicines and countermeasures."

Trump has also indicated he is seeking further independence on supplies, emphasizing in a Thursday meeting with pharmaceutical companies that the virus “shows the importance of bringing manufacturing back to America so that we are producing, at home, the medicines and equipment and everything else that we need to protect the public’s health.”

The concern is bipartisan. Three Senate Democrats backed legislation put forward by Sen. Marco Rubio (R-Fla.) last month that advocates for the U.S. to reprioritize its productive capability in order to achieve less supply chain dependence on China, particularly as it relates to products used in the federal health care system.

Sen. Elizabeth Warren (D-Mass.) and others previously raised concerns about such reliance in early December, urging Defense Secretary Mark Esper in a letter to “address the dangers posed by this reliance on foreign drug makers,” months before the coronavirus grew into a pandemic.

Their concerns followed the 2019 annual report from the U.S.-China Economic and Security Review Commission, which warned Congress that U.S. consumers, including the military, are “heavily dependent” on China for drugs and active pharmaceutical ingredients (APIs), arguing that this “presents economic and national security risks.”

But the U.S. also relies on China for key supplies such as masks and gowns to help protect health care professionals from contracting disease as they treat infected patients.

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Moving manufacturing back to the U.S. could prove a rough transition, coming nearly 20 years after China effectively pushed the U.S. out of the scene.

And experts have described a domino effect in the U.S. of China taking over the global production of key chemicals used in drugs.

Shortly after the U.S. opened up free trade with China in the early 2000s, the last U.S. aspirin plant closed in 2002. The last vitamin C plants shuttered around the same time, and then the last penicillin plant closed in 2004. The Chinese industry, heavily subsidized by the government, put its medical products in global markets while keeping costs low in order to drive out competition, experts say.

Now, companies and manufacturers are scrambling to obtain chemicals that are in short supply.

In addition to the military delivering needed supplies, the Trump administration and state governments have employed a series of methods to help address the shortage, including leaning on foreign countries and U.S. businesses to bring supplies from overseas

The federal government and private companies have teamed up to help bring aid from other countries to the U.S. in what is called Project AirBridge. A spokesperson from the Federal Emergency Management Agency said Wednesday that this project has coordinated four shipments since March 29, with more arriving daily.

Comment by Riaz Haq on April 8, 2020 at 7:25am

الحمد اللہ پاکستان میں کورونا حوالے سے شاندار خبر کل 7 اپریل ملک میں نئے مریضوں میں محض 140 کیسز کا اضافہ ہوا جبکہ 6 اپریل کو 577، 5 اپریل کو407، 4 اپریل 172, 3 اپریل 258، 2 اپریل 161، 1 اپریل 250 کیسز رپورٹ ہوئے تھے گویا الحمد اللہ پاکستان میں کورنا سمٹ رہا ہے شکر اللہ

https://twitter.com/AajKamranKhan/status/1247720194383937547?s=20

http://covid.gov.pk/stats/pakistan

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