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March 22, 2020

Now is the time to panic


March 22, 2020

It started off as a crass joke: someone ate a ‘bat-sandwich’, and sent a billion and a half people into a frenzy. One hemisphere made Love in the Time of Corona jokes as the other snickered Corona Pyaar Hai. As the rest of the world alternated between orientalism and flat-out racism, our local Whatsapp brigade pronounced it retribution for the Uyghurs.

Today, Europe is the epicentre. Cool white marble glistens around the Kaabah, as the Pope addresses an empty Vatican. Azaans around the world urge people to stay home while Trump went from calling it a hoax to announcing a day of prayer.

Jokes that were never funny to begin with are now on us. Unfortunately, if laughter is medicinal, it’s no antiviral.

The first Nobel Prize given out for work related to a virus was in chemistry – not physiology or medicine. For something that barely verges on ‘living’ to have brought the planet to a grinding halt has been quite a humbling experience.

It is as if the whole world collectively discovered a lump under the skin, hollowing out abstractions like dreams, deadlines and shareholder value. Really, it isn’t Earth that has been brought to a halt – just us. Trite metaphors like blooming cherry blossoms, from DC to Islamabad, unfurl unphased by our aesthetic sensibilities. Nature, it seems, will be just fine without us.

Capitalists that once berated socialist breadlines entered superstores to find empty shelves. As markets asphyxiate from the demand and supply sides, alike, the DOW reported its second biggest single day drop in history. Millennials were introduced to the idea that the original context of the word ‘viral’ had little to do with memes.

To some, history repeats itself; to others, it rhymes. But as the same, plagiarised script is broadcast from one country to the next, a few days apart, one thing is clear: when the right steps are taken, we see the curve flatten. When exceptionalism pervades, we dig mass graves.

In Pakistan, we are not paying attention. As the tin-foil donning Whatsapp club points at biological warfare or a Dettol conspiracy, they still acknowledge danger. Meanwhile, macho momins continue to believe they are either too pious or too robust to contract the virus, while Lahore’s M M Alam Road pulses with apathy and privilege.

Where every third person could give South Korea’s notorious Patient 31 a run for their money, the one thing Pakistan needs is a shot of honest reality. But as the prime minister continued his transformation into an increasingly one-dimensional caricature of himself, he announced, “Ghabrana nahin hai” (and “ps: wash your hands”).

Yes, we are a poor country. We are not Gal Gadot, crooning ‘Imagine’ atop a financial cushion as plush as the bed she lazes on. We are the calloused labourer that leaves home thinking only that they must make it through another day.

Faced with the sickness and hunger of his people, the prime minister chose option C: he asked them to choose for themselves.

If this were really a clean choice between hunger and death, one would expect the Gadots of the world to stay home, with the rest thrust out of compulsion, not choice. But consider what followed.

Indignant parents told their children they were overreacting as they shut the door on their way out. Toes continued to slip out of Gucci slippers into the frothing waters of French Beach. Millions stood shoulder to shoulder five times a day. At the Punjab Governor House, Usman Buzdar, along with over a hundred others led (others astray) by example.

At the end of the day, even 42 million rupees can only suppress facts for so long (it can, however, increase the national ventilator count by a full percentage point). The global case-mortality rate is above four percent. There is no discernible reason why we will be at this, let alone below it.

Consider first the strong correlation between casualties and pre-existing conditions such as diabetes, cardiovascular disease and lung disease. Pakistan ranks fourth, twelfth and thirteenth in the whole world for these. Mortality rates vary – from 0.2 percent cases in Norway to around 8 percent in Iran, and the health of a population is only half of the problem. The other variable is healthcare capacity.

Imagine this: you are a country of 10,000 people. Let’s say half (5,000) will be infected before we find a cure or become immune (common estimations of the ‘attack rate’ peg the number at between 40 percent and 70 percent). Of these, let’s say 750 will require hospitalisation (while Imran Khan said the hospitalisation rate was 4-5 percent, China’s is three times this and Italy’s is over eight times this). Now let’s say 150 will die despite your best efforts – a 3 percent mortality rate (we’ll give the prime minister this one). You don’t know which 150 won’t make it, and want to make sure you hospitalise all 750. Unfortunately, you don’t have 750 beds. You only have 250. This isn’t ideal, but as long as no more than 250 people visit the hospital at the same time, you’ll be okay.

But what happens when 251 people arrive on a particular day. What happens when, right when you hit capacity, one is discharged but two more people show up? You have to choose who lives and who dies. Really, in not choosing between ‘death by corona and death by hunger’ the Prime Minister is only forcing someone else to choose instead.

Except, it’s not just a one-to-one trade: the actual number of beds we have per 10,000 people isn’t 100. It’s 43 in China, 32 in Italy, 32; and 28 in the US. In Pakistan, it’s 6. Six beds per ten thousand – and around half of these are probably already occupied.

Also, the average patient spends a whole week in the hospital, not one night. At this rate, we will run out of hospital beds in a little over two months. Change whatever assumptions you want, but the number of infected people doubles every six days: you’ll only delay the inevitable by a few days.

So, now, the only way to keep the mortality rate at 3 percent, for a virus that we know is going to affect most of the country, is if no more than three people show up for treatment over any week.

But the number of infected people do not politely increase linearly; they explode exponentially. Soon, you have two football teams worth of people competing for one bed. And they’re not just competing for a good night’s sleep: they’re fighting to stay alive. By the way, each one of these people represents 20,000 actual people.

Now consider the math for ventilators, of which we have less than one for every 100,000 people.

So what do you do? You are a poor country. You can only buy so many beds and ventilators. See, for example, the terrifying presser out of PIMS in Islamabad, where we are told the government’s emergency response included adding ten beds and two ventilators. How do you make sure no more than three people end up at the hospital during the whole week?

Definitely not what we are doing at the moment. Only, we don’t have the time to keep experimenting. When every other country’s graph will become our reality, we will be forced to accept there is no escaping this.

This is no time for partisan politics; it is a singularly difficult time to be Imran Khan. But this is no time for political pandering either. Difficult decisions must be made, as they are being made the world over. Reducing prayer time, like restricting Mall timings, will do nothing. The virus does not wait for two or five minutes, just like it does not need to abide by the family-only entry policy into a mall. All this is the equivalent of wrapping a time bomb in band-aid.

Public gatherings, including congregational prayer, must be banned, as they are the world over. Quarantine and isolation will have to be enforced; no one is listening to suggestions, least of all the government itself. Continuing to act like feckless, passive spectators, will send us down Iran’s path; rigorous, early testing will send us down Korea’s.

Yes, these are difficult decisions to make; but this thing doesn’t care for our comfort or our convenience. We are living in a worst-case scenario. We must realise this. Full bellies are no good if they are to be lowered into mass graves.

The writer is an Islamabad-based lawyer.

Twitter: @brainmasalaar