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March 27, 2020

Coronavirus: the endgame


March 27, 2020

Much is being written in the electronic, print and social media in Pakistan about the coronavirus pandemic, yet the federal government has failed to formulate a clear, cohesive and effective strategy to bring the crisis to an end. Expecting people to isolate themselves voluntarily in a country like Pakistan however, is unrealistic.

Lack of education and awareness, a culture of socializing and closely knitted communities, prevalence of social networks around mosques, shrines, caste/biradari and extended families with multiple influencers can make it difficult to convince people into self isolation. The natural response of religious clerics, community leaders and elders in a family is to bring people together in calamities, partially also to sustain their privileged position as protectors and providers. Needless to say, the exact opposite is required to deal with the crisis at hand.

The government must therefore strictly enforce social distancing through a legally enforced lock-down throughout the country, as the Sindh government has initiated and others have followed. Exceptions can be made for essential public services to continue and basic amenities such as food and medical supplies to be made available through the market mechanisms.

While there is genuine concern about daily wagers and those at the lower socio-economic tiers of society, two points need to be considered. First, if the coronavirus outbreak spreads, the country will eventually come to a standstill anyway, economic activity will stall and there will be no work left for daily wagers in any case. Even cities such as Paris, London and New York came to a halt when the viral disease spread. At that point, however, significant human cost had already been incurred.

It is important to act now to prevent that eventuality.

Second, the government needs to ensure the rationing and provision of basic food items to the bottom 10 percent of society. The beneficiaries can be identified through the BISP/Ehsaas programme database and delivered food through state machinery. Large charities and community groups can also be mobilized to ensure that food, medicine and other necessary items can be collected through donations and delivered to those who need these the most.

Finally, the lockdown itself is not the solution for the crisis. It only acts to slow down the spread of the outbreak and buys time for the government. A more critical question is how this time can be used to eliminate the coronavirus from the country. This is where again strategic clarity is required.

The only way to end the crisis is by identifying and isolating each and every person in the country who is carrying the virus at a particular point in time. There must be clarity within state institutions about this end-goal so that a strategy can be formulated to achieve this.

Experience from the world shows that, apart from China, whose capacity and resources are unmatched compared to most developing countries, it is the South Korean model that has been most successful in achieving such an end-goal.

South Korea managed to control the spread of the disease within two months through extensive testing of the population, isolation of the infected and putting their contacts in quarantine. To date, South Korea has tested more than 270,000 people and quarantined thousands to ensure that the spread of the virus is stopped.

Mass testing, isolation and quarantine must therefore be prioritized to identify and treat coronavirus victims and save those around them from the disease. The time gained through lockdown will only help if utilized to gear up health services to achieve this.

The government needs to move quickly to develop strategic clarity to consider the ‘Lockdown, feed and test’ model presented here.

There are of course logistical and capacity questions that need to be answered before such a strategy can be deployed. Do we have the capacity to enforce a countrywide lockdown? Do we have the food supplies and the delivery mechanisms to provide for the poor and the needy? Do we have enough testing kits and the isolation wards/beds to ensure mass testing and quarantine?

These are however precisely the questions that the government should be grappling with right now. Unfortunately, however, its thinking is still stuck around the less than three percent global mortality rate in coronavirus cases, strategies advocating herd immunity and fears of an economic meltdown.

Let me warn the government and the people that the mortality rate in Pakistan can be higher than the global average due to not just the poor healthcare system, but also the overall poor health of the nation. We have some of the highest percentage of people with chronic heart, lungs and kidney diseases. There is malnutrition, stunted growth and some of the poorest health indicators in the country even compared to other countries in South Asia.

It is of utmost importance, therefore, that the government develops clarity on the end-goal for this crisis and utilizes all its resources and the state’s machinery towards achieving this. Without bold decisions and a swift, rational and coordinated response, we may end up facing an uncontrolled viral outbreak, thousands dead, an economic meltdown and even social anarchy at our hands.

The writer holds a PhD in Politics from Oxford University.

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