Look to science

Like the rest of the world, the Covid-19 pandemic is slowly unfolding in Pakistan. If we go by the available data, the Covid curve is headed relentlessly upwards. This means two things: new cases seem in the offing over a protracted period.

Since the crisis is assuming a protracted character, the response has to be more fine-grained in the coming days and weeks than it has been so far particularly when we have some sense now of the trajectory of the virus. However, there are growing worries about the pace and direction of the response. First, the overall response seems to be oriented more towards mitigating its worst economic impacts rather than tackling it head-on as a public health emergency of a scale not seen before in our recent history. Second, the response also tends to be viewed largely from the disaster management angle rather than from the perspective of a primarily public health emergency.

It has to be recognised first and foremost that the pathogen can only be contained, slowed and controlled by good science and public health. All other efforts are subject to this reality which only underscores the need for putting clinical, public health and scientific expertise in research, planning and execution at the front and center of the response. All across the virus-ravaged world, scientific and public health experts are in the vanguard of the response with politicians deferring to their advice and judgment.

Dr Anthony Fauci, the top US public health and infectious disease expert, has become the steady and rational voice of scientific rigor standing beside President Donald Trump at his press briefings where he knocks science into the president’s confabulations.

The UK government too is guided and led by its scientific advisory group in its response to Covid-19. The initial political and ideological strategy of the British focusing on herd immunity was immediately reversed when Imperial College affiliated scientists produced a model which predicted 250,000 deaths if the UK persisted with its herd immunity (or doing nothing/ minimal response) strategy. This scientific input is further bolstered by science-based reporting and scrutiny of government plans by the media, health-focused think tanks, public health researchers and global health experts. The National Health Service is at the forefront of the response and being lauded for its self-less dedication and commitment despite losing scores of its staff in the war against Covid-19.

Our government'a response has been less than desired as evident in press comments and commentaries. Data on the number of cases is relayed daily, but doubts persist about its robustness and accuracy. Thick hints have been dropped about the possibility of under-reporting, which, in fairness, are largely ascribable to limited testing capacity; however, there is little point to the exercise of trotting out a set of figures daily if they are not being used to inform granular analysis feeding into data and modeling-based improved response strategies. Worryingly, there is a visible lack of modeling experts engaged in charting Covid-19’s destructive trajectory in Pakistan (in all other countries, mathematical models are the backbone of the public health response).

Nor do we know the state of preparedness in the event of hospitals getting swamped which is a looming prospect not far off the horizon. In that case, what are our projections for hospital admissions of the serious new cases and the resultant demand for ventilators, bed capacity and health workforce and Personal Protective Equipment (PPE) for doctors (Punjab alone has thousands of health workforce posts lying vacant).

As for the PPE, doctors are being penalized, punished, traduced and, worst, baton charged for demanding personal protective care. This further reinforces the impression that the Corona response is more focused on its economic and disaster and rehabilitation aspects rather than medical and public health aspects. Contrast this with other countries where doctors, the frontline soldiers, are being lauded as national heroes because the response is public health and science-driven.

More crucially, other scientifically advanced countries, as key part of their medical response, were able quickly to identify the genome of the virus and build domestic testing kits which gave them a head start in the fight against the novel coronavirus; China, South Korea and Germany fall into this category. I suspect, given the parlous state of our science and technology, we cannot go down that road, which partly explains why the corona crisis is set to protract into the near future at least.

In light of the above observations, I would suggest a number of policy measures which can go some way in getting a handle on the worryingly worsening public health crisis. Following the UK model, there is an urgent necessity to form a scientist advisory committee – drawing representation from public health, infectious disease experts, epidemiologists and allied science fields such as virology, microbiology and modeling specialists to design a vivid, comprehensive and reassuring response plan which commands the consent of all provinces and regions.

A robust data collection and data analysis mechanism needs to put in place to inform policy around the corona response. The value of having public health experts and scientists at the table and at media briefings is obvious. Though lack of science and scientific rigour is our national preexisting condition, a healthy and sustained infusion of science and old fashioned public health would bring a world of good to the response.

More importantly, a much-needed switch to a public health led response in preference to generic disaster management would more narrowly focus minds and actions on the coronavirus and its adverse health impacts. The government should also think of innovative ways to ramp up mass or pooled testing, contact tracing, and beef up hospitals and well-protected health workforce to face down this relentlessly escalating public health calamity.

The writer, a public health consultant, is the author of 'Patient Pakistan: Reforming and fixing healthcare for all in the 21st century'.

Email: Drarifazad@gmail.com