Corona testing priorities

Covid-19 has generated many urban myths. One very apt one is about the health minister of a certain third world country who was asked why his country didn’t have any coronavirus patients; he responded by saying: “because we have not conducted any coronavirus tests.”

Covid-19 tests form the basis of the Corona policy response; be it isolation of patients, priority of hospitals, decisions for total or partial lockdowns – all are linked to testing. If there are no tests, there are no confirmed Covid-19 patients and therefore there is no reasonable basis for optimal allocation of resources and assigning priorities.

One country that has effectively used testing to not only control the spread of the novel coronavirus but also to avoid lockdowns is South Korea. Its response has been so effective that the country managed to hold its General Elections on April 15, 2020. The turnout of 66 percent has been the highest in 16 years. Despite this record turnout, just 15 days later ie on April 30, South Korea announced that it had no new cases to report for that day. How was South Korea able to manage all that?

South Korea’s response to Covid-19 has largely been shaped by its experience with the Middle East Respiratory Syndrome (MERS) which killed 36 and infected 186 South Koreans in 2015. For South Korea, one of the main takeaways from MERS was the importance of testing and the subsequent contact tracing. This was such a strong realization that following MERS, South Korea enacted legislation that smoothed out the legal impediments towards approval of testing and the placement of necessary contact tracing measures. The impact of this preparation was seen in South Korea’s response to Covid-19, as it approved Covid-19 tests in record time and put in place effective contact tracing measures.

Given the reluctance of our prime minister to impose a lockdown, it is indeed strange that he almost never mentions South Korea, a country that has been able to control Covid-19 without lockdowns. It should be obvious that the US, UK, and some other European countries largely failed not because all efforts against Covid-19 are futile, but because their leaderships are guilty of criminal mismanagement and incompetence. The fate of US, UK and many other first world countries could have been different had their governments taken effective and timely measures. The failure of these rich countries should not be a reason for our ministers and their advisors to shrug shoulders, South Korea’s examples shows that horrific death tolls can be avoided through efficient and timely use of resources.

So how does Pakistan compare against South Korea when it comes to testing? One measure is to look at the total number of tests conducted as a proportion of population. As per the World Meter website, for May 3, 2020, South Korea has one of the highest proportion globally at 12,365 tests per million population, in comparison Pakistan was at a mere 962 tests per million population.

But our weakness in testing at the national level is even more pronounced on the provincial levels. The worst is Khyber Pakhtunkhwa, where testing stood at 520 tests per million population on May 2, 2020 – at almost half the national average. Punjab was slightly better at 664, followed by Balochistan at 813. Among the four provinces, only Sindh scored higher than the national average, at 1274 tests per million of population.

The situation becomes much worse when one goes down to the district level. I could not find the district level testing coverage for other provinces. However, Khyber Pakhtunkhwa shared its district level testing statistics till the 16th of April, after which Khyber Pakhtunkhwa also stopped reporting on district level testing numbers. Khyber Pakhtunkhwa’s data till April 16, 2020 reveals that three districts – Peshawar, Mardan and Swat – accounted for 41 percent of the five thousand tests done by Khyber Pakhtunkhwa till then. Despite their relatively larger populations, Mardan had a testing coverage of 320 tests per million population, Swat was at 223 and Peshawar at 206, much higher than the provincial average which was at 137 tests per million population by that day.

The districts of the ex-Fata region were particularly worse off, as Mohmand Agency showed a coverage of mere 15 tests per million, South Waziristan was at 32 and North Waziristan at 42. The three districts of the Kohistan region – Kohistan Upper, Kohistan Lower and Kolai Pilas – had had no tests by the 16th of April. Considering that travel history has been a critical criterion for qualifying for testing, it’s important to note that a considerable number of Pakistanis from ex-Fata work overseas. What percent of those have come back before Peshawar airport’s screening requirements were made more stringent?

Also, given that 77 percent of cases in Khyber Pakhtunkhwa were caused by domestic spread, then how far is Mohmand Agency from Peshawar and Kohistan from Swat? Is it that easy to presume that these peripheral and under-developed districts would be that immune, and deserve such low levels of testing? In fact, considering the education and awareness levels of underdeveloped districts, it would be safe to conclude that knowledge and practice of precautions might be much lower in underdeveloped districts than in developed ones.

It would be wrong to assume that testing priorities in other provinces are different from Khyber Pakhtunkhwa. In fact, if one plots district-level Corona incidence against the Human Development Index (HDI) score of the districts across Pakistan, it reveals a positive relationship – districts with high HDI scores are also districts with high incidence of Covid-19. One explanation could be that districts with higher HDI also tend to have bigger populations, like Karachi and Lahore. However, there are exceptions such as Islamabad, which constitutes one percent of Pakistan’s population and almost two percent of Pakistan’s Covid-19 patients. It is also the district that has a testing coverage of 5,922 persons per million people, more than 6 times the national average on May 2, 2020.

Given these trends, it may very well be the case that our Corona priorities and efforts, which are tied to testing for the virus, are geographically focused on our most developed districts. This means that districts with low or even nonexistent health facilities might be getting ignored in the tracking and isolation efforts that that are currently underway. Call it oversight or negligence, but ignoring less developed districts can have major implications in the near future. By dragging our feet on testing as well as lockdowns, our prime minister is wishing for a situation where he can have his cake and eat it too. Human history has shown that that is never a good strategy.

The writer is a freelance contributor. He blogs at iopyne.wordpress. com

Email: iopyne@gmail.com

Twitter: @iopyne and @DataKahani