670,800 feared infected, no Lahore locality virus-free

LAHORE: The findings of Punjab government’s smart sampling data analysis of Covid-19 prevalence in Lahore revealed estimated 670,800 actual new cases, which is six per cent of the city's population of 11.18 million.

The study reveals that the results of the tests from Lahore show six per cent of all tested were positive with few towns showing positivity as high as 14.7 per cent.

“These cases, being asymptomatic, could not be reported to the health facilities, but became the main source of infection and local transmission,” revealed Technical Working Group’s findings in a Primary and Secondary Healthcare Department (P&SHD) summary, sent to the chief minister, detailing the results of the smart sampling data analysis in Lahore – the epicentre of coronavirus in Punjab.

The summary, which was sent to the chief minister by Secretary P&SHD Capt (retd) Muhammad Usman on May 15, 2020, was kept secret for over two weeks despite startling findings vis-à-vis high prevalence of coronavirus in provincial capital, calling for urgent action to contain the spread of virus.

With the approval of Cabinet Committee to Combat Corona Virus Threat, the Punjab government formed a Technical Working Group (TWG) consisting of consortium of epidemiologists, public health specialists, applied economists, statisticians and public policy specialists, to assist the P&SHD initiate a smart sampling project to detect and determine spread of Covid-19 and to structure and guide its response towards its containment.

While giving the international perspective through predictive and impact analysis, providing technical input and determining disease prevalence and spread rates, the experts recommended that decisions regarding the hardening or softening of lockdown could not, and should not, be taken in isolation from various departmental viewpoints and other key stakeholders.

The P&SH Department, as advised by the Technical Working Group, conducted the exercise in two parallel sampling cohorts, firstly, randomised targeted sampling (RTS) to determine the prevalence of the disease in those occupational sectors that remained functional during the lockdown, and secondly smart sampling (SS) through the ‘S’ grid strategy to understand its community spread in order to efficiently use the existing testing capacity and take informed decisions on the basis of prevalence of virus in selected population pockets in Punjab.

With the results of both sampling exercises pouring in, a worrisome picture of the Covid-19 prevalence in the communities is emerging i.e. positivity rate at 5.18 per cent in RTS, and 6.01 per cent in SS (both by RT-PCR), respectively. The results of the analysis, averaging out results of both the strategies, suggested that the data retrieved from various hotspots including workplaces and residential areas was comparable (5.18 per cent vs. 6.01 per cent).

The town-wise break-up shows a value of more than 3 per cent for all towns, except Wagha Town, and ranges between 2.11 per cent to 9.33 per cent, thereby, refuting the justification of zoning and smart lockdown. This means that no workplace and residential area of any town is disease-free and, as such, entire Lahore exhibits an alarmingly similar transmission pattern.

It is also notable that while looking at the ageing break-up, the most seriously hit age group is above 50 years. As reflected in the international literature, highest mortality of Covid-19 has been reported in the age of 55 years or above worldwide; therefore, the highest positivity in the older age groups in this sample poses a serious concern to this aspect as well.

Among various age categories, the P&SHD team collected 12,257 samples for Covid-19, conducted 8,313 tests with the result of 426 confirmed positive, 7,887 not detected, showing an overall infectivity of 5.18 per cent.

The break-up of percentage of positive results among various age groups is 3.41% among age group from 0 to 10, 5.04% among 10 to 20, 4.66% among 20 to 30, 5.18% among 30 to 40, 5.10% among 40 to 50, 6.23% among 50 to 60, 9.28% among 60 to 70, and 8.20% among 70 plus age group.

The smart sampling does not show any difference in positivity based on gender as both being equally vulnerable with 6 per cent infectivity among males and 6 per cent among female.

While the results are still pouring in and a clearer picture will emerge after all results have been received; there is clear-cut evidence that the situation is not normal and requires immediate attention of policymakers.

The TWG, after analysis of sampling data, advised for stricter regime to control the spread of virus in Lahore. It recommended complete lockdown for at least 4 weeks i.e. 28 days immediately.

Any subsequent decision of lifting, relaxing or doing away with any such lockdown be taken after reviewing results of smart sampling conducted with regular intervals till the final tapering down of this deadly virus. It recommended special emphasis on quarantine / isolation of elderly (50 years and above), mandatory stay at home policy, and minimal interaction with household members with enhanced contact and droplet precautions.

Keeping in view the rising number of cases, particularly in district Lahore, it is recommended that a timely plan for surge capacity may be implemented in all healthcare facilities to deal with any unprecedented situation likely to emerge in coming few weeks.

Public awareness campaign should be re-energised under the changed situation. An effective communication strategy with special focus on elderly population should be implemented.

It is pertinent to mention that this department endorses the views, analysis and recommendations of TWG in the best interest of “prevention and control of Covid-19” – infectious and contagious disease – in terms of entry 2(d) under the P&SHD, Schedule II of Rules of Business, 2011.

In the above backdrop, while the government is considering easing the lockdown including retail, industrial and public transport sectors, it is important that the findings of the above smart sampling project and recommendations of the TWG, may be kept in view while decisions regarding the lockdown are made.

The department is fully cognisant of the multiple dimensions involved in decisions regarding the prevention of spread of Covid-19 through enforcement of social distancing measures and lockdown. These measures of course carry socioeconomic implications, costs to economy and export sector and in particular likelihood of poor segments of our urban populations.

Although, the Punjab government initiated its response to combat the virus at quite an early stage by sensitising public about its severity, enhancing the testing capacity and strengthening its hospital capacity vis-à-vis bed strength yet numerous milestones on this count have to be envisioned, planned and achieved in the days to come. Covid-19 has already been declared as a serious and imminent threat to public health, requiring restriction on movement, gatherings and business-linked activities. However, public health emergency also necessitates striking a balance between the economic sustenance and prudent health interventions to save precious lives.

Therefore, it is warranted that any such non-pharmaceutical interventions (NPIs) including decisions regarding the hardening or softening of lockdown cannot, and should not, be taken in isolation from the departmental viewpoints and other key stakeholders. It should, however, be necessarily articulated through larger consensus and based on evidence gathered through smart sampling and testing. These may include, at least, Transport Department, Social Welfare Department, Food Department, Labour Department, Home Department and Industries Department.

It is, therefore, proposed that the analysis and recommendations of the TWG, along with the views of these departments, or any other department as well, if deemed fit, regarding the lockdown, shutdown, enforcement of social distancing, or opening up of particular sectors like transport, may be placed before the cabinet for a final decision.

The P&SH Department routed copy of the summary to the departments concerned in advance to allow them to firm up their views, sought chief minister’s approval in this regard.