The surging second wave

The writer is former special assistant to the PM for health.

Despite constant cautioning against victory – with which inevitably sets complacency – and, despite raising alarms about resurgence, we ended up where we are today. At the moment, we are again witnessing a rising tide of cases, some of those on ventilators and some dying. The curve is climbing with every passing day; now it seems back with a vengeance.

At the time of writing this column on December 2, the last 24 hours have witnessed 75 deaths, the highest number since the peak in June; 311 cases were on ventilators in different hospitals of the country, another high; and 80-90 percent of them, if not more, are going to die in the coming days.

Some of us have been constantly ringing alarm bells about the resurgence. The second wave of the pandemic has enveloped the globe. Record daily cases and deaths are being reported from more and more countries and the world is being locked down – and yet we seem to have developed a belief that Pakistan has developed immunity to the virus. Defying science and mocking statistics, complacency seems to have permeated all layers of society, from cortex to core.

This time we had the benefit of hindsight. We knew exactly what to do, what worked last time and where we faltered. We knew our strengths and where our underbelly was. And yet we have let it happen again.

With space for improvement here and there, the NCOC has been making right recommendations but the NCC this time could not reach a consensus – and not because of scientific differences or anything, but due to brutal politics. Heartless about the people’s right to life, the political opposition has announced it will continue to defy the ban on political mass gatherings. We are allowing ourselves to slide into the abyss of our own making. Political rallies are moving from city to city, showing leaders with masks and big crowd gatherings with no SOPs of any sorts. This is highly irresponsible of the political leadership and nothing less than equal to endangering the health and lives of the very people they claim to care so much about.

This time we are also late in taking action. We saw the rising trend more than ten weeks back. With the passage of time, the NCOC kept raising red flags but we didn’t see befitting measures being taken. Schools were opened when the trend was already going up. Of course, educational institutes could not be kept indefinitely closed but a better timing of opening could have been chosen. Our risk-communication has gone down. Electronic channels moved away from public service messaging, which was so effective during the earlier phase.

People, as a result of this mildness at the top, swiftly changed precautionary behaviors. Marriage halls started teeming with people with hardly any one wearing a mask and observing physical distancing. Children were stuffed in vans to schools. Mosques were back to shoulder-to-shoulder and ankle-to-ankle filing. Cases kept increasing and we kept seeing all this without taking any effective actions. Through this inaction we have let the transmission reach a level where it is now accelerating exponentially and can get out of control.

Pakistan had its first case on February 26, as opposed to India on January 30 and Iran on February 19. We could delay the first case by reinforcing our points of entries, especially airports. Our peak was on June 14, with 6825 cases reported on that day. It took less than four months from the appearance of the first case to reach the peak. On August 31, there were 213 cases in a day, the lowest since the June peak. On October 30, we crossed the 1000 per day threshold but then in the next two weeks we doubled the number to more than 2000 cases. And all this is happening without any major change in the daily testing numbers. So, the doubling time is squeezing with every next doubling.

If this trend continues, and I don’t see any reason at present why this trend will change, the day we report a record number of cases, like many other countries in the second wave, doesn’t look very far. With this would rise the number of critically ill and the healthcare system will again be overwhelmed. The wedding season, the cold weather and our late and lukewarm interventions are only going to make this easier and quicker.

In a way, we have lost the July-October period by not increasing the number of daily testing, despite having a revised testing strategy which has fallen short of full implementation. The strategy had to go at the tehsil level and down, special camps were to be arranged for testing in peri-urban areas and all cases of influenza like illness (ILI) and Severe Acute Respiratory Infections (SARI) were to be tested for Covid-19. All this done along with the early incorporation of Covid-19 Antigen Detection Rapid Diagnostic Testing (Ag-RDT) would have greatly increased the daily testing numbers, which would have allowed isolation of positives and more informed smart lockdowns in areas of concentration and both these would have resulted in lowering the spread of virus.

The reality is that, despite a lot of deliberation and strategising and despite building capacity for conducting more than 100k tests per day in Pakistan, we have failed to increase daily tests beyond the average that keep oscillating between 30k and 35k over the last six months. This is a serious shortcoming. We need to drill deeper into the reasons why we have not been able to implement our own strategy and take immediate remedial actions.

A big difference I see between the first time and this time is the sternness (or lack of it) of action by the administration on non-compliance of SOPs in shops, factories and public transport. That vigilance is not obvious this time – not until now. The measures announced by the NCOC last week now need strict implementation and accountability. It worked last time and it can work again if the administration shows strong resolve.

As the saying goes, there are no mistakes, only lessons – but only if they are taken. Otherwise, mistakes will be repeated. In this case, mistakes translate into preventable loss of human life and multifarious and unaccounted misery. And in the end, we are the choices we make.

Email: zfrmrza@yahoo.com