Corona chronicle 2020: Punjab’s panacea for pandemic

This is the first part of a series of articles documenting Punjab’s response to the corona pandemic. It provides a succinct summary of key developments during the course of the pandemic.

The start of the year 2021 marks one year since the world officially acknowledged the existence of mysterious disease later identified as COVID-19. The virus, later named as SARS-COV2, went on to infect 83 million and kill more than 1.79 million people around the world. It devastated the world economy beyond estimates. Most cosmopolitans are under lockdowns, restrictions and curfews, yet hope allures in the form of new vaccines and treatments. Meanwhile, our battle with the ever-mutating virus continues amid emergence of its fresh variants.

Pakistan had surged to global spotlight for effectively controlling the pandemic. Notwithstanding the emergence of the second wave, which we were able to stem by the fag end of the year, a dramatic decline in the number of cases during the first wave was widely acknowledged by international experts as an ‘amazing success story’. World Health Organisation (WHO) chief Tedros Adhanom Ghebreyesus praised Pakistan's response in his Article in British newspaper The Independent in October writing the country had ‘suppressed the virus so that, as the country stabilises, the economy is also now picking up once again, reinforcing the lesson that the choice is not between controlling the virus or saving the economy; the two go hand-in-hand.’

Similarly, a study by UNICEF and International Policy Centre for Inclusive Growth (IPC-IG) acknowledged Pakistan as one of the top-ranked countries in Asia with the highest number of responses to Social Protection amid Corona Pandemic.

Former US Treasury Secretary and renowned economist Lawrence Larry Summers wrote that had his country handled the pandemic as well as Pakistan, it could have saved them in trillions of dollars. Indian opposition leader Shashi Tharoor said, “We look with envy across the border (Pakistan) because you chaps seem to be having a rather pleasant time of it in terms of being able to return to normalcy.”

Pakistan’s most populous province, Punjab, remained under special focus of epidemiologists and researchers. Punjab comprises 53 per cent of Pakistan’s total population, yet the province accounted for just 28 per cent of Pakistan’s total reported cases with 35 deaths per million against country’s average of 45 deaths per million population (neighbouring India has reported 107 deaths per million). Punjab’s cases stood at 1,245 per million population against country’s average of 2151 whereas neighbouring India reported 7404 cases per million. As these figures have intrigued a lot of people, key points of our response merit a discussion.

But before we explore the impact of some strategically important interventions that defined our response, let us recall that an Imperial College Study had predicted a disaster for us by June 2020 projecting some 22 million cases by the end of the month. Although I have always had reservations over Artificial Intelligence-based Spatio temporal micro-simulation models, yet I admit that the projections gave me many a sleepless night. Even for a potentially biased and exaggerated projection, half the figure meant a disaster we could ill afford. Luckily things did not turn that way.

In the second wave, there was a noticeable increase in the number of cases from October onwards. Figures continued to swell till the second week of December but curves have stayed consistent since then. By the end of September, cases in Punjab had slumped to a few dozen with occasional yet infrequent increases on certain days. Wards which were earlier vacant, started being repopulated by the start of November. We have reopened designated wards and kept our stand-by resources on alert. The Pakistan Kidney and Liver Institute, Mayo Hospital Lahore, Rawalpindi Institute of Urology and Nishter Hospital Multan were some of the key facilities reserved for COVID-19 patients. In Lahore, the High Dependency Units and ICUs which had nearly emptied out, are now at the level of the first week of June. Following careful analysis of key indicators, we have again closed down educational institutions and placed restrictions on public gatherings. Even as the scare of a new British variant threatens to lay down the world’s best laid plans, we are now continuously exploring indigenous and international best practices to thwart it.

In retrospect, dreaded times were two weeks post Eidul Fitr, Eidul Azha and Moharram gatherings. Barring Eidul Fitr spike, the other two events did not alter the curve by much although slight increase was reported around that time as well. I am greatly worried over the perception that corona no longer remains a serious threat. As reported by last Gallup Survey findings, close to 80 per cent Pakistanis feel that COVID-19 was now under control hence the need for continued precautions was superfluous. Conspiracy theories were found to be more popular among younger populations. This article is only an effort to draw a low-down on our response in the year 2020. As each component requires an elaborative feature on its own, only key events have been documented here.

January & February: Gearing up for the Challenge: Our response to the pandemic began soon after Wuhan outbreak in December 2019. We had ramped up preparations around the time when WHO had only officially acknowledged the reports of “pneumonia of unknown etiology” in Wuhan on 3rd January, 2020. By 30th January, when the WHO officially declared Corona as “public health emergency of international concern”, we had already developed a robust surveillance system at airports with simultaneous preparations for isolation and quarantine arrangement for suspected and confirmed cases. Officially, Punjab announced Medical Emergency on 12th February, the same day when the WHO officially gave the disease its current acronym COVID-19. Pakistan’s first case was reported on 26th February in Karachi and the second was reported from Islamabad, both patients returning from Iran.

March: An Inauspicious Spring: Our strategy, adopted globally back then, was to quarantine the suspected and confirmed patients to stop community spread. In view of this, we developed quarantine facilities at Multan and Dera Ghazi Khan and Faisalabad to isolate Zayereen returning from Iran. Around 150 pilgrims were kept at Faisalabad returning from Iran via Taftan border. Punjab reported its first lab confirmed case on 15th March, nearly three weeks after first case of Pakistan -- the hiatus affording us an opportunity to prepare well for the response. We were able to develop quarantine facility for Tablighi congregation members who gathered at Raiwind on 10th March. Contrary to our repeated requests, the organizers insisted on holding the congregation which acted as a super-spreader event as 539 confirmed cases were later linked to it across the country. Presumably, it was a huge gathering of 70,000 to 80,000 members with 3,000 attendees from 40 foreign countries. This was a classic example of Cluster Spread as nearly 30% cases from the gathering traced back the origin of infection to this event. We had to put entire Raiwind under quarantine after 40 Tablighi Jamaat participants tested positive for the virus.

Another worrying development was the start of local spread as some 50 participants were admitted to a quarantine centre in Kasur, including five Nigerian women. By 31st March, Punjab reached 708 cases, a worrying number yet still under control. We knew that our margin of error was much narrower and choices were far less. March was significant in many ways as we decided to constitute the apex technical forum for the Pandemic: Corona Expert Advisory Group, debuting its work with development of algorithm for Case Management on 27th March. Another milestone was setting up of the Corona Control Room in the Primary and Secondary Healthcare Department with a helpline to register patients. The Control Room served as Pandemic nerve centre as well as our central data repository. Back then, home isolation was not announced as a policy, hence a Patient Tracking System was developed which soon transformed into full-fledged Trace, Track, Quarantine Unit. Given the stigma and trauma attached with it, we also set up a psychological support helpline (0304 1110116) for patients requiring psychological counseling.

To be continued

The writer retired as Professor of Obstetrics and Gynecology at King Edward Medical University Lahore and currently serves as Health Minister of Punjab

Note: Acknowledgements for Sajjad Hafeez, Manager Communication Primary and Secondary Healthcare Department, for assisting me with background data and insightful perspectives. Queries may be emailed at sajjadhafeez@hotmail.com