Article: Miracle in the Making?

COVID-19 in Pakistan

Oct. 1, 2020

For a country that has a poor track record against infectious diseases, Pakistan is punching above its weight in the fight against COVID-19.

When COVID-19 first surfaced in Pakistan earlier this year, there were genuine concerns about how a country with a weak healthcare system, large population, and a poor track record against infectious diseases such as polio, tuberculosis, and hepatitis would fight a global pandemic and prevent both a catastrophic toll and an economic meltdown.

Pakistan shut down its economy in early March, which kept the virus from spreading widely. But after restrictions were lifted in May, many Pakistanis celebrated the end of Ramadan with the usual shopping and family visits.

By the end of the month, the country appeared to be on the edge of a devastating COVID-19 outbreak, with over 5,000 new COVID-19 cases every day and local transmissions accounting for 90% of them. Despite this, the government decided to lift the lockdown.

By lifting the complete lockdown, Pakistan's Prime Minister Imran Khan challenged the advice of WHO, declaring that lockdowns are too costly for the country's daily wage workers. The government then switched to a strategy of 'smart lockdowns' for high-risk areas and hotspots where a cluster of cases had arisen.

Soon after, analysts and health institutions started comparing Pakistan to Brazil, another developing country with a similar population size that has been ravaged by the novel coronavirus, stressing that Pakistan would broadly follow coronavirus trends seen in the West.

A simulation from Imperial College London produced a worst-case scenario of 30,000 deaths a day in early August.The danger increased in June, when hospitals were overwhelmed with patients, intensive care units were filled up, and families were forced to move relatives around in search for a bed. But just a few weeks later, hospital admissions started to fall drastically, baffling health experts and scientists around the world.

That the rate of infections didn't increase even after the resumption of business activities and religious holidays is a clear indication that the country is finally returning to normal. From public places like restaurants, gyms, and cinemas to tourist destinations and educational institutions, the government has opened the economy in phases while keeping COVID-19 at bay.

As of September, recorded daily deaths dropped to single digits and the number of daily cases has declined from more than 6,000 to well below 1,000.

Now, several recent reports are calling Pakistan a COVID-19 bright spot, and the WHO has reversed its criticism and included Pakistan on the list of countries from which the world can learn to fight future pandemics.But many are still pondering how a developing country managed to somewhat defeat COVID-19 against all odds.

For starters, Pakistan has a young population. Only 4% of the population is over the age of 65—compared to 16% in the US, 10% in Brazil, 19% in the UK, and 23% in Italy, according to UN data.

Moreover, the average age in Pakistan is 22, more than a decade younger than Brazil, and 25 years younger than Italy.

And there are no bars and nightclubs as well as no institutionalized homes for the elderly, sites of deadly outbreaks elsewhere.While differences in demographics and social behavior patterns can somewhat explain why Pakistan has done better than most western countries, it is less clear why it has fared better than neighboring India, where hospitals have come under even greater pressure and cases are continuing to rise. One theory is that Pakistan has just one megacity, Karachi, while India has several, and it isn't a high-rise city, which is a big factor because the virus spreads faster in denser settings.

Another major reason is that the Pakistani government managed to increase testing capacity in a short period and applied a sophisticated tracking system that ran through the ground to apex level. Notably, it is the same system that was originally developed by the Services Intelligence (ISI) to track terrorists.

Moreover, Pakistan has successfully used the infrastructure it developed in its fight against polio to fight COVID-19.

Community health workers that were previously used to vaccinate children for polio were redeployed for contact tracing and monitoring. In fact, the Polio Eradication Initiative (PEI) has been on the frontline ever since its surveillance, data, and communication capabilities were rerouted by the government in March 2020.

Then, there is Imran Khan's 1 million-strong Corona Relief Tiger Force, which is made up of volunteers from all walks of life, whose task is to distribute rations, implement the government's 20-point policy for worshippers, generate awareness among locals, and enforce social distancing measures.

Now that the dust has settled, the question on everyone's mind is, has the government's gamble played out? Well, the numbers say it all.

Pakistan recorded a USD424-million current account surplus in July. The same month, exports increased by 20%, returning to their pre-COVID-19 level, and remittances hit an all-time high. And the government is further building on that success by promoting value-added exports, providing a range of subsidies, and giving incentives to SMEs and low-income families.
Based on all this, the Asian Development Bank (ADB) released a report in September, stating that Pakistan has achieved notable success in containing the dual health and economic challenge presented by COVID-19 and is projected to experience a broad economic recovery in fiscal year 2021.

Although for now it seems as though Pakistan has turned the tables, the government must not get ahead of itself, simply because the risk of a second wave is very real. It is more important now than ever to keep densely populated cities under strict check and continue working behind the scenes to map out the pandemic across the country.

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