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How Did Pakistan Flatten the Coronavirus Curve?

  • Niha Dagia
  • Sep, 2020
  • 116
  • Herd Immunity

Despite ending its lockdown early, Pakistan managed to flatten the curve. But the country is still far from achieving herd immunity

In May, Pakistan appeared to be on the edge of a devastating COVID-19 outbreak. The government defied all norms by deciding to lift its lockdown at a time when the country was recording a daily average of over 5,000 cases, with local transmission accounting for at least 90 percent of the spread.

By mid-August, the global COVID tally crossed 23 million, with over 810,000 deaths. Pakistan’s numbers remained relatively low, at around 292,000 infections and over 6,200 deaths in a population of 220.4 million. While the world recorded more than 4 million infections and over 200,000 deaths in the past three weeks, Pakistan contributed around 12,000 cases and less than 250 deaths to that tally.

The government reopened the economy in phases and in doing so achieved the impossible by flattening the curve. But, as the saying goes, things are not always what they seem.

A seroprevalence study, conducted in July by the Health Services Academy (HSA) in collaboration with multiple partners including the Agha Khan University Hospital and World Health Organization, estimated 11 percent of Pakistanis have developed COVID-19 antibodies while 89 percent remain at risk.

“It means that every 10th Pakistani has developed antibodies in their blood against the SARS-Cov-2 virus,” reads the study. People between the age of 20 to 60, current smokers, urban residents, and those who have had contact with a known COVID-19 positive person were found more prone to be exposed to the virus.

“There is a very large number out there that needs to be protected from the virus,” said National Command and Operations Center (NCOC) chief Asad Umar.

Epidemiologist Dr. Rana Jawad Asghar interprets the findings to be in line with global studies suggesting 11 to 20 percent of the population in most countries have been exposed to the virus.

“The 11 percent could also represent the most vulnerable of the population and the remaining may not be susceptible to the virus,” he added, while expressing doubts over the seroprevalence study’s accuracy.

The Mystery of the Flattened Curve

The scientist-recommended strategy to contain the spread has been lockdowns, testing, and contact tracing. But it is nearly impossible to get a developing country where two-thirds of the population relies on daily wages to stay at home.

“There is a universal acknowledgment that the virus’ spread can be slowed down through behavioral change in the society,” said Umar. “It can be voluntary with the masses informed of the risk and how to save themselves or it can be administratively enforced. We chose to do both.”

He explained Pakistan’s strategy: “Media played an important role in creating awareness, which was backed by our testing, contact tracing, and quarantine program. We managed to increase testing capacity in a very short period and applied a sophisticated tracking system that ran through the ground to apex level.

“At one point, we had over 10,000 contract workers and more than 3,000 contact tracing teams. It became an integral part of our strategy coupled with smart lockdowns in high-risk areas and hotspots and SOP compliance. Those in violation were fined or sealed.”

Despite the SOPs (standard operating procedures) and smart lockdowns, a walk through Karachi’s streets on a midsummer’s evening in mid-July showed business as usual.

“For the first three months, we saw a significant change in behavior. People wore masks and maintained social distancing. Once the cases slowed down, we saw less adherence to the SOPs,” said Umar.

This was followed by Eid-ul Adha celebrations, which also fueled local tourism with thousands driving to the mountains during the holidays. The curve, however, continued on a downward trajectory.

Asghar, the epidemiologist, said he had found the high cases tally and death toll projections for Pakistan incredulous. “Outbreaks don’t behave in such a way,” he explained. “If there is an outbreak in a city, it doesn’t mean every person living in the city will get infected.”

The worst-hit countries have an average age of 35-45 with a high mortality rate in the geriatric population due to the virus’ spread in old-age homes. In contrast, Pakistan has a young population and a social construct that vetoes elderly placements in group homes.

It is not astounding, then, that the study found seropositivity more common in young adults and significantly less in children and older adults. It was also more prevalent in urban areas than rural.

“The youth steps out to work and the ...

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