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5 lessons Pakistan should learn from Italy’s coronavirus mistakes

by Farah Farooq

April 9, 2020 97

The Covid-19 outbreak in Italy offers plenty of lessons for Pakistan, if only we would heed them.

In a new Harvard Business Review article, a trio of academics — Gary Pisano, Raffaella Sadun, and Michele Zanini — broke down some of the key takeaways from the Italian experience. The authors called Covid-19 the country’s “biggest crisis since World War II.” Beyond the scale of the coronavirus spread there, the outbreak in Italy has been marked by a halting and inconsistent response from government officials. They were slow to implement strict social distancing measures and even once officials began to institute social distancing as Covid-19 cases spiked, the public did not seem to respond to government directives with urgency.

This all sounds oddly familiar because we’re seeing the same pattern play out in Pakistan.

The unavoidable implication is that Pakistan is already on the road to the same fate — unless it acts quickly and pays attention to other countries’ mistakes. Here’s what the Pakistan can learn from Italy’s mistakes:

1. Take the situation seriously

First and foremost, Pakistan has to recognise the seriousness of the situation. A couple of weeks ago, it was common to see citizens and government officials skeptical of the Covid-19 threat pointing to low fatality numbers and asking why there was panic, given how many people die of the seasonal flu every year.

The coronavirus spreads stealthily, with 25% of those who contract remaining symptomless for up to 5 to 14 days.

Italy’s political leaders did not act preemptively despite evidence suggesting such delays could increase the number of cases. State-of-emergency declarations were shrugged off by leaders. In one ominous episode, a group of politicians engaged in deliberate handshakes even after the Covid-19 risks were known — one of whom was diagnosed with the infection a week later.

Such lax attitudes reflect the same confirmation bias seen in Pakistan and elsewhere.

Our Prime Minister keeps on saying “Ghabrana nahi hai” (don’t panic) and thinks the number of cases will grow less as summer approaches. But it is too soon to assume that, no research has pointed towards Covid-19 transmission being delayed due to heat. According to WHO, “Exposing yourself to the sun or to temperatures higher than 25C degrees DOES NOT prevent the coronavirus disease.”

Pakistan is already way back on testing patients, thus the small number of cases. Once testing begins on a larger scale, the initial estimate that 20 million people could get infected might actually turn out to be true. WHO also claimed that if proper safety measures are not ensured, Pakistan could witness 200,000 cases by mid-July.

2. No half measures

Italy started small with its coronavirus containment and only expanded it as the scale of the problem revealed itself.

The country started with a targeted strategy: areas with a lot of infections were designated as “red zones.” Within the red zones, there were progressive lockdowns depending on the severity of the outbreak in the area. The restrictions were only broadened to the whole country when these measures failed to contain the outbreak.

In fact, these limited lockdowns might have made it worse, because the coronavirus transmits so silently, the “facts on the ground” (number of confirmed cases, reported deaths, etc.) didn’t fully capture the magnitude of the problem. Once partial lockdowns went into effect, people fled to less restricted parts of the country — and they may have taken the virus with them.

Italy’s experience indicates that segmented lockdowns and confusing social distancing policies across different interconnected areas will ultimately only prolong and deepen the problem. Luckily, the regions that took a more proactive approach may have something to teach their neighbors — and Pakistan.

3. Learn from successful containment strategies

However, there are strategies that have worked for the Italians, and Pakistan can adopt them too. The experiences of Lombardy and Veneto, two neighboring Italian regions that took two different strategies for their coronavirus response and saw two different results are instructive.

This is what Veneto did to successfully control the outbreak within its borders:

• Extensive testing: People with symptoms and people who were asymptomatic were tested whenever possible.

• Proactive tracing: If somebody tested positive, everybody they live with was tested or, if tests weren’t available, they were required to self-quarantine.

• Emphasis on home diagnosis and care: Health care providers would actually go to the homes of people with suspected Covid-19 cases to collect samples so they could be tested, keeping them from being exposed or exposing other people by visiting a hospital or doctor’s office.

• Monitoring of medical personnel and other vulnerable workers: Doctors, nurses, caregivers at nursing homes, and even grocery store cashiers and pharmacists were monitored closely for possible infection and given ample protective gear to limit exposure

4. Avoiding what went wrong in Lombardy

Lombardy, on the other hand, was much less aggressive on all of those fronts: testing, proactive tracing, home care, and monitoring workers. Hospitals there were overwhelmed, while Veneto’s have been comparatively spared.

Does this comparison play out true for Sindh and Punjab in Pakistan?

5. Transparency

The Harvard researchers also singled out the importance of good data — the raw numbers themselves. These figures should focus on important metrics like tests conducted and hospitalizations. Some questions have already been raised about whether Pakistan is undercounting its fatality numbers.

What those numbers say and what policies they suggest might be most effective at mitigating the outbreak are largely a concern for policymakers, journalists, and medical professionals. 

Everyone needs to take heed from the authors’ concluding point of the research:

“An effective approach towards Covid-19 will require a war-like mobilization — both in terms of the entity of human and economic resources that will need to be deployed as well as the extreme coordination that will be required across different parts of the health care system (testing facilities, hospitals, primary care physicians, etc.), between different entities in both the public and the private sector, and society at large.

Together, the need for immediate action and for massive mobilisation imply that an effective response to this crisis will require a decision-making approach that is far from business as usual.”