The following article has been contributed by Omer Azhar Bhatti. Omer is the co-founder of the Future of Pakistan Conference and a graduate of the London School of Economics and Political Sciences.
A day before Prime Minister Boris Johnson announced that the spread of Covid-19 could no longer be contained in the United Kingdom, the head of the Nudge Unit in the No. 10 Downing Street spoke to the BBC.
David Halpern, the head of the Nudge Unit stated, “There’s going to be a point, assuming the epidemic flows and grows as it will do, where you want to cocoon, to protect those at-risk groups so they don’t catch the disease. By the time they come out of their cocooning, herd immunity has been achieved in the rest of the population.”
No. 10 Downing Street’s cohort of medical experts, led by Sir Patrick Vallance, thought they could control the epidemic by building herd immunity and that way they could protect people. On 12 March, Patrick Vallance announced that the UK had moved from containing the virus to delaying its spread-they reassured that herd immunity would be achieved once 60% of the population had been infected. But that strategy didn’t factor in that 15% of people infected with Covid-19 would end up with severe symptoms. At that pace, a staggering number of people would require hospitalisation which would terrorise the NHS.
Fast forward to 25th of March, Richard Horton, the editor-in-chief of the Lancet medical journal, told British MPs on the science and technology select committee that the Scientific Advisory Group for Emergencies (SAGE) had very limited input from public health experts and doctors, despite being chaired by the chief medical officer, Chris Whitty, and the chief scientific officer, Sir Patrick Vallance.
Britain’s watershed moment arrived when it completely ignored the 3 pronged approach advised by World Health Organisation-testing, isolation and quarantine-in January and February. Warnings issued by Chinese scientists on the severity of Covid-19 had not been understood and the outbreak could no longer be contained.
BBC predicts the UK death toll, which currently stands at 6,159 deaths, could exceed that of Italy’s by next week.
On the other side of the world, Pakistan is still in the primitive stages of the outbreak as compared to the western world. The jump from 3000 to 4000 Covid-19 cases came within a matter of 3 days-which is alarming. While Pakistan reels from the travesty at the Taftan border that launched thousands of untested suspected cases into the country, Pakistan must ensure that it learns the right lessons from the United Kingdom-and doesn’t make the same mistakes.
The challenge is to strike the right balance between sustaining the lockdown for a period long enough to delay the spread of the virus while ensuring daily wagers and those below the poverty line continue to be secured by government’s Covid-19 emergency package.
Unfortunately, there seems to be significant tension between the federal and provincial government over the extension of the lockdown; the former’s vision is where the trouble lies at the moment. Since the get-go, Imran Khan has led the Covid-19 response with failed signalling and vague messaging-which leads one to assume that he is aiming for herd immunity to build as soon as possible rather than clamping down and enforcing the test, isolation and quarantine strategy.
During his addresses to the nation, the Prime Minister has consistently argued that the young and middle aged are not vulnerable and only the elderly will fall prey to the virus. Science and evidence point in the other direction; in March, America’s centre for disease control and prevention reported that 40% of cases requiring hospitalisation were under the age of 55. The federal government’s response has also highlighted that only a small percentage who fall sick will require hospitalisation, which is roughly 15% based on hospital admittance from across the world. Unfortunately the federal government believes these figures are insignificant and warrant reopening the economy.
The only logic behind such a step can be the same one the UK had hoped for-to establish successful herd immunity i.e. once enough people get infected and eventually recover, the pandemic will no longer debilitate public health.
Opening the economy and returning to business as usual means that not only will young people get infected with the possibility of severe disease but an unrelenting amount of total infections will pummel the public health system. To put the crisis into perspective, Ukraine has an estimated 1100 ventilators for a population of 40 million, the Ukrainian government is dusting off Soviet era ventilators to meet the challenge. Pakistan, on the other hand, has a paltry 2400 ventilators for a population of around 220 million.
This decision can potentially rattle the public health system as there is a significant likelihood of relatively younger sections of the population requiring hospitalisation alongside the elderly. Regardless of the mathematical model followed, the expected number of confirmed cases in Pakistan are dark numbers.
The Ministry of National Health Services Regulations and Coordination submitted a report to the Supreme Court bench which predicts the tally of coronavirus infections may top 50,000 by 25th April-with no conclusions as to when the numbers will start falling.
Pakistan has taken bold steps by cancelling regularly operating international flights, installing airport screenings and placing all provinces under capital. But as the country struggles to find the balance between stopping infections and ensuring hunger doesn’t kill Pakistan’s most vulnerable segment, it must be emphasised that herd immunity is not the answer. Betting that younger sections of the population will not fall severely ill is only as good as a gamble.
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