Pakistan’s preparedness to combat COVID-19

Dr. Jamil Ghori

Corona virus, the so called COVID-19, is spreading like a wildfire and has reached to every corner of the continents making it a deadliest pandemic outbreak of the 21st century!
It is about 102 years since the outbreak of the Spanish Flu that infected about one fifth (~500 million) of the world’s then population and was considered as the deadliest flu of the 20th century! To some estimates, 50-100 million people died, including 675,000 Americans. Like the Spanish Flu that was spread by the movement of the soldiers coming back homes from the front lines, the COVID-19, as we know for fact, is also spread by the movements of the human beings from place to place as tourists, businessmen, diplomats, family visits, pilgrims, etc.
All the countries in the world have been caught off guard by the rapid spread of the virus that started out from Wuhan, a high densely populated major cosmopolitan and capital city of Hubei province located in Central China. Instead of paying attention to it and taking the virus seriously, many leaders of the western world, including the USA did not take it seriously and rubbed it off as a seasonal flu. Now, many of those countries are paying the price as the number of the diagnosed Covid-19 patients are multiplying and death tolls are skyrocketing due to the inadequate preparedness and lack of resources to combat the virus and to contain its spread. After China, Italy, Spain, Iran, Hongkong, South Korea, USA are among the worst hit countries. The death tolls in each country’s case could have been minimized if enough medical resources, like the diagnostic test kits, masks, protective suits, gloves, ventilators, etc. were available.
Like the other viruses, COVID-19 attacks body’s vital organs, often resulting into incapacitating lungs capacity (breathing difficulties) to perform its normal function of blood purification (by absorbing the fresh oxygen and removing the carbon dioxide from the body). Since there is no vaccine to-date available to treat the severely affected COVID-19 patients, the only hope to make the patient survive is to put the patient on the ventilator so he/she can breathe by the assistance of the machine. It means that the patients must be admitted in the Intensive care units of the hospitals where the ventilators are usually installed. Normally, even in the developed countries (like the EU and the USA), usually hospitals have a couple of dozen ventilators located in their ICUs that are required for their critical cases.
Recently, after weeks of silence since the spread of the virus in Pakistan, Prime Minister Imran Khan in a conversation with the media highlighted his administration’s plan and steps taken so far for containing the virus. At the occasion, NDMA (National Disaster Management Authority) Chairman, Lt. General M. Afzal gave details about the procurement efforts for securing the medical supplies, including the ventilators for the country. He reconfirmed that currently Pakistan has about 2,200 ventilators in the public sector and more are on orders, mainly from China. This means that for a country with 220 million inhabitants, for every 100,000 people, there is only ONE ventilator!! Same is true for the other medical supplies and it shows how unprepared and under equipped Pakistan is in the health care supplies to effectively combat the virus to contain its outbreak! Replying to the questions by the media it was argued to justify that unlike Italy, Spain, South Korea, and other virus affected countries, Pakistan is different as the virus spread is very slow so we don’t have to compare Pakistan with them. A very un-intelligent and scientific reasoning…. So far, Pakistan has been very fortunate that there have been very few cases reported and just a handful of the deaths have occurred directly related to the COVID-19. This is the time for the PM to get the nation ready for the worst-case scenario. However, if the outbreak will take its course just like in Italy, where it started out very slow giving false perception to the country leaders that they are safe and the conditions do not warrant them to take any drastic actions for its containment. Bu when the virus propagating and replicating itself by showing the number of the cases doubling every other day, it was too late! Italy went into panic as the country was forced to a complete shutdown, the hospitals getting full at their capacities and the ICUs experienced the worst bottleneck for the medical staff to work tirelessly around the clock to save as many lives as they could. Having limited number of the ventilators, doctors didn’t have any other choice but to decide giving the ventilator to the patient who had the highest probability of surviving while others to let die. However, if the country’s leadership had giving its due attention when the virus was taking its roots (few cases were reported in the northern Italy) and have learned the lessons from China by ordering more medical supplies and the ventilators, there is no doubt that many of the precious lives would have been saved.
It is understandable that Pakistan being a developing nation, like many of its peer countries, does not have resources nor the capacity, like the Western rich nations. However, Pakistani leadership and the Covid task force headed by the PM’s advisor, Dr. Zafar Mirza, should be updating on a regular basis country’s preparedness and informing the nation how many test kits, masks, hospitals, beds are currently available and how many more are in the pipeline, with the time line. Without the containment measures, Pakistan will be exposed to an onslaught of the virus that could not be controllable, resulting into devastation to the entire nation. It is the duty of the media and the politicians to ask the tough questions and not just listen the number of cases and the deaths as are reported by the government. As a matter of fact, when it comes to the virus testing kits, no one knows if the kits used for the diagnosis are the WHO compliance or just home developed and unreliable. If the kits used for reporting the cases do not meet the diagnostic criteria, not only the reported cases will be unreliable, like in Wuhan during the initial period of testing that resulted into under-reporting, but will be creating an environment conducive for a major onslaught by the virus!
It is still not too late that the PM should mobilize to converting the schools, convention centers, civic/city centers, wedding halls, and other large public and private venues into temporary virus treatment centers equipped with beds, tents and the necessary medical supplies.
Ventilator is the last hope for a severely affected patient and its access can determine if the patient can live or die. According to the WHO, currently there are 7 major Ventilator manufactures, globally. Combined, they can produce just a few hundred thousand, while the need and demand is growing at an alarming and exponential rate.
According to the reports, currently the cost of a ventilator found in the ICUs (intensive care units) is about $50,000 per unit. With the technological advancements, a single unit can be shared by 2 patients simultaneously. As is mentioned earlier in the article, according to NDMA Chairman, there are about 2,200 ventilators in the entire country! Most likely, these ventilators are in the major hospitals equipped with the ICUs in the major cities of the country. Transportation of the patients from smaller cities to the ICUs centers will not only create great challenges for the health professionals but will also make it next to impossible due to lack of the airlift ambulances. The NDMA chairman also said that there are more ventilators on orders but having just a few suppliers in the world, there is a severe competition among the buyers who are trying to procure for their own countries and having deep pockets, out bidding the traders and the representatives of the poor nations. In any event, placing orders directly with the manufacturers, in the best-case scenario, the expected delivery will be in a couple of months. As a matter of fact, today, there is not a single country in the world that is not looking to procure ventilators from any supplier and at any cost!!
In today’s telecast to the nation, the PM did not even mention how his government is planning to combat the virus if the infection escalates like in other countries. One good thing that stood out from his address was to supply food to the unemployed and the hungries, but again without giving any details. There are so many practical examples like the “food banks”, “soup kitchens” and the “sandwich supply service” that can be used as the models to streamline the preparation and distribution of the food without any waste in serving the needing citizens.

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