The perfect storm conditions for the COVID-19

Recent death of a good Samaritan Dr. Furqanul Haq is such a tragic story that no one could imagine in today’s civilized society! The doctor died in transition from hospital to hospital begging by his wife (who accompanied him) to put him on a ventilator but without any luck! Can one imagine if a doctor who has spent his or her entire career in a hospital curing patients by putting them on the ventilators in dire situations but when he or she needs medical assistance can’t have it? According to some sources, Dr. Furqan couldn’t have access to a single ventilator to save his own life in Karachi hospitals, the largest city of Pakistan, because there was none available to spare for him! This horrific tragedy could have easily been avoided if the PM and his COVID-19 task force would had paid any sincere attention to the several reminders and warnings by the health professionals, leaderships of the medical community, and other experts of the subject, including this writer. Their appeals and the warnings went to the deaf ears of the PM Imran Khan’s entourage of the advisors and the cabinet members. After many attempts by the media and journalists to the prevailing acute shortages of the health and safety supplies throughout the country hospitals, the lip service got to-date is nothing more than a status quo. As the tragic death was unfolding on the streets of Karachi, Asad Umar, cabinet minister for Planning was stating that there is no shortage of the ventilators or the testing capacity. As a matter of fact, he was justifying the status quo by quoting that Pakistan has lower fatalities compared to the USA and the major EU countries. This shows the analytical capacity & knowledge about the COVID-19 pandemic progress, Mr. Umar has. Besides the facts of having very limited testing capacity and under reporting of the cases resulting into lower numbers (confirmed cases with the COVID-19 and the number of deaths) than the other countries are an irrelevant comparison. In many of these countries, the COVID-19 arrived about a month earlier than in Pakistan and as a result they have much higher cases than Pakistan. Additionally, the Minister Umar justified the COVID-19 related deaths with the traffic related fatalities by saying that “deaths in road accidents are much higher in Pakistan but because of that, we don’t stop vehicles from running on roads”. This again shows how knowledgeable and comprehension PM’s cabinet and his advisors are. The example is just like comparing apples to oranges!!! In the traffic accidents, only those people die who are involved (as it is not an INFECTION phenomenon) and not the people who come in contact with the injured or died individuals. While the COVID-19 is an infectious chain phenomenon disease, anyone who comes in contact with the affected person also becomes part of the chain in transmitting and spreading of the virus to his or her contacts (family, friends, visitors, passengers, shoppers, shop keepers, drivers, mosques goers, religious congregation attendees, preachers, fellow prayers, hospitals, medical staff, other public gathering places, etc.). It multiplies un-noticeably in a noticeably short time from one person to thousands of the people as the affected people move around. Similarly, another member of the PM’s cabinet for Science & Technology, Fawad Chaudry, was painting a very rosy picture for the readiness of the country during the upcoming peak of the COVID-19, which is contrary to the facts that the medical professionals who are dealing with the patients on daily basis are reporting and warning the government for acute shortage of the supplies and limited testing capacity across the country. According to Minister Usman as of May 7, Pakistan is conducting 14,000 tests per day, a faraway from reaching the target of 20,000 tests per day!
As a matter of fact, no one knows what kind of testing is done in Pakistan to diagnose and confirm the COVID-19 patients! There are just two types of tests for the COVID-19;Molecular and Serological.
The molecular tests look for the presence of a virus’s genetic material, showing that there is an active infection. Those are the tests that require a swab to be shoved through the back of the nose and into the throat to collect a specimen (although – good news – the FDA recently authorized specimen collection by swabbing around the nostrils, and there’s a new test that uses only saliva).
The serological tests look for antibodies to the virus in the blood, the presence of which indicates there was an infection in the past. While the molecular tests for Covid-19 have been around since the beginning of February, serological tests weren’t authorized until April 1. Many people see these tests as a way to prove immunity against the virus, allowing those who test positive to resume their normal lives, free from the threat of contracting the virus again, but with some reservations! Some countries are even using serological test results to issue “immunity passports” to citizens who test positive.
According to the World Health Organization (the UN body called WHO), there are just three approved test methods for the COVID-19 virus. One is called Real Time PCR that uses molecular assays for the viral nucleic acid (method used for testing the PM) and can take 5-15 minutes for the test using ABBOTT ID NOW system. This is the same equipment that was promised by President Trump to send to the PM during their recent phone conversation. Second method is Lamp & Lamp based COVID-19 Near-Patient Assay and it takes about an hour for the test and is similar to PCR test but not as reliable. The third is called ELISA & Fluorescence Detection for lgG&lgM and it takes about 4 hours. This is a very specific test method and can be applied to mid to late stage diagnosis.
According to the experts by July, 2-6 B people will be afflicted by the COVID-19 resulting into a tsunami size health care crisis in the world. In Pakistan, before the summer-end, massive melt down of the already fragile health care system will happen that will not only create a nightmare for the government to handle it but will also result into deaths that the country has not seen ever before. This will happen because of the lack of attention to the repeated warnings by the health professionals and the medical community at large.
According to the CDC, respiratory droplets are the main source of the COVID-19 spread. If left uncontrolled by not following the CDC and WHO protocols (social distancing and wearing face masks when out in public) on individual basis, the virus will spread so fast that it will make the Spanish flu look like just the trailer for the COVID-19 perfect storm. One can have up to 5 days showing no symptoms but still infecting others. According to the public health care experts and medical modeling, number of reported cases by Pakistan is low due to lack of willingness by the officials for a wide scale of testing and under reporting intentionally to keep the public at a un-concern level. The government narrative for the lower cases is that Pakistan is in hot summer period that is making the COVID-19 virus less spreadable than the outbreaks in cooler temperature countries! Australia, Singapore, Brazil, Peru, etc.; they all have been in the hot summer season and are reporting remarkably high number of the COVID-19 cases.
In a recent news release by the PM office about the phone call with Bill Gates, the PM was quoted that his government is making all out efforts to combat the COVID-19 pandemic, while the reality is very different as he is promoting the so called “smart lockdown”! If the public under normal (not FULL LOCKDOWN) do not follow the basic rules of social distancing and wearing face mask in the public places, what will be the scenario played out on the ground under the “smart lockdown”. The public is encouraged not to follow these rules when they see the advisors and the cabinet members are not following what they are preaching, either. In a live TV footage and in the print media dated April 27 during a meeting presided by the Interior Minister Brig. Ijaz Ahmed Shah in Islamabad, Dr. Mirza, the special advisor to the PM was shown sitting closer to the others and NOT wearing the mask while most of the other attendees were wearing the masks. This can only happen in Pakistan that an advisor to the PM and having medical knowledge & training can publicly violate his own advice and expects that the others should follow it! It also says that the rules and regulations are made for the inconvenience of the public and not for the ruling class of the country. Coincidentally, a similar incident happened a couple of days ago in Britain where Dr. Neil Ferguson, the senior health advisor to PM Boris Johnson was caught seeing in close contact with her female friend violating his own advice of social distancing and thus was forced to resign! If Prime Minister Imran Khan is really sincere about the welfare of the public, then he should follow this example to fire immediately (no questions asked) if any of the cabinet members or the advisors found in violation of the COVID-19 containment protocols, without any exception.
By the RO factor (an epidemiology term refers to the average number of the people that one sick person infects), every individual who is carrying the COVID- 19 virus can infect three other people who come in contact and this cycle perpetuate once it stars. It becomes a non-stoppable cycle unless the protocol of testing, tracing, tracking, isolation and quarantine is implemented. With the continued lip service by the advisors like Dr. Mirza and the senior cabinet members for the confused and chaotic testing capacity explanations is like playing with the Russian roulette. They all talk and compare Pakistan with the other countries that has no relevance to the existing ground conditions in Pakistan society. If this bickering and talking irrelevance will continue without any real increase in the health services capacity, it will brew the environment for the explosion of the “Perfect Storm” resulting into innumerable deaths that the current health system can’t handle and like in Ecuador, dead bodies will be seen at places that no one could have imagined.
Recently, another alarming outbreak happened in China in its northeastern city in near Russia called Harbin, famous for its winter festivals. The city has about 10 million population. The outbreak was traced to a Chinese student who was coming back home in March from the USA. As aresult, the entire city of 10 million people was lock downed. The student must spend 14 days in government quarantine center followed by another 14 days in isolation at home. At the time of the lockdown, Harbin city had just 63 confirmed cases and another 17 symptomatic cases. This again confirms that the COVID-19 must not be taken lightly by anyone because when it starts spreading, it does not show any mercy!
Since the first-time assessment of the countrywide preparedness for the COVID-19 was described in this publication by the writer and the same issues were highlighted by the health professionals more than a month ago, not much has changed! Now, the COVID-19 is much closer than just the footsteps away as the total number of the reported cases countrywide (as of May 8) have reached to over 31,000, number of the daily cases are running in thousand and the reported deaths are reaching closer to 700. Even the “under-reporting” conditions, these are substantial increase and extraordinarily little time is left to save some precious lives by taking actions and not just by talking, holding meetings or political bickering.
All the provinces are now reporting substantial increases in the confirmed COVID-19 cases as well as the number of the deaths are on the rise, as has been described earlier. All these stats show that the COVID-19 is onits trajectoryslope, a time when strict FULL LOCKDOWN must be enforced, like the othercountries have done that have been often cited by the PM and his senior administration members. These countries enforced their lockdowns with full force when the COVID-19 was on its trajectory path (like now in Pakistan) and did not allow any exception to anyone. Once they passed the trajectory slope and after continued declining and reaching to a single digit for a few days, they started relaxing an orderly lockdown. Thus, the experience from the other nations and the commonsense dictates that in Pakistan, now is not the time for any relaxation when the cases are doubling in every few days. It is better to wait for the slope to start declining and afterthe cases and the deaths, both starts ina single digit, consistently for a few days. By relaxing the lockdowns now in any manner will be like “spraying gasoline on fire.”
A true leader is judged in the time of a crisis who uses his or her political will & capital for making difficult decisions and making tough choices for the welfare of the entire nation and not just for the few special interest groups.

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