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Pakistan's strategy to stop the spread of Cornavirus - the numbers are rising, no need to panic yet!

Sirris

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I read this in another thread which motivated me to write a LOT.

I know what you are saying is right but to be honest we are already past the point of no return. Even if they shut things down officially, it would mean very little in practical terms. Most people are just not aware/serious/literate enough to take a quarantine seriously and even now are treating the current situation as a holiday. The streets of Karachi are not deserted like the rest of the world and an official shutdown is unlikely to change that unless they do something extreme like calling in the army and imposing a curfew. It is more of a cultural issue. Local transmission has already started and it is now almost certain that the virus will spread exponentially. Our only hope now is the low mortality rate. Even IK seemed resigned to this and while the speech was honest and frank , it wasn't something that inspired a lot of confidence.

Pakistan is nowhere near the point of no return.

Yes! things will be difficult.
Yes! people would have to change their lifestyle for next few months.
Yes! Pakistan doesn't have crucial resources.
Yes! the virus is spreading at this very moment.
Yes! the average person is stubborn!

Still there is a long way to go for it to be point of no return.

People of Pakistan CALM DOWN!

I have the privilege to be living in the middle of Europe. In one of the richest country with top quality health care. BUT at this point if I had the choice where I'd be with my family to protect them and myself from getting the virus it would be Pakistan. Given that the option is only between Pakistan and my current residence and the only criteria was to survive the pandemic.

Pakistani think-thank has the habit of being heavily western oriented and looking towards them for the strategy. I hope they don't when it comes to fighting corona! There are very different dynamics at play in Europe in contrast to Pakistan. Those in charge need to understand these dynamics very well and not just what measures European countries have taken.

A shut down is a desperate measure those European countries were forced to take because they acted too late for their country. Pakistan still has a very good chance.

First of all remember even the best and most developed country in the world has NO CURE for Covid-19. This is a viral infection. There is NO known therapy that would heal a patient. The few advantages they have over Pakistan is an educated population, the government's financial reserves and better medical infrastructure in case a patient requires hospitalization.

But Pakistan also has many advantages over developed countries in fighting this virus which we need to be aware of:

Young population.

This is a very BIG advantage. The virus has shown over and over again to have a very mild progression among young population. Most don't require hospitalization and all they need is eat healthy, drink tea, get plenty of rest and stay at home. Yes there are exceptions but this is a very observable trend so far. Imran Khan failed to mention this aspect in his speech I feel. So if you are infected just isolate yourself so that the virus doesn't spread further and most likely you are going to survive it.

However in case a young person does need hospitalization our capacities will run out quickly and hence the mortality rate among the young might be higher than in europe but it still should be far lower than among the elderly.

The current mortality rate of 3% is hugely inflated and due to elderly people. Most of the Covid-19 patients hospitalized are 60+ many are 70 and 80+. Since these elderly are in retirement they also love to travel a lot and hence got easily infected by the virus. If we can isolate our elders at home and tell them to remain at home for now we already have won half the battle. But we really need to keep our distance from them. Not that we get the virus from outside, come back home and infect them. That's where a change in lifestyle is necessary.

Another thing to keep in mind is that people with cardiovascular disease and diabetes are also at risk regardless of age. So if you have someone in your family tell them to avoid social gatherings as much as possible.

The country is big and the public transport sucks

Believe me that's a good thing in this case. Pakistan is big country, public transport sucks and it is not easy to move from one region of the country to another. Most people prefer to use their own private vehicle to travel. Yes there are overloaded buses but that's nothing compared to the volume of public travel in Europe. We can easily limit these sort of Bus travel in Pakistan but for now even this is not necessary.

European countries have very good public transport system. But that's a bad thing in this situation because it improves the mobility of the people hence making it easier for the virus to spread quickly all across the country. You have people going to work on a jam packed train traveling for an hour. Which helps the virus to spread all over the place through out the whole country.

For Pakistan it means that for now the virus is locked up in certain communities and areas of the country. Most people hardly ever leave a certain radius and for most part of their lives and stay there. Hence it is easy to track down their movement and contain the virus. Though the area can be as big as a small European country.

A lack of booming tourist industry and not many people go abroad for holidays

European countries not only have a booming tourist industry but the people themselves love to travel abroad. Most schools have holidays after every 5 weeks. The virus spread in Scandinavian countries because many had gone to Italy for holidays and came back infected!

Most people in Pakistan don't have the means to travel abroad. This is another advantage it means the source of the virus in the country can easily be tracked down and only few parameters need to be controlled!

The population is largely rural and their is a segregation between the communities

Pakistan's population is rural. This could be a good and a bad thing. But right now it's mostly good. From my judgment most of the rural population is untouched. If the virus were to reach them it would be by someone who lives in a city and went back home.

There is also a segregation among the communities.

You have villages and even part of cities which are known to either be "Shia" dominated or "Sunni" dominated. This can further help us in identifying the areas which need our most attention right now.

I listed these aspects so people in Pakistan can be assured and realize that they aren't sitting in the same boat as the Europeans. Don't look at Europe as a guideline to fight corona. Develop your own specific approach.

I also have good news for those who have been to Iran recently and are concerned. If 14 days have passed since they came back from Iran and no symptoms yet then congratulations they most likely don't have the virus. This info needs to be communicated to encourage the Shia population.

Pakistan's disadvantages are obvious: bad infrastructure, financially weak, ignorant masses and highly populated urban areas.

At this moment the Pakistani government needs to concentrate on getting the test kits and proper protection kit for medical staff performing these tests. Forget about getting enough ventilators. They are required but don't go and panic buy 1000s of them. For now the focus should be on getting more test kits and increasing the capability to test the hell out of the society in a strategic manner.

The goal should be find out those who are infected, gather their data, track down their movements, contact their close friends, test them and put them under isolation. There is no point in testing the population from A to Z. Go for specific areas. Shia community first and foremost. Shia community leaders need to show responsibility and ask their followers to limit their movement, be honest and report to authorities.

Pakistan needs to mobilize it's medical staff and set up medical tents across these communities for a large scale testing. We have a door to door polio scheme, what we need right now is a door to door testing scheme in those areas.

Before we lock down the whole country or even big cities we need to start small. Depending on where the big number of infected live lock down certain areas of the city, lock down a certain district and only gradually increase the radius of the lock down if the numbers are rising. With lock down I mostly mean limit the movement in and out of the area first and then gradually make it stricter like no more bazar visits etc.

Also the situation has slightly progressed, people coming in from west and golf region are also suspect but not to such a large scale. They need to stay home and report to authorities as well. International flights banned.

Another major challenge is providing the nation with proper information and a disciplined approach to this. Just having a cough or fever doesn't mean the person has corona. The person needs to have come in contact with a person of risk or himself been to a country of risk. Everybody else needs to calm the F down not rush to a doctor. Just stay home.

There should be a public hotline where people can call and get guidance.

Washing hands is not enough and social distancing is the number one best thing you could do

Social distancing doesn't mean don't shake hands. It means don't go to parties, don't visit large gathering and keep at least a distance of 2 meters when talking to someone. The proven way the virus spreads is when you drink the other person's spit when they are talking to you. Hence keep the distance.

Guys stop worrying about 200 people being diagnosed with it. This numbers will rise immensely and rapidly. Which is good. It means we are testing properly and finding out the infected. Also remember this number represents the situation of 5-14 days ago. They are number of people who are showing the symptoms. The number of infected is larger. There are people who are infected today but will show symptoms in 5-14 days.

Fear of the virus is a good thing but no need to throw in the towel. The battle has only started and can be won without causing devastation with a strategic approach which takes into account the unique situation of Pakistan!

Look at this parameter total diagnosed cases per one million of the population:

Italy 521 cases
Switzerland: 317 cases
Norway: 271 cases
Spain: 253 cases

Pakistan: 1.1 cases

https://www.worldometers.info/coronavirus/

Of course in Pakistan's case the number of diagonsed right now can't be trusted since we only began testing. If we assume that 5000 are infected even then the ratio would be 25 cases/million.

Now we are in a middle of a pandemic and don't know whether this parameter has any importance or not but right now for Pakistan it is pretty low. Which should give us some time to think clear headed.

Flatten the curve

In western media you may have heard the concept of flatten the curve. It means to keep the total number of infected person at a given time at such a low level that there is enough medical infrastructure in place to deal with those who need hospitalization. This strategy accepts the continuous transmission of the virus within the population. THIS should NOT be Pakistan's strategy. Because our medical resources are so low that the curve would practically have to be a flat line. Our strategy and goal should be to identify and isolate each and everyone infected. It's a herculean task and it will require time and resources, people will die but we need to get it done. This is a far more realistic goal then to aim for a low curve in accordance with out medical infrastructure.

Guys inform yourself and inform your families back home. Tell them to not panic but to also be cautious.

Is there a way spread this message to a broader audience of Pakistanis? I wish I could address the nation right now. There is still a lot more to be said.
 
I read this in another thread which motivated me to write a LOT.



Pakistan is nowhere near the point of no return.

Yes! things will be difficult.
Yes! people would have to change their lifestyle for next few months.
Yes! Pakistan doesn't have crucial resources.
Yes! the virus is spreading at this very moment.
Yes! the average person is stubborn!

Still there is a long way to go for it to be point of no return.

People of Pakistan CALM DOWN!

I have the privilege to be living in the middle of Europe. In one of the richest country with top quality health care. BUT at this point if I had the choice where I'd be with my family to protect them and myself from getting the virus it would be Pakistan. Given that the option is only between Pakistan and my current residence and the only criteria was to survive the pandemic.

Pakistani think-thank has the habit of being heavily western oriented and looking towards them for the strategy. I hope they don't when it comes to fighting corona! There are very different dynamics at play in Europe in contrast to Pakistan. Those in charge need to understand these dynamics very well and not just what measures European countries have taken.

A shut down is a desperate measure those European countries were forced to take because they acted too late for their country. Pakistan still has a very good chance.

First of all remember even the best and most developed country in the world has NO CURE for Covid-19. This is a viral infection. There is NO known therapy that would heal a patient. The few advantages they have over Pakistan is an educated population, the government's financial reserves and better medical infrastructure in case a patient requires hospitalization.

But Pakistan also has many advantages over developed countries in fighting this virus which we need to be aware of:

Young population.

This is a very BIG advantage. The virus has shown over and over again to have a very mild progression among young population. Most don't require hospitalization and all they need is eat healthy, drink tea, get plenty of rest and stay at home. Yes there are exceptions but this is a very observable trend so far. Imran Khan failed to mention this aspect in his speech I feel. So if you are infected just isolate yourself so that the virus doesn't spread further and most likely you are going to survive it.

However in case a young person does need hospitalization our capacities will run out quickly and hence the mortality rate among the young might be higher than in europe but it still should be far lower than among the elderly.

The current mortality rate of 3% is hugely inflated and due to elderly people. Most of the Covid-19 patients hospitalized are 60+ many are 70 and 80+. Since these elderly are in retirement they also love to travel a lot and hence got easily infected by the virus. If we can isolate our elders at home and tell them to remain at home for now we already have won half the battle. But we really need to keep our distance from them. Not that we get the virus from outside, come back home and infect them. That's where a change in lifestyle is necessary.

Another thing to keep in mind is that people with cardiovascular disease and diabetes are also at risk regardless of age. So if you have someone in your family tell them to avoid social gatherings as much as possible.

The country is big and the public transport sucks

Believe me that's a good thing in this case. Pakistan is big country, public transport sucks and it is not easy to move from one region of the country to another. Most people prefer to use their own private vehicle to travel. Yes there are overloaded buses but that's nothing compared to the volume of public travel in Europe. We can easily limit these sort of Bus travel in Pakistan but for now even this is not necessary.

European countries have very good public transport system. But that's a bad thing in this situation because it improves the mobility of the people hence making it easier for the virus to spread quickly all across the country. You have people going to work on a jam packed train traveling for an hour. Which helps the virus to spread all over the place through out the whole country.

For Pakistan it means that for now the virus is locked up in certain communities and areas of the country. Most people hardly ever leave a certain radius and for most part of their lives and stay there. Hence it is easy to track down their movement and contain the virus. Though the area can be as big as a small European country.

A lack of booming tourist industry and not many people go abroad for holidays

European countries not only have a booming tourist industry but the people themselves love to travel abroad. Most schools have holidays after every 5 weeks. The virus spread in Scandinavian countries because many had gone to Italy for holidays and came back infected!

Most people in Pakistan don't have the means to travel abroad. This is another advantage it means the source of the virus in the country can easily be tracked down and only few parameters need to be controlled!

The population is largely rural and their is a segregation between the communities

Pakistan's population is rural. This could be a good and a bad thing. But right now it's mostly good. From my judgment most of the rural population is untouched. If the virus were to reach them it would be by someone who lives in a city and went back home.

There is also a segregation among the communities.

You have villages and even part of cities which are known to either be "Shia" dominated or "Sunni" dominated. This can further help us in identifying the areas which need our most attention right now.

I listed these aspects so people in Pakistan can be assured and realize that they aren't sitting in the same boat as the Europeans. Don't look at Europe as a guideline to fight corona. Develop your own specific approach.

I also have good news for those who have been to Iran recently and are concerned. If 14 days have passed since they came back from Iran and no symptoms yet then congratulations they most likely don't have the virus. This info needs to be communicated to encourage the Shia population.

Pakistan's disadvantages are obvious: bad infrastructure, financially weak, ignorant masses and highly populated urban areas.

At this moment the Pakistani government needs to concentrate on getting the test kits and proper protection kit for medical staff performing these tests. Forget about getting enough ventilators. They are required but don't go and panic buy 1000s of them. For now the focus should be on getting more test kits and increasing the capability to test the hell out of the society in a strategic manner.

The goal should be find out those who are infected, gather their data, track down their movements, contact their close friends, test them and put them under isolation. There is no point in testing the population from A to Z. Go for specific areas. Shia community first and foremost. Shia community leaders need to show responsibility and ask their followers to limit their movement, be honest and report to authorities.

Pakistan needs to mobilize it's medical staff and set up medical tents across these communities for a large scale testing. We have a door to door polio scheme, what we need right now is a door to door testing scheme in those areas.

Before we lock down the whole country or even big cities we need to start small. Depending on where the big number of infected live lock down certain areas of the city, lock down a certain district and only gradually increase the radius of the lock down if the numbers are rising. With lock down I mostly mean limit the movement in and out of the area first and then gradually make it stricter like no more bazar visits etc.

Also the situation has slightly progressed, people coming in from west and golf region are also suspect but not to such a large scale. They need to stay home and report to authorities as well. International flights banned.

Another major challenge is providing the nation with proper information and a disciplined approach to this. Just having a cough or fever doesn't mean the person has corona. The person needs to have come in contact with a person of risk or himself been to a country of risk. Everybody else needs to calm the F down not rush to a doctor. Just stay home.

There should be a public hotline where people can call and get guidance.

Washing hands is not enough and social distancing is the number one best thing you could do

Social distancing doesn't mean don't shake hands. It means don't go to parties, don't visit large gathering and keep at least a distance of 2 meters when talking to someone. The proven way the virus spreads is when you drink the other person's spit when they are talking to you. Hence keep the distance.

Guys stop worrying about 200 people being diagnosed with it. This numbers will rise immensely and rapidly. Which is good. It means we are testing properly and finding out the infected. Also remember this number represents the situation of 5-14 days ago. They are number of people who are showing the symptoms. The number of infected is larger. There are people who are infected today but will show symptoms in 5-14 days.

Fear of the virus is a good thing but no need to throw in the towel. The battle has only started and can be won without causing devastation with a strategic approach which takes into account the unique situation of Pakistan!

Look at this parameter total diagnosed cases per one million of the population:

Italy 521 cases
Switzerland: 317 cases
Norway: 271 cases
Spain: 253 cases

Pakistan: 1.1 cases

https://www.worldometers.info/coronavirus/

Of course in Pakistan's case the number of diagonsed right now can't be trusted since we only began testing. If we assume that 5000 are infected even then the ratio would be 25 cases/million.

Now we are in a middle of a pandemic and don't know whether this parameter has any importance or not but right now for Pakistan it is pretty low. Which should give us some time to think clear headed.

Flatten the curve

In western media you may have heard the concept of flatten the curve. It means to keep the total number of infected person at a given time at such a low level that there is enough medical infrastructure in place to deal with those who need hospitalization. This strategy accepts the continuous transmission of the virus within the population. THIS should NOT be Pakistan's strategy. Because our medical resources are so low that the curve would practically have to be a flat line. Our strategy and goal should be to identify and isolate each and everyone infected. It's a herculean task and it will require time and resources, people will die but we need to get it done. This is a far more realistic goal then to aim for a low curve in accordance with out medical infrastructure.

Guys inform yourself and inform your families back home. Tell them to not panic but to also be cautious.

Is there a way spread this message to a broader audience of Pakistanis? I wish I could address the nation right now. There is still a lot more to be said.

I don’t completely disagree with you. I probably shouldn’t have used the phrase ‘point of no return’ because that is not what I meant. Firstly, I was talking mainly about Karachi rather than whole of Pakistan. I personally feel that once local transmission starts in a densely populated city like Karachi with sub-par health facilities and a population that lacks awareness, it will spread like wildfire and we have already missed that window of containment. For the rest of Pakistan and especially more rural and isolated areas there is still much that can be done. However, we must understand that without some sort of internal travel restrictions no place will be safe. Karachi is not called mini-Pakistan without a reason and people from all over Pakistan live here and travel back to all parts of the country. We were barely able to quarantine a thousand pilgrims at Taftan, forget about stopping people from traveling internally.

And while I agree that the young population is an advantage when it comes to number of fatalities, an uneducated young population which the govt is taking no steps to keep at home is a death sentence for the older generation. That is why I was disappointed with the speech not taking a harder tone with respect to self- isolating. Our people and especially less educated young people WILL NOT self-isolate unless you take some strict measures even if they are just symbolic measures. I understand that a total shutdown like developed countries is not practical, but I also don’t understand what the current govt strategy is. They can’t just wait and watch and hope the people will know what is best for them. Most don’t and will put at risk even those that do.
 
Guys inform yourself and inform your families back home. Tell them to not panic but to also be cautious.

Also one more thing I feel it is very important to realize. The problem in Pakistan right now is not panic. It is the absolute lack of any panic among the masses. You can only only be cautious if you accept that something is a serious threat.
 
Pakistan's number are 650 confirmed cases. This is nothing to worry about yet. The numbers of infected might as well be 10'000 no worries.

What worries me is that false measures are being given a priority. Country wide or even province wide lockdown is not necessary yet, it will just waste valuable resources which are needed somewhere else.

Priority should be to increase the testing capacity all across the country and encourage people to come for a test while a massive information campaign explaining social distancing in- and outside of the home.

Those who have been tested positive and don't have a travel history their whole family and close contacts need be tracked down tested and isolated if necessary. If people are frightened they should be assured that the virus is most likely harmless.

I saw pictures of Army in Karachi, hopefully the will be exercising social distancing too. Remember the authorities in wuhan who were responsible for enforcing the lockdown all had masks and full on protective gear. If caution is not applied and army members start having friendly chat and chai with local members it could backfire.
 
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