Pakistan cobbles together action plan against coronavirus outbreak

Ministry seeks emergency fund to build capacity to deal with novel coronvarius outbreak

KARACHI: As fears of a global pandemic grow, the Pakistan government has chalked out a national action plan against the novel coronavirus as the deadly infestation is spreading fast.

The World Health Organisation announced that the epidemic has peaked at its epicentre in China, where it has killed more than 2,600 people and infected over 77,000 others.

However, the situation worsened with nearly 2,700 other cases and more than 40 deaths globally, prompting restrictions on travellers from infected nations.

South Korea, Italy and Iran have logged sharp increases in infections and deaths while some Middle Eastern countries have also reported confirmed COVID-19 cases.Keeping in view the frequency of travel to and from China and Iran, the risk of importing the virus is high.

Pakistan has already suspended flights to China and Japan, and closed the border with Iran. But the country’s capacity to deal with a health crisis remains ambiguous.



National Action Plan

Devised by the Ministry of National Health Services, Regulation & Coordination, NAP looks to define “national effort for maximum preparedness” to “potential outbreaks of respiratory pathogens with pandemic potential including COVID-19” and develop the plan as a blueprint for pandemic preparedness under the Global Health Security Agenda.

“The overall aim to provide policy framework for federal, provincial and regional stakeholders to build capacity to prevent, detect and respond to any events due to COVID-19 or other novel pathogens with pandemic potential in Pakistan,” reads a copy of the plan available with The Express Tribune.

PHOTO: AFP

Through this plan, the authorities seek to advocate “prioritising financial and other resources for community and country emergency preparedness, and mobilising increased domestic and international investment in this area”.

“Provincial/Area Departments of Health can use this plan to prioritise and implement important emergency preparedness actions while strengthening inter-sectoral collaboration with other government sectors, private sector and civil society,” reads the document.

In the short-term, the plan aims to identify and activate “available financial and other resources to ensure maximum preparedness”. It also seeks to strengthen “organisational, structural and coordination mechanisms to ensure maximum level of preparedness over time and to effectively respond to all hazards including Covid-19 emergency”.

In the long-term, it would contribute in “development of robust national health security agenda for all hazards and pandemic preparedness framework for Pakistan” and develop capacity including “reorganisation of health security establishment at national and provincial/ regional levels”.



Emergency fund

The health ministry has sought an emergency fund from the government to ensure the implementation of the action plan – with the federation allocating a rs85 million. It has urged the provincial governments to do the same and the ministry of finance to ensure backup support.

The plan emphasizes the country’s capacity to contain an outbreak and suggests assessment of organisational capacity including healthcare, public health and diagnostic facilities; trained human resource; management of cases and follow up of contacts when feasible; IPC in healthcare settings; implementation of health measures for travelers; awareness raising in the population though risk communication and community engagement; and financial sources/mobilisation.

“The current capacity of the country for responding to the outbreak need augmentation including surveillance system in general and at PoEs.”

Keeping in view that the case management and IPC at healthcare facilities are among the challenges, the ministry has recommended evaluation of existing health and organizational infrastructure and resources at hand.

Steps taken under the plan

The document lists out response plan on national and provincial level.

It seeks to strengthen coordination mechanism at national and provincial level. For which an Emergency Core Group has been established at the Ministry of NHSR&C under PM’s aide Dr Zafar Mirza with “members from area of expertise as leads”.

The ministry has also established an Incident Command and Control/Incident Management System as National Emergency Cell and the system is being replicated provincial level including Azad Jammu and Kashmir and Gilgit-Baltistan. It has also issued an advisory to relevant stockholders for taking necessary steps/preparedness measures.

Representational image. PHOTO: Reuters

As the epicentre of the COVID-19 is China at the moment, the government has initiated screening at three main airports - namely Islamabad, Lahore and Karachi where direct flights between Pakistan and China are operating.

“The health declaration form in the context of Covid-19 of the passengers has been prepared and dispersed to all the relevant airlines. This information is mandatory for all the passengers entering Pakistan especially those travelling back directly or indirectly from China.”

“The Khunjrab Pass at KKH and Gwadar Seaport are also the PoEs for trade and travel between the two countries. The Khujrab pass is closed till April 2020.”The ministry has also stressed surveillance system at the three seaports: Karachi, Port Qasim and Gwadar.

“Surveillance system needs to be in place to detect any case if symptoms develop after arriving at the place of work,” it reasoned. “Furthermore, surveillance system will be strengthened for contact tracing and monitoring. Sentinel surveillance will be also initiated at major hospital.”

Elaborating on establishment of sentinel surveillance, the document noted that a mandatory incorporating event-based surveillance, indicator-based surveillance and sentinel surveillance to engage all the stakeholders can provide health related information.



Recommendations

In its suggestions, the ministry has recommended strengthening disease outbreak information management system, hospital information management system as basis for early detection of outbreaks, and surveillance & Response Units (PDSRU) at district level and collaborated with Emergency Operations Centers (EOC) at provincial level.

It has highlighted availability of statistics and data and the capacity to monitor and analyse it. “The reports on epidemiological investigation and analysis must be submitted to the health administrative departments and simultaneously to the National Institute of Health,” it asserts.

“Hospitals and laboratories in the major cities have been designated to collect the samples from suspected cases on biosafety and biosecurity standards. The preparation includes availability of relevant supplies, PPEs and lab reagents for safe collection, storage, packing and transportation of samples from the designated hospitals to the National Reference Lab/ designated labs will be ensured.”

While the NIH will remain the point referral centre for the country, the Shaukat Khanum and BSL labs in Punjab, Agha Khan University Hospital lab are also being assessed.

“Hospitals have been designated for admission and management of cases based upon availability of isolation wards at Federal, provincial and regional levels. Emergency Response Teams have been identified, trained and equipped with ambulances to transport suspected cases to hospitals Ambulance services by relevant hospitals, 1122 and PRCS should be ensured,” reads the document.

The ministry has direct medical facilities to “conduct initial availability assessment of supplies (equipment, personal protective equipment, laboratory diagnostics) potential need and including identification of sources to secure provision and availability of PPEs and other equipment at PoEs and key designated hospitals.”

Egypt confirms first coronavirus case in Africa. PHOTO: AFP

The plan states that Infection Prevention & Control (IPC) measures will be strictly implemented at all the healthcare facilities. “Notify and train IPC team at the designated hospitals and PoEs or at least trained IPC focal person nominated to ensure the IPC measures implanted. Focal person in the other healthcare facilities will be identified and trained. The recently draft National IPC guidelines will be implemented.”

“Infectious waste generated from such sources including labs should be disposed of appropriately.”

The ministry has also prepared guidelines burial of patient dying with COVID-19 infection.



Public service message

On the awareness front, the health ministry has urged the ministry of information and broadcasting to take lead. “The relevant healthcare workers, media and other staff need to be trained on risk communication, social mobilisation and community engagement,” reads the document.

It has suggested public service messages on the virus, its transmission and preventative measures alongside “direct text messaging to travellers coming back from China about disease symptoms and appropriate action”.