In the age of definitions

“Prime Minister, it is time to move on beyond definitions. We are in a war against a pandemic which continues to maul our people as we speak. Real lives are being lost, and if they are not as many as you hear from other countries it is only because we are behind in time. Soon the pandemic will be all over us. We are lucky to have the time to do something about it. So as the provinces, or those grappling with it at the forefront move along unrestrained by the frivolity of forms of lockdown or a curfew, it is for the Prime Minister and his team to be at the head of it all. Reality dictates its own terms and pace and leaders cannot be seen to be distanced in any way. Real lives matter. Debates are for another time.”

Why? Patient 31: A woman returned to Korea from China with the virus, unknown to her. After a mild car-crash four days later she was advised by the follow-up medical team to report to a fever-clinic. She opted out suggesting she was just fine. Over the next 10 days she attended the Church twice and ate out at a restaurant a few times; once with friends over dinner. When she was finally too sick she was found out and hospitalised. She is considered responsible for 60% of the total coronavirus cases in South Korea which makes a hefty 5,000 plus. That is the nature of this beast. And that is why ensuring “social distancing” to “mitigate” and “flatten the curve” is a necessity and not a choice. For those who would not heed or just not understand it will need to be enforced. Call it Lockdown Plus, if not a curfew; even a curfew will have exceptions. What matters is saving lives and not overwhelming an already fragile health delivery system.

Here is also why. Dr Michael Ryan, WHO’s top health expert, notes that it took 67 days for the number of cases to reach 100,000 since the first case was reported. The next 100,000 took 11 days; the third 100,000 only three days, while the fourth 100,000 took just another day and a half. And it isn’t done yet. Total number of cases worldwide now top over 500,000 and counting as I write. By the time it appears in print, we may be hovering shy of a million. This is with “social distancing” in place and the best medical care in the world under test. The US now tops the list of the reported cases in the world with over a thousand deaths. A study estimates around 80,000 will die in the US alone. At this ratio at least six million Americans will catch the virus. Pakistan’s 67 days complete on May 2 which is when we may expect the number of cases to reach around a 100,000. That’s only a month away.

Let’s cut ourselves some rope here. Say over the next two months only a 100,000 contract the virus — the real numbers may be far higher, around half a million, if the rate of spread continues unabated — and only 10% end up needing critical care. That makes 10,000 critical patients who will need ICU beds; 6,000 of those with ventilators. The current reported capacity may barely suffice considering that some would be taken by patients with other ailments. Now multiply by five the support needed for half a million, indeed if that is the spread. At least 40,000 coronavirus patients will not have an ICU bed and 24,000 will never get to see a ventilator, left to their fate. Italy and New York are in the midst of exactly such a stage where hundreds are dying without medical care. New York is still 21 days short of its apex. Here is another. New York and California have begun rationing medical support to selective cases only. Essentially, they are making decisions over who will die and who may not. Fear the moment if it ever befalls us. Stories abound of lonely deaths, un-mourned burials and queued cremations. That is why a lockdown, segmental quarantine and even a curfew make huge sense. “Flattening the curve” is a governmental obligation not a social choice.

On to “herd immunity”, which suggests: “let a lot of people quickly get the virus, most will recover fine, tend to the most ill, but within a period of weeks (develop) a critical mass of (immune) people who will eventually force the virus out because it won’t have enough hosts”. Thomas Friedman calls it social Darwinism — ‘the idea of the survival of the fittest’. To him it is a utilitarian approach to allow an exponential spike to separate the immune from the vulnerable who will die. IK seemed inclined towards the British model but then leaned away very quickly. Instead what we have in play here is a mix. The government thinks that the bottom 29% should be free to pursue livelihood while most others quarantine themselves. That’s untenable and toxic. The borders are semi-shut as pilgrims and religious tourists come in at regular intervals. Eighty per cent of the corona cases in Pakistan are imported. Soon they will contaminate enough to proportionally increase the locals in the mix.

There are lessons to learn though. South Korea resorted to universal testing and identified those infected early in their cycle. It kept the disease from spreading widely. China followed roughly a similar model. We may not have the means for such wide-scale testing, hence targeted testing and mapping for segmental quarantine remains our only choice. If coupled with a countrywide lockdown — exempted for essential production, services and a sustainable supply line — we may just be able to come out less scathed from this ordeal. The army with its management and logistics skills and enforcement expertise can help achieve these objectives. Not engaging them earlier was wrong. The NDMA when permitted to play its role has shown its effect and given direction to the government’s efforts which now seem coherent and better coordinated.

Pakistan did well by not calling its students back from Wuhan but then slept over what was needed to be done especially when the calamity had struck its other neighbour Iran too. It is now paying for that slackness. Pakistan did poorly to let streams of returning pilgrims enter from Iran without adequate safeties and is now paying for that sloppiness. The Centre seemed stuck in the definition groove early on and a reluctant partner even as rest of the country moved on. That made the leadership look muddled. It has now recovered from such disinterest, though the time lost already may be difficult to make. Murad Ali Shah in Sindh continues to boldly challenge the status quo across the entire spectrum of response even where the state seems to lack greater resolve. Kudos to him. There will be light at the end of the tunnel; we just got to make it there with least damage.

Published in The Express Tribune, March 29^th, 2020.

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