Hastening the end

There are three established ways for Covid-19 to end, and then one more.

The first is how New Zealand rid itself off the virus — locked itself down for four weeks; separated the healthy from the sick; treated the sick as it tested around for more carriers; and voila, they were done and out in six weeks. Any function within the lockdown period was strictly per parameters of safety in social conduct. Those, who did not follow this prescription or were late in instituting such protocol or did not have responsible citizenry to follow the protocol, missed the boat.

Next is a vaccine and a cure both of which might take months if not years in developing; even more importantly in being widely available to the seven billion humans on the planet to secure themselves from the virus. Pakistan is low in the global pecking order and might realise the availability of the vaccine quite late in the cycle. Which really takes us down to at least two years of waiting. If the formula is widely shared, companies in China and maybe Pakistan will begin the production. If India too gets on the act — it has a big pharmaceutical base — she might export some to us. There is though always the fear of the counterfeit which may restrict the production to only a few bona fide producers. This might translate into Pakistan having to live under a lockdown for the next 2-3 years or learn to live with Covid in a conditionally functional society and economy till a vaccine becomes available. Closing the economy and the society down for as disorderly a society as Pakistan’s is an impossible option.

And finally, one way to see the end of coronavirus is to let the virus wear itself out. This occurs around the time when sixty to seventy per cent of the population is infected and the virus is unable to find unaffected receptors, which breaks the transmission link sufficiently for the virus to cease its deadly travel. It is called herd immunity.

Pakistan is unable to wait for two or three years of a closed economy even if the society wasn’t much of a consideration. We have seen how the people have failed the attempt by state to institute safety protocols in day-to-day conduct; unless of course those were enforced in a curfew-like application. The only option left to it is to somehow squeeze the process of seeing the virus off by letting herd immunity develop. The lockdowns till date have been partial at best; even the most touted in Sindh. It helped flatten the curve but the virus still rages uninterrupted. As we open businesses and the society we are willy-nilly on the path to herd immunity. This is a default choice for a weak state and a fragile system. No use ruing it. Let math take over.

Pakistan’s 2017 Census lists the composition of population as follows: 0-14 years (of age) — 35.4 per cent; 15-64 years — 60.4 per cent; and 65 and over — 4.2 per cent. The virus has been kind to the below 15 years group for whatever reason, though there is news that a mutation may have infected a few young-ones in New York and in Europe but not on a wide scale. That takes the 35.4 per cent of possible victims out of the equation though epidemiologists caution us against being ‘cavalier’. This leaves about 65 per cent of the population as probable victims of the disease. Models are ruthless in developing and always need to be qualified especially when we base decision-making and strategy formulation around those. For the sake of our model discount also the 4-5 per cent old and frail hoping they will keep out of trouble by staying home. This segment can be unfortunate receivers of the virus from others though and become easy secondary victims in our kind of social set-ups.

It is the second segment which merits our attention and is material to developing the model of decision-making for us. The sixty per cent (15-64 yrs) equates to about 120 million potential carriers of the disease. A further refinement of the statistic in urban and rural division in our scenario helps; the chance of surviving the spread is far brighter in the villages then our congested cities. A 60-40 divide between rural-urban corresponds to around 50 million who in the cities are more susceptible. Approximations and assumptions in the model on the side of caution help ease out variations and exceptions. Not all urbanites will become victim nor will all rural(s) be immune.

Of the nearly 350,000 corona tests conducted in Pakistan till date, around 37,000 have tested positive. Of these 37,000 positive cases, 800 have died. That gives us a base infection rate of approximately ten per cent in our population. It will vary, possibly increase, as we open up the economy under any proposed rubric. The mortality rate of the tested positive cases is 2.2 per cent. Because of a low testing base for reasons of resource constraints, health professionals suggest a three times greater infection incidence than recorded. If it be so then the mortality rate further lowers itself to around 0.7 per cent. To err towards safety let us assume the mortality is in the range of around 1-1.5 per cent for our model.

Of the 50 million probable cases in a population it should test between 5-7.5 million positive if indeed such testing capacity was possible. Yet a mortality rate of 1-1.5 for the probable sick will hover at 75,000 in inverse computation. Opening up the society and the economy close to their usual functioning in a largely uninitiated, ill-informed and poorly disciplined people in matters of following instructions may unfurl such consequences. By some counts if we can somehow stop around these figures of lives lost it will be an achievement of sorts. America’s example haunts. Stats are devoid of human element but make hard decisions easier to digest. Absolute numbers make for a scary reading. This is the possible route that our stats may take.

The numbers can be reduced and the spread mitigated with absolute adherence to the protocols of safety — masks, distancing and avoiding gatherings of all kinds. But that’s monumental considering where we are placed as a society. On the other side of this, when it’s over, remedying the distortions in the society should be the priority. Without it we will always be on a wing and a prayer, not terra firma.

We will be buffeted into reviewing our decisions on the road to early ‘herding’ because of weak knees and an insufficient health infrastructure when numbers in these ranges grow on us forcing us to cascade lockdowns and partial openings in an unending stream. This will prolong our agony. When the pain becomes unbearable we will stop and as soon as it abates some, we will restart. This shall be our state for the next couple of years, at least. The only other way out is God’s grace. Many are depending on it.

The writer is not a data-scientist or remotely connected to public health except his own but does fall back on science and math to make some sense of what may be in the offing. Especially when life doesn’t offer easy options.

Published in The Express Tribune, May 17^th, 2020.

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