Lost in transmission

By the time these lines reach you the federal budget for the fiscal year 2020-21 must have been presented. As I write the total number of Covid-19 cases in the country stands at 125,927 as per the Government of Pakistan’s official portal. Given the current rate of infections, there is little doubt in my mind that the number must have increased further as the ink dries on these pages.

The total number of deaths has reached 2,463. But that number does not frighten me. Not right now at any rate. The number that bothers me a great deal is that of total recoveries which stand at 40,247. In absolute terms, it is not as worrying. The mortality rate is still very low and the recovery rate impressive. But when the total number of recoveries in relation to the total number of infections is taken into consideration, we stand at around 31%. This tells you of two things. One that instead of flattening the curve we have achieved the exact opposite. In short, we are only inches away from an exponential explosion. Two, as the number of existing cases spikes, all hell is breaking loose at hospitals. For instance, I know of some brave young doctors in Lahore who picked up the virus while carrying out their professional responsibilities, had a hard time getting tested, were compelled to self-isolate at home where the infection spread to their entire family unit including minors.

So, at the time of writing this, my expectations for a relief package for the frontline soldiers in this fight against Covid-19 to be announced in the budget speech are a little higher than what is currently being reported. Our doctors, paramedics, and, why, even the janitorial staff working for the medical sector need massive, massive morale and financial boost. Do we have the needed fiscal space? We obviously do not. But then if we have learned anything from examples of the IMF and the US Federal Reserve during the ongoing economic crisis it is that money is what you make of it. Fiscal space can be created if you want, albeit temporarily. In the order of priorities, the next in line are the law enforcement functionaries because intermittently they are being asked to go in harm’s way and enforce lockdowns or Covid-related standing operating procedures. The way numbers are parsed we do not even have an idea how many of them have been infected.

The healthcare sector is clearly in the spotlight right now. The way our systemic vulnerabilities have been exposed merits no further elaboration. The system which has historically received only token investment has been threatening to come to a grinding halt any moment will be further overwhelmed. We know that the National Disaster Management Authority (NDMA) in collaboration with the federal and provincial governments is leaving no stone unturned to offer more solutions. But given the scope of the problem there is a need to separate the immediate from the long-term issues. The immediate problem necessitates considerable upgrade in our treatment capacity. But since our limitations are deeply entrenched and systemic, we need a comprehensive and sustainable solution to our healthcare problems too.

It is plain that the healthcare sector is driven by the profit motive. What it does in the private sector will be highlighted shortly, however, even in the public sector where the governments constantly intervene to keep prices in check the said profit motive takes the shape of corrupt practices. When an institution is not profitable and has to rely on handouts from the government, it cannot be asked to be very efficient. The bureaucratic human resource then can exploit the situation by selling hospital beds and other amenities to the highest bidder. In the private sector the push and pull factors decide the cost of services provided. Consequently, the private sector is being accused of offering services at exorbitant prices. The immediate temptation is to aggressively control prices and punish those who do not comply. But given that the existing public sector facilities are wholly inadequate, we do ourselves a huge long-term disservice if we go aggressively after the private sector. This will only drive the investment away from the sector and ensure that it does not grow any further. In the long run, what we need is more openings for private investment in the shape of a comprehensive health insurance policy. This is easier said than done. It is one thing to offer health cards to the most vulnerable in the society, wholly other to come up with a health insurance system that covers all segments of the society and is in sync with our professional and personal lives. This will need a lot of homework, consultations with the IMF, insurance companies, private healthcare providers, employers and may take some time. But the country needs this. Right now, the government is aggressively trying to provide health cover to the very poor. And the rich by virtue of being rich know how to protect themselves. The middle class, however, finds itself at a loss. I know this should not be a consideration for a government that has committed to providing relief to all but this is the key demographic that votes for the ruling Pakistan Tehreek-i-Insaf (PTI). Do not subsidise healthcare for the very rich if you think you don’t have the resources but, at the very least, offer a comprehensive health insurance solution to all citizens of the country.

The government’s chief function is to act as a regulator not a business competitor. The socialist-capitalist hybrid model that we try to put to work in the country only adds to the misery of the people. Because the government is encumbered with providing the direct relief, it is not doing a great job of a regulator. Consequently, we have witnessed one price spike followed by a scandal after another. This task of sifting through these priorities may need a lot of hard work and moral courage but without it we are going nowhere.

Let us return to the issue of Covid spread. We hear the office bearers talk about the expected peak. The problem with the idea of a peak is that it presupposes that there exists a natural occurring statistical ceiling to the spread. That once the infections reach that number the virus will stop spreading on its own. Without sterner mitigation efforts there is no guarantee that such a ceiling would even exist. Of course, the proponents of herd immunity hypothesis claim that that may happen. But even they do not see this happening before the 70-75% of the entire population getting infected. But if their hypothesis is incorrect, like the rest of the presumptions have, what do you think stands in the way of a hundred percent population getting infected? Now consider the number of people most vulnerable to the lethal effects of the virus. That number may look relatively smaller on a piece of paper but it is not in real life.

Right now, the signal appears to be lost in the noise. This signal demands broad-based national consensus and unity in the eye of the approaching storm.

Published in The Express Tribune, June 13^th, 2020.

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