Covid-19: water is already in the house!

I lived in Islamabad’s I-8 sector for years. In pursuit of squeezing more residential area, the Capital Development Authority levelled many natural waterways to set up its sectors. Until this sector was fully developed excess water was able to absorb in unbuilt areas, but not anymore. My house was on a street which was regularly flooded. I also realised that once the house’s water defences are broken nothing can be done as water will find its way in from multiple entry points. I saw this in despair when for the first time my house was flooded from multiple sides. I knew then I couldn’t do much.

The coronavirus pandemic is no different. We should try our best to strengthen our defences against its spread before it enters a geographic area. Even if it enters an area, the early phase is critical as we can limit its spread by effective public health measures including immediate testing, contact tracing and isolation. So what steps do we need to take before it enters and establishes in a geographic area? We need a good health intelligence system to identify any clusters early and limit its spread. Good data also guides in effective decision-making like precise public health interventions instead of general and harmful measures as total lockdowns. The numbers, if trusted by the community, also help make people listen to and follow government guidelines. However numbers and their inherent value are lost on those supposed to collect them.

Numbers here are considered a commodity whose value could be fixed by the wishes of decision-makers. Numbers in Pakistan especially in our health system are either poorly collected or actively manipulated. But just as commodity price can’t be fixed by just administrative processes unless demand and supply is factored in, similarly faulty numbers can’t protect a nation from death and misery of an outbreak. Where good health intelligence may not save you from an impending pandemic it could help you control it better.

We had a good interval when the number of Covid cases declined significantly. That time was wasted in self-congratulatory illusions of success. A major reason for our fewer numbers was fewer vulnerable people in our population. Though as a public health person it is a matter of shame that the average life of a Pakistani is so low, it helped the narrative that Pakistanis defeated the virus. There is no doubt that governments (federal and provincial) took some effective steps to limit its spread. But whenever someone raised the issue of not letting the guards down they were directed to hospital indicators which are three to four weeks delayed. But water will enter the house if it’s around you and coronavirus is no different.

For the past few weeks we have again started hearing about people getting infected with Covid-19. The numbers are small but steadily increasing. If we see the rest of world, Europe is going through a tsunami. Daily numbers are multiple times higher than the first wave. In the United States, the first wave has transformed into sustained waves, each behaving differently in different states but nearly all are rising. Islamabad is one city which I know does not try to hide its numbers and shares them publicly (Sindh as a province too). We are seeing numbers in Islamabad steadily increase.

Pakistan and other countries need to realise they can’t win a war without good intelligence. Daily testing numbers are not a replacement of good health intelligence. But we are trying to win this epic battle of with faulty intelligence and leaders who have never seen the battleground. Covid-19 is a public health problem and only public health strategies will help. There is still some time to correct but time is running out!