Pakistan’s early victories against coronavirus

Author Name: Dr. Usman Chohan      03 Sep 2020     COVID-19

As with all countries, the coronavirus pandemic has been a foremost concern for governments and societies seeking to strike a balance between preserving both lives and livelihoods. Although many countries continue to suffer exacting tolls, there have been some surprising winners in the battle against Covid-19, and Pakistan is one of those countries that scored early victories that have surprised a great many observers.

Indeed, at the beginning of the pandemic, the foreboding of Pakistan’s predicament was very grim. Public health resources were meagre, the economy was facing paralysis, and national-level disease control measures were limited. Some early estimates worried that Pakistan would be especially vulnerable and that, without very strict lockdowns, by August 10 Pakistan would suffer 79,000 deaths.

Worse still, if adequate measures weren’t taken, it was predicted that the toll thereafter would spiral to a colossal 2.3 million, harrowing by any account. Yet by mid-August, the actual death toll in Pakistan was less than 7,000 deaths, not even one-tenth of what was predicted in a worst-case scenario. This remarkable outcome stood in particularly stark contrast to other large countries such as the United States, India, and Brazil, whose deluge of cases continues unabated.

Both Pakistanis living within the country and overseas appear perplexed at this comparative success, and many ask why the contagion remained mercifully meek. Many of course attribute this to the grace of the Lord, and rightly so, but there are both structural and policy factors that together offer considerable explanatory power regarding Pakistan’s early victories against Covid-19.

The foremost factor that stood in Pakistan’s favour was its demographics. Although young people are not immune to the respiratory illness, their death rate is miniscule (<1 percent) compared to that of elderly patients (double-digit fatality rates). Any country with a comparatively young age structure could thus bear the brunt of contagion more readily. Certainly, with 70 percent of Pakistan’s population below the age of 29, the demographic pyramid was an intrinsic blessing.

The second major factor favouring Pakistan was the low co-morbidity of factors such as obesity. Preliminary studies have indicated that obesity (and its concomitant side-effects) significantly worsen outcomes for coronavirus patients. Fortunately, Pakistan ranks 148/191 countries with an obesity rate of just 8.6 percent, and China ranks even lower at 6.2 percent. By contrast, Brazil has an obesity rate of 22 percent and the United States has a whopping 36 percent obesity rate. This is not referring to overweight people but to the obese, a category still beyond, and more than one-third of Americans falling into this danger zone bodes very ill for their immune response.

A third factor speaks to the “non-specific immunity” that might have been generated due to existing vaccination programmes in Pakistan, specifically the BCG vaccine that has been actively immunising the population since 1965. BCG offers non-specific immunity to several horrible diseases such as leprosy and tuberculosis, and there is a compelling hypothesis (which still requires further scientific trials) that BCG vaccination in Pakistan might have provided an ancillary and non-specific protection to many Pakistanis.

A fourth factor worth noting is in the urban design, a point that is quite subtle but important. Pakistan’s generally ad-hoc urbanisation is characterised by low-rise buildings as opposed to tall high-rises. This means that there are fewer points of concentration in residential zones, such as elevators or stairwells, where people would be forced to transit. Although low-rise urban sprawl may bring many drawbacks with it, from a contagion perspective it lowers the risk of concentrated hot-zones for large groups.

A fifth factor is cultural in nature and is attributable to the conservatism and traditionalism of the public sphere. In Pakistan, traditional gender roles are more prominently enforced, leading women to occupy a wider presence in the private sphere and men in the contrasting public sphere. In other countries, both men and women roam about in more equal proportions in the public sphere, making both genders a likelier vector for Covid-19. Yet in Pakistan, women were in a semi-state of de-facto quarantine through their ascription to domesticity, lowering the transmission rates considerably.

It may be gleaned from this that there were many structural factors and norms that were advantageous to Pakistan from the get-go, something that wasn’t factored into the dismal forebodings in early 2020. However, this alone wouldn’t have been enough, as can be seen in the disastrous mismanagement of the pandemic by countries such as India and Brazil that share many of these structural traits with Pakistan.

The Government of Pakistan, unlike that of the United States or Brazil, took the pandemic very seriously from the beginning. There was enormous political will behind preserving both people’s lives and their livelihoods. Hence, a thorough national coordination mechanism was created that involved the resources of the centre and the provinces, along with both civil and military expertise and manpower. Policies such as makhsoos-bandishein (smart lockdowns) and widespread public messaging further curtailed the virus’ onslaught, and reflected the sobriety with which the government mobilised, despite its resource constraints.

Furthermore, the spatial confinement of people was such that they were largely grounded wherever they were at the time of lockdowns, and so rural transmission was not to become a major concern. Rural areas in Pakistan have deficient healthcare provision, and so a massive outbreak in rural areas would have borne a catastrophic outcome. Yet consistent testing has shown that rural cases have remained very low in the country. This is a marked difference with the mismanagement in India, where tens of millions of people were virtually heaved out of cities, including many carriers of the virus, to eke out a survival in the hinterlands. The path they collectively trudged offered a much wider dissemination of the virus beyond the urban areas through heavy community transmission.

In addition, and perhaps above all, there was a strong civil society response to the pandemic in Pakistan. Many charities and individuals set to work assisting the poor and the needy, wherever the state’s resources fell short. This helped reduce the trade-off between lives and livelihoods to a considerable degree. Although much fake news circulated around the country, there were enough sane minds that understood the importance of government guidelines and took to assisting others without exposing themselves to viral transmission. Finally, as with many other countries, the doctors and nurses in Pakistan tirelessly worked day and night to save lives in a monumental and selfless effort.

In sum, when both the structural and policy factors are taken into context, it becomes evident that Pakistan’s early victories against coronavirus were particularly noteworthy when juxtaposed with other large countries that continue to suffer at the hands of an invisible enemy. Surely there was the Lord’s mercy, but a careful analysis of the advantageous factors, both in prudent policy and the general social architecture, is also necessary.

That said, it is too early for us, or any other country, to celebrate as of yet. Several countries that thought they had eradicated the outbreak have seen it return with renewed vigour. It is important to remember that the battle against coronavirus is an ongoing one, and continued vigilance is required for the longer-term assurance of reprieve.

 

- Dr Usman is Director at Centre for Aerospace & Security Studies (CASS). This article was first published in The Nation newspaper. He can be reached at cass.thinkers@gmail.com.