On March 21, the government of Pakistan announced the suspension of all international flights to Pakistan until April 4, to contain the novel coronavirus outbreak in the country. These restrictions have been met with disdain from overseas Pakistanis across the globe who feel abandoned and stranded.
In the context of repatriation schemes open to citizens of other countries, complex and expensive bureaucratic processes for Pakistanis, including a nebulous document called a coronavirus certificate, seem unfair. And while the government has said travel restrictions are temporary as it expands the country's quarantine capacity specifically for overseas citizens’ arrival, that may not be sufficient to absorb the steadily rising numbers of Covid-19 patients already present in Pakistan.
One doesn't need mathematics to answer the question that each country is posed with today: is there enough intensive care capacity to match the rate of infection from Covid-19? Intensive care capacity includes sufficient beds, ventilators, hospital personnel with adequate personal protective equipment, testing kits and medication to treat all patients who need it.
The last available information on ICU bed capacity in Pakistan is World Bank data that suggests that there were around 0.6 ICU beds per 100,000 people in the country in 2014, with most located in urban centres such as Karachi, Lahore, Islamabad, and Quetta. This means that the rural population, which makes up two thirds of the public, will be travelling to these urban centres to access intensive care for Covid-19. In these circumstances, does it make sense for Pakistanis to travel from, for example the UK where there is more intensive care capacity, back to Pakistan?
The Pakistani government, like others across the globe, is responding to this pandemic by working on its healthcare capacity on an emergency basis. The situation begs the question whether importing expats into precious quarantine spaces be helpful or will it negate the efforts made to beef up Pakistan's healthcare capacity. Given what we've seen, there will be no shortage of local Covid-19 cases in the country in the days to come.
Although the emerging statistics are preliminary and a fuller picture will only be visible later, we have the opportunity to learn from contexts further along the pandemic trajectory. Prime Minister Imran Khan contends that we are not in the same position as Italy. This is true, our population is larger, our ICU capacity lower, our economy poorer, and our healthcare system not entirely free or accessible. Simply put, Pakistan’s healthcare system, like that of many countries in the global south, is donor dependent, ill-equipped, and unable to handle the double burden of an infectious pandemic on top of pre-existing burdens of chronic illnesses like cancer, diabetes, renal diseases, polio, and other infectious diseases like tuberculosis and HIV. This is combined with evidence that in Pakistan there are significant numbers of cases within a younger age bracket who are additionally more likely to cause the spread of the virus through their generally increased mobility. Additionally, in a context where families struggle to contain children in overcrowded houses and religious gatherings continue, the fact is that if we are not proactive, we will be a lot worse than Italy a lot faster.
About two weeks ago, I was also relaxed compared to friends in Italy, their news about hundreds of deaths each day, while upsetting, seemed like their experience and distant from my own. Since then, the number of cases of Covid-19 and deaths in the United Kingdom has shot up, and I now have a personal list of friends and acquaintances who have been infected here, in Italy, Spain, and the United States. For overseas Pakistanis in any of these countries, maybe this is one reason why you want to leave and go home, so you can be with your families and away from the epicentres of the pandemic.
I want to urge my fellow overseas Pakistanis, particularly the thousands of students who have the ability to think critically about future possibilities, to look at the data and think about what this pandemic could and might look like in Pakistan.
There is a reason why Pakistan did not repatriate students from Wuhan at the beginning of the outbreak there. There is no point in running away from the epicentre of the virus. As live hosts of the virus, when we move, the epicentre of the pandemic moves too.
In theory, Pakistani citizens with sufficient funds can return home if they test negative for Covid-19, if they obtain a certificate issued within 24 hours of travel confirming a negative test result. The NHS in the UK does not test healthy bodies, but news outlets have quoted a GP as saying that some private practices offer the service at prices around £375.
Ultimately, the question is, should individuals be taking these measures to reunite with their families at the expense of public health and fellow citizens’ access to healthcare. I think this certificate serves as a barrier that gives us an opportunity to stop and think literally about the cost, material and other, of this journey.
We all want to reunite with our families but this is not an extended holiday. It's a pandemic. This means we have a role in the global coordinated response to contain it, by staying put. Some say: let us enter Pakistan, test us there and put us in quarantine if they can. My question is: do you want to be part of the problem or would you rather be part of the solution? We have history intersecting with our lives. Which side of history do you want to see yourself standing on?
These tests are in limited supply, so limited that the general population in the UK is not yet being tested. Tests have only just been rolled out to frontline health workers. I recommend that if you have the means to travel home, use those means to support yourself abroad and stay where you are. It is better to leave limited tests for healthcare professionals whose diagnosis has a direct impact on the well-being of their patients. Secondly, your negative test results might not be a confirmation you are virus free. They may just mean it’s too early and you might test positive a few days later, or you may be asymptomatic and unknowingly spread the virus. We still don’t know enough about Covid-19. We don’t know if it can withstand warm temperatures or not. The only sensible course of action is that which scientists have recommended across the world, work from home, wash your hands, and practice social distancing. While the rate of spread is still unclear, a rough estimate tells us that if the nearly 40,000-strong Pakistani student body in the UK were to take flights back to Pakistan, they would run the risk of infecting around two people each on average along the way, and once in the country, would then go on to do the same. Double that number on a loop and think about the impact that could have.
Restricting flights may appear to be an act of abandonment. As Pakistanis, our instincts are to stick together and it is natural to want to be with our loved ones in times of uncertainty.
However, we need to remember that by staying where we are we are playing a part in not burdening healthcare systems and are allowing the most vulnerable to access treatment. If we are based overseas, we are more likely to have access to health systems with greater capacity and systems that are more equitable than the ones back home. This means that we will get treatment if needed. By staying where we are, we are flattening the curve. On the other hand, by moving, at best we are taking up quarantine beds and medical attention, thus robbing fellow citizens of their right to adequate and timely treatment. And at worst we are risk of contracting and spreading the infection to an already vulnerable population.
My request to the Pakistani government is to take a tough decision and restrict travel further, which can of course be reviewed in a few weeks. There may be practical problems facing Pakistanis overseas who unexpectedly need to remain abroad for longer than planned. Our government can liaise with foreign governments to address these. Some measures have already been taken. For example, the UK has launched a scheme to extend visas that were expiring between January and May. To mitigate Pakistanis running out of monetary resources, I urge the government to consider a monetary relief scheme to be administered through the missions abroad.
To fellow overseas Pakistanis, I request you to stay where you are. We have all seen images of crowded hospital corridors across the globe, and testimonials from frontline health workers attending to the ill until they reach their physical limits, not to mention images of truckloads of coffins being carried from homes to warehouses to crematoria in Italy. Those dying of Covid-19 die alone, and at best in the company of doctors. I think we can bear our solitude away from our families in the meanwhile. You may feel isolated, but at least you are healthy, and the alternative can cost lives. Meanwhile, if you look around, you will see that you are not alone in this, because the other thing about a pandemic is that we are all going through it at the same time.