“You cannot fight a fire while blindfolded,” World Health Organisation chief Tedros Adhanom Ghebreyesus said last month. “Test, test, test. Test every suspected case.”
In Pakistan, the number of coronavirus patients is rising rapidly. For a long time, Sindh had the highest number of cases and Chief Minister Murad Ali Shah repeatedly said that the province has more positive cases than any other because it is conducting more tests.
However, in the past week, Punjab surged past Sindh, not only in the number of positive cases but also in the total number of tests conducted.
Keeping Chief Minister Shah's premise in view, Punjab's higher number of positive cases can be attributed to the fact that they have conducted nearly 15,000 Covid-19 tests while Sindh, even with the second-highest number of cases, has conducted nearly 7,000 tests.
Khyber Pakhtunkhwa and Balochistan's testing figures are lower than both Sindh and Punjab.
The infographic above shows the number of confirmed cases in each province and region, and the tests carried out there until March 31.
The data for this information has been obtained from the National Institute of Health (NIH) for Islamabad and situation reports released by the respective provincial health departments.
There may be discrepancies between the data shared by provincial authorities and that available with the NIH, largely because the latter only accounts for data from the reference laboratories. In the case of Punjab, for example, the NIH only reports data from the provincial reference lab, while there are four other laboratories conducting the tests, according to the provincial health department.
While provincial officials, when contacted, generally complained about lack of testing kits and labs, federal Planning Minister Asad Umar had told a press conference on Tuesday that the number of labs that could carry out tests for coronavirus had increased from 13 to 30 and would increase to 32 in the coming days. He added that the current testing capacity was 280,000 which was expected to increase to 900,000 by April 15.
Meanwhile, Special Assistant to the Prime Minister on Health Dr Zafar Mirza had announced that the government would acquire a synthesiser in a few weeks which would enable the country to start producing testing kits on its own.
Here, we look at the status of testing across the four provinces, Islamabad, Azad Jammu and Kashmir, and Gilgit-Baltistan.
The province of Punjab receives between 500 and 1,000 testing kits on a daily basis from the NIH, according to Primary and Secondary Healthcare Department Secretary retired Capt Mohammad Usman.
Tests are mainly carried out at the Provincial Public Health Reference Lab, Shaukat Khanam Memorial Cancer Hospital (SKMCH) and Chughtai Lab. Tests are carried out for free at the provincial lab and SKMCH, which are provided kits by the NIH, while residents can pay to get tested at Chughtai Lab.
The testing capacity of the Primary and Secondary Healthcare Department itself is around 350-400, Usman said.
He told Dawn that the department aims to establish eight additional labs across the province by mid-April, which will increase its testing capacity to more than 3,000 per day.
Sindh, meanwhile, has the capacity to conduct 1,000 tests per day but around 350 tests are currently being carried out daily, said Atif Vighio, spokesperson for the provincial health department.
"We face no hurdles in terms of testing materials and labs; the only problem arises when people try to hide or run away rather than get tested, like in the past couple of days we have had to locate some Tableeghi Jamaat members who had gone into hiding when they found out testing was being done on all Jamaat members," he told Dawn.com.
Khyber Pakhtunkhwa, with 253 confirmed cases, has so far carried out 1,711 tests — the least among the four provinces.
Provincial health minister Taimur Saleem Jhagra said KP's current capacity is 250 tests per day. It was 200 tests per day yesterday and will rise to up to 400 tests per day by Thursday, he added.
"We are constantly working to increase the capacity. The procurement rules were suspended to speed up procurement, including that of testing kits and equipment," he said.
Jhagra revealed that the provincial government will now invite bids for testing from the private sector, saying four institutions with a combined capacity of 350 tests/day have already shown interest.
"We expect to achieve 1,000 tests/day capacity by next week after increasing our own capacity and including private sector labs."
Commenting on the hurdles in mass testing, the minister said the Provincial Public Health Reference Lab, the only lab in the province for testing, is "a very new lab" that came online recently. "They had a lack of kits and machinery initially but now they have been provided with both which has led to an increase in the capacity," he said.
Additionally, he noted that Pakistan does not produce testing kits indigenously. "There is a high demand for testing kits in the world and there is a shortage of supply. We are working aggressively on procurement of kits, but it is taking time due to global shortage," he said.
Asked about the relatively low number of tests conducted in Balochistan, provincial government spokesperson Liaquat Shahwani told Dawn.com: "We don't have enough kits."
Balochistan carried out 1,934 tests and had 158 confirmed cases by Tuesday.
Shahwani said the province has asked the National Disaster Management Authority (NDMA) for 50,000 testing kits.
The Balochistan government also plans to establish 11 labs in the province "but they won't be effective unless there are enough testing kits", he added.
NIH Executive Director Maj Gen Dr Aamer Ikram said they have "enough kits" for testing in the capital and their quantity will further increase in the next few days.
He said 21 labs across the country are currently carrying out Covid-19 tests. Each lab is equipped with at least one machine that can perform 200 tests per day, Dr Ikram added.
A total of 1,703 tests have been carried out in Islamabad, where 54 cases have been confirmed.
Asked whether there was a need for more aggressive testing, Dr Ikram said they have been following the standard operating procedures in this regard — people with symptoms or foreign travel history are being tested first and "no one who came from public sector hospitals has been refused testing".
Gilgit-Baltistan, on the other hand, has a capacity to carry out 20-25 tests each day but the number of samples collected from suspected Covid-19 patients is a lot higher, according to GB health department focal person Dr Shah Zaman.
He said the region's government has started work to purchase lab machinery that will take GB's testing capacity to 35-40.
Testing kits and other equipment are being provided by the GB government, however, "we also have the cooperation of the NIH", Zaman said.
He added that although the citizens are fully cooperating with authorities, the setting up of additional laboratories will help provide timely treatment to Covid-19 patients through increased testing.
AJK Health Minister Dr Najeeb Naqi told Dawn.com that as of Tuesday evening, hospitals in the region had collected 239 samples, most of which were sent to the NIH in Islamabad for screening.
Of those 239, reports of 175 samples, including nine positive cases, had been received, he said.
According to Naqi, screening of samples had also begun at the Virology Lab of Abbas Institute of Medical Sciences (AIMS) Muzaffarabad since late last week.
“The lab in AIMS has the capacity to conduct 40-50 tests in a day but it has been conducting 8-10 tests daily because few symptomatic cases are being received.
“However, now we will screen even the asymptomatic persons, mainly those who have remained in contact with the positive cases or have returned from outside [of AJK] for which lists are being prepared on a fast track basis,” he said.
The minister revealed that two more testing labs in the towns of Mirpur and Rawalakot will become operational “in a day or two” while a third lab in Kotli will also be established within one week.
“After the commissioning of two more labs, we will be conducting over 100 tests per day,” he said.
Note: All data is based on numbers up until March 31.