In Pakistan, lockdown eases — fear doesn’t

Updated 09 May 2020

Email

“We can only project trends two weeks ahead with reasonable confidence. Beyond that is conjecture.” — AFP/File
“We can only project trends two weeks ahead with reasonable confidence. Beyond that is conjecture.” — AFP/File

ISLAMABAD: As the coronavirus-related lockdown eases in the country from Saturday (today), the federal government feels cautiously confident its data-driven decision will succeed in striking a delicate balance between lives and livelihood.

What are the grounds for this measured assurance?

Detailed conversations with key stakeholders and officials reveal a picture that is patterned on an interplay of data and policy and their cross-pollination that generates interpretation. This design forms the basis of conclusions drawn by experts and government officials which in turn have directly fed into the final decision by Prime Minister Imran Khan.

Officials are quick to admit however that the decision to ease the lockdown from today carries an element of risk. “We can only project trends two weeks ahead with reasonable confidence,” says a key expert involved in decision-making at the federal level. “Beyond that is conjecture.”

Governments do not make policy on conjecture. The decision to open up the country gradually while the infection rate continues to spike daily has generated a debate that is laced with unease and fears for the worst. This debate centres on a key question: Is data driving policy, or policy driving data?

Enter the NCOC.

At the National Command and Operations Centre (NCOC), ministers, doctors and generals pored over data every single day as it poured in from all corners of the country. The quantity and quality of this data improved with each passing week and enabled the men and women in the NCOC to extrapolate trends and projections with a greater degree of clarity. This clarity was peppered with a dose of reality: the federal and provincial governments were testing far less than was required. “We recognised this was our weakness,” says Dr Faisal Sultan, Prime Minister’s Focal Person on Covid-19.

Since the prime minister tasked him away from his day job as the CEO of Shaukat Khanum Memorial Hospital and brought him to Islamabad to coordinate the effort against Covid-19, Dr Faisal — who looks younger than his 57 — has been the key policy driver in collating, processing and analysing data. Dr Faisal has been a vocal and engaged presence at the NCOC meetings and in many respects the resident expert who breaks down dense data for the non-medical politicians and military officers gathered around the long and shiny table inside the operations centre.

Today he defends the easing of the lockdown with arguments that are less political and more medical. He says if Covid-19 were an iceberg whose tip is visible, we have not as yet detected the lower portion. This means the largest body of infections may still be out there without us knowing and therefore skewing the assessment of the real picture. However, he argues, we have a better handle on the middle and upper portions.

But here’s the important thing in his view: the death data is fairly accurate.

This has enabled the government to trace a trajectory of the death numbers over the last eight weeks and come to a conclusion. The slope of the trajectory is not sharp but gradual.

All this is of course relative. Compared to the sharp spikes in deaths in Europe and the United States, Pakistan’s graph shows a ‘slow burn’. This relativity also applies to earlier projections. According to an official who helped in conceptualizing NCOC and is a key participant, Pakistan was projected by May 15 to have 175,000 infected people with 10,000 of them in critical condition and nearly 3,500 deaths. Today we are far less than these numbers.

Now officials needed to calculate a critical point: given the data of the last eight weeks and the projections based on them, how soon would Pakistan’s health facilities come under severe stress. For this, all provincial governments were needed to report the state of their facilities and equipment with the minutest of details.

Outside of the NCOC, a raging fight had broken out between the federal and Sindh governments (which refuses to subside till today). But a senior member of the Sindh government says they provided all the data about health facilities and equipment as requested by the NCOC. The data was collated and plotted against graphs that showed infection rates and the percentage of projected critical cases requiring intensive care. The results were surprising.

But before the results could be interpreted credibly, there was the questions of the interpreters. Senior federal officials now say they can boast of a strong team of medical experts who squeezed meaning out of numbers. In Islamabad, Dr Sultan was the pointman for all medical advice. From the government of Khyber Pakhtunkhwa, Dr Amjad Mehmood, an infectious diseases specialist joined the consultations. He has been working closely with KP Health and Finance Minister Taimur Saleem Jhagra who is leading the province’s efforts against Covid-19.

From Sindh, Dr Faisal Mehmood, a specialist in infectious diseases from Aga Khan University, added his expertise. He has been closely advising Sindh chief minister Murad Ali Shah on his government’s policies and actions on the virus. From Balochistan, Dr Rubab Buledi, parliamentary secretary for health, became an active and articulate participant while from Punjab Health Minister Dr Yasmeen Rashid added her bit. In addition, two data science people – Syed Tajammal Hussain and Tayyab Tariq – were brought in as consultants to plot data projections according to international best practices.

It was these specialists who looked at the results of the data of health facilities plotted against projections and found something rather unexpected.

The health facilities – hospitals, wards, beds, masks, ventilators etc – still had excess capacity to cater to the pressure. The number of patients were increasing gradually but nowhere was there any run on hospitals reported that would indicate that the health infrastructure was near being overwhelmed. Could the numbers be lying?

To buttress the numbers, data of the available health facilities sent by the provincial governments was then complimented and re-verified by reports from the ground. According to a senior official, NCOC harnessed the wide network of the National Rural Support Programme (NRSP) to get situation reports from the ground in terms of infections and deaths reported at district and local hospitals. A further re-verification was done from two sources usually considered reliable in Pakistan: Intelligence and ‘boots on the ground’ military presence in all corners of the country.

The state intelligence set up has been especially galvanised in the fight against Covid-19. It is also playing a leading role in the Tracing, Testing, Quarantine (TTQ) strategy employed by the government to aggressively do ‘smart suppression’ of the infection. The military has formed the backbone of the national Covid-19 strategy, starting of course from the conceptualisation and operationalisation of the NCOC itself. All provincial governments are actively assisted by military commanders and, as per another senior official, the Chiefs of Staffs (COS) of the relevant army corps are a key part of high-level provincial meetings.

The reports from the ground by the NRSP, intelligence and military outfits confirmed that the health facilities were holding well to the pressure and the official death rate appeared fairly accurate. “Overwhelming number of deaths cannot be hidden,” argued an official coordinating these efforts.

Despite a tense and acrimonious relationship with the federal government, a senior member of the Sindh government agrees with the assessment: “We do not have too much burden on our health facilities till today,” he says. “As of today (Friday) we have 73 people in ICUs in Sindh and 18 people on ventilators.” According to him, all governments were fearful of the situation seen in countries like Italy where hospitals were clogged and doctors were deciding who would live and who would be left to die. That situation has not happened in Pakistan. Yet.

At this stage came the big question: would it be better to keep the lockdown and further suppress the infection, or utilise the relatively controllable situation to ease up on the economic pain? This is where the medical prognosis and expert opinion blended into the politics of Covid-19 and re-ignited the fundamental question of the day:

Is data driving policy or policy driving data?

A member of the Sindh cabinet disagreed with the easing of the lockdown today. He argues the present situation is under control precisely because they locked down early and managed to suppress the spread of the infection to a great extent. When the government eases up today, he argues, there is a huge risk that within 10 to 12 days the infections will spike sharply. “Now there is no room for complacency,” he says. “We should have been strict for another two weeks at least.”

Strictness is also relative. The federal government insists the easing is partial even though the perception is that the lockdown is all but finished. The actual presentation made in the meeting of the National Coordination Committee (NCC) chaired by the prime minister on Friday (and seen by Dawn) contains some interesting information.

For instance, it states the following shall be opened: Pipe mills (PVC & steel), electrical cable and switchgear manufacturing, steel/aluminium manufacturers, ceramic manufacturers, paint factories, sanitary ware and ceramics products, paint shops, steel/aluminium retailers, electrical cable switchgear retailers, hardware stores.

Then the presentation details other sectors that shall open: shops in rural areas, neighbourhood shops located in residential localities/standalone shops (excluding malls, large market places and mega department stores).

The presentation also gives traffic data: On all motorways, cars traffic since post-corona has reduced by 55 per cent; coaster/minibus traffic has reduced by 73pc; and bus traffic has come down by 95pc. This data is of course meant to portray that the impact of the lockdown is far heavier on the financially weaker segments of the population. This gels in with the overall narrative of the prime minister favouring an easing of the lockdown.

While the health situation is verifiable through data metrics and physical reporting from the ground, the economic arguments to ease the lockdown are essentially political arguments. Officials from the Sindh government say they are acquiescing to the federal decision because Chief Minister Murad Ali Shah wants the Centre and provinces to move in one direction. However, many in the Sindh government are uneasy with the easing of the lockdown. “We had to follow suit also because the federal government’s mixed messaging had diluted the impact of our lockdown,” argues a minister.

In fact, in the NCC meeting on Friday, people noted that representatives of all provincial governments, including chief ministers, were wearing masks but hardly anyone from the federal government was wearing one.

Sindh CM Shah pointed this fact out aloud in the meeting. On hearing this, one very senior member of the provincial government belonging to the Pakistan Tehreek-i-Insaf quietly slipped off his mask too.

In the coming weeks, all kinds of masks may come off — in every sense of the word.

Published in Dawn, May 9th, 2020