Red zone files: Known unknowns

Updated 14 May 2020

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The hunt for a sustainable strategy is on. Meanwhile there’s always hope.

But former prime minister Shahid Khaqan Abbasi is having none of it. He wants a plan. Not a plan to have a plan but to actually have a plan. So when Mr Abbasi stood on the floor of the National Assembly on Wednesday, he challenged the government to produce a one-page document for the parliament that spelt out the strategy for combating Covid-19. “They don’t have a strategy,” he stated again and again while tearing into the government’s inept handling of the crisis.

He will say all this. But of course. The government will reply with the usual deluge of clichés. As it did. Politicking aside, the basic question does indeed waft in the air like a bad odour: what is the PTI government’s strategy on Covid-19?

The problem is there is no short answer. There is however a long one. And if this were to become the one-page strategy document that Shahid Abbasi has asked for, it may look like this:

“Our policy is to defeat Covid-19. To do this, we do not think lockdown is a good strategy. It is only partially good. So we do not want a lockdown. Except when we need a lockdown. Not before that. Not after that. We are more afraid of people dying from hunger than lockdown. Therefore our strategy is to feed the poor so they do not die of hunger. But we are not rich like the USA. So we cannot feed the poor. So we will lift the lockdown so people themselves can decide if they want to suffer from Covid-19 or from hunger. Our policy is to trust our people’s judgement. Our strategy is also our hope that there is something that is keeping our death rate low and therefore it makes it easier for us to base our strategy on hope. But we have also prepared our health facilities if hope runs out. But at some point facilities will also run out. Our hope is that point will not come. That is also our strategy.”

When you ask policymakers in the Red Zone what all this means in simple words, they put forward an interesting argument which goes something like this:

Our strategy is to see how the situation develops. Since it is an evolving situation and no one has answers, the best we can do is experiment with various strategies, change direction if they don’t work, and then monitor the impact of our policies. It’s a flowing process that requires us to make decisions day by day. We will lift lockdowns when we feel things are in control so people can generate economic activity, and we will clamp the lockdown back if we see the situation spiralling out of control. Simple.

Let’s make it even simpler. The government’s strategy is essentially made up of the following components:

(a) Prime Minister Imran Khan’s dislike for the concept of lockdown and his opinion that the disadvantages of a lockdown far outweigh the advantages;

(b) The government’s assessment that health facilities can cope with the pressure of patients at the given rate for many weeks ahead;

(c) The official conclusion that something is keeping our death rate low and that something will continue to keep it low;

(d) Therefore based on points (a), (b) and (c), we can ease lockdown and monitor the impact closely;

(e) If infections and deaths spike and pressure begins to build on hospitals (which will be clear by mid-June), then we will return to a lockdown. If not, then we continue opening up gradually.

Here’s what the government is banking on but will not say publically: that infections may continue to rise but without a proportional rise in hospitalisation. There is logic buried in this policy that is based on a foundation of hope. The logic is that if the rate of hospitalisation remains lower than the rate of spread of infections that means a greater proportion of the population is successfully fighting off the virus without adding extra pressure on the health facility. The rate of hospitalisation is also linked to the rate of patients requiring intensive care, which in turn is linked to those needing ventilators, which in turn is linked to those who die from Covid-19.

More on hope then. The known is that far less Pakistanis have died so far from the virus than were feared. The unknown is the actual scale of the population already infected. The known unknown is whether easing of the lockdown will spur the infection rate to an extent that the increased numbers of people requiring hospitalisation will overwhelm the system. Pakistan doesn’t need to rack up infection numbers on the scale of the United States or Italy for this stage to be reached. When will this stage be reached? That is the critical assessment that the government needs to make with the help of some credible data crunching.

The politics of Covid-19 is making it difficult to have a reasoned debate on this specific point. Cabinet members say there is almost no debate on the Covid-19 strategy in cabinet meetings. Therefore there is no counterargument to the stated approach. No minister wants to argue anything contrary to what the prime minister believes. Opposing the lockdown and crafting arguments and evidence to fuel this narrative is now a political compulsion of the PTI that can overwhelm dispassionate analysis of the situation.

Has this happened yet? Ministers deny. But the policy of ‘informed hope’ tells us much remains unknown about the knowns that are strutting around our infected landscape dressed as policy and pretending to be strategy.

Published in Dawn, May 14th, 2020