HYDERABAD: While Sindh’s trajectory of Covid-19 cases keeps showing an inclining trend, the desert district of Tharparkar has, luckily, come up with negligible number of coronavirus cases. Similar pattern is seen in Thar’s neighbouring district of Umerkot which according to health department’s chart also has active cases in single digit.

Mirpurkhas and Badin districts — also connected with Thar — have reported two deaths each.

Tharparkar for the past few years has been in the limelight for all the wrong reasons — deaths of malnourished newborns, prolonged drought and suicides. But at least in this pandemic that has been wreaking havoc in the world with thousands of deaths in the developed countries, Thar has reported zero Covid-19 deaths.

Scattered population in Tharparkar — stretching over 19,638sq km — seems to be a major factor to have stemmed the spread of contagion. Parts of Umerkot fall in the desert, too. Badin and Mirpurkhas districts have shared one death each. Ten positive cases are reported in Tharparkar, 26 in Mirpurkhas, eight in Umerkot and 25 in Badin. Tharparkar has two active patients, Umerkot four, Mirpurkhas seven, and Badin nine. Both patients are in home isolation in Tharparkar.

Thar’s population dynamics, including its density (1.649m as per provisional 2017 census results), distances between villages etc, “by default” offer social distancing model, something being advised by health experts. The district, now home to coal production, is yet to see larger urbanised centres that otherwise bristle with activities in cities like Karachi, Hyderabad, Sukkur, Larkana and thus higher number of cases there and mortality.

Also, the lockdown was effective there. It stopped mobility of desert’s dwellers considerably, otherwise they travel amidst cramped conditions from area to area in not-so-fit vehicles in the absence of public sector transport system. The area has seen somewhat better road network in the past few years.

“Thar’s population is scattered and it helped contain spread of the infection or kept local transmission limited to a greater degree,” said a doctor who is part of Sindh government’s Field Epidemiology & Laboratory Training Programme (FELTP) in Karachi.

One of the present two active Covid-19 patients in Thar is a house job officer of Liaquat University Hospital (LUH) and was said to have been infected in the LUH with other colleagues. His father was believed to have contracted infection from him in Mithi.

“People do object over their home isolation as they fear spread of infection,” said a local from Tharparkar. “Secondly, Tharparkar or Umerkot has lesser number of buildings, paraphernalia, larger bazaars, markets, shops and other facilities. All these areas have things like furniture, surfaces etc, which serve as potential spots to keep virus alive,” he said.

Surveillance-based targeted sampling?

The surveillance-based testing eludes Sindh. A larger part of Thar’s population works in irrigated areas as farm workers. One should not lose sight of fact that many — mostly residents of Chhachhro and Dahlai talukas — work in factories and homes of Karachi, the single largest hotspot of virus with over 12,000 cases in Sindh. One claim is that major chunk of this labour had returned home from Karachi after the March 23 lockdown and some have left for Karachi after easing of restrictions. Many work or visit Hyderabad which is too showing upward trend of Covid-19 cases since March.

“Required testing is not ideal in Sindh for multiple reasons. Tharis have to return to their homes from big centres on Eid holidays. We don’t rule out possibility outright that those returning from Karachi or Hyderabad won’t end up as potential carrier [of virus] for their families and areas,” cautioned one official.

Testing on road did not meet definition of ‘random sampling’ and it needed to be understood well, said the FELTP official. “It has to be based on surveillance model. We need to ramp up surveillance-based random sampling in areas with low burden of disease to find actual positivity rate of the infection,” he remarked.

Random or targeted sampling is key to detecting the infection in local population of a district. “It is not ideally done and it needs to be based on surveillance,” says an officer associated with pandemic emergency operations in Sindh.

“Given the present crisis desired attention is not given to targeted sampling. Be it Tharparkar or any other area, all those travelling from and to hotspots of contagion like Karachi, Hyderabad Sukkur, Larkana, Ghotki and Khairpur need to be identified as they can be potential carriers,” he said.

With 17,000-plus cases until May 18, Sindh’s positivity rate (prevalence of the infection) has been invariably 11per cent (pc) to 13pc since the outbreak of the pandemic. Sindh’s Covid-19 crisis monitors believe that prevalence ratio could rise in days to come in the backdrop of relaxations being given by the government. Now the Supreme Court has called for relaxing restrictions more by opening malls. The federal government is to resume railway operations. This proposition is fraught with danger, observers fear.

In case of Tharparkar, around 600 locals as well as Tableeghi Jamaat men were tested which led to detection of only 10 cases. According to Tharparkar’s district health officer (DHO) Dr Mubeen Memon, around 50,000 people are screened (not tested) in the district in different areas also. “We don’t have people with travel history from abroad and the number of pilgrims are negligible,” he said.

Likewise, in Mirpurkhas, 743 tests, including around 350 of Tableeghi Jamaat people, were done, leading to detection of 26 cases. Mirpurkhas DHO Dr Mushtaq claimed of 26 cases, 19 were detected locally while the rest were Mirpurkhas natives, but actually contracted infection somewhere else. “We do random sampling at dairies, banks, groceries, vegetable markets etc,” he said.

Population dynamics may have helped matters in Thar, but experts believe that one should not get carried away with this theory alone and start throwing caution to the wind. People are required to take all sorts of precautions as advised by experts because Covid-19 cases are witnessing spike daily.

Published in Dawn, May 23rd, 2020