The worst is yet to come. In the last week or so, Covid-19 seems to have exploded in Pakistan. The pandemic has finally started to live up to its name as it permeates homes, timelines and dashboards with a menace that grows by the day.
The crisis is now actually looking like one. But under the overhang of this public health crisis lie sheltered a number of smaller crises that are ballooning in size as the spread of the virus picks up pace. The foremost among these, possibly, is the government’s handling of Covid-19.
It has been over 13 weeks since the first Pakistani citizen was diagnosed with the virus. In this relatively short period, PTI government’s policy has seen some successes like the formation of the NCOC, and some failures like the confusion and contradictory public messaging. In all, the policy has combined in itself a potent mix of dynamism and denial. These two contradictions worked fine — in a twisted way — till such time the virus remained an abstract notion that was seen as affecting some people far away from us.
Now, suddenly, the government is faced with a fresh set of challenges.
The first real challenge is to recognise the challenge itself. In a recent briefing at the NCOC premises, Minister for Planning Asad Umar was on the mark when he said the world had moved beyond the lockdown debate and it was time we did the same. He was also correct in saying that the numbers of the day have not come as a surprise to the government. Other senior officials within the Red Zone argue that Prime Minister Imran Khan had been consistently saying the infection would spread in the coming weeks and people should follow all SOPs.
The challenge for the government in the first 13 weeks was then to make a success of its anti-lockdown policy. The crux of the official approach was to frame Covid-19 not just as a public health issue but as a health/economic issue. This framing provided strategic direction to all aspects of policy, which was then parroted by party personnel with varying shades persuasive sobriety.
Thirteen weeks later, Pakistan’s infection count is hitting global lists. Line and bar graphs are spiking and threatening to go off the charts while most citizens now personally know the Pakistanis who are infected with Covid-19. This when the worst is still ahead of us. As per official projections, the number of citizens infected with Covid-19 by June 15 would be between 110,000 and 125,000. The death count on this date is projected between 2,750 and 3,250. Hidden within these numbers is the post-thirteen weeks challenge.
The summary of the challenge: Cases are too many, deaths are not. How does one frame this?
Some officials in the federal government have begun to recognise the broad contours of this new challenge but most are still stuck on the polarizing ‘lockdown vs. no-lockdown’ debate. This inability to grasp the mutating nature of the challenge is turning out to be a major obstacle in drawing the borders of the new framing that is now required to tackle the swiftly growing crisis. This is how the government explains its present policy: we have done our numbers and projections down to the last detail possible and so far the actual cases are lower than projections. This is good news. We know the numbers will increase. To cater to them, we are focusing on expanding and upgrading our health facilities and equipment. As of now, the capacity (that we have enhanced in the last few months) is far in excess of the load. As long as we have enough capacity to treat patients, we should be fine. We are now zoomed in on improving Tracking Testing and Quarantine (TTQ) and operationalising the Resource Management System (RMS) that will coordinate information about health facilities so that Covid-19 patients can reach the right place without delays. Hence no need for further lockdowns etc. that have severe economic costs.
The key aspect of this strategy is the death number. Since this number remains low (compared to the hardest hit countries), the number of patients requiring critical care also remains low (of the 3,506 beds with oxygen equipment, 522 are occupied). It is the load of critical care patients that actually puts hospitals under stress and not the total figure of infected. So while the number of infected people may rise to a huge level, as it is in the process of doing, as long as most of them do not require critical care, the system should be able to handle the pressure. To its credit, the NCOC has coordinated and supervised an impressive enhancement of health facilities in a short period of time. The armed forces have played a central role in this.
But this is half the challenge. The other half is the changing dynamics of the other number that will cross the 100,000 mark in the next few days. This is where perception collides with policy and threatens to produce significant collateral damage within the Red Zone.
The PTI government has missed a key nuance in the last 13 weeks: Not opting for a lockdown is a policy; not appearing to take Covid-19 seriously is a blunder.
For some strange reason, the federal government has unwittingly ended up clubbing them together. So while arguing against a lockdown (albeit with solid logic) is perfectly fine and can be sold to the citizen as policy; underplaying the threat of the pandemic through mixed signalling and weak articulation is indicative of an underwhelming appreciation of the threat. If a dangerously large part of the population does not take Covid-19 seriously; if it prefers to ignore basic SOPs about social distancing etc.; if it has little idea about which symptoms to take seriously and what to do if they appear; and if it constantly hears senior PTI officials running down Covid-19 as a mere flu, then it is not the fault of the citizens but of those whose job it is to inform and educate citizens.
Thirteen weeks later, lack of success in this area poses the gravest challenge for the PTI. While the NCOC is holding up its end of the deal in terms of operationalising the nuts and bolts of the fight against the virus, the federal government continues to struggle in explaining to the citizens why it is doing what it is doing. Or not doing.
Published in Dawn, June 4th, 2020