ALARMINGLY, Covid-19 cases have crossed the 125,000 mark, with deaths over a couple of thousands, and R0 (the infection reproduction rate) racing to two. But this only matters to a handful of us in Pakistan. We are leaping towards the 200,000 Covid-19 infection mark predicted by the WHO executive director. Are those in charge numb or apathetic to the looming crisis, which we may not be able to handle and which may drown us altogether? Have we officially surrendered to the Covid-19 pandemic?
Almost every day this is what we are told: we are poor, we have a weak health system, we have a growing national debt and other unavoidable expenses that eat up our budget. Alas, we can do nothing to save the lives of those who ultimately do not matter, in the greater good of saving our economy. This is the moral decision that will taint 2020 and haunt those of us who manage to come out unscathed.
There is still time to redeem many of the wrongs.
The biggest wrong is to have undervalued and deliberately endangered the lives of our healthcare providers. These honourable professionals are seen on talk shows, at least when anchors take a break from fighting politicians and invite them. They are united with one clear message. They plead for unequivocal support to slow down this wildfire. They talk about hospital overflows, lack of beds, lack of PPE equipment for all staff, lack of protection and insufficient trained staff. Despite all this, they face a high risk of infection and mortality. Sadly, this makes little difference to national decisions about how to deal with Covid-19, and worse, with a handful of exceptions, their voice is left out altogether from major decisions.
Let’s have campaigns with clear, honest messages before conspiracy theories take over.
To top this disregard, is the huge stigma attached to the illness which makes front-line healthcare providers vulnerable to anything from abuse, assault, eviction from homes, isolation, insult, etc. Worst off are the female providers who spend most time providing care to the sick in hospitals and at home. These are our valiant nurses and community health workers who face gender-based violence, threats and other forms of discrimination at the hands of patients, colleagues at work, the community while going to work and family members when they return home exhausted.
The second wrong committed is allowing the spread of misinformation which far outweighs any earnest efforts to spread positive, coherent information. The dominant message at the moment is virtually a white flag of surrender which leaves the responsibility of dealing with this deadly virus on individuals who are left to protect themselves. It leaves them confused about when to self-isolate or to self-quarantine, when to go to seek medical help and where. Easily overlooked is the responsibility of the state for getting this information out to the public.
Health education and communications are necessary everywhere, but especially where the size of the problem is a high pattern of contagion and where the majority are not educated. Such communication is an absolute must for our population to learn safe behaviour. It is even more necessary because the vast majority of citizens are left with the heavy responsibility of curtailing the impact of the pandemic.
So far the campaign has been replete with mixed messaging: ‘we have to fight the virus and not be scared, no there is a need to be serious since it has not peaked; we should wear masks, no we don’t really need to; the illness is serious, no it’s only serious for those with prior conditions or older relatives.’ Worst still are messages that make one feel falsely safe that the virus is merely flu and not the lethal infective strain wiping out major global economies and societies.
Let’s have major campaigns with clear, honest messages immediately before ridiculous conspiracy theories about vaccines and Western plots take over. Let’s use colloquial Urdu instead of English terms for social distancing and staying safe.
The third wrong may be the biggest challenge — clearing the cobwebs from the muddled debate about saving the poor from hunger by lifting the lockdown. Instead, payments should be made to the poorest in their homes through verification of their CNIC and mobile transfers that Pakistanis are now well versed in. Poor beneficiaries should certainly not be paid at facilities that parade them to show the world.
There is now ample proof in post Eid Pakistan that lockdowns, especially in major cities, are the only way of curtailing the contagion. Above all, let’s not fool ourselves with economist-led ‘smart’ lockdowns. All Pakistani cities are now too infested to avoid full lockdown. With population densities of more than 4,000 persons per square kilometre, this was inevitable. This is the only way to restrict further spread of the contagion to the rural areas.
There is no choice but to provide the essentials like food, water, healthcare for the poorest 20pc of the population for the next few months. The counterfactual is skyrocketing poverty, malnutrition and deaths of key household members that will be difficult to repair financially and emotionally.
Whether the economy recovers fully or not, it will take its own time to stumble back to its doddering feet. Pakistan will still be accountable for how we fared in coping with this global crisis faced by everyone, including other poor countries. A broken economy needs desperate fixing, but a very broken healthcare system needs to be fixed immediately. An underfunded, top-heavy public healthcare system is already facing its worse test. Its overhaul should be addressed in cabinet meetings, budget discussions and press conferences.
Finally, we cannot expect profound changes in the weak public health system unless mindsets of the leadership change. The major alarm will happen when all private VIP beds are occupied and they too have to utilise public facilities. I don’t know if any of the elite are now under care in a public facility. I would be happy to be proven wrong on this!
The writer is country director, Population Council, Islamabad.
Published in Dawn, June 13th, 2020