Containing Corona Spread in Pakistan Through a Data Driven Strategy

Introduction

There is no real medical emergency in Pakistan as of today(4th April 2020), which is clear from lack of any pressure on hospitals related to Corona. As of now, we have clearly over-reacted which is not a bad thing if this is used to prepare the nation for a long battle against Corona virus. But we can't see a well thought out timely response as seen from shortages of masks, Dettol, sanitizers, in some cases flour etc. We have not galvanized our industry to produce all essentials needed for this war.

Pakistan lost hundreds of children in just one terror incident in one day, and we did not implement curfew or lock-down.

This war against a virus won't be won with lock-downs or curfews alone. These measures should be used selectively and at local scale and not only country/province or city level. On the contrary long term impact of these regressive measures will result in economic meltdown, destruction of agriculture and ultimately social unrest leading to lawlessness and then everything will be lost.

People are so scared that they can't look at data and make logical decisions. Eve now, most of the deaths occurring are due to non-Corona related reasons including hunger and disease.

What will happen in six months , if agriculture, trade and industry fails now ?

We will see massive world-wide famine and unrest if agriculture, trade and industry is destroyed because of merciless lock-downs.

Understanding the Trend

Corona spread pattern is different in south Asia as compared to Europe. So, its a question of choosing right policy measure at right time and place. Looking at data from Italy, Spain and Iran while ignoring data from Germany, India, Bangladesh and South Korea is not the right approach to understand spread of the Corona.

Even within Europe spread rates, and death rates are completely different as seen in Germany(0.8%), Spain(8%) and Italy(10%).

All countries rich and poor are suffering from COVID19. Only difference is some are suffering more and few countries are fortunate at this point in time. This may be due to demography, temperature or any thing else.

Pakistan has totally different demography and Corona trend when compared to Italy, Spain, Iran etc. Pakistan has to adapt its policies accordingly. Policies should be adaptive and data driven rather than static and non-responsive.

Lockdown As Effective Preventive Measure in Asia versus Europe

Assumption that lockdown may have been instrumental in reducing number of cases in Asian countries such as Pakistan, India etc is dubious. China and Japan are highly westernized countries and don't fit in with poor Asian countries.

Lock-down to enforce isolation may work in Europe/America because of low population density; but it may not work in Asia because of very high population density.

 In these countries lock-down would achieve the exact opposite result, because up to 10 people may be crammed in a single room of the house, small houses with multiple families, narrow streets with tens of thousands of people.

Corona related panic steps including lock-downs, country level curfews are causing a lot of more economic suffering, long term damage to agriculture, industry and trade than Corona itself in 3rd world countries like Pakistan.

Did lock-down help in bringing down Corona Cases ?

It seems steps taken to prevent spread including closure of academic institutions, closure of borders, putting travelers in quarantines, curfews and lock-downs have helped control Corona spread in Pakistan from its peak at 90% to around 30%. This is still very high and should be brought under 10%.

Leading factors for slowdown is reduction in number of travelers coming from Iran, and flight ban. However at a later stage tableghis became a key contribute due to Ijtema and religious gatherings in mosques. So quarantine of Tableqhis and restrictions on Friday prayers may have helped further.

Curfew/Lock-down may have also helped indirectly by localizing the problem in most cases.

Facts

1). Most the cases i.e. over 71% have direct foreign connection.

2). Around 10%(1528/13000) infections in a country of 200 million out of those being tested due to symptoms are turning out to be Corona positive. And most of these have travelling history so why did we apply country wide lock-down rather than effective border closure ?

As seen in figures above, even with increased testing available now Corona positives are not increasing at alarming rates, and still admitted cases are decreasing which indicates that most of the patients are showing only mild symptoms, do not require hospitalization and very few patients require ventilators.

3). Around 1% of those who test positive are fatalities.

4). There have been many cases of people escaping from quarantine

5). People don't understand quarantine, and self isolation at home

6). Many more people will suffer and die with this one size fit all approach, where a province wise or country wise curfew or lock-down is imposed.

7). People above 60 years, and having various ailments have higher risk, so targeted restrictions should be in place for this age group.

We have to realize that we can slow down Corona virus, but we can not stop it from spreading. This means that it will ultimately cause the damage unless we find treatment/vaccine for it.

Possible Policy Interventions

There were five policy interventions according to researchers at Imperial, that would have an impact :-

1. Isolating people with a cough and temperature at home for seven days.

1. Quarantining families where somebody has symptoms for 14 days, to allow time for any symptoms in the others to show.
2. Social distancing, involving cutting the normal contacts people make at home, school or work by three-quarters.
3. Social distancing for everyone over 70, by asking them to stay at home.
4. Closure of schools and universities.

"Some countries especially Pakistan, India and Bangladesh may already have Herd immunity that is evident from fewer positive cases, low death rates etc. They should not be imposing curfews, and lock-downs."

Policy

1). Given the facts that most of the positive cases have foreign origin, we need to keep borders closed and country open. We are doing completely opposite.

2). We need to increase testing bandwidth and make it easily available across the country to make sure that we do not miss out on potential outbreak.

3). Since less than 1% of positive cases are fatalities, therefore spend most of the effort in testing and prevention.

4). Preventive measures such as curfew and lockdown should be applied in localized, data driven approach. So there should be well defined policy with well defined threshold for closing streets, mohallahs or cities.

5). Age group with higher risk should be targeted for restrictions on movement.

Pakistan's government should learn from China, they have not yet defeated Covid19, because no one has. But they are working really hard to help everyone in the world.

Pakistan is very fortunate as far as spread and impact of Corona virus is concerned. We should focus on enhancing productivity, efficiency to not only be able to meet our own needs, but also help America, and Europe where humanity is suffering a lot more than us.

Strategy

1). Lockdown borders and not the whole country. Avoid potentially dangerous spread through aggressive testing and quarantine.

2). Adapt the strategy, if the ground realities change. 

3). Use selective but effective lockdown at local levels e.g. village, mohallah when needed.

4). Enhance productivity and efficiency to overcome shortages of masks, sanitizers and all other essentials rather than shutting down.

References

https://www.kaggle.com/getting-started/139524

https://www.kaggle.com/hassanamin/comparative-analysis-using-corona-novel-datasets

https://jpma.org.pk/article-details/8672

https://www.kaggle.com/hassanamin/corona-trend-analysis-with-official-pakistan-data

https://www.thenews.com.pk/print/638685-perhaps-god-wants-to-save-us-from-severity-of-corona

https://www.theguardian.com/world/2020/mar/16/new-data-new-policy-why-uks-coronavirus-strategy-has-changed