What is the actual number of coronavirus cases in Pakistan? As soon as the pandemic struck Pakistan, this was the most commonly asked question. Nobody believed the numbers released by the government. As I was part of the federal government’s core committee on Covid-19, I knew no one hid the numbers though we had the challenge of availability of testing kits and related equipment. Today, I am witnessing another side of mistrust. Many in Pakistan are claiming that the Covid-19 pandemic is a hoax and the government will get more funding if they declare more coronavirus cases in the country. According to mass circulating posts on social media, Bill Gates, WHO, Pentagon and other international corporations are part of this “conspiracy”. These posts are being forwarded by very well-educated and professional elites of Pakistan, so you can well imagine its reach in our population.
I was one of the few epidemiologists who did not buy drastic projections of many seasonal modellers and epidemiologists who claimed the Earth will stop rotating and people will drop dead on the streets in Pakistan. Panic is a hot sell in traditional and social media that makes you popular within hours. I talked about these false Doomsday claims and contradicted them in print and on television, angering many. I clarified earlier that due to our age distribution (younger population) we are less likely to have the same death rate as Western countries. Then there are some environmental and societal issues which may favour us. The pandemic doesn’t spread evenly in every country and that gives us an opportunity to learn and address our vulnerabilities.
But this pandemic is a serious killer and a real deal. It has already killed more than 325,000 and infected millions worldwide. In Pakistan too, almost 1,000 people have died and the number is rising. Unfortunately, doctors and medical staff are getting infected disproportionally and paying the ultimate price with their lives. Doctors from across Pakistan are also reporting increasing number of untested deaths with Covid symptoms. Due to the aggressive behaviour of some provincial health departments, suspected cases are not getting tested for the sake of their families. Now with a public outcry about the lack of sufficient testing in Pakistan, some health departments are just giving a quota of daily tests to employees. Taking improper samples and the lack of sensitivity of the test means a significant number of false negative results.
So what is the actual number of cases in Pakistan? To know this we need a surveillance system in Pakistan. The government has hastily put a system to track positive cases in Pakistan. Is it giving a reliable number? No surveillance system is meant to give information on all the cases of a specific disease. We look at the reach of any surveillance system in a population, its strengths and weaknesses and then estimate the infected population. But to truly make these estimates, the surveillance system’s integrity needs to be guarded. It means the system has to stick to clear and universal case definitions. These do change over time but that needs to be enacted across all levels. Just doing convenient surveys (aka random testing), imposed testing (when an influential gets infected and then you test hundreds of his staff) and dropping all these numbers in your tally makes the numbers less useful. Honestly, no one can tell the actual number of cases in Pakistan. If numbers released by the government don’t reflect reality on ground, they lose credibility. So now everyone wins — those who think there are so many unreported cases and those who say there are not many. But for those who want to control this pandemic, clarity on numbers is critical, and we must fix the testing and surveillance system to save lives.
Published in The Express Tribune, May 21st, 2020.