KARACHI ― Three months after Pakistan confirmed its first case of the novel coronavirus, the country of more than 200 million people is abandoning protective measures and allowing citizens to gather to celebrate one of its biggest annual festivals. That decision will likely cause cases to spike, experts warn. Like Brazil and the United States, two major epicenters of the pandemic, Pakistan is on the brink of deepening a public health crisis because leaders insist on following political whims over scientific experts.
COVID-19, the disease caused by the virus, has already killed more than 1,100 Pakistanis and infected more than 52,000, according to government statistics, which offer only a partial picture of the national situation because of inconsistent and disproportionately low testing. This incomplete data suggests the trend in new reported cases ― the so-called “curve” ― is plateauing at best, without beginning a real decline.
But authorities have been winding down their national lockdown for weeks, most recently reopening the few shopping malls that were still closed and restarting domestic travel ― days ahead of Eid al-Fitr, a holiday at the end of the Islamic holy month of Ramadan during which most Pakistanis attend large family gatherings, often showing off rare treats from special shopping sprees.
As in the U.S. and other countries, safety measures are up against political polarization and conspiracy theories, making some resistant to do what’s needed to slow the virus’s spread. The cost of Pakistan’s choice will fall on its citizens ― particularly the poorest, whom politicians have cited as their top concern in challenging stay-at-home orders ― and its fragile health care system, the staff of which is being infected at high rates.
After Eid, the number of new infections reported daily could be 15% to 20% higher than the current rate, National Institute of Health director Aamer Ikram told local newspaper Dawn. The Pakistan medical association says officials are not taking the coronavirus seriously enough, and government critics paint a dark picture: “We are now officially the control group for herd immunity in South Asia,” Ammar Rashid of the leftist Awami Workers Party wrote on Twitter, noting that Bangladesh extended its lockdown to the end of May. Building up widespread immunity in a country as large as Pakistan by allowing the virus to spread mostly unimpeded would entail at least tens of thousands of additional deaths.
There are some indications that Pakistan has reached its peak of cases, said Rana Jawad Asghar, a top epidemiologist who has served as a government adviser on the coronavirus outbreak. He cited dips in how quickly the number of cases was growing and the three-month period for which COVID-19 has been present in the country, and he has long believed Pakistan may be spared the devastation seen in other nations because of its relatively young population and environmental factors.
But the country’s recent change in course, which could leave citizens more likely to gather and be in public, means it will likely squander its chance to reach a high point of cases and then see a decrease ― subjecting Pakistanis to a more painful coronavirus experience immediately after the national tragedy of a major plane crash.
“We have this big Eid and people are traveling and people are ignoring social distancing,” Asghar told HuffPost. “We may have not a second wave but another spike of cases if we don’t do social distancing, which I don’t see happening now.”
Political Dysfunction Inhibits A Response
COVID-19 appears to have entered Pakistan in late February, via citizens returning from pilgrimage sites in neighboring Iran, which had one of the world’s biggest outbreaks.
Two weeks later, federal authorities launched a high-level committee to coordinate with the governments of the country’s provinces, which have broad leeway over public health decisions, and asked experts like Asghar to participate in its daily meetings. With the number of cases nationwide still in the hundreds, provinces began banning public gatherings and closing schools.
“People were paying attention and there were more scientifically based discussions,” said Asghar, who has worked at the U.S. Centers for Disease Control and Prevention and previously ran an effort to train Pakistani “disease detectives” in the mold of the CDC’s Epidemic Intelligence Service. He recalled telling officials that even though the country was inching toward banning international travel ― using temperature checks at airports in the interim ― the pandemic could not be stopped there and a concerted contact-tracing effort would be key.
But Pakistan’s political polarization, which has dramatically grown in recent years as the ruling Tehreek-e-Insaf party has pummeled rival politicians with the backing of the country’s powerful military, was already undermining the national response to the crisis.
Officials in two provinces criticized the way Prime Minister Imran Khan and his political partners handled pilgrims returning from Iran: First they were quarantined for weeks in deplorable conditions, then they were allowed to return to their home regions ― where local officials tested them and found some had the virus.
As Sindh, the one province fully controlled by an opposition party, began implementing tighter restrictions than its peers, like closing nearly all shops, Khan’s allies began criticizing its leader. On March 22, he declared that Pakistan would not be imposing a lockdown because of its economic toll, particularly on millions of daily wage earners.
But less than 24 hours later, the army announced that it would deploy troops to enforce a national shutdown.
Khan spoke about the threat of the coronavirus, and his government pushed through a major aid package for poorer citizens, but he continued to cast doubt on the value of a lockdown, saying faith and other factors would help Pakistan, much like U.S. President Donald Trump has done. Khan’s supporters pushed for a limited reopening. Meanwhile, the government centralized most power over the decision of what parts of the country could remain open in a new command center ― one with multiple military, political and bureaucratic members but few scientists.
In April, officials extended nationwide policies meant to keep people at home, but wavered on a crucial point because of a fresh political pressure campaign, this time from the religious right. The government allowed mosques to begin hosting large group prayers for the month of Ramadan, saying they could trust those attending to follow social distancing guidelines. Efforts to make worshipers accept previous limits had already caused clashes between police officers and prayer attendees.
By early May, Khan and the new federal council on the outbreak decided to ease the national lockdown even as the country’s rate of infection grew, saying that could simply be a result of increased testing and that it was unfair to prolong economic pain when it was impossible to predict when a peak would arrive.
On May 18, one more political force put the final nail in the coffin of the lockdown policy. Pakistan’s Supreme Court inserted itself into the national debate and ruled that all shops should be allowed to open immediately. The order did not even allow for instructions to stay closed over weekends as “all days of the week are the same.” The government did not have the right to tell Pakistanis they could not purchase new clothes for Eid, the chief justice said. The ruling shocked attorneys as a remarkable move even for a judiciary that has become more assertive and controversial, one lawyer told HuffPost.
Alongside the weakening of the restrictions, the changing messages and power struggles dealt their own damage to efforts to keep Pakistanis safe. Asghar, the epidemiologist, said it’s key for leaders to be clear about who is in charge and send a unified message. It’s also vital that technical experts have the power to make decisions and that those choices are based on data about the spread of the disease; and for officials to clearly explain the risk and consider the concerns of different local contexts in making appropriate decisions, say for big cities versus rural areas.
It’s hard to say Pakistan succeeded on any of those fronts.
But there are new narratives on offer. Pakistani users of WhatsApp, the popular messaging service, are increasingly sharing claims that the pandemic is really an international hoax propagated by powerful figures like Bill Gates and that some in their government are wrongly diagnosing patients to attract international aid. Meanwhile, Khan is trying to shift attention to the country’s longtime boogeyman, its neighbor India. He has warned of a “false flag” operation to justify an Indian assault on Pakistan twice in the last week.
After all, there can’t be a national crisis ― or a need to seek accountability from Pakistan’s leaders ― if the country’s struggles are manufactured by outsiders.
Understanding Life And Death
While officials have publicly clashed over coronavirus response measures, Pakistan’s medical professionals have been consistent. They see a potential disaster in the making that could hit them hardest ― in turn diminishing their ability to help. Television hosts and politicians here regularly praise health care workers as “front-line heroes,” but their day-to-day experiences remain fraught.
Health care professionals made rare public pleas to the government ahead of its final decision on continuing the lockdown; they lost the argument. Days later, the family of a patient who died of coronavirus in a Karachi hospital vandalized a ward after being told they could not handle the corpse in line with guidelines to prevent possible infection.
“Health care providers may stop working if such incidents continue. Around 1,100 doctors have already gone in isolation,” Qaisar Sajjad of the Pakistan Medical Association told the Dawn newspaper on Friday.
Even medical professionals’ fight for crucial personal protective equipment has become politicized. In April, police beat doctors and paramedics who went on strike over their lack of such gear. The army then won a public relations victory for filling the gap. Now the government is publicizing its decision to ship protective gear to the U.S., a populist jab at a foreign patron.
Officials have made progress on contract tracing, improvised facilities for the possibility of hospitals being overrun, and even digital telehealth services (though given limited internet access, that opportunity has only a modest impact, like the government’s attempt to provide online education as a substitute for the one big sector of society that remains closed).
But other parts of their medical preparation remain questionable, like the policy in Punjab province of isolating people who test positive in central facilities, away from their families, which experts believe has deterred possible patients from being tested.
“They have certainly beefed up things,” Asghar said, noting that at present the number of available beds appears more than sufficient.
With cases now widely expected to increase ― including, by the government’s own admission, possibly beyond the capacity that has been developed ― it should soon become clear if those efforts were enough.