August 04, 2020

    The tragedy of testing: How can we know when to end lockdowns without testing many more people?

    Covid-19 has become a truly global phenomenon of the 21st Century. Six months after coronavirus was first reported to the World Health Organisation, confirmed cases have surpassed 10.5 million, according to Johns Hopkins University. More than 500,000 people are known to have died from the virus, while over 5 million are known to have recovered.

    As the world grapples with Covid-19, chaos and negligence seem to be the only common denominator in responses by individuals and communities. Pakistan is no different. While it is true that once this pandemic is over, we will have learnt many a lesson, a singular point of focus for the world and Pakistan would remain investment in outbreak preparedness.

    The pandemic hit Pakistan – a country of 220 million people – in late February and has since killed over 4,700 Pakistanis and infected over 230,000 individuals across the length and breadth of the country. The critical question that all countries will and are facing in the coming months is how to live with this virus.

    Although many countries have made some progress, globally the pandemic is actually speeding up. This calls for countries to re-evaluate their priorities and focus on hard measures which can slow down the spread of this disease.

    There has been a lively debate amongst various circles on what critical actions are needed to slow down the spread of disease in Pakistan; and while many focus on availability of medical facilities, others still believe that the country needs to enhance its focus on mass testing which has been touted by medical experts and international organisations as the best bet to restrict and isolate the spread of Covid-19.

    Various think tanks and experts have said that as countries approach the peak of the pandemic, they must focus on increased testing and data-driven decision-making.

    The naysayers argue that Pakistan does not need to increase its testing since our case fatality remains low compared to countries like the UK, US, and Spain. It needs to be realised that following Eid-ul-Azha, 28,000 to 31,000 tests a day is going to highly insufficient.

    The United Nations and WHO experts have suggested that for Pakistan to move towards a downward trajectory on its curve, it is imperative to conduct more than 70,000 tests a day for a minimum of two months.

    Widespread testing has a hugely important impact, not just for individuals, but also for the society and country. There is a direct correlation between increased testing and flattening the infections curve. If we look at global data, we see that countries that conducted a greater number of tests as a percentage of their population were able to significantly flatten their curves.

    For instance as of June 2020, if we look at the data sets for testing from countries such as Australia, Italy, Germany, Canada and the UK, we see that their testing stands between 110–70 tests per 100,000 people. These countries have successfully flattened their curves and are witnessing a much lesser spread of the disease. Pakistan has conducted approximately 14 tests per 100,000 people.

    While many argue against the utility of mass testing, it is important to understand that testing provides data analytics which can be used to make informed decisions. Knowing the result of a test allows rational decisions at both individual and community levels.

    If a person living in a house with others knows whether they have Covid-19 or a common cold, it greatly affects how he interacts with them. If the person is Covid-19 positive, it makes sense for him or her to self-isolate and elderly members of the household might be moved out. Without testing, it is harder, not easier, to keep the more vulnerable people isolated from others — including members of their own families who may have been exposed to the virus.

    Various think tanks have informed that as countries approach the peak of the pandemic, they must focus on increased testing and data-driven decision-making.

    Widespread testing can also help manage the burden on our healthcare system. By effectively testing and isolating individuals at home, we can protect the medical system from being overwhelmed by low-risk groups seeking its resources.

    As is, our public healthcare system has largely failed to cope with a surge in demand for health services due to decades of neglect, allocation of inadequate resources, broken infrastructure and poor governance. Additionally, and perhaps most importantly, widespread testing of all those “presumed Covid” patients who are not hospitalised gives us a far clearer picture of this new viral disease, which we currently have so little data about. It will help us separate the most vulnerable from the less vulnerable.

    Based on the currently available data, medical experts opine that nearly 80 percent of those infected with the virus do not require any direct medical intervention; 15 percent require mid-level intervention and 5 percent require direct, high-level medical intervention. This trend can be further explored and studied if we have a bigger data pool of tested populations.

    It is also crucial to understand the socio-economic factors at play. According to National Command Operation Centre (NCOC), Pakistan’s daily testing capacity currently stands at 71,780 tests per day. Currently, we utilise nearly 42 percent of the capacity.

    It is only by tapping into this unutilised potential of mass testing that we can flatten the curve by September-end. Conducting over 70,000 tests a day calls for a financial outlay of Rs 31.5 billion. Pakistan’s current budget allocates a total of Rs 25 billion for the health sector for the financial year 2020-21.

    It is imperative that we re-evaluate the needs of the healthcare system and focus on directed interventions catering to the development of new facilities and upgrade of existing infrastructure. It is also important to form public-private partnerships.

    The onus is on the corporate sector at large to provide for testing services across Pakistan.

    In the first week of July there was a slowdown in the trajectory of Covid-19 cases in Pakistan. While these official figures look promising, they are at variance with the global trend and data. Also, the number of deaths and burials across Karachi and Lahore for the month of June showed an increase of 51 percent and 113 percent, respectively.

    Perhaps, the trends need to be studied more closely to determine the true cause of the declining trend of new cases which can also be correlated to decreasing number of tests over the past two weeks.

    The government, the private sector and the civil society should empower communities by educating them on what they can do to stay healthy in terms of safety and preventive measures. This has become all the more important in the backdrop of Eid-ul-Azha.

    Data collection and research about the virus and the way it affects different groups of individuals should be accelerated.

    It is estimated that Pakistan risks losing Rs 2.5 trillion due to Covid-19 aftermath and approximately 20 percent of the labour force, i.e., almost 12 million jobs are at risk of becoming redundant. It is only through dedicated efforts which calls for collaboration amongst various stakeholders that we can hope to come out of this pandemic.


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