Pakistan puzzles health experts as virus cases drop

Six months after the coronavirus arrived in Pakistan, the country appears to have dodged the worst of the pandemic, baffling health experts and dampening fears its crowded urban areas and ramshackle hospitals will be overrun.

Following an initial surge, the number of infections has plummeted in recent weeks, with Covid-19 deaths hovering in the single digits each day, while neighbouring India tallies hundreds of fatalities.

Pakistan has a long history of failing to contain myriad infectious diseases such as polio, tuberculosis and hepatitis, while successive governments have underfunded its healthcare sector for decades.

Added to that, many Pakistanis live in crowded, multi-generational homes or packed apartment buildings that favour rampant virus transmission.

“No one has been able to explain this decline… We don’t have any concrete explanation,” said Salman Haseeb, a doctor at Services Hospital in the eastern city of Lahore.

Pakistanis have proposed numerous hypotheses for their country’s seeming ability to weather the pandemic, crediting everything from the young population and the hot and humid climate to unproven claims of natural immunity.

Its median age is only 22 and the coronavirus is known to disproportionately impact older people with prior health complications.

In comparison, Italy, with a median age of 46.5, has recorded more than 35,000 deaths, while Pakistan’s official toll is about 6,300.

To date, the South Asian nation has confirmed more than 295,000 infections and currently is recording a few hundred new cases per day.

Observers say that with only limited testing the true number of infections is likely considerably higher. One testing exercise in Lahore suggested as many as seven percent of the city’s population had been exposed to the virus.

But anecdotal evidence from hospitals across Pakistan supports the downward trend.

While healthcare facilities were initially swamped, doctors across Pakistan told AFP they are now no longer seeing a coronavirus-related rush on emergency services.

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“Regardless of the reasons, the good thing is the first wave of the virus is almost over in Pakistan,” said Khizer Hayat, a doctor at Nishtar hospital in the central city of Multan.

“The situation is now under control and the number of coronavirus cases is dropping, the wards are emptying. It’s hard to know why.”

– ‘Smart’ lockdowns –

A flattening curve is all the more curious considering how the coronavirus has hit India, which with a median age of 26 and crowded cities has a somewhat similar demographic.

Over the weekend, India set a new global record for the highest number of daily cases, with 78,761 new infections recorded in 24 hours, though Delhi is testing at a far higher rate than Islamabad.

India has also reported more than 64,000 deaths — the third-highest globally after the United States and Brazil.

Since recording its first case in late February, Pakistan has responded in fits and bursts to the pandemic, rolling out loose lockdowns that were later reversed, while crowds shunned social distancing guidelines and continued to flock to markets and mosques.

Still, the government of Prime Minister Imran Khan has been quick to bask in the progress, crediting itself with “smart” lockdown policies and other measures, even though these were often not enforced.

Last month, Pakistani authorities lifted most of the country’s remaining coronavirus restrictions after new cases dropped for several weeks.

Restaurants and parks have reopened while people have flocked to theatres, malls, and crowded back onto public transport. Schools and universities are set to reopen later in September.

Masks have become an increasingly rare sight, spurring warnings from experts for the public to remain vigilant over fears of a second wave. 

“People think we have defeated Covid-19 but my belief is that the chances of the second wave are still there,” warned Hassan Waseem, a microbiologist based in Pakistan.

However, other doctors suspect the country has experienced the peak of the pandemic.

“I would reluctantly say that there won’t be a second wave in Pakistan. Most urban centres in Pakistan like Lahore and Karachi have already seen the worst when it comes to coronavirus,” said Waheed Uz Zaman Tariq, head of the department of virology and infectious diseases at Chughtai Lab.

“People must also understand that (the virus) is not completely gone,” he added. “Precautions must be taken still.”


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India virus deaths pass 1,000, but low toll puzzles experts

India’s confirmed coronavirus death toll passed 1,000 on Wednesday following its highest daily increase, but the numbers remain low compared with Europe and the United States in a phenomenon that is puzzling experts.

With massive slums and a shaky healthcare system, there were fears India would be ravaged by the pandemic that has killed more than 214,000 people worldwide.

The latest daily toll of 73 deaths was India’s highest, offering a warning that the giant South Asian nation was not yet in the clear.

A lack of testing and many other factors mean that India’s official toll of 1,007 deaths could be far below the real number of coronavirus victims.

“We see low numbers but we do not know how to validate those numbers or rates,” virologist T. Jacob John told AFP.

“Governments desire under-reporting and… we are flying blind for true rates and numbers.”

India appears so far to have been spared the devastation seen in New York, Milan and other hard-hit parts of the world, where hospitals have been overwhelmed by cases of coronavirus.

Experts have offered a number of theories and factors, but there is no definitive explanation yet.

“It might well be true that the trajectory of the Indian epidemic is very different for reasons that we do not understand… but those are all theories right now,” Prabhat Jha, an epidemiologist at the University of Toronto, told AFP.

One possible factor is that India imposed a lockdown on its 1.3 billion people on March 25, when there were 606 confirmed cases and 10 deaths, and it has been rigidly enforced.

The government says the number of infections could have reached 100,000 without it.

There are also other issues that could also have kept the risk low — including a young population and the possible positive effects of the BCG tuberculosis vaccine, said John.

Another factor could be decades of widespread dengue fever providing communities with some “innate immunity”, he speculated.

Still, experts caution that no-one has an accurate picture of the pandemic in remote rural villages and deep in slums.

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Even in normal times, accurately recording deaths or causes in India can be a difficult task, where many poor people fall sick and die without entering a hospital or seeing a doctor.

Just under half of the country’s estimated 10 million annual deaths are not recorded, according to Jha, who leads the Million Death Study that regularly surveys Indian households on the issue.

He said authorities could use his study’s framework to survey households and get a sense of the pandemic’s spread beyond the small testing regime, or find answers to why the coronavirus is not devastating communities.

“A survey likes this, if it showed lower death rates than expected and was able to get at the cause, would be important,” he said.

“India needs to count the dead, quickly.”

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