Health-WPS Office

Health
Ensuring food safety
The PFA sealed 640 food points and had production stopped at 344 food outlets in September alone.
The Punjab Food Authority (PFA) is doing a good job by regularly checking the quality of food at
restaurants and manufacturing units. The importance of ensuring food safety can be gauged from the
fact that most visitors to developing countries from advanced countries eat only at the high-end hotels
where they stay. Otherwise, they eat only peanuts and bananas. We expect other provinces too to
undertake regular inspections of food points to ensure food safety. The PFAsealed 640 food points and
had production stopped at 344 food outlets in September. In the same period, food safety teams
imposed fines worth over Rs19 million on food business operators for violations of PFA regulations.
Notices were served to 32,963 eateries while carrying out routine inspection drives across the province.
PFA Director General Captain (retd) Mohammad Usman said PFA teams inspected as many as 40,526
food points in all 36 districts of Punjab. These included dairy shops, ice-cream parlours, general stores,
bakeries, poultry shops, confectionery shops and food manufacturing units. In September, food safety
officials seized the carcass of a dead animal while it was being transported to Lahore from Kasur. The
carcass weighed around 500kg. The PFA also carried out an inspection of 144 production units of Jams
and pickles. Around 2,640 kgs of jams were found affected by fungi and 873 kgs of pickles unfit for
human consumption. Fines were slapped on 26 production units for failing to adhere to health safety
rules. As many as 82 food production units in Lahore zone, 29 in Rawalpindi, 26 in Multan and seven in
Muzaffargarh were inspected. Food manufacturing units were sealed for using rotten stuff and for the
use of prohibited chemicals. Dead flies and mosquitoes were found in pickles. In any case, excessive
intake of food should be avoided. A man wrote on a piece of paper, “I am a big eater. Today, I broke the
world record,” and lost consciousness, which he never regained.
Published in The Express Tribune, October 15th , 2019.
Selling poison
Editorial | October 15, 2019
FOR years, health authorities have warned about the harmful effects of gutka — a chewing tobacco
made of betel nut, lime water and other substances — that is widely consumed in powder form
throughout the province of Sindh. Its use is particularly pervasive amongst the poverty-stricken coastal
communities, even amongst small children, and is often used as an appetite suppressant or mild
stimulant. The harmful habit — in fact, addiction — can only be described as a culturally acceptable
choice of slow poison since a wide range of diseases have been linked to its use: mouth ulcers, oral
submucous fibrosis and oral cancer in the most tragic instances. According to the World Cancer
Research Fund, Pakistan has the second highest rate of oral cancer in the world, and it is also the most
prevalent form of cancer amongst men in the country.
Keeping these harrowing realities in mind, the Sindh High Court slapped a ban on the sale and
manufacturing of gutka and mainpuri across the province this August. All violations of this law will be
registered under Section 337-A of the Pakistan Penal Code, which criminalises those who cause
‘intentional’ harm to others.
Following the most recent stern orders, the Sindh Police claimed to have registered 211 cases against
offenders across the province, predominately in the city of Karachi.
The polio problem
ON the behest of the government, the Council of Islamic Ideology issued around 100 fatwas in support
of polio vaccination. While some are lauding the move as a muchneeded breakthrough, similar pro-polio
vaccination fatwas have been declared in the past. For instance, in 2013, Maulana Samiul Haq and the
Sunni Ittehad Council issued a fatwa in favour of anti-polio campaigns and condemned the targeted
killings of health workers. The most recent fatwa comes a month after the Islamic Advisory Group for
Polio Eradication raised concerns about the persistence of the virus in Pakistan and Afghanistan in a
meeting in Cairo. Indeed, Pakistan and Afghanistan are the only two countries battling to control the
polio virus, as Nigeria is well on its way to being declared polio-free. In particular, Pakistan is struggling
to control a massive spike in the number of new cases this year. At the last count, the figure stood over
70, with the vast majority of cases recorded in Khyber Pakhtunkhwa, followed by Sindh, Balochistan and
Punjab.
While the major hurdle in eradicating polio in the past was religiously motivated militancy (the banned
Tehreek-i-Taliban brutally gunned down polio health workers and security personnel in their war against
the state, spreading the falsehood that the vaccine was a conspiracy to sterilise Muslims), the greatest
challenge in more recent times has come from misinformation campaigns that are quickly disseminated
through social media and create panic and paranoia among the people. While the challenges to anti-
polio efforts by militancycare not over yet, the issue of vaccine refusal is arguably now more about a lack
of awareness regarding health and how vaccines work. The battle against polio must be tackled on a war
footing, and community leaders and local mosques must be engaged in such efforts. It is not an easy
task, but one must remember that countries with even larger populations and conflict zones have been
able to successfully eradicate the disease.
Seven cases of extinct poliovirus detected
- https://www.dawn.com/news/1515576?ref=whatsapp
ISLAMABAD: Seven cases of the vaccine-derived poliovirus type 2 — a type of the crippling disease for
which vaccination in Pakistan were stopped in 2014 — have been detected in the northern areas of the
country over the past few months, it has officially been confirmed.
Sources claimed that officials concerned had been reluctant for some time to admit that there was any
case of the vaccine-derived poliovirus type 2 in the country.
“It is not a wild poliovirus outbreak. It is an outbreak of Sabin-Like Type 2 Derived (SLT2D). Similar
outbreaks have been recently reported in Philippines, China, Indonesia, Nigeria, Democratic Republic of
Congo and several other countries in Africa which have completely eradicated the poliovirus,” Special
Assistant to the Prime Minister on Health Dr Zafar Mirza told Dawn.
There are three serotypes of wild poliovirus type 1, type 2, and type 3 each with a slightly different
capsid protein.
Pakistan has been giving Type 1 and Type 3 viruses in Oral Polio Vaccines (OPVs), but had stopped
administering Type 2 vaccine in 2014 and the virus could not be found even in environmental samples
since 2016.
An environmental sample is declared positive if virus is found in sewage water.

“However, suddenly cases have been reported from different areas which mean there was some vial left
in some laboratory or somewhere else and started spreading due to human error. Just after getting the
cases, which cannot be included in the number of wild polio virus, we sent samples to the lab of Centres
for Disease Control and Prevention (CDC), Atlanta, and after getting the confirmation, that children were
paralysed due to Type 2 polio virus, we have started polio campaigns,” Dr Mirza said.
He said the virus had caused seven cases of paralysis in recent months, mainly in the northern parts of
the country. Outbreaks of polio occur where a large number of children were under-immunised, he
added.
“The only way to reduce the risks of further transmission is to address gaps in immunisation coverage.
The polio programme is working on a comprehensive outbreak response that includes rounds of
vaccination in the area to protect every child under the age of five years. The programme has also
enhanced its acute flaccid paralysis surveillance by active search for additional cases, increasing testing
of contacts of cases and strengthening environmental surveillance,” he said.
He said through the Expanded Programme on Immunisation (EPI) schedule, children in Pakistan receive
routine immunisation against 10 vaccine-preventable diseases (childhood tuberculosis, poliomyelitis,
diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type b, pneumonia, diarrhoea and
measles). Through the service pregnant women are also vaccinated against tetanus.
The secretary of the Ministry of National Health Services, Dr Allah Bakash Malik, told Dawn that Dr Mirza
had directly taken the challenge and he was being supported by the entire team in the ministry.
Published in Dawn, November 8th, 2019
Polio persists
Dawn Editorial
EXPLOSIVE revelations in a recent investigation into Pakistan’s polio programme by The Guardian have
rattled the trust of many. Citing unnamed sources and a member of the polio eradication programme,
the investigation alleged there was a re-emergence of the P2 virus in the population, possibly through
an ill-administered vaccine. Furthermore, the article claimed, efforts were made to cover up this
disturbing new development, while a furtive vaccine programme was planned to target the outbreak of
the P2 virus this month. Presently, Pakistan uses P1 and P3 vaccines, as the P2 virus was thought to have
been eradicated in 2014. The special assistant to the prime minister on health issued a statement
denying these very serious allegations, but also confirmed there were seven new cases of vaccine-
derived P2, after The Guardian story created a storm. He mentioned that the resurgence of the vaccine-
derived P2 virus was not unique to Pakistan, as similar outbreaks were witnessed in countries that had
long been declared polio-free. While there has indeed been a resurgence of the vaccine-derived P2 in
some countries over the past two years, this cannot be accepted as a valid excuse.
There is a need for greater transparency, accountability, and perhaps an official investigation. One
cannot help but question the former and present leadership of the polio programme, at a time when
there has been a massive spike in the number of new cases in the country. Pakistan has the misfortune
of being one of three countries in the world that are yet to be declared polio-free. In 2017, there were
eight cases of polio recorded in the country. In 2018, this figure rose to 12. As of writing this editorial,
three more cases have been reported, increasing the number of new polio cases to 80 this year.
Pakistan’s polio vaccination efforts have battled religious militancy and misinformation. It would be a
tragedy if they failed due to the ineptitude of those overseeing the programme.
Monitoring body terms polio in Pakistan ‘political football’
• Shows concern over highest-ever number of children missed during a recent polio campaign
• NHS spokesperson says new strategy formulated to address the issue
LAHORE/ISLAMABAD: Bringing Pakistan’s political issues under discussion at a global health forum for
the first time, the International Monitoring Board (IMB) has declared the ‘polio programme and the
importance of delivering polio vaccine has become a political football in the country’.
The IMB, which provides an independent assessment of the progress made by the Global Polio
Eradication Initiative (GPEI) in the detection and interruption of polio transmission globally, sees lack of
political unity behind polio resurgence in the country.
“Early in 2018, the Polio Programme in Pakistan believed that it was on the brink of interrupting wild
poliovirus transmission. Just over a year later, the epidemiological picture in the country represents a
massive reversal of the trajectory to global polio eradication,” says the latest IMB report.
The IMB also expresses serious concern over the September 2019 campaign in which the highest-ever
number of missed children in Pakistan were reported. The reports says polio in Pakistan began its
resurgence in the third quarter of 2018, and intensified in the second quarter of 2019, with a record
number of cases (38) in that quarter alone. This was followed by 30 cases in the third quarter of 2019.
“The epidemiological situation is grave and of very deep concern. Pakistan has reported more than 80
per cent of the total global polio cases this year, with 90pc of them reported outside the traditional core
reservoirs (Oct 25, 2019),” reads the IMB report.
“Throughout the lifetime of the IMB, the Technical Advisory Group for Pakistan has made helpful and
constructive criticism of the polio programme in Pakistan allowing technical areas to be addressed and
strengthened,” according to the IMB report. However, it says, the most recent report of this committee
made a searing and devastating condemnation of the state of polio transmission in Pakistan.
Its report says, “The programme in KP has shifted from being an example to the country as a whole to
becoming an emblem of the national programme’s current crisis. The KP has reassumed its position as a
major global barrier to polio eradication.”
It says, “Transmission in Karachi is now everywhere”, while in Punjab “signs of programme deterioration
are everywhere.”
The IMB in its November report states the polio programme remains particularly susceptible in many
areas of Pakistan “where the power structure is divided between different political parties”.
The report says, “it seems extraordinary that the IMB’s analysis found that 89 per cent of all paralytic
polio cases over nearly the last eight years have been in Pashto-speaking families (Oct 25, 2019). Yet the
GPEI does not seem particularly interested in this striking statistic as an opportunity for a major
breakthrough.”
The IMB questions, “How can the people of Pakistan have faith that the polio programme is working in
their interests if they hear conflicting messages from their political leaders?”
The report also mentions that at the board’s meeting in October 2019, there could not have been a
starker contrast between the Nigerian and the Pakistan government delegations. “Both groups were led
by health ministers and those running the programme delivery,” it observes. But it says the Nigerian
delegation included all three chairmen of the health committees in the House of Representatives and
the Senate, who were from different political parties. “And what is more, Nigeria has just had a national
election, just like Pakistan,” the IMB report says while releasing fresh report on the disturbing and
alarming increase in polio cases in Pakistan.
“The IMB has found the GPEI and the country’s polio programme very slow to learn, or adopt best
practices from elsewhere. Top programmatic performance is achieved when the best technical
standards and procedures are delivered after being shaped and focused by accurate and timely local
knowledge and context.
The number of wild poliovirus cases stood at 77 in Pakistan and at 19 in Afghanistan on Oct 29, 2019.
The corresponding figures for the same time in 2018 were six for Pakistan and 19 for Afghanistan.
While talking to Dawn, spokesperson for the Ministry of National Health Services Sajid Shah said a new
strategy had been formulated to address the issue and reappointment of Dr Rana Safdar as polio
coordinator at the National Emergency Operation Centre was part of that strategy. “Dr Safdar reduced
cases from 306 (in year 2014) to just eight in 2018,” he claimed.
So far this year 88 polio cases have been reported from across the country. Last year 12 cases were
reported while only eight cases had been identified in 2017. Of the 88 cases reported from across the
country, 64 were detected in KP only, while 10 cases were confirmed in Sindh, seven in Balochistan and
five cases were found in Punjab.
Mr Shah agreed that there were issues with the programme in the past but said it had been reviewed to
completely eradicate the virus. He said: “Special Assistant to Prime Minister Dr Zafar Mirza is in the UAE,
collaborating with international donors and stakeholders to protect the children of Pakistan from polio
virus.”
"Polio resurgence" by Dawn Editorial
THE impact of political polarisation in Pakistan is beginning to show in the country’s anti-polio efforts. In
a scathing report, the International Monitoring Board has attributed the vicious resurgence of polio in
Pakistan this year to a “lack of political unity”. Describing the polio programme and related efforts as “a
political football”, the report states that the recent resurgence of polio cases — 88 so far this year,
including seven of the more dangerous P2 strain that had been eradicated in 2014 — reflects “a massive
reversal of the trajectory to global polio eradication”, and that too in less than a year. Pakistan reported
more than 80pc of the total global polio cases this year, with the crippling disease detected in areas that
had been polio-free as recently as the beginning of 2018. This is not the first time that lack of political
consensus with regard to the anti-polio efforts has been pointed out. But the present report has drawn
greater attention to the internal factionalism caused in large part by the prevailing brand of national
political discourse. It has also highlighted the extent of damage to whatever progress Pakistan had made
in it is anti-polio efforts over the years with the help of international donors.
In fact, deep political divisions are not specific to polio. Similar verbal sparring and blame games have
hampered attempts at dengue control in Punjab and KP, as they have in Karachi where even municipal
services such as garbage collection have been politicised. In addition, arbitrary bureaucratic changes and
the inertia that has beset the civil service after the last elections have contributed to the crisis in
provincial polio programmes. The fact that the polio programme, for all its flaws, has managed to
continue is a tribute to the efforts of our polio workers who have had to face hostility from misinformed
parents and threats to their lives by religious extremists.
The prevalence of polio was highest in 2014 when 306 cases were reported and the IMB had advised
Pakistanis travelling abroad to carry immunisation certificates. However, the government had managed
to restrict the active polio virus to a handful of locations in the country by 2018 and reduce the number
of cases to eight. With Prime Minister Imran Khan’s announcement to lead the vaccination drive himself,
the PTI-led government appears well-intentioned. But it has allowed its petty rhetoric and open
disregard for other political players to get in the way, leaving it with very little political capital to be able
to have a constructive dialogue even on an issue as apolitical as polio eradication. One hopes that the
government will reflect on the findings of the report so that it can lead a joint effort by all provincial
health authorities and politicians to work towards the eradication of a national and global health risk
affecting the future of millions of children.
Published in Dawn, November 21st, 2019
"Polio resurgence" by Dawn Editorial
ON Friday, Prime Minister Imran Khan inaugurated a three-day polio immunisation drive in the capital
city. Starting from Dec 16, approximately 39.6m children under the age of five will be administered anti-
polio drops by a 260,000-strong vaccination team. In a short speech, the prime minister noted that it
was a matter of “shame” for Pakistan to be one of only two countries in the world that still suffer from
outbreaks of the virus. He also honoured the memory of all those workers who had lost their lives in the
struggle to ensure a better future for the nation’s children. Despite the risk to their lives, vaccine teams
continue their duties on the ground, braving harsh winters and hostile terrains to reach their targets.
Not too long ago, it seemed like the country was on its way to joining the long list of nations that have
been declared polio-free over the years. In 2017, Pakistan recorded only eight new cases of polio, which
was a commendable achievement, considering thousands of new cases used to be registered in the
1990s. In 2018, that figure rose slightly to 12.
But 2019 has not been a good year for anti-polio efforts. There were a few instances of attacks on polio
teams, which led to the death of two security officials and one polio worker in April. The refusal rates
also remained high due to the malicious spread of disinformation about the vaccine on social and
mainstream media. And then last month, The Guardian’s investigation into Pakistan’s polio programme
resulted in the state minister of health admitting that there was indeed a re-emergence of the vaccine-
derived P2 virus in the population. He said that seven children had contracted this P2 strain of the polio
virus, which was believed to have been eradicated from the country five years ago. There are now more
than 100 new cases of the polio virus in the country, with over 70 of them in Khyber Pakhtunkhwa. In
the most recent instance, two cases from Sindh and one from KP have been detected. At this rate, it is
sad to note the likelihood of yet more polio cases as we prepare for the new year. Whatever the
challenges may be — and indeed, there are many — the polio eradication effort’s eventual failure or
success will rest on the shoulders of the current prime minister.
Published in Dawn, December 15th, 2019
Polio mess - https://www.dawn.com/news/1525228?ref=whatsapp

THE outgoing year has proved a devastating one for the anti-polio campaign. As 2019 progressed,
reports about the number of polio cases and the mismanagement of the campaign itself went from bad
to worse. At least 119 cases have been reported so far, making the previous year’s tally of 12 look
almost paltry by comparison. What is also unnerving are the reports of the large number of children
who were missed in the vaccination drives. Health authorities in Sindh have revealed that out of the 9m
children targeted in the recent polio drive earlier in the month, some 297,000 children were not
vaccinated against the crippling disease. The highest number of children who were not administered the
vaccine were from Larkana division, followed by Hyderabad division, Shaheed Benazirabad and then
Mirpurkhas. Though the number of children may not seem that high given the target of 9m, there are
reasons why the matter should still be of concern. The first is that polio officials in Sindh had claimed at
the conclusion of the immunisation drive that they had achieved ‘101pc coverage’. In fact, this puzzling
assertion was not limited to Sindh; even the Ministry of National Health Services claimed that 99pc
children under the age of five had been immunised across the country in the latest vaccination drive.
The other reason is the constant emergence of new polio cases from Sindh and KP, even in winter that is
usually seen as as the low-transmission season. Immunisation drives carried out in the colder months
are important for building up herd immunity in children, which is more difficult to achieve during the
summer. The fact that polio cases keep emerging is a sign that immunisation drives carried out earlier in
the year may also have missed their intended targets. The battle against polio is long and Pakistan has
just begun its struggle anew. Perhaps it is time to review our anti-polio efforts and make them more
transparent and credible for the collective benefit of millions of children across the country.
Published in Dawn, December 30th, 2019
"Polio workers" by Editorial

ONCE again, tragedy has followed Pakistan’s polio eradication efforts into the new year. This week, two
polio workers were gunned down in the line of duty in Swabi, KP. While one of the women workers died
immediately from the bullet wounds she sustained, the other succumbed to her injuries later in a
hospital in Peshawar. Last year, following the spread of harmful rumours about the polio vaccine’s
effects on children, several attacks were reported against polio workers. In Chaman, Balochistan, a
woman polio worker was shot dead, while her colleague was wounded. Before that, there was a knife
attack on a polio worker in Lahore by a parent who refused to have polio drops administered to his
child. That same year, two security officials who were guarding polio teams were killed in Buner and
Bannu. Meanwhile, a string of other attacks on polio vaccination teams were also reported from other
parts of Balochistan, Sindh and Punjab.
In the war against polio, Pakistan’s front-line workers continue to pay the price of a society teeming with
religious extremism, paranoia and disinformation around the vaccine. Such dangerous propaganda not
only endangered the lives of workers, but led to a massive spike in the number of refusals last year. As a
consequence, the total number of new cases reported in the country has been steadily increasing at a
time when other countries are close to being declared polio-free, or have long been declared polio-free.
In 2019, the number of new cases shot up to 140, which included several cases of the P2 virus that was
thought to have been eradicated. And yet, despite all the odds stacked against them in what often feels
like a losing battle, polio workers put their lives at risk every few months, with each new polio drive, for
a meagre pay. They not only come face to face with hostile populations, but also brave extreme weather
patterns and harsh terrains to ensure the vaccine reaches even the most isolated parts of the country.
World Food Day

By minà dowlatchahi Oct.16,2019
Hunger and malnutrition pose a profound challenge to the lives and livelihoods of more than 820 million
people around the globe, and the malnutrition epidemic is back on the rise. In South Asia, the
Prevalence of Undernourishment (PoU) was estimated to be as high as 14.9% in 2016-2018. In Pakistan,
the average incidence has only slightly reduced, by 3%, in the period 2004-2014, and remains at critical
levels, at around 20%, with about 40 million of its population undernourished today, with stark
variations across the country. For example, the PoU was estimated at 12% in Islamabad, 22% in Sindh
and 40% in Balochistan. The efforts aimed at reducing childhood stunting have had a more significant
impact, with the stunting rate decreasing from 43% to 37.6% in the period from 2012-2018. But 9.5
million children in Pakistan are still stunted today. By contrast, and this does seem a contradiction in
terms, the waistlines of men and women have been expanding in recent decades, and obesity is on the
rise in Pakistan, with nearly 8% (9 million) adults being obese.
Simply put, the world is facing a triple burden of malnutrition — from undernourishment, micronutrient
deficiencies (lack of vitamins and minerals) and from becoming overweight or obese. At the same time,
we are depleting our soils, oceans, forests and biodiversity, when agriculture systems are not
sustainable. In Pakistan, nearly half of the average caloric intake is derived from consumption of three
cereal crops — wheat, rice and maize.
The 2019 UN Report on the State of Food Security and Nutrition (SOFI) introduced a second indicator for
monitoring Zero Hunger SDG Target 2.1, the prevalence of moderate or severe food insecurity based on
the Food Insecurity Experience Scale (FIES). While severe food insecurity is associated with the concept
of hunger, which captures issues of food availability, people experiencing moderate food insecurity face
uncertainties about their ability to obtain food regularly because of issues of access and stability in
access, and have been forced to compromise on the quality and/or quantity of the food they consume
(utilisation), including how diversified their diet is. The prevalence of food insecurity is slightly higher for
women than for men, in all continents.
The poor and the rural poor in particular are, therefore, more vulnerable to economic downturns.
Recent analysis tends to show the strong relationship between poverty and food insecurity, in both
urban and rural areas, and more so in rural areas. But income alone is not the only determinant to
improve food security, where a smaller household size seems another important variable.
Pakistan has achieved an uninterrupted and significant poverty reduction since 2004. Between 2004 and
2016 the incidence of poverty was halved, from 52% to 24%, nationally. The urban areas have registered
a far larger reduction in incidence of poverty (66%) than rural areas 47%. Still, 39% of Pakistan’s
population is multi-dimensionally poor. However, the close linkages of and nexus between poverty and
food insecurity in Pakistan still need to be explored and fully understood. The new data on Pakistan FIES
and poverty that the Pakistan Bureau of Statistics will soon be releasing will allow more in-depth
analysis.
Most of Pakistan’s poor are in the rural areas, with multi-dimensional rural poverty at 55% and urban at
9%. Smallholder men and women farmers can learn how to adopt safe and climate resilient agriculture
and livestock practices, kitchen gardening and how to reduce post-harvest losses. This will increase their
incomes and provide more diverse food availability at their household. They quickly gain awareness of
the importance of breastfeeding newborns, of a diversified diet that includes milk, eggs, vegetables,
fruits and pulses on a regular basis, of basic hygiene and safe drinking water. Social protection,
incentivising nutritious school feeding and school attendance are also critical for food security and
nutrition for these men and women and their families, especially during economic slowdowns, and to
break the poverty and food insecurity cycle. This is a Zero Hunger programme that can improve food
security and nutrition and help pave the way towards poverty eradication. Solutions are there. We need
action — our actions are our future.
Published in The Express Tribune, October 16th , 2019.
Mental health anxieties
I.A. Rehman | October 17, 2019
THIS year, World Mental Health Day (Oct 10), with the focus on ‘preventing suicides’, received more
attention in Pakistan than in the past, and what leading psychiatrists said at various events increased
public anxiety at the scale of mental health problems in the country.
A Peshawar gathering was told that over 34 per cent of Pakistanis suffer from anxiety, and that the
incidence of mental health problems is increasing day by day. The psychiatrists attending the meeting
said the incidence of suicide in KP was increasing, with the highest number of cases being reported from
Chitral.
The struggle to have Section 325 (which says attempting suicide is a criminal offence, punishable with
imprisonment) deleted from the Pakistan Penal Code is worth recalling. In 2017, a bill was moved in the
Senate for omitting Section 325 from the PPC. The reason offered was that suicide indicated an extreme
form of depression, and that those who attempted but failed to take their own lives deserved treatment
and not punishment. The bill was adopted by the Senate but it lapsed as it was not passed by the
National Assembly before it was dissolved. There was near-consensus among the audience on the
renewal of efforts to decriminalise suicide attempts. In view of the resistance from the conservative
lobby the passage of a new bill may not be easy but the attempt to push it through should still be in
order.
The experts found that 71 per cent of the people who decided to end their lives suffered from
depression, 12pc from anxiety, 11pc from behavioural problems, 2pc from bereavement, another 2pc
from eating disorders, 1pc had suffered sexual abuse, while 1pc of the cases could not be diagnosed.
Since all of these risk factors are increasing in Pakistan and threats to security of life are growing, the
rate of suicide is bound to rise.
According to a 2018 report by WHO, the suicide mortality rate (that is, suicides per 100,000 deaths) in
Pakistan in 2016 was 2.9, while it was 16.3 in India, 15.3 in the US, 15.6 in Austria, 12.5 in Canada, 12.8
in Denmark, 15.9 in Finland, 17.7 in France, 13.6 in Germany, 16.5 in Japan, 11.6 in South Africa, 8.9 in
the UK, and 26.9 in South Korea. This reveals among other things a more factual reporting of suicides by
developed countries than by developing states
Experts agree that reports on suicides in Pakistan are not reliable; on the one hand, suicides are
underreported, and on the other, many murders, especially of women, are wrongfully put down as
suicides. Even then, the latest figure for the suicide rate in Pakistan is 7.5, more than twice the 2016
figure, and the conclusion is obvious.
Describing suicide prevention as a global imperative, the WHO member states in 2013 committed
themselves to reducing suicide rates by 10pc by 2020. While drawing up the Sustainable Development
Goals, the United Nations perhaps chose to be realistic and only called for the promotion of mental
health as one of the targets to be achieved under SDG 3 to ensure healthy lives and promote well-being
for all.
SDG 3, even with a vague target with respect to mental health, poses a daunting challenge to Pakistan.
With its total allocation of less than 1pc of GDP for health, and mental health receiving a tiny bit of this
allocation, the prospects for a significant improvement in mental health care are quite bleak.
The latest studies say that the annual shortfall in funds needed for the SDGs the world over is estimated
at $2.6 trillion. In view of the acute economic crises it faces, and its long tradition of giving health low
priority, the government of Pakistan is unlikely to be able to seriously address mental health issues.
Under these circumstances, the organisations of psychiatrists in the country and their allies in civil
society will have to seek increasing support from philanthropic associations and public-spirited citizens
to raise the level of mental health in the country.
Considerable help can be received from the research done in various parts of the world on the specific
causes of mental illnesses that include poverty, unemployment, feeling of social failure, poor nutrition,
the plight of abandoned children, reliance on witchcraft or religiously inspired ‘exorcism’ of ‘evil spirits’,
the stigmatising of mental illness, exposure to violence at workplace (sexual harassment, bullying, rude
behaviour, physical or even verbal aggression and threats to one’s physical/ mental integrity), and the
alienation of members of a family from one another. The level of mental health should improve if we
start caring for every other human being and don’t leave him or her to drift from frustration to mental
illness.
‘Triple burden’
IN an alarming report on the state of global child nutrition, Unicef has declared that at least one half of
the world’s children under the age of five are victims of ‘hidden hunger’. This means that essential
vitamins and minerals are missing from their diet. The report also highlights that at least one-third of the
world’s under-five population is either undernourished or overweight — obesity rates are surging in the
developing world — leading to lifelong health problems. Moreover, out of the total 700m children in the
world, at least 149m are stunted: because of nutritional deficiencies, they are shorter than what is
normal for their age, and their brain and bodily functions may also be affected. Another 50m suffer from
wasting. The report collectively calls the three aspects of malnutrition a “triple burden —
undernutrition, lack of critical micronutrients, obesity”.
The report is a wakeup call for Pakistan which is among the seven countries that make up two-thirds of
the global undernourished population. According to the 2018 National Nutrition Survey, four out of 10
children in Pakistan under the age of five are stunted. This is the third highest statistic in the world.
Moreover, nearly 18pc suffer from wasting while almost 30pc are undernourished. Unfortunately,
Pakistan also has the worst mortality rate in the world, while the maternal mortality rate remains one of
the highest in the region.
Investment in early childhood development will result in concrete rewards as those who benefit will go
on to become part of a productive workforce that will act as a powerhouse for development by boosting
economic and social growth.
Exorbitant prices of drugs

By editorial Oct.24,2019
The most strange thing about fake and exorbitantly priced medicines is that even those engaged in
these practices don’t like them. In Multan on Oct 21, shopkeepers in a medicine market were caught
charging exorbitant prices for life-saving drugs. The Drug Regulatory Authority of Pakistan has
confiscated stocks of overpriced medicines in different cities during an ongoing countrywide crackdown.
A team of drug inspectors raided a market in Multan and seized stocks of overpriced medicines. The
team found horrible levels of profiteering in the market. A packet of a blood pressure medicine was
being sold for Rs1,200 instead of Rs170; another medicine for blood pressure was being sold for Rs1,900
against the normal price of Rs457. Another medicine normally priced at Rs62 was being sold for Rs1,350.
The profit margin was as high as 1,500 per cent. Speaking the other day in Islamabad at the opening
ceremony of a training course for drug inspectors, Special Assistant to the Prime Minister on Health Dr
Zafar Mirza said a crackdown against those engaged in unauthorised increase in prices of medicines had
been launched and those involved in the trade of fake medicines and unauthorised increase in prices of
medicines would be dealt with an iron hand. He said the government would soon introduce the first
national medicine policy to resolve issues relating to manufacturing of medicines. The training course for
drug inspectors is being held as per standards of the World Health Organisation. The WHO wants every
country to bring its regulatory authority on a par with the international standards to improve the
process of manufacturing of medicines. Dr Mirza has regularly been drawing the attention of the public
and their representatives to the inadequacies of our healthcare sector and what needs to be done to
overcome these issues. Spurious medicines and exorbitant prices of medicines are issues of utmost
importance.
"Racket of selling expired medicine" by Editorial
- https://tribune.com.pk/story/2101473/6-racket-selling-expired-medicine/?amp=1
We often get to hear the lecture that a poor diet is associated with major health risks that can cause
illness and even death. But spare a though about poor medicine! If served to the infirm, it can prove
infinitely more perilous. Selling expired medicines to the unsuspecting patients or their caregivers is a
crime that many rapacious profit-seekers indulge in. One such racket has come to light recently
following an investigation carried out by Drug Regulatory Authority of Pakistan (Drap). The inquiry has
found that drugs past their sell by date were being sold at the medical store of a well-known public
hospital in the federal capital. According to the report, though the manufacturing and expiry dates of
some medicines were changed the batch numbers showed that the drugs were expired.
A senior official of the drugs watchdog informed an English-language newspaper that there was an old
case in which a patient had claimed that expired medicines were given to him at the private hospital
almost a decade back and since then he had approached different forums, including the Pakistan
Medical and Dental Council (PMDC), to get relief. Federal Investigation Agency (FIA) also opened an
investigation into the case. “As the matter finally came to us we sent an inspector to the hospital to look
into it. Though it could not be confirmed that expired medicines were given to the patient as it was an
old case, it was revealed that even after 2015 the hospital had purchased medicines with bogus
receipts,” the official said.
The peril of selling drugs beyond their shelf-life is two-fold, as explained by an office-bearer of Pakistan
Pharmacists Association. In some cases such medicines become ineffective and stop curing the patients.
However, in some cases the active ingredients start showing negative effects due to which a number of
health complications can occur. It is unfair with the patients because they purchase medicines to treat
their diseases but end up with more complications. Indeed, it is sickening to learn that some
unscrupulous elements could stoop so low to play with the life of fellow citizens.
Published in The Express Tribune, November 18th, 2019.
Like Opinion & Editorial on Facebook, follow @ETOpEd on Twitter to receive all updates on all our daily
pieces.
A life worth living
Saadia Waheed | October 25, 2019
The writer is an advocate for persons with disability.
OCTOBER is Down Syndrome Awareness Month. For me, as a mother of two children with DS, this
month represents an opportunity to change mindsets, educate, advocate, celebrate and encourage
acceptance of my children and all who are like them.
Everyone wants to be valued, to be loved, to belong — it’s what makes us human. One’s possessions,
abilities or appearance have nothing to do with one’s true worth. This is exactly how individuals with DS
should be made to feel. Raising awareness is the first of many steps to creating an inclusive, non-
judgemental, accepting world. DS occurs when a person has three, rather than two, copies of the 21st
chromosome. Individuals with DS can have mild-to-moderate intellectual and cognitive disabilities, along
with delayed developmental milestones. They may have distinct physical features that include almond-
shaped eyes, relatively small stature and low muscle tone. They are at an increased risk of medical
complications like congenital heart defects, hearing and vision problems, and endocrine and
autoimmune conditions. Both our children spent several weeks in the neonatal intensive care unit after
birth due to congenital heart defects.
DS is a chromosomal, not hereditary, disorder that happens by chance and at random. It can happen to
anybody, yet the child’s diagnosis is often blamed on parents. Mothers are often stigmatised for giving
birth to a so-called ‘abnormal’ child. For Muslims, it is a particularly regressive mindset as our faith
dictates that everything is by the decree of Allah and He does as He pleases. There is perfection in each
one of His creations, and that is how we see our children.
Communication is an essential part of human interaction and despite their inborn drive to communicate,
children with DS often have physical and cognitive characteristics making speech and language
difficulties more likely, which can sometimes lead to frustration. Sign language is especially useful for
communicating their needs before they start talking.
People with Down syndrome can lead fulfilling lives.
People with DS are capable of leading fulfilling lives if provided proper early childhood intervention in
schools and homes. Our children receive physical, speech and occupational therapy regularly, which
enabled them to be more independent. Parents have to be their child’s best advocate and fight for their
right to an inclusive education in mainstream schools and in extracurricular activities like sports, etc.
Inclusion means embracing everyone by not excluding anyone on the basis of disability. In schools, it is
the first step to instilling in children an appreciation for each other’s differences. Modifications and
accommodations in curricula and environment can enable children with disabilities to study in
mainstream schools. Our children are part of an inclusive classroom that allows general education
teachers to work alongside special education teachers to meet all students’ needs. Inclusive education
benefits all students as they learn to appreciate values of empathy, caring and community.
As parents of children with special needs, our goal is to create a less restrictive and more accessible
environment. Mundane things that most families take for granted are cherished in our home. The
constant struggle for our children’s inclusion is our toughest battle. If all parents remember that there is
beauty in our differences and everyone is born with a purpose, the battle for special needs parents
becomes easier.
To parents who have a child with DS, I would advise you to walk into the future with hope, not with fear.
The first few years are tough, but things start looking brighter as you see your child progress and achieve
their goals in their own way, at their own pace. Understand that they may take longer, but they will get
there. There is no doubt that parenting children with
DS has its unique challenges. But by diligent planning and working together as a society, these
challenges can be turned into opportunities to seek goodness in this world and the hereafter. We find
joy and satisfaction in knowing that each accomplishment, however small it may look to others, is a
major victory. Know that each of your child’s achievements is at least partly your own.
Every day we make choices. Let’s make a choice to be kind, to show empathy and to spread love. There
is a dire need to spread the message of love and eliminate all forms of discrimination by appreciating
others around us who may be different. When you see a person with disability, remember to look at
their strength, the hardships that shaped them and their perseverance instead of making them
uncomfortable by staring and whispering. People with DS can read, write, attend school and college,
work and pursue jobs in something they enjoy. They can lead happy, fulfilling lives.
So, the next time you see someone with DS, walk up and start a conversation. Instant inspiration is
guaranteed — and you can thank me later!
Renal database
THE launching of the Pakistan Renal Data System by the Pakistan Society of Nephrology is a milestone in
our attempts to assess the prevalence of chronic kidney diseases in the country. With this registry,
clinical information will be collected from private and public hospitals across the country to make it
easier for researchers and medical practitioners to spot and identify the causes of renal failure. It will
also enable them to review patient demographics, and enhance the scope of local and clinical research
on the subject. For many developing countries, including Pakistan, the challenge in countering various
illnesses often stems from the lack of locally available clinical information due to which health
practitioners have to rely on international databases that often overlook region-specific dimensions of
an endemic disease.
According to the Pakistan Medical Association, around 20,000 people die of kidney problems every year
in Pakistan. With about 20m affected individuals, the country is said to rank eighth in the world with
regard to the prevalence of chronic renal ailments. Besides helping improve research, this registry will
also help pinpoint problems in renal therapy including dialysis and transplant. Data collected so far by
the PKRDS has already provided greater insight into the subpar dialysis standards in Punjab. It seems
that almost half the 1,500 patients registered with this portal contracted hepatitis C within three months
of starting dialysis. With time, and some help from the government, this registry can also function as a
centralised network for dialysis and kidney transplant patients, enabling online registration for dialysis
sessions and the listing of potential donors. Taking its cue from this initiative, the government can
coordinate with health institutions to launch similar directories of other serious ailments, such as cancer
and HIV/AIDS, to help expand research on disease prevalence. Such initiatives will make it easier for the
government to plan and execute targeted interventions to manage chronic illnesses, as well as seasonal
disease outbreaks such as dengue.
Fungus among us
IT is bright yellow and has 720 sexes (imagine the preferred pronouns for that, if you will). It has no
nervous system or brain but yet is capable of solving problems like navigating through a maze (thanks to
algorithms embedded in its biochemistry) and it can learn from experience and also transmit that
knowledge. If it merges with another of its species, the newly formed creature possesses the knowledge
of both halves.
It also has no stomach, eyes or mouth but can seek out and digest its favourite food which, you’ll be glad
to know, isn’t human flesh but oatmeal. You’ll also be relieved to hear that its maximum speed is about
four centimetres an hour so if this creature changes its mind regarding its diet there’s a good chance
you’ll be able to run away.
Oh, and did I mention that it is also functionally immortal? The only things it doesn’t like are light and
drought but in the worst-case scenario it can just go to sleep for a few years or even decades and wake
up once the danger has passed.
It has no stomach, eyes or mouth but can seek out and digest its favourite food.
Because this sounds like something out of a science fiction movie, the people at the Paris zoological park
where this creature is exhibited are calling it ‘the blob’ in a nod to the classic 1950s horror movie,
though its actual name, which translates to ‘the many-headed slime’, may be even cooler. While
scientists admit that they ‘don’t actually know what it is’ they are pretty sure it’s not an animal or a
plant, but may well be some form of fungus.
If so, it belongs to a truly ancient family; in 2014, scientists digging in the Canadian arctic found a billion-
year-old fossil of a fungus they named Ourasphaira giraldae. When thinking about the implications of its
age, please note that the first dinosaurs only appeared a mere 270 million years ago and that this
discovery basically upends everything we thought we knew about how life on earth evolved.
Until now we thought that fungi and plants acted mostly together to colonise the surface of the earth,
but given that the oldest plant fossils only date back some 470m years, this means that the fungi were
first. This, in turn, means that animals (closely linked to fungi in the ‘tree of life’) may also have
appeared on earth far earlier than we imagined.
While we are familiar with the descendants of this ancient fungus: mould, yeasts and mushrooms (magic
and otherwise), it may come as a surprise that it is also related to the largest living organism in the
world. No, that’s not the blue whale but is in fact the Armillaria ostoyae, which is also appropriately
dubbed the ‘humongous fungus’. Humongous because not only does it weigh over 400 tons, this single
organism covers about 2,385 acres in Oregon’s Malheur National Forest.
That’s close to four square kilometres, a size a little larger than Male, the capital city of the Maldives and
it was alive and kicking around the time Socrates was born. It, and other giant fungi (yes, there are quite
a few … that we know of) live largely underground, and feed and multiply by literally sucking the life out
of the trees in the forests where they live and planting their spores in the rotting husks.
If you think that’s rather unpleasant, then you haven’t met the downright evil Ophiocordyceps
unilateralis, the zombie-ant fungus. This sinister ’shroom not only invades ants’ cells but also creates its
own linked networks inside the ants’ body, killing its neurons and forcing it to move and act according to
the fungus’ wishes.
These franken-ants then find an appropriate plant and sink their jaws into the leaves at the precise
height dictated by these body-snatching fungi and wait there while the fungal stalks sprout out of its
body to rain down spores on other, unsuspecting ants. Nature certainly does give off serial killer vibes
sometimes.
And if that is not mind-blowing enough, did you know that fungi can also act like an internet for plants?
Known as the ‘fungal internet’ or the “wood wide web’, this is an interlinked underground network of
fungi that actually helps plants communicate and exchange not just nutrients but information as well.
For example, if a tomato plant at one end of the network is attacked by aphids or a disease, tomato
plants at the other end of the mycorrhizal network learn about it and implement countermeasures
making themselves less susceptible to the infestation.
How far do these networks span? We don’t know for sure but they may well be continent-wide in some
cases — an underground brain with potential beyond what we can currently imagine. Indeed, the more
we learn, the less we know about how to define ‘life’ itself, let alone sentience. Think about that the
next time you’re enjoying your cream of mushroom soup.
The writer is a journalist.
Twitter: @zarrarkhuhro
Published in Dawn, October 28th, 2019
"Hospitality & medicine " by Mohsin Fareed

IN today’s healthcare industry, the distinction between objects and human beings has become
increasingly blurred. The tendency to see the patient as an object rather than a living person is almost
universal. As with other modern-day businesses, the medical profession too is incorporating market-
based, scientific or bureaucratic terminology. Money has become the central motive in every aspect of
the contemporary healthcare system.
Our unconsciously biased belief system regarding the nomenclature of those who are sick and those
taking care of the sick (clinicians) has created a multi-dimensional framework comprising four important
domains.
The first domain is purely scientific, termed as an ‘object-observer relationship’. It depicts clinicians as
objective scientists and the sick as material bodies for experimentation by way of examination,
investigation, diagnoses and cure. This model expects patients to see themselves as objects to be
studied or treated.
It is an approach that distances the patients from their living experience and depersonalises them,
turning them into objects for testing a hypothesis. The problem with this model is that it ignores the
healing aspects of the science of medicine and projects it as a mechanism of cause, effect and
intervention.
Physicians must humbly ‘incline’ towards their patients.
The second domain is of the economic type, termed the ‘buyer-seller relationship’. In this model, the
physician’s role is that of a provider and the patient’s of a customer. While the patient is considered a
buyer of health and healing apparatus, the clinician is a seller of expert knowledge and techniques.
Though economic considerations are crucial for the success of medicine, this model should not be a
basis for the patient-clinician relationship because illness and healing are elements of the human
experience that should not be for sale. The patient-clinician relationship must remain a bond based on
dependence and mutual trust, with finances always the secondary factor. For healing to flourish, the
patient-clinician relationship needs to be shielded from economic tenability as a primary motivation.
The third force driving the doctor-patient relationship is bureaucratic, referred to as a ‘user-manager
relationship’ where clinicians are health managers and administrators in institutionalised healthcare and
patients are end users. Physicians have designated technological requirements, eg spending more time
in front of computer screens and filling out paperwork than in looking, talking, touching or analysing the
patient. Patients are regarded as itemised boxes to be checked and completed. While the organisational
dimension of care is essential considering the socioeconomic complexities of modern medicine, it also
threatens the humane connection in the healing encounter.
In contrast to the impersonal forces, there is a fourth dimension largely framed by the practice of
hospitality. In the context of illness, hospitality is an individual and collective practice in which the
unwell stranger is graciously received by all components of the healthcare delivery system. It is regarded
as a ‘guest-host relationship’. Among the taxonomy of patient-clinician models, hospitality stands out
because it combines characteristics that are authoritarian, patient-centred and mutually interactive.
From the enriched perspective of hospitality, patients are considered predominantly as subjects and not
objects. The clinical encounter establishes a personal rather than impersonal relationship.
The word ‘clinician’ is derived from the Greek word ‘Kline’, meaning bed, denoting the one who attends
at the bedside. The verb associated with clinician is ‘klino’ translated as to ‘incline’, ‘bend’ or ‘bow’.
Serious illness is distressing, yet the hospitality aspect of a ‘guest-host relationship’ creates a sacred
space of human love with mysterious healing powers.
Human suffering is not something that can be entirely fixed with money or more rigorous bureaucratic
measures. The foundations of healing need to be applied to modern medicine so as to engage both the
physical and spiritual needs of the patient. If physicians collectively understood their identity as those
who humbly ‘incline’ towards their patients, healthcare would have been transformed.
The transition to hospitality is a re-emerging phenomenon in modern medicine. Hospitals and medical
professionals need to be more receptive to the need for inculcating a humane, friendly and hospitable
culture in healthcare.
A spiritual relationship is more important than all the money or technology we might spend on illness.
While the medical profession is looking towards wider disciplines that help cure the seemingly incurable,
it is worth exploring these perennial concepts that invite us to look deeper into the interaction of curing,
caring and healing.
The writer is a Harvard graduate.
Twitter: @mohsinfareed
"Battle against diabetes" by Dawn Editorial
THE battle against diabetes is one that the world has not been able to come to grips with. An estimated
463m people globally are afflicted with the chronic condition (up to 90pc of them with type 2 diabetes);
that is 38m more than were living with it in 2017. These figures by the International Diabetes
Federation, released on Nov 14 — World Diabetes Day — also contain alarming news for Pakistan.
According to the report, we figure among the top 10 countries for absolute increase in diabetes
prevalence, with over 19m people suffering from the disease. Of these, some 8.5m are undiagnosed,
which makes them even more susceptible to the life-threatening health issues that diabetes can lead to
if not managed properly, including heart disease, stroke, kidney failure, blindness, lower limb
amputation, etc.
Diabetes is known, for good reason, as a silent killer. It can sneak up on an individual without presenting
any, or very mild, symptoms; public awareness about its innocuous onset is thus imperative to facilitate
early detection. Our already creaking public health infrastructure is now dealing with the added burden
of a condition that is the gateway to serious complications. It is also equally important for people to
realise that unlike type 1, type 2 diabetes is preventable, even though some individuals may be
genetically predisposed to it. A healthy lifestyle, in which exercise and a balanced diet play an important
role, can help stave off this condition or at least help ameliorate its most debilitating effects.
Unfortunately, however, in our part of the world, the tendency is towards a sedentary existence where
maintaining one’s weight within reasonable, prescribed limits goes against the cultural pattern. That, as
the numbers show, has proven to be a recipe for disaster. As per the IDF report, diabetes prevalence in
Pakistan has touched 17.1pc, an astounding 148pc higher than what was previously reported. Public and
private health facilities must be proactive in dealing with this distressing state of affairs by raising
awareness and early testing.
Countrywide dengue cases nearing 50,000
ISLAMABAD: Dengue outbreak has set a new record with the number of reported cases surging to
49,587 in the country during the current year, taking a leap of over 5,000 cases in less than two weeks.
It’s nearly double of the maximum number of Pakistanis infected with dengue in a year over the past
decade, as prev iously the highest number of cases was reported eight years ago. In 2011, 27,000 people
had been infected with dengue.
However, the previous death toll was 370, over four times of this year’s 79 mortalities.
Explaining major reasons for the surge in number of reported cases this year, the spokesperson for the
Ministry of National Health Services (NHS), Sajid Shah, said: “This year unprecedented number of
dengue cases has been reported across the globe. Besides, the mechanism of recording the cases has
improved across the country.”
Pakistan’s statistics are much better than other countries, says NHS spokesperson
According to a document available with Dawn, during the current year 49,587 cases of dengue have
been confirmed from across the country. As many as 13,173 cases were reported from Islamabad,
13,251 from Sindh, 9,855 from Punjab, 7,776 from Khyber Pakhtunkhwa and 3,217 cases from
Balochistan. Besides, 1,690 cases were reported from Azad Jammu and Kashmir while 625 cases were
placed in the ‘other’ category. The ‘other’ category indicates the cases whose origin could not be found.
No death was reported from Khyber Pakhtunkhwa and Gilgit-Baltistan while as many as 22 dengue
patients died in the federal capital. Of the remaining 57 cases, 33 persons died in the province of Sindh,
20 in Punjab, three in Balochistan and one died in AJK.
Mr Shah explained the World Health Organisation had included dengue in the top 10 global public
health threats to the world. This year, he said, 371,717 dengue cases and 1,407 deaths had been
reported in the Philippines till Nov 5. In Sri Lanka, 234,078 cases and over 100 deaths had been reported
till Oct 23. Similarly, 146,000 cases and 89 deaths in Thailand, 124,751 cases and 15 deaths in Vietnam,
104,950 cases and 204 deaths in Malaysia, 122,136 cases and 104 deaths had been reported in
Bangladesh till the second week of October, he said.
Sharing Pan American Health Organisation data, Mr Shah said 2.07 million cases and 702 deaths had
been confirmed in Brazil, 213,822 cases and 108 deaths in Mexico, 157,573 cases and 26 deaths in
Nicaragua, 106,066 cases and 74 deaths in Colombia, and 96,379 cases and 156 deaths had been
reported in Honduras till Nov 14.
“It is for the first time in the history of Pakistan that Emergency Operation Centre (EOC) has been
activated at the National Institute of Health for dengue outbreak. Our statistics are much better than
other countries, but our task is not over. Based on recent experience, we will develop a comprehensive
multisectoral national action plan in coordination with the provinces and will defeat dengue within the
next few years,” Mr Shah claimed.
Dengue is spread by the mosquito bite and patients face deficiency of platelets due to which transfusion
of platelets is required as patient’s blood does not have the normal clotting ability. If timely treatment is
not provided, the disease may turn into life-threatening dengue hemorrhagic fever. Fever may lead to
bleeding, low levels of platelets and blood plasma leakage, or into dengue shock syndrome– a
dangerously low blood pressure.
Pakistan has experienced many dengue outbreaks since the first outbreak in 1994. During the past two
decades, two major outbreaks were reported in the country. In 2005, over 6,000 cases with 52 deaths
were reported from Karachi, while in 2011, more than 21,000 cases were reported from Lahore only
with 350 deaths. Between 2011 and 2014 more than 48,000 confirmed cases of dengue were reported
from across the country.
"Resistant bugs" by Editorial
FOR some years now, the irrational use of antibiotics across the world, including in this country, has
emerged as a major health crisis. To highlight this concern, events have been held this past week to
mark World Antibiotic Awareness Week — observed from Nov 18 to Nov 24. The theme this year is, ‘the
future of antibiotics depends on us all’. According to WHO, around 700,000 people die globally every
year because the overuse of antibiotics has made common bacterial illnesses more difficult to treat, and
regular lifesaving medical procedures such as C-sections and hip replacements riskier to perform. WHO
has termed antimicrobial resistance a global health crisis that could cause 10m deaths across the world
by the year 2050.
Though increased resistance to antibiotics has emerged across countries of all income levels, the
challenges are far greater for states such as Pakistan. Health experts have raised the alarm that with the
increased use of antibiotics, consumed with or without prescription, a number of infectious diseases
including tuberculosis, food-borne conditions and pneumonia are not only getting harder but almost
impossible to treat. These illnesses are already rampant in Pakistan, which, unfortunately, also has the
highest rate of neonatal deaths in the world while the maternal mortality rate remains the highest
regionally. According to the World Economic Forum’s Global Risk Report of 2013, more than 70pc of the
infections among newborns in Pakistan are caused by antibiotic-resistant bacteria. Last year, the US
Centres for Disease Control and Prevention issued a warning that Pakistan could export the XDR typhoid
fever — an extensively drug-resistant strain of the illness — believed to have emerged as a result of the
overuse of antibiotics in the country. In this regard, the Sindh government, earlier this month,
introduced a vaccine for schoolchildren hoping to reduce the prevalence of XDR typhoid that has
become endemic in many parts of the province. However, stronger measures are needed such as
improving sanitation, cracking down on unqualified doctors and checking over-the-counter sales of
antibiotics. Moreover, the widespread use of antibiotics in poultry and cattle farming, and agriculture,
also compounds the problem. The federal health ministry had devised a national action plan in
collaboration with WHO to curb the overuse of antibiotics; however, so far, there has been no
implementation of this due to lack of resources. The authorities need to review the situation before
another superbug emerges as a global health risk, posing a threat to lives in and outside Pakistan.
Published in Dawn, November 22nd, 2019
"Medical ethics" by Najib ul Haq
THERE is an alarming tendency in Pakistan to disclose the day-to-day health conditions and treatment of
‘important patients’. This is in complete violation of basic medical ethics. It is unfortunate that both the
politicians and medical professionals are part of this disturbing trend, as we have seen of late.
In the field of healthcare, medical professionals are obligated to abide by a set of basic, universally
acknowledged principles of medical ethics. These include autonomy, beneficence and non-maleficence,
justice and confidentiality.
The history of patient confidentiality dates as far back as ancient Greece and is attributed to Hippocrates
— hence, it is known as the Hippocratic Oath. It is a pledge that all doctors are meant to uphold, and
declares: “What I may see or hear in the course of the treatment or even outside of the treatment in
regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding
such things shameful to be spoken about.”
It is on the basis of these ethical standards that trust is formed between patients and their doctors, the
former comfortable with the understanding that the information they provide shall be kept confidential.
The breach of patient confidentiality in high-profile cases is an alarming trend.
This trust is crucial to disclosing required information by patients for appropriate medical treatment. The
lack or loss of this trust leads to non-disclosure or incomplete disclosure of information by patients,
which can seriously jeopardise the management of patients’ treatment.
Confidentiality is defined as “the state of keeping or being kept secret or private”, while medical
confidentiality is defined as the “non-disclosure of the private information of a patients to another
person”.
The substantive rule of bioethics is that the information a patient reveals to a healthcare provider is
private, and that there are limits on how and when such information can be disclosed to a third party,
and that this may only be done with the express permission of the patient. It is normally allowed only to
those who need to know about a patient’s condition for medical purposes.
In routine hospital practice, many individuals have access to patients’ medical data, but all are enjoined
to keep such information, including patients’ medical records, confidential. In fact, confidentiality should
be maintained even if a patient dies.
Patients provide various kinds of important information to their healthcare providers, including
particularly personal information. There is an implicit understanding that any information disclosed by a
patient during the course of the patient-physician relationship will be kept confidential by the physician
to the greatest possible degree.
Any breach of this trust will seriously affect the patient’s attitude in providing further information to the
doctor that might prove necessary for making the correct diagnosis and planning appropriate treatment.
Thus, it may adversely affect patient care. The same is true for any investigation carried out in the
process of making a diagnosis.
Confidentiality is an extremely important right of the patient and a primary ethical responsibility of
healthcare providers. Patients’ information can only be revealed in certain situations, but even in such
situations, it is always preferable that the information is disclosed with the consent of the patient.
In rare cases, confidentiality may be breached when required by the prevailing law, or the need to
protect the life of an individual, or when there is a serious threat to the public. Medicine and law do not
always work in harmony, however, and one of the most common sources of conflict between these two
arise on the issue of medical confidentiality. Disclosures may also have important social implications,
which must be considered.
From the point of view of religion too a breach of confidentially is frowned upon. For instance, according
to Islamic principles, matters discussed in private meetings are confidential and must not be disclosed
beyond that meeting. Again, certain tenets may permit a breach of confidentiality, but only to the
concerned parties and for specific reasons.
Talking to the media about any information of a patient’s clinical condition or their investigation is
against medical ethics and may have serious medical and social implications for not only that patient but
also anyone else who seeks healthcare services.
It is imperative that all political workers and medical professionals take care to uphold the principle of
confidentiality. Combining medicine and politics may have serious short- and long-term implications for
society at large. Consider that we are still living with the awful consequences of a vaccination campaign
being used for political purposes a few years ago — it seriously jeopardised all efforts to eradicate polio
from Pakistan.
The writer is dean of faculty of health sciences at Peshawar Medical College.
"Women doctors" by Dawn Editorial
A REPORT in this paper has shed light on a new initiative which will attempt to bring 35,000 non-
practising women doctors back into the field through the innovative use of technology. Launched by the
Dow University of Health Sciences last year, the eDoctor programme has so far recruited 700 women
medics in its training sessions. Many of these women left or were made to leave their careers many
years ago and now have adult children. The programme offers them re-training courses that will update
their expertise and knowledge of the medical field and enable them to practise once more. The problem
of women doctors not continuing to work after graduation, marriage or motherhood has been a long-
standing issue in our society, and written about countless times before. But there are also many men
who leave the country to practise their profession in other lands. Unfortunately, and partly due to the
brain drain and large number of non-practising doctors, Pakistan has one of the world’s lowest doctor-
to-patient ratios. It takes many years to create a doctor, and the amount of time and money that go into
producing the nation’s healthcare providers are seen as a waste of resources if the medics are not in
position to tend to the sick.
While the concept behind eDoctor is certainly inventive and well-intentioned, and hopefully will achieve
what it aims to do — deliver important medical services to the needy segments of society, while
providing employment to women — there is the question of its outreach and how effective and
sustainable it will be. But there is another, deeper malaise that needs to be addressed too, and that is
not related to technological advancement: why do so many Pakistani families disallow women from
having a career after marriage? It is unfortunate that even in this day and age, the Pakistani woman’s
role is restricted to the confines of the home — regardless of how educated she is, or her potential to
contribute meaningfully to society.
"World AIDS Day" by Dawn Editorial
AS Pakistan braces for a potential HIV/AIDS outbreak for the second time this year, countries around the
world are observing World AIDS Day today to acknowledge the role of communities in dealing with and
controlling the spread of the deadly virus. However, this day should be a sobering moment for the
country’s health authorities who keep grappling with an increasing number of HIV/AIDS cases even in
the midst of a global decline. After a severe HIV outbreak in May in Ratodero, Sindh, where many of
those infected were small children, a significant number of HIV-positive cases have emerged in about 20
Punjab districts. According to official documents, almost 320 suspected cases of HIV/AIDS surfaced in
these districts including Attock, Lahore and Multan, in October alone. To add to the sudden upsurge in
HIV-positive cases, internal rifts within the Punjab AIDS Control Programme have sparked a series of
resignations. With four key officials gone, the programme may almost be on the verge of closure.
Despite the PACP crisis, the blame for the uptick in HIV cases must not be heaped on AIDS initiatives
alone. The problem is part of a larger malaise that ails Pakistan’s healthcare system. Social taboos,
unqualified doctors and unsafe sexual and medical practices, including the reuse of syringes, sharing of
needles by drug users, inadequate screening of blood donors, and contaminated surgical and dialysis
equipment, have all contributed to Pakistan’s place among the 11 countries with the highest prevalence
of HIV/AIDS. As of 2018, there were more than 160,000 HIV-positive people in Pakistan, according to
UNAIDS, while the number of AIDS-related deaths has increased by 369pc since 2010.
Popular narrative holds that drug users, male, female and transgender commercial sex workers and
prisoners are most at risk of being infected. Also, a number of migrant workers, having acquired the
virus because of risky sexual activity, infect their unsuspecting spouses upon their return. However, the
outbreaks in Sargodha (2018) and Ratodero have shown that unsafe medical practices are just as likely
to infect the general population. In both places, the reason for the spread of virus was apparently the
use of unsterilised equipment and infected syringes. Unfortunately, a large number of people have
limited access to healthcare services and are unaware of safe medical practices. Crucially, societal
attitudes towards HIV/AIDS have complicated matters. Those infected are often shunned by society, and
this prevents many others from seeking medical help or intervention for their symptoms. The dilemma
of our country’s approach to HIV/AIDS is especially apt for this year’s theme for World AIDS Day —
‘communities make the difference’. Today should be a moment of reckoning for our healthcare
providers, who not only need to come up with an overhaul of the healthcare system but must also work
to eliminate social taboos surrounding diseases such HIV/AIDS.
Published in Dawn, December 1st, 2019
"Health crises" by Dawn Editorial
THE past year proved to be injurious to the collective health of Pakistanis. The already paltry federal
health budget was further slashed by half as the challenge appeared to worsen with several disease
outbreaks — eg, dengue, HIV/AIDS, XDR-typhoid and polio. This was also pointed out by the Pakistan
Medical Association in a statement issued on the first day of the new year. It is evident that much of the
deteriorating state of the nation’s health can be attributed to government negligence. So much could
have been avoided. Had the government taken timely measures, the aftermath of the 2019 monsoon
would not have seen such high numbers of dengue cases in Punjab and Sindh or XDR-typhoid in the
latter province. According to the PMA, more than 50,000 cases of dengue fever were reported across
the country in 2019, nearly double the figure in the preceding decade. Meanwhile, in August alone, as
many as 4,700 cases of XDR-typhoid were reported in Sindh with 3,000 in Karachi — the authorities
would have done well to launch a vaccination drive in the city, and not only in schools. There were also
two separate outbreaks of HIV/AIDS in 2019 — in Sargodha and in Larkana district — only a couple of
months apart. Shockingly, more than 700 victims of the HIV/AIDS outbreak in Larkana were children.
What must also be mentioned is the shortage of/lack of access to the rabies vaccine, which was
reportedly responsible for the painful deaths of some 30 people in Sindh. And, new polio cases kept
emerging throughout the year, with the total national tally reaching 119.
The PMA is right in pointing out that the lack of proper planning, political will and a timely response
aggravated the intensity and prevalence of these illnesses. As we usher in 2020 as the ‘year of economic
growth’, it should be remembered that serious diseases will continue to afflict the people of Pakistan
even beyond the current year. Sick nations seldom travel far, but improved healthcare could ensure
economic progress.
Published in Dawn, January 2nd, 2020
"Curbing hepatitis C" by Editorial
CONSIDERING that Pakistan has the second highest prevalence and disease burden of hepatitis C in the
world, the Punjab government’s decision to reach out to WHO for help in curbing the illness is a much-
needed move. Punjab accounts for up to 70pc of all hepatitis C cases in Pakistan and the provincial
government has sought technical assistance from WHO to check and prevent what it believes could be a
“possible explosion” of the disease. According to government estimates, there are between 8m and 11m
people with active hepatitis C virus in Pakistan, while about 240,000 new cases are detected every year.
The figures show that as many as 20m people may not be aware that they have contracted the virus.
The high prevalence of infectious diseases in Pakistan, including HIV/AIDS and hepatitis C, can be largely
attributed to unsafe medical practices and the lack of regulation. Last year, a major HIV outbreak
occurred in Larkana district due to the extensive reuse of syringes. The use of contaminated needles and
unsterilised equipment for invasive medical procedures, the transfusion of unscreened blood or other
bodily fluids and the sharing of razors, a normal practice at barber shops, are among the major reasons
for the high prevalence of hepatitis C in the country. In fact, according to WHO, Pakistan has the highest
rate of therapeutic injections administered to patients, which is said to be the primary cause for the
spread of the virus.
Ironically, Pakistan produces relatively cheaper medicines to treat the hepatitis C infection but since a
large number of patients remain undiagnosed, few are able to get treated in time. The current
government appears to realise the frightening magnitude of the disease burden. Hopefully, with WHO’s
help, the prime minister’s programme for the prevention and control of hepatitis will be able to increase
access for treatment even as it works to reduce unsafe medical practices. This will also help reduce the
burden of other infectious diseases such as HIV/AIDS.
Published in Dawn, February 3rd, 2020
Coronavirus
18th January 2020
China reported the first death resulting from a virus that has infected more than 40 people, most of
whom had visited or worked in a fish-market in the Chinese city of Wuhan. The who said it was possible
that “limited” human-to-human transmission was occurring.
25th January 2020
Hundreds of people in China were confirmed to have been infected by a newly identified form of
coronavirus, a type that includes the one responsible for a deadly outbreak of sars in 2003. Most of the
cases have been found in the city of Wuhan, where the outbreak began. Seventeen people with the
virus, which can cause pneumonia, have died. Travel restrictions were imposed on Wuhan and two
nearby cities.
The Chinese coronavirus
Time and again

A new virus is spreading. Fortunately, the world is better prepared than ever to stop it
How and when it infected the first human being, by making the jump from an animal, is anybody’s
guess. But one thing is certain about the new coronavirus which was discovered in December in China
and is now causing a global scare: it is a known unknown. And this, along with the health authorities’
response so far, is mostly good news.
People’s fear is understandable. As The Economist went to press, over 600 cases had been confirmed in
six countries, of which 17 were fatal. The new virus is a close relative of sars (severe acute respiratory
syndrome), which emerged in China in 2002 and terrorised the world for over half a year before burning
out. sars afflicted more than 8,000 people and killed about 800, leaving in its wake $30bn-100bn of
damage from disrupted trade and travel (see China section).
That toll would have been lower if the Chinese authorities had not hushed up the outbreak for months.
But things are very different this time. The Chinese have been forthcoming and swift to act. Doctors in
Wuhan, the metropolis where it began, have come in for criticism, but the signs are that they promptly
sounded an alarm about an unusual cluster of cases of pneumonia—thereby following a standard
protocol for spotting new viruses. Chinese scientists quickly isolated the pathogen and shared its
genomic details with the world. Back in the days of sars, genetic sequencing like this took weeks. The
genomic data can help scientists spot cases quickly, both in China and abroad. The government stopped
travel in and out of Wuhan and two nearby cities, coralling almost 20m people. That is extreme and
heavy-handed. Yet, although it could drive some cases underground, it will also slow the spread of the
virus across China and abroad.
Even so, an awful lot rests on some of the known unknowns. The two big questions are how easily the
virus can be passed directly from person to person and just how dangerous it is. Data from monitoring
people who have had contact with those infected will soon help answer the first question. The second
will be harder. The 3% mortality rate among cases confirmed so far is alarming, for it is like that of the
Spanish influenza pandemic in 1918, which killed 3-5% of the world’s population. But in many people the
new virus causes only mild symptoms, so many cases may not have been recognised for what they are
and hence not added to the total. As more such people are identified through expanded screening, the
estimated death rate should fall. Conversely, though, that rate could go up as more of those infected
become seriously ill—a progression that takes about a week and is seen in 15-20% of patients in
hospitals.
The true character of the new virus will become better known in the coming weeks. Public-health
measures will adjust accordingly, using lessons learned from sars and mers, a still-deadlier cousin
discovered in 2012 in Saudi Arabia that spreads only through close contact.
The who has long worried about the possible emergence of a “disease x” that could become a serious
international pandemic and which has no known counter-measures. Some experts say the virus found in
China could be a threat of this kind. And there will be many others. Further illnesses will follow the same
well-trodden path, by mutating from bugs that live in animals into ones that can infect people. Better
vigilance in places where humans and animals mingle, as they do in markets across Asia, would help
catch viral newcomers early. A tougher task is dissuading people from eating wild animals and
convincing them to handle livestock with care, using masks and gloves when butchering meat and fish,
for example. Such measures might have prevented the new coronavirus from ever making headlines.
"Handling crises" by Huma Yousaf

WHAT is the likelihood that Pakistan will ban visitors to and from China during the coronavirus
outbreak? Nil — and this is probably proportionate in light of what we know about the virus and the
Chinese response. But make no mistake, this decision will be driven by political considerations rather
than public health concerns. And given the health challenges that the 21st century holds in store,
Pakistan has to move beyond a realpolitik approach to crisis management.
Reports surfaced over the weekend about a Chinese man admitted to a Multan hospital with a
suspected case of coronavirus. There are more than 20 flights in and out of Pakistan from China each
week. An estimated 1,500 Pakistani traders travel to China frequently, and there are 28,000 Pakistani
students in China.
To its credit, Pakistan pre-empted the first suspected case by screening passengers boarding inbound
PIA flights in Beijing and installing thermal scanners at major airports. There have also been the stirrings
of coordination on how to tackle a coronavirus outbreak between the health ministry, the NDMA and
the Army Medical Corps.
But we aren’t prepared to handle a major outbreak of a communicable disease. A booming population,
rapid urbanisation, city sprawl, and poor health literacy among the public create a toxic mix. Recent
dengue outbreaks have highlighted the lack of collaboration between health administrators and
environmental, sanitation or public works departments.
How prepared are we to deal with disease challenges?
The healthcare system is too fragmented to deliver a coordinated response to an outbreak. There’s the
split between alternative and medical care (i.e. hakeems vs clinics) and the divide between public and
private sector healthcare, with the latter reporting minimally to the former. Within the public sector,
health administration is arbitrarily carved up.
Such bureaucratic failings can be addressed. Indeed, we saw them being overcome during last year’s
response to the dengue outbreak in Islamabad and Rawalpindi, during which a high-level cross-
departmental and interdisciplinary team launched a coordinated response. This included medical
interventions and monitoring, hotlines, disease tracking, garbage clearance and spraying.
But our undoing in the face of any public health crisis will occur as a result of intrinsic flaws in our
democratic culture, not just gaps in political administration.
The overall disdain for transparency is the greatest challenge. Petty bureaucrats prefer to suppress bad
news rather than face accountability or criticism. This is what happened in Wuhan, in China’s Hubei
province, where the coronavirus outbreak began. Local officials initially underreported the disease,
delayed providing updates on cases of human-to-human transmission, and tried to quash online
discussions on the topic. Rather than let on something was amiss, Wuhan officials allowed a public
gathering of more than 40,000 households in January, even after China had reported the outbreak to
the WHO.
This cover-up mentality would have persisted if President Xi Jingping had not delivered a strong message
on state television prioritising public health. The world is now praising how China’s mega-bureaucracy is
responding to the outbreak. Few are discussing how a strongman approach to politics allows crises to
fester, as local officials become paralysed, prone to passively awaiting information and direction from
the top, rather than taking any initiative lest it impact their ability to curry favour.
We should also not be naive about the chilling effect of top-down demands for better service delivery or
crisis management. While the messaging is right, the authoritarian dynamic creates a counterintuitive
approach. Bureaucrats begin to fear punishment for failings, and cover up what they can. Demands for
accountability only work in the context of transparent institutionalised systems, data sharing and
incentives for responsiveness.
Pakistan would also suffer due to the media’s lack of credibility in the event of a public health crisis.
Responsibility for this lies both with the state that has sought to undermine an independent media, and
with the industry itself for chasing ratings at the expense of integrity. But the consequences of what has
so far been political jockeying could be severe. Since the public now defaults to conspiracy theorising
and dismissing all content as ‘fake’ or ‘bought’ news, there are no channels available for an effective
public information campaign.
During a public health crisis, the most important control factor is the community- or household-level
response in terms of reporting and sanitation. We need to build up credible platforms that can
disseminate public health information at short notice.
Pakistan likes to learn from China, and will focus on the heavy-handed coronavirus crackdown. But we
stand to learn more from our friend’s failings, and should dwell instead on what came before.
Viral pneumonia
The Wuhan crisis

BEIJING AND SHANGHAI
An outbreak of disease caused by a new virus is causing global alarm
China’s leader, Xi Jinping, often warns officials to be wary of “black swan risks”, meaning sudden
unexpected events that can harm the economy. People typically assume he means wobbly banks or
trade tensions. But the most immediate threat may be a new, sometimes deadly, virus that appears to
be spreading. The outbreak raises dark memories of another one 17 years ago that killed hundreds of
people and, briefly, nearly halted China’s growth.
The main worry is whether the government can control the virus, which can cause severe pneumonia.
The bug is known as 2019-ncov, or more commonly, the Wuhan virus. It appears to have originated in
early December in a fish and animal market in Wuhan, a city of 11m people. On January 20th an official
said 14 health workers who had treated patients were ill. This was the first clear evidence that the
disease could pass from human to human and therefore spread more widely.
Between January 17th and 22nd the number of confirmed infections grew tenfold. It stood at 618 as The
Economist went to press, of whom 17 had died. There are cases in most of China’s provinces. Infected
travellers from China have been found in America, Japan, South Korea, Taiwan and Thailand. On January
23nd Wuhan declared a travel ban. Hours later Wuhan’s public transport was halted, airports closed and
expressways blocked. A similar lockdown was imposed on two nearby cities, Ezhou and Huanggang.
This has echoes of sars, a respiratory disease also caused by a coronavirus, the family to which the
Wuhan virus belongs. More than 8,000 people in China and other countries contracted sars between
2002 and 2003. Close to 10% of them died. Data released so far suggest the new virus may be less lethal.
Officials tried to cover up sars, probably increasing its toll. This time, they have been quicker to take
preventive measures and give information.
Officials in Wuhan initially downplayed the new virus, but that changed just before the government said
that health workers had been infected. On the day of that announcement, Mr Xi said officials should
“put people’s lives and health first”, a crucial signal that he would tolerate no cover-ups. The
government started providing daily updates. It has appointed Zhong Nanshan, a doctor renowned for
disputing the official line during the sars crisis, to lead an advisory team.
Now that China has switched to crisis mode, few doubt the government’s resolve. But there are still
plenty of reasons to worry, both about the impact on people’s health as well as on firms and investors.
Just as sars suggests how a coronavirus might spread, it also has lessons for how such a pathogen might
affect an economy. In May 2003 passenger traffic numbers in China plunged more than 40% from a year
earlier. Shops, restaurants and hotels all suffered. In annualised terms, quarter-on-quarter growth at the
peak of sars fell to 3.5%, down from more than 12%, according to Wang Tao of ubs, a Swiss bank.
In the case of the Wuhan virus, there are some grounds for optimism. Most hopefully, the government’s
faster response could mean that it takes less time to contain it. If experts conclude that the virus is not
as dangerous as the one that caused sars, China might also be able to relax its controls on travel to and
from Wuhan before big economic damage is done. Efforts to ensure transparency could reduce panic.
However, Chinese people are far more mobile than they were in the early 2000s. About 450,000 of them
travel daily by train in Hubei, the province of which Wuhan is the capital. That is more than double the
daily passenger volume in Guangdong in 2002 when that province became a hotspot of sars. Helped by a
vast bullet-train network built over the past decade, passengers from Wuhan will have gone farther and
faster than those in Guangdong back then. China is also far more connected to the rest of the world. In
2018 some 205,000 people took flights into and out of China each day, six times as many as on the eve
of sars.
The timing of the new outbreak compounds the difficulty of containing the virus. It has come just ahead
of the spring festival, a public holiday which this year runs from January 24th to 30th. In recent days
millions have travelled across the country to celebrate with relatives. At transport hubs, travellers’
temperatures are being checked to detect fever. But it may take a week or more for the virus to
incubate, so some infected people may not be spotted.
The economy is bigger but less fizzy than it was in 2003. During the sars outbreak a few big sectors
thrived even as others struggled. Exports surged 35%. Spending on infrastructure and housing held
strong. Today, however, export growth is far weaker—only 0.5% in 2019. Property sales have started
falling after a long boom. And the country has less scope to increase its spending on infrastructure,
having already built so much over the past decade. In the first few days after the number of confirmed
infections surged this month, Chinese stocks fell about 5%. They could tumble further. During sars, Hong
Kong’s main index declined by nearly 20%.
The part of the economy most hurt by sars was the services sector, which then accounted for about 40%
of gdp. Today the share is higher than 50%. But consumer spending could be more resilient this time
because of huge growth in the popularity of online shopping. If they are fearful of venturing out (Wuhan
has ordered residents to wear masks in shops and other establishments where people congregate),
people can continue to buy goods at home.
China can also draw comfort from the speed with which its economy recovered after sars was
conquered. By the second half of 2003 it was back to double-digit growth. Consumers indulged their
pent-up demand for everything from cars to beer. But as the current crisis grows, the grim reality of the
present is all that many people—especially the millions confined to Wuhan—are likely to be
contemplating.
Coronavirus
How bad will it get?

The coronavirus is likely to become a pandemic. That need not be as catastrophic as it sounds
Two things explain why a new infectious disease is so alarming. One is that, at first, it spreads
exponentially. As tens of cases become hundreds and hundreds become thousands, the mathematics
run away with you, conjuring speculation about a health-care collapse, social and economic upheaval
and a deadly pandemic. The other is profound uncertainty. Sparse data and conflicting reports mean
that scientists cannot rule out the worst case—and that lets bad information thrive.
So it is with a new coronavirus, known as 2019-ncov, which has struck in China. The number of reported
cases grew from 282 on January 20th to almost 7,800 just nine days later. In that time four reported
cases outside mainland China have multiplied to 105 in 19 territories. Doubt clouds fundamental
properties of the disease, including how it is passed on and what share of infected people die. Amid the
uncertainty, a simulation of a coronavirus outbreak by Johns Hopkins University in October, in which
65m people lost their lives, was put about as a prediction. It is not.
Those are the right questions, though: will the new virus become a global disease? And how deadly will
it be? A definite answer is weeks or months away, but public-health authorities have to plan today. The
best guess is that the disease has taken hold in China (see China section) and there is a high risk that it
spreads around the world—it may even become a recurrent seasonal infection. It may turn out to be no
more lethal than seasonal influenza, but that would still count as serious (see International section). In
the short term that would hit the world economy and, depending on how the outbreak is handled, it
could also have political effects in China.
The outbreak began in December. The repeated mingling of people and animals in China means that
viral mutations that infect humans are likely to arise there; and mass migration to cities means that they
are likely to spread between people. This virus probably originated in bats and passed through
mammals, such as palm civets or ferret badgers, ending up in Wuhan’s wet market, where wild animals
were on sale. Symptoms resemble flu, but can include pneumonia, which may be fatal. About 20% of
reported cases are severe, and need hospital care; about 2% of them have been fatal. As yet, there is no
vaccine or antiviral treatment.
The greatest uncertainty is how many cases have gone unrecorded. Primary health care is rudimentary
in China and some of the ill either avoided or were turned away from busy hospitals. Many more may
have such mild symptoms that they do not realise they have the disease. Modelling by academics in
Hong Kong suggests that, as of January 25th, tens of thousands of people have already been infected
and that the epidemic will peak in a few months’ time. If so, the virus is more widespread than thought,
and hence will be harder to contain within China. But it will also prove less lethal, because the number
of deaths should be measured against a much larger base of infections. As with flu, a lot of people could
die nonetheless. In 2017-18 a bad flu season saw symptoms in 45m Americans, and 61,000 deaths.
Scientists have started work on vaccines and on treatments to make infections less severe. These are six
to 12 months away, so the world must fall back on public-health measures. In China that has led to the
biggest quarantine in history, as Wuhan and the rest of Hubei province have been sealed off. The impact
of such draconian measures has rippled throughout China. The spring holiday has been extended,
keeping schools and businesses closed. The economy is running on the home-delivery of food and
goods.
Many experts praise China’s efforts. Certainly, its scientists have coped better with the Wuhan virus than
they did with sars in 2003, rapidly detecting it, sequencing its genome, licensing diagnostic kits and
informing international bodies. China’s politicians come off less well. They left alone the cramped
markets filled with wild animals that spawned sars. With the new virus, local officials in Wuhan first
played down the science and then, when the disease had taken hold, enacted the draconian quarantine
fully eight hours after announcing it, allowing perhaps 1m potentially infectious people to leave the city
first.
That may have undermined a measure which is taking a substantial toll. China’s growth in the first
quarter could fall to as little as 2%, from 6% before the outbreak. As China accounts for almost a fifth of
world output, there will probably be a noticeable dent on global growth. Though the economy will
bounce back when the virus fades, the reputation of the Communist Party and even of Xi Jinping may be
more lastingly affected (see Chaguan). The party claims that, armed with science, it is more efficient at
governing than democracies. The heavy-handed failure to contain the virus suggests otherwise.
Outside China such quarantines are unthinkable. The medical and economic cost will depend on
governments slowing the disease’s spread. The way to do this is by isolating cases as soon as they crop
up and tracing and quarantining people that victims have been in contact with—indeed, if the disease
burns out in China, that might yet stop the pandemic altogether. If, by contrast, that proves inadequate,
they could shut schools, discourage travel and urge the cancellation of public events. Buying time in this
way has advantages even if it does not completely stop the disease. Health-care systems would have a
greater chance to prepare for the onslaught, and to empty beds that are now full of people with
seasonal flu.
Despite all those efforts the epidemic could still be severe. Some health systems, in Africa and the slums
of Asia’s vast cities, will not be able to isolate patients and trace contacts. Much depends on whether
people are infectious when their symptoms are mild (or before they show any at all, as some reports
suggest), because such people are hard to spot. And also on whether the virus mutates to become more
transmissible or lethal.
The world has never responded as rapidly to a disease as it has to 2019-ncov. Even so, the virus may still
do great harm. As humans encroach on new habitats, farm more animals, gather in cities, travel and
warm the planet, new diseases will become more common. One estimate puts their cost at $60bn a
year. sars, mers, Nipah, Zika, Mexican swine flu: the fever from Wuhan is the latest of a bad bunch. It
will not be the last.
"Bats bite back" by Irfan Husain
ON the Chinese horoscope, this is the Year of the Rat. Traditionally, the New Year begins with
celebrations and feasts, but the lethal coronavirus has dampened all such festivities.
Many scientists trying to pinpoint the origin of this virus have concluded that it was caused by bats from
a certain cave in Hubei province. From them it appears to have jumped to civet cats kept in small cages
in the seafood market at Wuhan by way of urine or faeces. Some biologists conjecture that the outbreak
was caused by snakes.
Whatever the cause, it is certain that China’s food preferences have triggered this plague.
Don’t get me wrong: as a foodie, I like to experiment and have been known to slurp down all manner of
exotic dainties. Once in Hanoi, I was happily scoffing stir-fried locusts until my wife stopped me in mid-
bite by saying: “That one looks like a cockroach.” To this day, I don’t know if she was joking.
People will be reluctant to visit a country that poses such a serious health risk.
But bats? Civet cats? No way. However, not everyone is restrained in their tastes. Most faiths practised
in China do not offer dietary guidelines, so people will eat whatever catches their fancy. In fact, the rich
will buy the most expensive beast or bug on the menu. Thus, entire nations are being stripped of their
wildlife to satisfy the Chinese desire to impress and try novel dishes.
Donkeys in Africa are being shipped to China where their skins are turned into gelatine for traditional
medicine. There have also been proposals to export donkey hides from Pakistan to China. The meat, of
course, is eaten.
Pangolins, too, have been pushed to the edge by China’s dietary habits. These helpless, scaly beasts are
being scooped up from East Africa to Pakistan and trafficked to China where they are sold for $470 per
kilo (as against $11 per kilo in the 1990s). The scales cost another $3,000 per kilo in Vietnam and China,
and are used in spurious cures, including as a cure for impotence.
In fact, more endangered animals and birds have been slaughtered in search of an elusive virility than in
any other cause. Our own houbara bustards have fallen victim to Arab royalty’s compulsion to overcome
impotence. But the killing of rare species like the Indian tiger, the rhinoceros for its horn, and elephants
for their tusks has pushed them to the edge of extinction.
Fortunately, the giant panda and many types of whales are staging a slow comeback. Partly, this is due
to their appeal to animal lovers: it has never hurt to have good PR. But if you are a bat in a cave in Hubei
province, you don’t stand a chance. Other bears don’t fare as well: some are locked up in cages to make
them secrete bile which again is used in Chinese medicine.
Fortunately, China has shut down the animal food markets, but how long this ban will last — and
whether it will be rigorously implemented — is an open question. If the SARS epidemic of 2003 is any
guide, we can conclude that the authorities in China have learned little from the past.
However, China has a lot to lose from the current outbreak: tourists and investors will be reluctant to
visit a country that poses such a serious health hazard. Millions of overseas Chinese are being seen as
potential carriers of coronavirus.
At a time when President Xi is trying to position China at the top table, the last thing he needs is for his
country to be dragged into pariah territory.
So is the coronavirus a case of wild animals striking back? Well, I’m certainly on the side of the pangolins
and the donkeys. Nobody can convince me that an animal on the endangered list is good for me, no
matter how delicious it tastes.
And yet we all have our own foodie preferences that must seem odd to foreigners. Force-feeding geese
to make them produce more liver for foie gras must be painful for the birds, but we do it anyway to
obtain the unctuous paste so beloved by diners in luxury restaurants.
The Japanese continue to hunt whales despite worldwide criticism. Meat from these giants of the deep
is frozen and stored. Consumption is down to a small fraction of what it used to be during the Second
World War, but the Japanese insist that whale meat is part of their culture.
People in France, Italy and Germany still eat horse meat. When I was a boy in Paris, it was fairly common
to see butchers with a horse’s head on the shop front. A horse steak I once had in Italy was lean and
tasty. And what would foreigners make of the nihari/brain/marrow combination that makes us salivate?
So it’s all about perceptions and preferences at the end. But I still draw the line at bats.
irfan.husain@gmail.com
Published in Dawn, February 1st, 2020
AN infectious disease snowballing in intensity across the globe and inadequate health facilities at home
to prevent its spread — the coronavirus outbreak poses a serious dilemma for Pakistan.
The concerns are centred on approximately 30,000 Pakistanis resident in China, particularly 500-plus
students in Wuhan — ground zero for the epidemic — and whether the Pakistani government should
evacuate them.
Read: Govt stays firm on decision to not repatriate Pakistanis from virus-hit China
Four individuals among these are diagnosed as being infected with the coronavirus and are under
treatment in China. Videos have emerged of frightened students in Wuhan pleading to be reunited with
their families in Pakistan. However, the Pakistani government has taken the position that it will not bring
these expats home in light of the risk that unwitting carriers of the virus could lead to a spread of the
disease in this country.
Certainly, the state has valid reasons to be concerned.

The virus is spreading around the world at an exponential rate: at least 22 countries have been affected,
with the total number of patients numbering around 12,000. More than 250 have died.
Granted, the fatality rate is not very high, but this is clearly a transmissible infection.
While acknowledging the distress of the stranded Pakistanis and the fact that they should have been
provided government assistance much earlier, pragmatism must dictate the state’s response — at least
in the short term.
Given our shambolic health infrastructure and far from robust infection-control practices, our high
population density and hospitals teeming with people, the conditions are ripe for an infection to spread
like wildfire. In the event of such a development, the health system would be overburdened beyond its
capacity to cope, leading to knock-on effects in other areas of life.
That said, it is regrettable that facilities in this country are not equal to the task of properly managing
quarantine requirements, an important aspect of a well-functioning health system.
There have been a number of global viral outbreaks in recent years; a country that learns from
experience would have had quarantine protocols in place at entry points into the country.
Consider that the student who managed to return from Wuhan on his own initiative has been placed in
an isolation ward at a private hospital. However, isolation is a public health practice used to restrict the
movement of people diagnosed with a communicable disease.
On the other hand, quarantine is meant to separate from the general population those who appear to
be well but may have been exposed to an infection, such as the aforementioned student. Moreover,
quarantine calls for a dedicated facility — rather than a hospital — where ostensibly healthy individuals
can be kept under observation for a period of time so as to ensure they are not infected. In the long run,
then, the government must set up such facilities in the event a deadly virus does make its way into the
country.
Published in Dawn, February 2nd, 2020
The Wuhan ban
The number of infections and deaths from the Wuhan virus continued to rise. More than 99% of the
cases are in China. Several countries, including America and Australia, banned the entry of non-citizens
who have recently visited China. Hong Kong announced that visitors from the Chinese mainland would
have to undergo quarantine for 14 days; medical workers went on strike, calling for a complete closure
of the Hong Kong-mainland border. A Chinese diplomat accused other countries of over-reacting by
barring travellers from China.
China
The Wuhan virus
Under observation
BEIJING
A weak health-care system complicates China’s battle with the coronavirus

The doctors who examined Rana Zhou’s parents decided that the couple had probably caught the
coronavirus which has been sweeping their home city, Wuhan, and spreading globally. But they said
they did not have enough test kits to be sure. Instead of finding them beds in a hospital, officials in their
neighbourhood told them to go to one of many hotels which the government has requisitioned in order
to monitor and isolate people with minor virus-related symptoms. But when her father’s fever
worsened, staff said they could not take care of him. They told the pair they would have to return home.
It is a scary time to be ill in Wuhan. The city has one-third of all confirmed infections by the virus and
three-quarters of the deaths caused by it. People there are barred from travelling elsewhere (similar
rules apply across Hubei, a Syria-sized province of which Wuhan is the capital). Since late January
military medics have been piling into the city. Soldiers are helping enforce its cordons. The army’s
growing presence reassures many people, says a resident. But some find it unnerving.
With hospitals brimming, the local government has announced new rules. Rather than visiting hospitals,
people who think they might have the virus should tell district officials about their symptoms and seek
examinations at local clinics—facilities which, in normal times, many people eschew in favour of what
they regard as the hospitals’ more professional care. Wuhan has opened makeshift hospitals in an
exhibition centre and a sports arena to house patients who are only mildly ill from the virus. Elsewhere
in China health services are also under strain, even if the pressure is less than in Hubei. Officials in many
places have banned non-essential hospital visits to avoid contagion. But many people, afraid of catching
the virus, now avoid hospitals anyway, except in emergencies.
China’s health system can cope better with shocks than in 2003 during the sars outbreak. At that time,
officials feared that the spread of the virus might be hidden because rural residents, lacking health
insurance, would avoid hospitals. The government tried to allay such concerns by offering free
treatment for sars. Since then it has considerably expanded access to state-funded insurance schemes.
More than 95% of Chinese are now covered. Out-of-pocket payments have fallen from about 60% of
medical expenses to 30%.
But for poorer people, the costs can still be crippling. The government recently promised that it would
pay for all treatment related to the new virus. That was too late for a pregnant woman infected in
Wuhan. She died after her husband decided he could no longer afford the bill, according to a doctor
there interviewed by Caixin, a magazine. The policy changed the next day.
Barely better than barefoot

The government has spent lavishly on infrastructure, but its investment in health care has failed to keep
up. China says it has about 2.6 doctors for every 1,000 people, higher than the average for middle-
income countries. But the World Health Organisation says half of China’s doctors do not have a
bachelor’s degree. Among those in villages and small towns, only 10-15% do. Some practise traditional
Chinese medicine, a form of treatment that has government approval but little scientific basis (stocks of
an oral liquid based on such medicine have been flying off shelves since a recent report by Xinhua, an
official news agency, that it can “suppress” the virus). There is also an acute shortage of nurses. The
average in rich countries is three per doctor. In China it is only one.
China’s investment in health care has mostly gone to big hospitals in cities. Wuhan has about half of
Hubei’s best medical facilities, but only about one-fifth of the province’s population. Far less attention
has been paid to primary-care clinics, which in more developed systems handle minor ailments and
escalate the rest to specialists. Only about 5% of China’s registered doctors serve as general
practitioners. The average in the oecd, a club mostly of rich countries, is 23%. After Wuhan imposed a
lockdown in late January, panicky residents converged on large hospitals seeking reassurance. The
queues would have promoted cross-infection, says Xi Chen of Yale University.
Public anger about health care, including the gouging of patients by hospitals, has triggered occasional
violence against doctors. In late January a man attacked medical staff in Wuhan after his father-in-law
died from the virus. But the system’s public image may have improved during the current crisis. Many
people praise doctors’ willingness to join the fight in Hubei, despite high rates of infection among
medical workers there. They will need such support in the struggle ahead.
When China sneezes
Read More at: https://www.dawn.com/news/1535378/when-china-sneezes

BEYOND the inevitably immediate concerns about the steadily rising death toll from the Wuhan
coronavirus infection and the prospects of a worldwide pandemic, crucial questions have arisen about
its political and economic impact in China as well as internationally.
Economically, whatever happens in China reverberates across the world. It is the global manufacturing
hub. It provides both products and parts that keep the international economy humming. When factories
cannot function and ships cannot sail, or shipments are quarantined, there are worldwide palpitations.
Japan reportedly faces a recession as a consequence.
Japan is also the harbour for the Diamond Princess, one of those massive cruise ships that appear to be
the ideal incubators for viruses. The rate at which the coronavirus named Covid-19 has been spreading
aboard the vessel bears out that assumption.
More broadly, though, the thus far restricted level of international infections and fatalities suggests that
Chinese efforts to curb the spread of the virus have been broadly successful. The World Health Organi-
sation (WHO) has praised China for both its efforts and its transparency. It has not, however, ruled out
the risk of a pandemic.
Will the rest of the world catch a cold?
At the same time, the fact that the Chinese authorities have been somewhat less reticent in sharing
their information and concerns than they were during the SARS emergency at the turn of the century is
commendable — only up to a point.
It is hard to ignore the fact that the initial response in Wuhan — the capital of Hubei province, and the
epicentre of the outbreak — was to clamp down on information. At the beginning of last month, eight
medical professionals were hauled up for spreading ‘rumours’. Among them was Li Wenliang, a young
doctor who apparently succumbed to the virus on Feb 7, sparking nationwide grieving.
Although China is undoubtedly better equipped than almost any other nation to put into place drastic
restrictions on movement that stretch from extreme measures in Wuhan to slightly less extreme ones in
Beijing and Shanghai, there are obviously limits to its transparency.
Sure, some newspapers and websites were able to get away with a little more questioning of the
authorities than was normally permitted, but criticism of President Xi Jinping’s leadership remains
beyond the pale, as evidenced by the treatment of Xu Zhangrun, a professor who has been quarantined
in more ways than one for daring to criticise Xi’s leadership. Former lecturer in law Xu Zhiyong has been
taken into custody on similar grounds. There are likely to be numerous others we will never hear about.
So, sure, totalitarian control helps in locking down half of a more than billion-strong population, but the
fear that Xi Jinping’s crown as president-for-life might be tarnished is possibly more of a concern for the
Communist Party hierarchy than the coronavirus.
The president is yet to venture into Wuhan, where the bulk of around 1,800 deaths from the affliction
have occurred. He sought to burnish his image instead through a masked and well-publicised visit to a
hospital in Beijing. Premier Li Keqiang, on the other hand, has visited Wuhan — and may well become a
leading scapegoat if the epidemic gets any worse.
If so, he would join the purged health officials and local party stalwarts in Wuhan, who have by and large
paid the price for following the Beijing-ordained logic of downplaying any crises and disowning all
concomitant errors.
China’s efforts in the context of Covid-19 are commendable at many levels, and it is hard not to be
impressed by its capability of setting up huge hospitals within weeks. But it must at the same time be
acknowledged that, despite all this, all too many patients in Wuhan remain unattended.
In the past few days, Beijing has been keen to point to an apparent decrease in new infections, even as
the death toll goes on rising. WHO has been less complacent, declaring that it is too soon to tell whether
the threat of a global pandemic has been averted. There have not been many deaths outside China, but
the virulence of the disease continues to provide cause for concern.
In some eyes, the global economic repercussions are a bigger worry, pointing to the extent to which the
rest of the world relies on China as a manufacturing and trade hub. In that sense, the repercussions will
play out both domestically and internationally over the coming months and perhaps even years. The
architecture of globalisation means that when China sneezes, the rest of the world is not immune from
catching a cold.
Future historians may look upon Covid-19 as little more than a blip on the radar in the context of the
international economy, but perhaps it will also be seen as the juncture at which the advent of Xi Jinping
stopped being viewed as the second coming of Mao, and many Chinese suddenly developed an empathy
towards the Uighurs subjected to mass and indefinite incarceration.
mahir.dawn@gmail.com
Published in Dawn, February 19th, 2020
"Welcoming the virus" by Zarar Khuso
VIRUSES get a bad rap. Admittedly, much of that is deserved, what with the novel coronavirus (or
COVID-19 if you prefer) which has much of China in a lockdown and the rest of the world in a panic.
Highly infectious and showing no real signs of subsiding, this latest viral variant, according to the US
Centres for Disease Control, will “probably be with us beyond this year”. On a larger scale, it’s not as bad
as it is being made out to be as its fellow viruses (I’m thinking of smallpox) have in the not-so-distant
past devastated entire civilisations.
But amidst all the panic and apocalyptic fear-mongering, we forget the debt that we owe viruses. After
all, without these strange, mysterious entities (they can’t exactly be classified as life forms) you and I
would not be you and I, or at least not in any currently recognisable form. Because viruses, along with
making us sick and occasionally killing us, have helped us evolve.
Over 65 million years ago a tiny shrew-like creature — an egg layer according to scientists — was
infected by a particularly sneaky retrovirus that didn’t just make its way into the host’s genome but
managed to get into its sperm or egg cells, ensuring that the mutation it caused would be passed on to
every subsequent generation. Countless generations later, this infection led to the development of the
placenta in this creature and others similarly infected, thus allowing for the development of a foetus
inside the mother’s body.
Without this ancient chance encounter humans may well have been egg layers. This sort of viral ‘tough
love’ has been a constant feature of our evolution, forcing us to adapt or die. According to scholar David
Enard, “When you have a pandemic or an epidemic at some point in evolution, the population that is
targeted by the virus either adapts, or goes extinct.”
We may have to thank our viral friends for the existence of life.
Indeed, we may have to thank our little viral friends for the existence of life as we know it; while
traditional scientific thought has it that viruses appeared fairly late in the evolutionary timeline, after the
development of cells, the discovery in 2014 of a giant frozen virus in Siberia, dubbed the Pithovirus, is
causing a rethink. So large and complex is this virus that some scientists now feel that this viral ancestor,
as opposed to being reliant on cells for propagation, may well “have provided the raw material for the
development of cellular life and helped drive its diversification” into the varied life forms we see today.
But the origin of viruses, and, indeed, viruses themselves, remain a mystery. Along with the Pithovirus,
other giant viruses have also been discovered such as the Megavirus which contains 1,120 genes (the
HIV virus only has nine) leading us to believe that these may be an entirely new ‘domain’ of life.
Essentially, the viral ‘chicken’ may have come before the cellular ‘egg’.
We know that viruses are gene stealers, acquiring and transplanting genetic material from and to a
variety of hosts. Fair enough, but what should we think when we find a virus that has no recognisable
genes whatsoever? Say hello to the Yaravirus, which contains genes that no scientist has ever seen
before! Which begs the question: exactly where did these genes come from? Did they somehow mutate
beyond recognition in the virus itself or are they the legacy of a hitherto undiscovered form of life?
While the eventual answer may be far more mundane, the fact remains that what we do not know
about viruses dwarfs what we do know. And some answers may well be found in outer space, as the
growing field of astrobiology includes those who believe that viruses may, in fact, have come from outer
space. In fact, one controversial claim is that influenza itself was seeded by dust from comets passing
near the earth, some perhaps even eons ago.
Others are scouring the heavens and heavenly bodies for extraterrestrial viruses which could, if
discovered, provide proof of life on other planets.
Meanwhile, back on earth we are busy harnessing the strange abilities of viruses for our own ends.
Given that these sneaky little packages of genetic material are very good at unlocking cells to deliver
their payload, scientists are aiming to create treatments for diseases like Huntington’s, which is caused
by an error in the genetic code, by using redesigned viruses to deliver a ‘corrective’ dose exactly where it
is required.
In practice, this is even cooler than it sounds: a young girl called Emma, who suffered from leukemia,
was treated by having her blood cells ‘infected’ by a specially modified virus of the same family as the
HIV virus (yes, that’s right) and then re-injected into her bloodstream. Her cancer went into remission.
Less spectacular, yet no less promising, is the research being done on Bacteriophage viruses, which
infect and destroy specific bacteria, and the day perhaps isn’t far that viruses, long reviled as scourges,
may well be hailed as saviours.
Twitter: @zarrarkhuhro

"A humanitarian response" by Editorial
WHEN news of a dangerous new virus — now named Covid-19 by the World Health Organisation — first
broke, governments around the world rushed to evacuate their citizens from the epicentre of the
outbreak in Wuhan, China. In contrast, Pakistan requested the many hundreds of its citizens studying in
Wuhan to stay put until further notice. At the time, it was thought to be the right decision, as little was
known about the disease and how it spread, and as the already burdened health facilities here were
deemed ill-equipped to treat infected patients, let alone manage a potential outbreak. But many weeks
have since passed, with the students and their families growing increasingly anxious, desperately
beseeching the government to allow them to return home — only to, at best, receive noncommittal
responses or, at worst, have their cries fall on deaf ears.
The situation is not just a health issue but also a humanitarian one. The government must allow these
citizens to return home, while simultaneously ensuring that appropriate quarantine protocols are
implemented upon their arrival. China, which has constructed hospitals virtually overnight to manage its
outbreak, can even be asked to lend its expertise and support. Besides, has the government taken
serious, substantive steps to ensure treatment of infected patients were the virus to emerge in this
country, despite efforts to keep Pakistanis in China at bay? Nearly all our neighbouring countries have
recorded cases of Covid-19. This week, two elderly people in Iran died from the virus. India confirmed
three cases in Kerala; all have fully recovered due to timely medical intervention. Earlier this month,
Special Assistant to the Prime Minister on Health Dr Zafar Mirza said that Pakistan now had the ability to
diagnose Covid-19 — so why is the government still dithering? How it plans to address a potential
outbreak has not been made clear yet. What is clear, however, is that citizens cannot just be abandoned
in a foreign land indefinitely. A plan for their repatriation must be announced soon. ( via KeyOpinion )
"Coronavirus spreads" by Editorial
IT is distressing to note that the new strain of coronavirus is spreading across countries at an alarming
speed, at a time when the Chinese premier had reassured the world that the virus would be under
control soon. Instead, even more deaths are being reported from mainland China, where the total
number of cases has swollen to over 77,000 — a massive uptick since the virus was first reported in
December 2019. Meanwhile, South Korea and Italy have seen a sudden increase in the number of cases
in recent days. Especially worrying for Pakistan, all four of its neighbours have now recorded cases of
Covid-19 within their borders, with the Afghan health ministry confirming its first case in Herat
yesterday, after three men who returned from their travels from Iran were tested and placed under
quarantine. Iran itself is struggling to contain the outbreak of the virus, particularly in Qom. A global
health catastrophe that has claimed more lives than the previous SARS scare of the early 2000s, the
news will unfortunately continue to be peppered with a generous dose of xenophobia and politicking,
but fear of the virus is not irrational.
As the death toll in Iran keeps increasing — though the exact figures continue to be debated —
Afghanistan, Turkey, Armenia and Pakistan have now imposed travel restrictions and closed their
borders with the country, fearing that the outbreak will spiral out of control without strict measures in
place to restrict the movement of people crossing boundaries. In fact, it is a rather remarkable fact that,
so far, Pakistan has yet not reported a single case, despite fears being expressed by some that the virus
may already be here. If such a contagious illness were to enter the country, one can only imagine the toll
it would take on the already overburdened and under-resourced healthcare system. It will be a massive
challenge for the government to combat the virus, as Pakistan is already struggling to end diseases
which the rest of the world eradicated many years ago such as polio.
"Coronavirus cases" by Editorial
IT was perhaps only a matter of time before Pakistan joined the ranks of countries hit by the
coronavirus. On Wednesday, the federal health ministry confirmed the first two cases of COVID-19 — in
Karachi and Islamabad — prompting the authorities to close schools in parts of the country. The national
health authorities had been vigilant over the last few weeks, for instance, by shutting off the border with
Iran (where the number of cases has risen to nearly 250) and checking international flight passengers at
airports for symptoms. Now that the highly infectious virus is in the country, they must double their
efforts to contain its spread — a huge challenge indeed.
For one, state-of-the-art quarantine and treatment facilities are needed in virtually all districts with
special instructions to healthcare staff on how to manage COVID-19 patients. At present, there are only
five quarantine facilities in the country — two in Islamabad, two in Rawalpindi and one in Karachi. This is
clearly not enough to deal with a potential outbreak. Suspected patients being transported to these
facilities from the rural areas will have plenty of time along the way to transmit the virus to others. The
pace of diagnosis should also be speeded up, while equipping at least some of the more reputed health
facilities to test patients for COVID-19 would ease the burden on the National Institute of Health that is
currently conducting most of the diagnostic tests. It is true that the situation does not call for panic, as
the special assistant to the prime minister on health has said. But whether “things are under control”
can only be assessed in the days to come, as Pakistan grapples with the virus in the midst of a
dilapidated healthcare system. To contain the virus and discourage the public from believing in
conspiracy theories, the authorities would have to run a robust awareness campaign about the
infection, give updated information about new cases, and share its plans to combat the illness.
The fact is that the government cannot afford to slacken its efforts. According to WHO, COVID-19 has
affected over 80,000 people in approximately 40 countries. New cases may be on the wane in China,
where the virus originated, but the infection continues to spread in other countries, with South Korea
reporting the most cases outside China. The global outbreak should put even more pressure on the
authorities here to mobilise all layers of the public health system to address the situation. This means
that all levels of the healthcare system — national, provincial and district — will have to work in tandem
under a clear, comprehensive, globally accepted strategy. Anything less could be a recipe for disaster—
and Pakistan, with its myriad health challenges, such as the resurgence of polio, has so far not proved
itself adept at tackling crises.
"The reality of Coronavirus, and the reality of the Flu" by

Simon Murray, MD
https://www.mdmag.com/medical-news/the-fear-of-the-corona-virus-and-the-reality-of-the-flu
According to the latest reports from the US Centers for Disease Control and Prevention (CDC), influenza
(flu) has caused the deaths of 10,000-25,000 Americans, hospitalized 180,000, and sickened 19 million
so far in the 2019-2020 season.
Coronavirus, on the other hand, has killed about 900 people worldwide. There have been only a handful
of cases in the United States, with no deaths reported. So why is the public so panicked over this
outbreak?
Novel coronavirus (2019-nCoV) has some obvious differences from the flu virus. The first difference is
that we do not understand how the virus will transform itself via mutations to become more contagious
in the future. The outbreak is similar to the severe acute respiratory syndrome (SARS) virus, which was
initially transmitted from animals to humans and believed to have originated from civet cats and bats.
Coronavirus, like the SARS virus, typically causes zoonotic infections, being transmitted from animals to
humans. One way that these viruses are suspected of getting into the human population is when they
are eaten as exotic foods, or taken as medicines, typically found in Asian countries like China. In many
ways, the Coronavirus and SARS virus are similar.
"They likely had a common ancestor in the bat population,” Stanley Perlman, a virologist at the
University of Iowa who is part of the Coronavirus Study Group, a subset of the International Committee
on the Taxonomy of Viruses, told The Washington Post. “However, over time the virus mutated and may
have infected other animals, and eventually mutated into a form that could be spread from 1 human to
another, but we don't completely understand the process of viral transmission yet.”
The CDC believes it has identified human-to-human transmission of the novel coronavirus between a
married couple in Illinois, but are not sure how it occurred. On the other hand, we clearly understand
the transmission patterns of the flu. There are hundreds of zoonotic infections that have the potential to
mutate into other forms capable of causing human-to-human transmission.
The second difference is that we have therapies for flu, albeit imperfect therapies, but antiviral drugs
that do work to shorten the duration of the illness. Antivirals can provide prophylaxis for those at
greatest risk and can treat symptoms. There are some antiviral drugs with activity against this version of
coronavirus, but they have not been approved. Recently scientists in China reported that combining the
antiviral drug remdesivir with chloroquine has been highly effective at killing the virus.
Third, patients infected with the flu virus generally become contagious about 1 day prior to developing
symptoms, and remain infectious for another 5 days. We are not sure when patients exposed to
coronavirus become infectious or how long infected patients remain contagious, so isolation strategies
are difficult to develop. To be cautious, we have chosen long periods of isolation. The Chinese
government has tried to isolate large populations of people to contain the virus. Entire cities have been
quarantined, leading to widespread shortages of everyday goods like food, medicines, bandages, and
water, triggering social panic. The idea that large cities could be quarantined is a frightening prospect for
many people and, the fact is, in today's world, it just does not work. The Chinese have built large
hospitals to quarantine people who are suspected of being infectious or exposed to the virus. This has
added to the public fear surrounding the disease. The fact remains that this strain of coronavirus is not
highly contagious; it behaves very similarly to other infectious viruses by targeting mainly the weak
and/or immunocompromised portions of the population. For most of us, contracting coronavirus
infection will lead to a flu-like syndrome, and the majority of patients will most likely survive—very
similar to the majority of people who get flu. There is a certain unspoken factor adding complexity to
this outbreak: The fact that it originated in China. There is a good deal of anti-Chinese sentiment in the
United States and around the world. Airlines refuse to travel to China and refuse Chines passangers,
Chinese tourists are barred from entering certain countries, Western businesses have closed, and ex-
pats have returned home. Some of this reflects a certain attitude of fear that the Chinese government
hasn’t been honest or upfront about reporting details about the outbreak. Chinese citizens have been
prohibited from traveling to some countries. I have even heard cases of Americans avoiding Asian
people unless they are wearing masks out of fear that they will contract coronavirus. All of this is, of
course, absurd and, frankly, xenophobic at best—and racist at worst. The fact is, a Chinese visitor visiting
the United States at this time is 10,000 times more likely to die from influenza than an American visiting
China is of dying from coronavirus. In any case, wearing masks affords little protection against
coronavirus since the virus is small enough to penetrate the microfibers of most masks. This strain of
coronavirus appears to be far less contagious than the flu. The fact is, influenza is an illness that is far
more deadly but also far more familiar to us. The current coronavirus outbreak, which originated in
China, serves as a surrogate for a good deal of xenophobia and fear of the country itself.
The views expressed are the authors and not reflective of the publication or its owners.
Pandemic planning
Faizaan Qayyum | March 01, 2020
The writer is a PhD student in planning at the University of
Illinois.
WE finally have confirmation: at the time of writing, there are at least four confirmed cases of Covid-19
in Pakistan. One of the patients travelled to Iran and was exhibiting symptoms before travelling back
home. Six days had passed by the time this patient was diagnosed and isolated.
This may seem like time to worry, but the simple fact is that epidemiologists have almost unanimously
concluded that it is impossible to contain the spread of Covid-19. A Harvard study estimates that most of
the world’s population would have an infection within a year.
Because of how this particular strain has behaved and can potentially mutate, public health
professionals are also preparing for it to become a seasonal occurrence: much like the flu, we can expect
it to go from a pandemic to an endemic. A mass global spread of Covid-19 is therefore inevitable and
imminent. It is not a question of if, but of when.
Several characteristics make Covid-19 a particularly unique global health emergency. While we don’t
have a consensus on the incubation period for the virus (current estimates suggest 14 days), it is
nevertheless contagious even when infected individuals are not displaying any symptoms. Even when
they do, symptoms may be mild — so much so that infected people may feel healthy enough to
continue with their daily routines, and they may infect others in the process. Because global statistics
mostly measure people who report symptoms and get tested positive, it is likely that the total number
of infected people is many times higher than reported.
Yet this is neither the time nor reason to panic. A higher total infection count means the actual mortality
rate is significantly lower than what we already know. In fact, the virus is difficult to contain precisely
because it can spread without exhibiting its symptoms which, in turn, can be quite mild or even
nonexistent. It means that if a healthy individual gets infected, it is likely that they will recover without
much cause for alarm.
How can we prepare our response to Covid- 19?
This is useful for how we should plan our public health response. The virus is not deadly forcthe general
public, but millions of people will probably get infected at some point in the next several months. Most
people will recover, some without even noticing any symptoms at all. Older people, and/or those with
weakened immune systems or respiratory problems, will risk more serious conditions, and the weakest
segments of our population would be at the highest risk.
The public health response should therefore move to minimise non-essential use of emergency services,
encourage mass vaccinations against common infections like the flu, and focus on building capacity to
support the most vulnerable people who are likely to get infected in this pandemic. These are critical
steps that cities in the developed world are taking; as an illustration, local public health departments
around the US are focusing on flu shots to improve overall levels of immunity and preserve system
capacity for a more serious Covid-19 outbreak when it happens.
Alongside protecting the population from other diseases, we should plan to preserve capacity for the
most vulnerable by encouraging other patients to stay at home, avoid contact with others, and follow a
care-regime that minimises burden on our already stressed public health delivery system.
Apart from strategising how our public health system is used, our response should encourage basic
healthy habits. We should engage educational institutions and workplaces to teach and encourage
practices like frequently washing hands, avoiding touching our face with unwashed hands, and not
sneezing or coughing into the air. Sick people should wear surgical masks to keep their illness from
spreading through cough, sneeze, or other droplets, and once community transmission is imminent,
healthy people should wear N95 respirators to protect themselves — it is important to use the correct
type of mask, and the administrative task is to ensure accessibility and availability.
Some of these strategies seem elementary but are enormously effective in containing the spread of viral
infections.
Once community transmission starts, it may become necessary to implement general quarantine
measures. The public should prepare by maintaining adequate food, water and medication stock for at
least several days, and also by ensuring availability of the same for those who cannot acquire it on their
own. This is not a call to panic, but prudent preparation.
It is difficult for a country like ours — that frequently bungles common immunisations — to check all the
boxes. China’s lockdown in Wuhan was unprecedented and impossible for any other country in the
world, and yet it can only buy us a few weeks before Covid-19 becomes a global pandemic. While we too
can buy a few days through containment and sealed borders, our real test is of preparation. The writer is
a PhD student in planning at the University of Illinois.
Coronavirus and the economy
Editorial | March 10, 2020
RECENT ADB estimates suggest that Pakistan’s economy could suffer a loss of up to 1.5pc in its GDP
growth rate due to the fallout from the spread of the novel coronavirus, while the capital markets have
already been roiled by a strong bout of volatility due to mounting fears and anxiety. World oil markets
are seeing a sharp fall — according to some reports the sharpest drop in oil prices since 1991. This has
driven down oil-related stocks that carry heavy weightage in the KSE 100, such as OGDC and PPL, both of
which hit their lower circuit breakers on Monday. In addition, some estimates suggest the global
aviation industry could see up to $113bn worth of revenue losses as a result. Global supply chains have
been disrupted badly because of the massive shutdowns in China that have either closed down
industries altogether, or disrupted the return of workers from the new year holidays to the point of
creating acute labour shortages in industrial areas that are not directly impacted by the shutdowns. In
every sphere, from travel and aviation to shipping and transport as well as oil prices and capital markets,
economies around the world are seeing sharp downswings as a result of the fallout from the efforts to
contain the spread of the coronavirus.
There are reasons to be concerned here in Pakistan as well. At the moment, there are no indications
emerging of a widespread outbreak of the virus. But each day the number of people diagnosed positive
is rising, albeit slowly, and there is no way of knowing how far this is going to go. Besides the obvious
public health emergency this poses, the fallout for the economy needs to be taken stock of. Some
people think it is a positive sign that Pakistani exporters are picking up the orders that might ordinarily
have gone to China and exports could see a spike in the months ahead. But it would be terribly
shortsighted to find much comfort in this fact. If the shutdowns persist and spread, it will also seriously
impact the scale of demand for Pakistan’s traditional exports, such as garments. Beyond that, the sharp
fall in the value of oil-related stocks means the divestment of OGDC shares that was planned in the next
few months will have to be postponed, and the privatisation programme will need to be shelved since
global buyers are in no mood to extend their stakes while the uncertainty persists.
It is not known how far the phenomenon will go and how many shutdowns we will have to see around
the world and for how long. In this environment, an economy such as Pakistan’s, which is struggling to
emerge from the crippling effects of a macroeconomic stabilisation programme, will face far more
challenges than opportunities.
Published in Dawn, March 10th, 2020
Hot money
THE rapidly accelerating departure of so-called hot money that came pouring into government debt
from last July onwards is now going to test the State Bank’s commitment to a ‘market-determined
exchange rate’. In the first 12 days of March, for example, close to $600m left Pakistani markets,
primarily from debt securities, as foreign investors and carry traders rushed for safety with the rising
economic impact from the fight against the COVID-19 virus. In the days to come, this exodus is likely to
grow, especially since it has induced exchange rate volatility which is the biggest source of uncertainty in
the eyes of the carry traders behind these inflows. Just in the last week, the rupee touched 160 to a
dollar, and then saw a mysterious dive back to 156.5 on Friday in a move that looked suspiciously like
intervention from the central bank. If so, we can be certain that the outflows have already given the
central bank cold feet, after its young governor had gone to some lengths to play down the risks of a
sudden outflow.
The financial markets will be the first to be tested by the growing clouds of uncertainty that are
engulfing the country and the world economy these days. The fact that this is happening in the run-up to
a monetary policy decision only complicates the picture for the State Bank.
Pressure to reduce interest rates is now higher than it has ever been through this cycle of monetary
tightening, and not a single voice is left in the public domain to make the case for continuing with high
interest rates. The problem is the State Bank cannot have it both ways.It cannot have a stable exchange
rate and low interest rates. Another problem is that the government is in no position to afford the kind
of stimulus measures that other economies are announcing to compensate for the slowdowns that the
fight against the virus necessarily brings. An important test is now shaping up for the governor of the
State Bank, who has confidently sold the public on the idea of hot money inflows to build reserves, a
market based exchange rate, and tight monetary policy. This is one test for which the textbook had not
prepared him, and Tuesday’s monetary policy statement will be his answer to the challenge. We will
wait to see the outcome.
Today WHO declared the coronavirus COVID-19 a “pandemic” when there is not the slightest trace of a
pandemic. A pandemic might be the condition, when the death to infection rate reaches more than
12%. In Europe, the death rate is about 0.4%, or less. Except for Italy, which is a special case, where the
peak of the death rate was 6%.
China, where the death rate peaked only a few weeks ago at about 3%, is back to 0.7% – and rapidly
declining, while China is taking full control of the disease – and that with the help of a not-spoken-about
medication developed 39 years ago by Cuba, called “Interferon Alpha 2B , very effective for fighting
viruses and other diseases, but is not known and used in the world, because the US under the illegal
embargo of Cuba does not allow the medication to be marketed internationally.
WHO has most likely received orders from “above”, from those people who also manage Trump and the
“leaders” (sic) of the European Union and her member countries, those who aim to control the world
with force – the One World Order.
This has been on the drawing board for years. The final decision to go ahead NOW, was taken in January
2020 at the World Economic Forum (WEF) in Davos – behind very much closed doors, of course. The
Gates, GAVI (an association of vaccination-promoting pharmaceuticals), Rockefellers, Rothschilds et al,
they are all behind this decision.
After the pandemic has been officially declared, the next step may be, also at the recommendation
either by WHO, or individual countries, “force vaccination”, under police or military surveillance. Those
who refuse may be penalized (fines or jail may be charged against them).
If indeed force-vaccination will happen, it would be another bonus for big Pharmaceutical companies,
people really don’t know what type of substances will be put into the vaccine, maybe a slow killer, that
acts-up only in a few years or a disease that hits only the next generation or a brain debilitating agent, or
a gene that renders women infertile …. all is possible always with the aim of full population control and
population reduction. In a few years’ time, one doesn’t know, of course, where the disease comes from.
That’s the level of technology our bio-war labs have reached (US, UK, Israel, Canada, Australia).
Hafeezullah (Columnist and student of International Relations)
‘ Super-spreaders’: Covid-19 myth or reality? -

https://www.dawn.com/news/1541026?ref=whatsapp
PARIS: Can a single Covid-19 patient infects dozens of others? Although transmission rates in the current
outbreak appear to be far lower, a variety of factors can lead to an individual infecting many.
The concept of so-called “super-spreaders” — patients who typically infect far more people than the
standard transmission rates — emerged in previous outbreaks of diseases such as Sars and Mers.
Amesh Adalja, an expert in emerging infectious diseases at John Hopkins University, said the term was
not scientific and there was no set quantity of transmissions that would define a super-spreader.
“But, in general, it is usually a markedly higher figure when compared to that of other individuals,” he
said.
A range of variables govern how many people an individual infects, from how fast they shed the virus to
how many people they come in to close contact with.
The novel coronavirus has a typical transmission rate of 2-3 — that is, every confirmed case appears to
infect between 2 and 3 other people on average.
But the pandemic has thrown up at least two patients who appear to have been super-spreaders.
One suspected super-spreader, a British national, appears to have infected a dozen others when he
returned from Singapore and then went skiing in the Alps. He recovered, but may have infected another
five people after returning home.
In South Korea, which has the second highest number of Covid-19 cases outside of Italy, a woman
known as Patient 31 appears to have infected dozens of others.
But in an ever better-connected world, it can be challenging to definitively link transmissions to an

individual patient.
“It’s possible that what we call super-spreaders exist, those patients who don’t only infect 2-3 others but
could infect dozens,” said Eric Caumes, head of infectious and tropical diseases at Paris’ Pitie-Salpetriere
Hospital.
“The problem is we aren’t spotting them.” According to Olivier Bouchaud, head of infectious diseases at
that Avicenne hospital in Paris’ suburbs, variable transmission rates could be down to how fast a patient
sheds the virus once infected.
“That’s just a hypothesis at this point,” he said. “Obviously we don’t have a clear explanation, and
there’s nothing specific to Covid-19.” Another unknown is the role played by young children, who are
less severely affected by the virus but are capable of transmitting it — part of the reason many countries
have moved to close schools in recent days.
Cristl Donnelly, professor of Applied Statistics at the University of Oxford, said all disease transmission
was by nature “highly variable”.
“But we are not all the same, we vary in our immune systems, in our behaviour, and in where we
happen to be,” she said. “All of these things can affect how many people we would transmit to.” Bharat
Pankhania, an infectious diseases expert at Britain’s Exeter University, even disputed whether super-
spreaders existed.
He said that the biggest factors determining transmission were environmental, made worse in dense-
populated cities.
“These circumstances often are: crowding; a confined space with poor ventilation; poor infection
control, meaning lots of non-porous, hard surfaces which can keep a virus viable for a longer time; a
favourable ambient humidity; and the infected person usually being in the early phase of their illness,
when virus secretions are at their peak,” he said.
It’s due to these contributing factors that many experts are reluctant to talk in terms of super-spreaders.
Added to this, as France’s health minister has pointed out, the term might be used to stigmatise
individuals, when it is likely they transmitted Covid-19 without realising.

Struggling to manage anxiety in the COVID-19 health crisis? | Psychology
Today
https://www.psychologytoday.com/blog/worry-and-panic/202003/struggling-manage-anxiety-in-the-
covid-19-health-crisis
Headlines declaring the lion's share of the population will be infected, the British Prime Minister
announcing ‘families are going to lose loved ones before their time’, endless photos on Facebook
showing shops that have run out of provisions – all these fan the flames of panic.
Panic and anxiety produce a great many physical symptoms – palpitations, headaches, sweaty palms,
flushing, difficulty focusing, diarrhea... the list goes on. As a result, thousands – possibly millions – of
people are dealing with a host of very distressing symptoms whether they have Coronavirus disease, or
not.
Here are ten ways to reduce worry and panic, most of which can be done if you’re self-isolating or
limiting contact with others.
Take a cue from others impacted by Covid-19: ‘Every day, I have tried to get up and exercise, cook and
eat, write a diary and do some volunteer work. Taking action and doing things makes you feel better,’
says Guo Jing, 29, Wuhan (Guardian)
9. Be kind. Hopefully some of the suggestions above will help you be kind to yourself. But don’t forget,
insofar as you can, to be kind to others too. As part of a #viralkindess campaign, postcards bearing the
message “Hello! If you are self-isolating, I can help” are being dropped at doorsteps across the UK. You
can download cards to drop to neighbors here. Being active about helping others can help boost your
mood and reduce the anxiety of those who are most vulnerable.
10. Last, but not least, remember that in feeling hyper anxious you are not alone and what you are
experiencing is completely normal. When I first had a panic attack, I thought I was going mad and having
a heart attack, both at the same time. However, I have managed to survive another 35-odd years and
whilst I have had some bouts of anxiety since, by and large I have learnt to manage using various
supports. Some find CBT hugely helpful. Others have been aided by medication. Meditation can play a
part too. Exercise is another tool that I have in my kit, but I’m no Olympic athlete and you needn’t be
either. I find it is many of these together that work best for me, along with talking to other sufferers and
improving my understanding of what was happening to me physically as a result of my catastrophic
thinking. In any event, please trust that heightened anxiety is not permanent. You can never be rid of
anxiety completely as it’s a natural physiological response, but its impact can be reduced. As for panic
attacks, they can feel terrifying, but they do pass.
If we can bring our personal and collective levels of panic down, then we will feel better able to cope
with the current situation. Meanwhile I wish you and your loved ones strength and courage, wherever in
the world you are reading this.
"Containing the virus" by Editorial
THE National Security Council has met to discuss a strategy for a looming healthcare crisis of
unprecedented proportions — the contagious coronavirus, which has sparked panic across the world
owing to its rapid spread and potential to kill. The government has announced the formation of a
national coordination committee along with a string of measures which include the sealing of borders
with Iran and Afghanistan, restricting international flights and barring mass public events. The advisory
also declared the shutdown of educational institutions, cinemas, theatres and marriage halls, the
adjournment of civil cases in courts and changes in hearing procedures for criminal cases. The decisions
came as Pakistan reported some 30 confirmed cases of COVID-19, which include at least one individual
who did not travel abroad, indicating that community spread within the country could be a reality.
Given that Pakistan is straddled by China and Iran which have among the highest reported cases, the
authorities’ response to the fast-spreading virus has been lethargic and more reactive than proactive —
a circumstance which has led the virus to thrive in other countries. States including China, Iran and Italy
were unable to contain the spread and have reported thousands of cases and hundreds of deaths. This is
a situation our authorities have been aware of for some time. One illustration of this is that until just a
couple of days ago, Punjab, the most populated province, had ostensibly taken no measures to limit
public gatherings or establish health protocols. The ijtima at Raiwind, a congregation of thousands,
began despite the provincial government’s pleas to organisers not to hold it. This defies logic. Pakistan is
a developing country with poor healthcare infrastructure and low hygiene standards, so authorities
ought to have sounded the alarm by enforcing strict screening and cancelling mass public events when
the first case was reported at the end of February. Moving forward, the government must share its
resources and work with the provincial governments to contain the virus. This would include effective
screening at entry ports, which until recently involved filling out a form. Resources must be allocated to
establish health desks at ports which check symptoms and isolate passengers who show signs of being
infected. Across cities, the government must kick off mass multilingual awareness drives about hygiene,
symptoms and the availability of medical help. The federal government must take on board religious
authorities to examine the roles that mosques can play to create awareness and limit the spread.
Prime Minister Imran Khan should follow in the footsteps of other world leaders and be visible in the
COVID-19 messaging campaign, which he had stayed away from until yesterday. Given the potentially
high mortality rate and the ensuing economic losses, this is not the time to bicker over the 18th
Amendment or the availability of funds. Our politicians ought to show leadership and focus on action,
transparency and communication.
"A pandemic of fear" by Sakiq Sherani
GLOBAL financial markets have been roiled the past week by extreme panic-induced volatility. Lower
locks/circuit breakers have been activated in stock exchanges around the world, oil prices have dropped
the most in a single day since 1991, while the yield on the US 30-Year Treasury bond has sunk to below
one per cent for the first time in history.
An estimated $9 trillion has been wiped off the market capitalisation of global stocks in the past two
weeks, with the S&P 500 index plunging 20pc since its peak on Feb19. The Pakistan Stock Exchange’s
KSE-100 index has fallen 10pc since. Not surprisingly, traders have dubbed the price action on March 9
as Black Monday and the recent carnage more generally as a ‘bloodbath’.
The two immediate catalysts for the collapse witnessed on global financial markets are the rapid,
contagious spread across the world of the novel coronavirus (COVID-19), and the start of an oil price war
between Saudi Arabia and Russia after the dramatic collapse of the OPEC+ agreement on production
cuts.
The two seemingly unrelated developments — the COVID-19 pandemic and the oil price war — are not
as unrelated as they may seem at first. The first development has amplified pre-existing worries about
the health of the global economy. These concerns have played into oil market fears about weak
demand. The second development (collapse of OPEC+ agreement) has added a supply shock to the
disquiet of oil exporting nations. Since the demand for oil — and in a second-hand way, its international
price — is an important indicator of the health of the global economy, the sharp fall in oil benchmarks
has reinforced the prevailing sentiment of gloom and doom.
The global economy has hit severe turbulence.
The categorisation by WHO of COVID-19 as a pandemic will fuel the panic. Given that over 103 countries
were reported affected as of March 9, including hard-hit advanced economies such as Italy, compared to
around 26 each at the time of SARS or MERS, and the extreme containment measures that countries
around the world are having to take, the scale of potential economic disruption is unprecedented. Huge
losses are being incurred by airlines, hotels, and the wider tourism/hospitality and recreation industries,
among others.
The fact that China was at the epicentre of this virus is leading to fears about the economic contagion
spreading far and wide. While China absorbs around 11pc of the world’s exports, almost 40pc of its own
exports, or nearly $1tr, are supplied to global companies as part of the latter’s supply chains. (This
number is down from around 80pc at its peak in the early 2000s.) The closure of factories and all means
of transportation between December and end-February would have imposed colossal losses that are
unlikely to be recouped with a global economy tipping into a ‘recession’.
According to an estimate by Bloomberg Economics, the COVID-19 pandemic can cost as much as $2.7tr
to the global economy in the worst case, with the loss to China’s economy estimated at 2.4pc of GDP.
The more relevant question for us of course is what will be the economic impact on Pakistan? The most
visible number that commentators are focused on is the international price of oil. With every decline of
$10 per barrel, Pakistan’s oil import bill drops by approximately $1.3 billion. With benchmark Brent
crude trading at $59 on Feb 20, and having lost almost $25 per barrel as of March 11, the import bill can
fall by over $3.2bn over the next 12 months if current levels are sustained. Since a fall in the
international price of oil is linked to other important energy products that Pakistan imports, such as
LNG, the potential savings are likely to be larger.
Lower imported energy prices should translate into a sharp fall in inflation, with the magnitude
depending on how much of the fall in international prices is passed on to domestic consumers by the
government. The prospect of sharply lower inflation should spur an interest rate-cutting cycle by the
central bank, which will ease budgetary pressure on the one hand, and lower the burden of financial
charges for businesses. Cheaper imported energy prices will also potentially translate into lower energy
costs for businesses and households via a reduction in electricity and gas tariffs. This should also ease
the pace of accumulation of circular debt.
These are substantial positives. However, the impact is not unambiguously positive. The upside from
lower oil prices will be limited to an extent by the growth-diminishing effects of fiscal consolidation.
Global recessionary conditions will also provide headwinds for Pakistan’s exports. The lower demand
and price of oil could at some stage impact Saudi Arabia’s willingness to continue with the generous oil
facility it has granted to Pakistan. The enormous impact on the global economy, with the oil export-
dependent Gulf economies hardest hit, could spill over into the country’s flow of worker remittances.
In addition, lower oil prices will negatively affect the government’s main revenue spinner. However,
lower revenue from the import and sale of petroleum will be offset to some extent by raising the
petroleum levy, as well as via lower debt servicing costs. Finally, conditions in the global financial
markets have prompted significant outflows from the stock of foreign portfolio investment in
government securities. Between March 9 and 11, around $400 million has flown out from the ‘hot
money’ book, or roughly 12pc of the total invested stock in a space of three days. This is possibly the
start of the worst case scenario readers will recall I have been warning against since July last year.
An even bigger risk that stalks Pakistan’s outlook than all the foregoing near-term ones, however, is that
the economic reprieve from falling oil prices could engender complacency in the already fairly
underwhelming reform effort this government is undertaking. If so, that would take us back to where we
started — square one.
"Coronavirus in a lesser governed state" by Shahzad Chowdhury
- https://tribune.com.pk/story/2176284/6-coronavirus-lesser-governed-state/?amp=1
This is our next challenge. Maybe it already is here, just that we don’t know of it for lack of testing kits
and for a laissez faire approach in how we deal with issues even when we know better. We haven’t
mapped our most-at-risk segments of the population and not tested enough people to know the real
spread and depth of how Pakistan may already be infected with coronavirus. We only know those who
enter from the Taftan-Iran border and quarantine them in our special way. Among them, those that are
responsible, or helpless, or persons of lesser means and influence, or cannot buy their way out, remain.
Others simply manage out of even this sham detention. Of those who travel from China into Pakistan, or
now call this country their second home, we do the perfunctory check only of their body temperature
and in testimony of our eternal friendship outscaling both the Himalayas and the Indian Ocean, we earn
their kudos.
The health minister assures us that in the last month and a half — since we woke up to a disease which
was killing people at random — we had had only 20 confirmed cases of the coronavirus. That beats the
odds by the hugest margin going by theorems of exponential growth which is how the epidemic, now a
pandemic, is spreading. There is this extremely well-elaborated narration of “Exponential Growth and
Epidemics” (https://www.youtube.com/watch?v=Kas0tlxDvrg&feature=youtu.be) which by all counts, if
true should have seen numbers multiply in 10s every few days. But we somehow are still lucky to be in a
very selectively linear growth. And without any mitigating intervention from our side. This trumps
science and mathematics, both.
The explanation in the video above talks of the inflection point when the exponential growth begins to
taper off and then decline. It occurs on two counts: when all are infected with the virus and there is
none left to add to the tally, or when remedial measures kick in to mitigate the spread through care,
discipline, precaution, isolation and extreme hygiene in individual and collective lives which stem the
tide and ultimately reduce it to zero. It’s a mathematical model of an epidemic and its growth path is
based on realistic data establishing a 15-20% increase daily from the previous day’s numbers —
compounding to excessively high rates qualifying it to the point of an epidemic. A rough calculation
suggests that numbers of afflicted must increase in multiples of 10 over every 15 day period. Our official
statements, of course, don’t match such profound scrutiny. That’s miraculous despite us being a
pedestrian society.
I am a man of science and mathematics and know well the society I live in, and the governance in vogue
under various governments and the lack of seriousness that pervades the entire structure of our state
and its people; dengue of last summer is the case in point. We are a poor people of a poorer nation in a
society which is even worse for its habits in collective living. We may have thus no other recourse than
to believe the daily fodder from the health minister that “all is okay”. It’s a different matter that the
WHO has upgraded the level of the spread to a pandemic. If that is how the epidemic will grow because
that is what nature through science and mathematics ordains, we should assume that we all will soon be
afflicted unless we did something about it. A society that prides itself in not sticking to norms is
inherently unhygienic in how it subsists, and leaves a lot to chance by way of trusting heavenly
intervention is not an ideal place to beat the epidemical growth model.
But here is what is happening in Chagai, close to where an isolation facility has been created for those
who arrive from the heavily-infested Iran: one, they all live in a tented village for sequestration —
hopefully it does the job though it isn’t as sexy as raising two hospitals in 10 days; two, they all amble
around freely visiting the local bazaars of Chagai and their tea-shops — reports now indicate that shops
have been set up at the facility as an evolving enterprise. This should soon exponentially infect all of
Chagai for being the backwater in an already poor state, the locals fear. And finally, with slight greasing
of the right palms those quarantined can flee the confinement and pay their carriers handsomely to take
them home. So much for communal discipline and responsibility. Those afflicted still might survive the
disease but will bring others down that they pass on to. But to know such is beyond their pail.
That’s the society we have built for ourselves over generations leaving little to whinge over. It is instead
the moment to do something. The NSC has done well to meet and bring focus back on what is already a
huge medical emergency. When we wish to enforce something our recourse of choice is the security
apparatus. They can help. Just this week the PM has allocated billions more in fulfillment of his promise
to make five million houses, and create jobs and trigger a part of economy with this building frenzy. The
coronavirus soon might upend such economic initiatives needing those billions to provide some
protection to the people instead. The media too will do well by moving from ethereal matters in political
game-playing to something which is far graver and imminent as a lockdown looms to save lives across
the country. Knowing the society we are such decisions will need to be enforced.
The decision to cancel the 23rd March Parade is opportune. Using the expense for the parade on
fighting the menace of the coronavirus epidemic is a far more nationalist thing to do. Closing
educational institutions till we have ridden the storm out is equally good, though a tad late. There
shouldn’t be any hesitation to add over time the advice and enforcement of avoiding all assemblies
whether social, organisational or religious, public or private. After all there are widespread changes
brought to how religious functions are being undertaken at the holiest of sites across all religions. We
should be able to ring in changes compatible to the needs of fighting the challenge of coronavirus and
limit its deadly reach.
On a wider scale, coronavirus has altered the face of the global economy like never before. Economies
are stalled, production ceased, consumption restricted and trading impossible. The world is in a state of
suspension. Oil has taken a hit, as have stock markets across the world. People and states are holding on
to their liquid cash. They anticipate using it for more emergent needs driven by the pandemic. We too
need to control our expenditure holding onto what we have till the storm is over. Science doesn’t lie and
numbers even lesser. It is good to pay heed now and mend what is either already broken or about to
despite the bliss of our ignorance, and perhaps some delayed reaction.
"Corona pandemic: History being written in Pakistan & World" by Saad

Rasool
https://www.globalvillagespace.com/corona-pandemic-history-being-written-in-pakistan-world/
History has a peculiar sense of inevitability. ‘Moments in history’ do not always announce themselves
with the bang of gunfire, or from the podium of some political stage. Such moments creep up on us,
silently, with a sense of cosmic reality that is bigger than any momentary fascination of our time. And
this silent writ of cosmic history continues to shape our collective fortunes, even as we remain ignorant
of its scale and scope.
While there is no way of being sure, but one such moment may have occurred earlier this week, as
ritualistic worship came to a halt (simultaneously!!) across the holiest places of all Abrahamic religions of
the world.
Before, commenting on the importance of this development, let us start with a brief recounting of some
of the relevant facts that has resulted in this unprecedented event.
Tawaf-e-Kaaba has been stopped twice before in the last 1400 years. Vatican was shut down, for a few
days, during the two world wars. Jerusalem’s worship has been stopped, several times, especially during
the Crusades
Tawaf-e-Kaaba has been stopped twice before in the last 1400 years. Vatican was shut down, for a few
days, during the two world wars. Jerusalem’s worship has been stopped, several times, especially during
the Crusades
Coronavirus, and it seemingly unstoppable footprint, has taken the world by a storm. The presence of
Coronavirus in human being, caused by the SARS-CoV-2, was first identified in the Wuhan Province of
China. The earliest reported symptoms occurred on 1 December 2019, in a person who had not had any
exposure to the Huanan Seafood Wholesale Market.
Since then, from one cell, in one human being, it has (as of this date) spread to 96 countries, resulted in
102,000 confirmed cases (of which 7,100 have been classified as “serious” by the World Health
Organization), with major outbreaks in central China, South Korea, Italy and Iran. During the continuing
spread of this epidemic, more than 3,400 people have died – around 3,100 in mainland China and some
425 in other countries. On the bright side, more than 57,000 people, who were affected by the virus,
have since recovered.
The Coronavirus primarily spreads from one person to another in a manner similar to influenza – via
respiratory droplets produced during coughing or sneezing. While scientists across the world are still
trying to come to terms with the precise nature of this unprecedented virus, it has been observed that
the time between exposure and symptom onset is typically five days, but may range from two to
fourteen days. Typically, symptoms manifest in the form of fever, cough, and shortness of breath. There
is some evidence that the coronavirus is evolving/mutating to adapt to the changes in temperature and
surface conditions.
Read more: Crisis of Governance in Pakistan
Importantly, at present, there is no vaccine or specific antiviral treatment for the Coronavirus, though
research is ongoing. In particular, efforts are being aimed at managing symptoms and to provide support
therapy. Recommended preventive measures, include sanitization techniques are being recommended,
till a vaccine is eventually developed.
Global response to the spread of Coronavirus, initially sluggish, has now caught up with the gravity of
the situation at hand. Travel restrictions, to and from places infected with Coronavirus, have been
announced by almost all countries. Most countries have ordered an evacuation of foreign citizens and
tourists. Foreign aid has been announced for countries struggling with this outbreak.
Schools, businesses and places of public gather have been shut down across various countries. As of 6
March, 291.5 million children and youth are not attending school because of temporary or indefinite
countrywide school closures mandated by the relevant government authorities, in an attempt to slow
the spread of Coronavirus. According to one estimate, the spread of Coronavirus is likely to result in
more than $300 billion in impact on world’s supply chain, highest in history.
In Baldia Factory. On the streets in Liyari. In the deserts of Thar. We spend more time and energy
defending Omni Group and Sharif empire, than we ever did in prosecuting Shahrukh Jatoi
defending Omni Group and Sharif empire, than we ever did in prosecuting Shahrukh Jatoi
All of these are important developments, indicating the critical nature of this growing epidemic. But
perhaps the most startling development, captured in a serious of photos that flashed throughout the
modern media machine this week, was the closure of almost all places of religious/historical importance
for the monotheistic religions of the world.
Specifically, on Thursday of this week, the tawaf in the Holy Kaaba was stopped, and the Zamzam well
has been closed first time in history. On the same day, the Wailing Wall (of the old Temple) in Jerusalem
was closed to all visitors. Some hours later, on the same day, the Church of Nativity (where Jesus was
born) was shut for all congregations. Also, on the same day, the Church of the Holy Sepulcher (the place
of crucifixion of Jesus) was also shut for visitors.
At the same time, the Al-Aqsa mosque (the place from where the flight of Mairaaj took place) was also
shut down for prayer. In Europe, Vatican was closed for its many visitors and priests. Even the Pope did
not come out to his balcony, or welcome the devotees. And the following day, within 24 hours, the
weekly Friday prayers were suspended at Imam Ali (A.S.)’s shrine in Najaf and Imam Hussain (A.S.)’s
shrine in Karbala, out of fear of spreading the Coronavirus.
Read more: Is our Education system actually teaching: The answer is NO
Let me attempt to put these developments in perspective: this is the first time – in all of human history –
that all of these places have been simultaneously shut down for worship and prayer. Tawaf-e-Kaaba has
been stopped twice before in the last 1400 years. Vatican was shut down, for a few days, during the two
world wars. Jerusalem’s worship has been stopped, several times, especially during the Crusades. But
never before, in a religious history spanning more than 5,000 years since Abraham first walked from
Cannan to Mecca, have all major places of monotheistic religions been simultaneously prohibited from
prayer.
It is as though the God of Adam (A.S.), of Noah (A.S.), of Abraham (A.S.), of Moses (A.S.), of Jesus (A.S.)
and, of course, of Muhammad (SAWW) has had enough of our hypocritical life and worship. That
whatever was the straw that was going to break the camel’s back, may finally have fallen in its place.
That perhaps, the millions clamoring for respite – including children in Syria, in Mayanmar, in Kashmir, in
Palestine, in Iraq and the famished deserts of sub-Sahara Africa – may finally have been heard. Our
collective inability to address the issues of our time may have precipitated the prophecies of old. And
yet we continue to focus on the absurd, while ignoring the important.
In Pakistan, for example, the rabid raucous of the likes of Marvi Sirmid and Khalilur Reham have
captured a higher fraction of our collective focus than the screams of Zainab Ansar ever did. We are
more obsessed with Nawaz Sharif’s platelet counts than we ever were with the plight of those
massacred in Model Town.
Read more: Trump’s Middle East peace plan: Deceit of the century?
defending Omni Group and Sharif empire, than we ever did in prosecuting Shahrukh Jatoi. We have
made heroes out the likes of Rana Sanaullah and Sharjeel Memon while allowing huddled masses to die
in hunger on our streets. The likes of Nawaz Sharif and Asif Zardari have been released (on medical
grounds), while thousands languish in disease in our jails, dying in captivity.
Maybe, just maybe, enough has been done. And the God of Torah, of Bible and the Quran, does not
want our prayers anymore.
I’ll stop here, before members of the liberal left decide to turn this piece a punchline. But before parting,
allow me the indulgence to say one thing: take a moment, in the coming days, by yourself, and reflect on
the personal/societal preferences that occupy your time and energy. And maybe, in the process, you will
feel the need to repent for individual and collective salvation.
Saad Rasool is a lawyer based in Lahore. He has an LL.M. in Constitutional Law from Harvard Law School.
He can be reached at saad@post.harvard.edu, or Twitter: @Ch_SaadRasool. This article originally
appeared at The Nation and has been republished with the author’s permission. The views expressed in
this article are the author’s own and do not necessarily reflect the editorial policy of Global Village
United States
Covid-19 and the economy
Spluttering
SAN FRANCISCO
Tracking the economic impact of the virus in real time
Shelf and safety
As fears grow about the impact of the covid-19 virus, financial markets have slumped. Now there are
signs that the virus is moving from traders’ screens to the real economy. No one will know the true
economic impact for some time, because official statistics are published with a lag: the first estimate of
gdp growth in the current quarter, for instance, will not appear until April 29th. Analysts cannot wait
that long. So they are turning to “real-time” data, mainly produced by the private sector, on everything
from transport use to social-media activity. None of these measures is reliable by itself, but together
they give a decent impression of what is going on.
It is not all doom and gloom. So far there are few indications—either from weekly jobless claims or from
company announcements—that joblessness is rising. Worries that broken supply chains would stoke
inflation also look overdone, for now at least. Data to the beginning of March from State Street
PriceStats Indicators, which measures inflation daily, suggest that inflation has been on a steady
downward trend since the beginning of the year (though in recent days food prices have inched up,
perhaps pointing to the effects of stockpiling). Railway and trucking volumes appear to be holding up.
There is some evidence of lower electricity demand, perhaps as people miss work, though the figures
are volatile.
Household spending is taking a big hit, however. Analysis by Goldman Sachs, a bank, of Twitter posts
suggests that consumer confidence has dropped. People are nervous of crowds—and some 40% of
household spending is vulnerable to people shunning gatherings, according to calculations by The
Economist using a methodology from an Oxford University research paper. (About 5% of consumer
spending goes on dining out, for instance.)
Google searches for “restaurant reservations” are way down. The maître d’ at San Francisco’s best
oyster bar was so pleased to see a customer that he offered a free plate of them when your
correspondent bought a drink (the bar looked over the bay towards Grand Princess, a virus-stricken ship
harboured in Oakland). A report from JPMorgan Chase, another bank, estimates that last weekend the
virus reduced cinema-ticket receipts by 20%. Attendance at Broadway shows has also dropped. Data
from TomTom, a location-technology firm, reveal unusually low traffic congestion in many American
cities since the end of last week. Lower consumer spending points to feeble gdp growth in the first half
of this year, though a recession still seems unlikely at this stage.
What happens next depends on whether America gets a handle on the outbreak. If it does not, then
over time revenue-starved firms and salary-starved families will struggle. Any short-term economic
boost from stockpiling would be cold comfort in the face of lower spending on services. But if America
contains the virus, it can look forward to a bounceback of sorts. Real-time data in China, from traffic
congestion to energy consumption, remain weak but are fast improving as the number of new infections
slows. An acute economic shock does not have to turn chronic.
Leaders
Covid-19
The politics of pandemics

All governments will struggle. Some will struggle more than others
To see what is to come look to Lombardy, the affluent Italian region at the heart of the covid-19
outbreak in Europe. Its hospitals provide world-class health care. Until last week they thought they
would cope with the disease—then waves of people began turning up with pneumonia. Having run out
of ventilators and oxygen, exhausted staff at some hospitals are being forced to leave untreated patients
to die.
The pandemic, as the World Health Organisation (who) officially declared it this week, is spreading fast,
with almost 45,000 cases and nearly 1,500 deaths in 112 countries outside China. Epidemiologists
reckon Italy is one or two weeks ahead of places like Spain, France, America and Britain. Less-connected
countries, such as Egypt and India, are further behind, but not much.
Few of today’s political leaders have ever faced anything like a pandemic and its economic fallout—
though some are evoking the financial crisis of 2007-09 (see next leader). As they belatedly realise that
health systems will buckle and deaths mount, leaders are at last coming to terms with the fact that they
will have to weather the storm. Three factors will determine how they cope: their attitude to
uncertainty; the structure and competence of their health systems; and, above all, whether they are
trusted.
The uncertainty has many sources. One is that sars-cov-2 and the disease it causes, covid-19, are not
fully understood (see Briefing). Another is over the status of the pandemic. In each region or country it
tends to proliferate rapidly undetected. By the time testing detects cases in one place it will be
spreading in many others, as it was in Italy, Iran and South Korea. By the time governments shut schools
and ban crowds they may be too late.
China’s solution, endorsed by the who, was to impose a brutal quarantine, bolstered by mass-testing
and contact tracing. That came at a high human and economic cost, but new infections have dwindled.
This week, in a victory lap, President Xi Jinping visited Wuhan, where the pandemic first emerged (see
China section). Yet uncertainty persists even in China, because nobody knows if a second wave of
infections will rise up as the quarantine eases.
In democracies leaders have to judge if people will tolerate China’s harsh regime of isolation and
surveillance. Italy’s lockdown is largely self-policed and does not heavily infringe people’s rights. But if it
proves leakier than China’s, it may be almost as expensive and a lot less effective (see International
section).
Efficacy also depends on the structure and competence of health-care systems. There is immense scope
for mixed messages and inconsistent instructions about testing and when to stay isolated at home.
Every health system will be overwhelmed. Places where people receive very little health care, including
refugee camps and slums, will be the most vulnerable. But even the best-resourced hospitals in rich
countries will struggle.
Universal systems like Britain’s National Health Service should find it easier to mobilise resources and
adapt rules and practices than fragmented, private ones that have to worry about who pays whom and
who is liable for what (see Britain section). The United States, despite its wealth and the excellence of its
medical science, faces hurdles. Its private system is optimised for fee-paying treatments. America’s 28m
uninsured people, 11m illegal immigrants and an unknown number without sick pay all have reasons to
avoid testing or isolation. Red tape and cuts have fatally delayed adequate testing (see United States
section).
Uncertainty will be a drag on the third factor—trust. Trust gives leaders licence to take difficult decisions
about quarantines and social-distancing, including school closures. In Iran the government, which has
long been unpopular, is widely suspected of covering up deaths and cases. That is one reason rebellious
clerics could refuse to shut shrines, even though they spread infection (see Middle East & Africa
section).
Nothing stokes rumour and fear more than the suspicion that politicians are hiding the truth. When they
downplay the threat in a misguided attempt to avoid panic, they end up sowing confusion and costing
lives. Yet leaders have struggled to come to terms with the pandemic and how to talk about it. President
Donald Trump, in particular, has veered from unfounded optimism to attacking his foes. This week he
announced a 30-day ban on most travel from Europe that will do little to slow a disease which is already
circulating in America. As people witness the death of friends and relatives, he will find that the
pandemic cannot be palmed off as a conspiracy by foreigners, Democrats and cnn.
What should politicians do? Each country must strike its own balance between the benefits of tracking
the disease and the invasion of privacy, but South Korea and China show the power of big data and
mass-testing as a way of identifying cases and limiting their spread. Governments also need to anticipate
the pandemic, because actions to slow its spread, such as banning crowds, are more effective if they are
early.
The best example of how to respond is Singapore, which has had many fewer cases than expected.
Thanks to an efficient bureaucracy in a single small territory, world-class universal health care and the
well-learned lesson of sars, an epidemic of a related virus in 2003, Singapore acted early. It has been
able to make difficult trade-offs with public consent because its message has been consistent, science-
based and trusted.
In the West covid-19 is a challenge to the generation of politicians who have taken power since the
financial crisis. Many of them decry globalisation and experts. They thrive on division and conflict. In
some ways the pandemic will play to their agenda. Countries may follow America and turn inward and
close their borders. In so far as shortages crimp the world economy, industries may pull back from
globalisation—though they would gain more protection by diversifying their supply chains.
Leaders
Financial conditions
V is for vicious
How to make sense of the mayhem in markets
When faced with a bewildering shock it is natural to turn to your own experience. As covid-19 rages,
investors and officials are scrambling to make sense of the violent moves in financial markets over the
past two weeks. For many the obvious reference is the crisis of 2007-09. There are indeed some
similarities. Stockmarkets have plunged. The oil price has tumbled below $40 a barrel. There has been a
flurry of emergency interest-rate cuts by the Federal Reserve and other central banks. Traders are on a
war footing—with a rising number working from their kitchen tables. Still, the comparison with the last
big crisis is misplaced. It also obscures two real financial dangers that the pandemic has inflamed.
The severity of the shock so far does not compare with 2007-09. Stockmarkets have fallen by a fifth from
their peak, compared with a 59% drop in the mortgage crisis. The amount of toxic debt is limited and
easy to identify. Some 15% of non-financial corporate bonds were issued by oil firms or others hit hard
by the virus, such as airlines and hotels. The banking system, stuffed with capital, has yet to seize up;
interbank lending rates are under control. When investors panic about the end of civilisation they rush
into the dollar, the reserve currency. That has not yet happened (see Buttonwood).
The nature of the shock is different, too. The 2007-09 crisis came from within the financial system,
whereas the virus is primarily a health emergency. Markets are usually spooked when there is
uncertainty about the outlook six or 12 months out, even when things seem calm at the time—think of
asset prices dropping in early 2008, long before most subprime mortgage borrowers defaulted. Today,
the time horizon is inverted: it is unclear what will happen in the next few weeks, but fairly certain that
within six months the threat will have abated.
Instead of tottering Wall Street banks or defaults on Florida condos, two other risks loom. The first is a
temporary cash crunch at a very broad range of companies around the world as quarantines force them
to shut offices and factories. A crude “stress test” based on listed companies suggests that 10-15% of
firms might face liquidity problems (see Finance section). Corporate-bond markets, which demand
precise contractual terms and regular payments, are not good at bridging this kind of short but
precarious gap.
In 2007-09 the authorities funnelled cash to the financial system by injecting capital into banks,
guaranteeing their liabilities and stimulating bond markets. This time the challenge is to get cash to
companies. This is easy in China, where most banks are state-controlled and do as they are told. Credit
there grew by 11% in February compared with the previous year. In the West, where banks are privately
run, it will take enlightened managers, rule tweaks and jawboning from regulators to encourage lenders
to show clients forbearance. Governments need to be creative about using tax breaks and other
giveaways to get cash to hamstrung firms. While America dithered, Britain set a good example in this
week’s budget (see Britain section).
The second area to watch is the euro zone. It is barely growing, if at all. Central-bank interest rates are
already below zero. Its banks are healthier than they were in 2008 but still weak compared with their
American cousins. Judged by the cost of insuring against default, there are already jitters in Italy, the one
big economy where banks’ funding costs have jumped. As we went to press, the European Central Bank
was meeting to discuss its virus response. The danger is that it, national governments and regulators fail
to work together.
Every financial shock is different. In 1930 central banks let banks fail. In 2007 few people had heard of
the subprime mortgages that were about to blow up. This financial shock does not yet belong in that
company. But the virus scare of 2020 does create financial risks that need to be treated—fast.
Briefing: The covid-19 virus
The covid-19 virus
Anatomy of a killer
How SARS-COV-2 causes covid-19, and how it might be stopped
The interconnectedness of the modern world has been a boon for sars-cov-2. Without planes, trains and
automobiles the virus would never have got this far, this fast. Just a few months ago it took its first steps
into a human host somewhere in or around Wuhan, in the Chinese province of Hubei. As of this week it
had caused over 120,000 diagnosed cases of covid-19, from Tromsø to Buenos Aires, Alberta to
Auckland, with most infections continuing to go undiagnosed (see International section).
But interconnectedness may be its downfall, too. Scientists around the world are focusing their
attention on its genome and the 27 proteins that it is known to produce, seeking to deepen their
understanding and find ways to stop it in its tracks. The resulting plethora of activity has resulted in the
posting of over 300 papers on Medrxiv, a repository for medical-research work that has not yet been
formally peer-reviewed and published, since February 1st, and the depositing of hundreds of genome
sequences in public databases.
The assault on the vaccine is not just taking place in the lab. As of February 28th China’s Clinical Trial
Registry listed 105 trials of drugs and vaccines intended to combat sars-cov-2 either already recruiting
patients or proposing to do so. As of March 11th its American equivalent, the National Library of
Medicine, listed 84. This might seem premature, considering how recently the virus became known to
science; is not drug development notoriously slow? But the reasonably well-understood basic biology of
the virus makes it possible to work out which existing drugs have some chance of success, and that
provides the basis for at least a little hope.
Even if a drug were only able to reduce mortality or sickness by a modest amount, it could make a great
difference to the course of the disease. As Wuhan learned, and parts of Italy are now learning, treating
the severely ill in numbers for which no hospitals were designed puts an unbearable burden on health
systems. As Jeremy Farrar, the director of the Wellcome Trust, which funds research, puts it: “If you had
a drug which reduced your time in hospital from 20 days to 15 days, that’s huge.”
Little noticed by doctors, let alone the public, until the outbreak of sars (severe acute respiratory
syndrome) that began in Guangdong in 2002, the coronavirus family was first recognised by science in
the 1960s. Its members got their name because, under the early electron microscopes of the period,
their shape seemed reminiscent of a monarch’s crown. (It is actually, modern methods show, more like
that of an old-fashioned naval mine.) There are now more than 40 recognised members of the family,
infecting a range of mammals and birds, including blackbirds, bats and cats. Veterinary virologists know
them well because of the diseases they cause in pigs, cattle and poultry.
Virologists who concentrate on human disease used to pay less attention. Although two long-established
coronaviruses cause between 15% and 30% of the symptoms referred to as “the common cold”, they did
not cause serious diseases in people. Then, in 2002, the virus now known as sars-cov jumped from a
horseshoe bat to a person (possibly by way of some intermediary). The subsequent outbreak went on to
kill almost 800 people around the world.
Some of the studies which followed that outbreak highlighted the fact that related coronaviruses could
easily follow sars-cov across the species barrier into humans. Unfortunately, this risk did not lead to the
development of specific drugs aimed at such viruses. When sars-cov-2—similarly named because of its
very similar genome—duly arrived, there were no dedicated anti-coronavirus drugs around to meet it.
As a known enemy
A sars-cov-2 virus particle, known technically as a virion, is about 90 nanometres (billionths of a metre)
across—around a millionth the volume of the sort of cells it infects in the human lung. It contains four
different proteins and a strand of rna—a molecule which, like dna, can store genetic information as a
sequence of chemical letters called nucleotides. In this case, that information includes how to make all
the other proteins that the virus needs in order to make copies of itself, but which it does not carry
along from cell to cell.
The outer proteins sit athwart a membrane provided by the cell in which the virion was created. This
membrane, made of lipids, breaks up when it encounters soap and water, which is why hand-washing is
such a valuable barrier to infection.
The most prominent protein, the one which gives the virions their crown- or mine-like appearance by
standing proud of the membrane, is called spike. Two other proteins, envelope protein and membrane
protein, sit in the membrane between these spikes, providing structural integrity. Inside the membrane
a fourth protein, nucleocapsid, acts as a scaffold around which the virus wraps the 29,900 nucleotides of
rna which make up its genome.
Though they store their genes in dna, living cells use rna for a range of other activities, such as taking the
instructions written in the cell’s genome to the machinery which turns those instructions into proteins.
Various sorts of virus, though, store their genes on rna. Viruses like hiv, which causes aids, make dna
copies of their rna genome once they get into a cell. This allows them to get into the nucleus and stay
around for years. Coronaviruses take a simpler approach. Their rna is formatted to look like the
messenger rna which tells cells what proteins to make. As soon as that rna gets into the cell, flummoxed
protein-making machinery starts reading the viral genes and making the proteins they describe.
First contact between a virion and a cell is made by the spike protein. There is a region on this protein
that fits hand-in-glove with ace2, a protein found on the surface of some human cells, particularly those
in the respiratory tract.
ace2 has a role in controlling blood pressure, and preliminary data from a hospital in Wuhan suggest
that high blood pressure increases the risks of someone who has contracted the illness dying of it (so do
diabetes and heart disease). Whether this has anything to do with the fact that the virus’s entry point is
linked to blood-pressure regulation remains to be seen.
Once a virion has attached itself to an ace2 molecule, it bends a second protein on the exterior of the
cell to its will. This is tmprss2, a protease. Proteases exist to cleave other proteins asunder, and the virus
depends on tmprss2 obligingly cutting open the spike protein, exposing a stump called a fusion peptide.
This lets the virion into the cell, where it is soon able to open up and release its rna (see diagram below).
Coronaviruses have genomes bigger than those seen in any other rna viruses—about three times longer
than hiv’s, twice as long as the influenza virus’s, and half as long again as the Ebola virus’s. At one end
are the genes for the four structural proteins and eight genes for small “accessory” proteins that seem
to inhibit the host’s defences (see diagram below). Together these account for just a third of the
genome. The rest is the province of a complex gene called replicase. Cells have no interest in making rna
copies of rna molecules, and so they have no machinery for the task that the virus can hijack. This means
the virus has to bring the genes with which to make its own. The replicase gene creates two big
“polyproteins” that cut themselves up into 15, or just possibly 16, short “non-structural proteins” (nsps).
These make up the machinery for copying and proofreading the genome—though some of them may
have other roles, too.
Once the cell is making both structural proteins and rna, it is time to start churning out new virions.
Some of the rna molecules get wrapped up with copies of the nucleocapsid proteins. They are then
provided with bits of membrane which are rich in the three outer proteins. The envelope and
membrane proteins play a large role in this assembly process, which takes place in a cellular workshop
called the Golgi apparatus. A cell may make between 100 and 1,000 virions in this way, according to
Stanley Perlman of the University of Iowa. Most of them are capable of taking over a new cell—either
nearby or in another body—and starting the process off again.
Not all the rna that has been created ends up packed into virions; leftovers escape into wider circulation.
The coronavirus tests now in use pick up and amplify sars-cov-2-specific rna sequences found in the
sputum of infected patients.
Take your time, hurry up
Because a viral genome has no room for free riders, it is a fair bet that all of the proteins that sars-cov-2
makes when it gets into a cell are of vital importance. That makes each of them a potential target for
drug designers. In the grip of a pandemic, though, the emphasis is on the targets that might be hit by
drugs already at hand.
The obvious target is the replicase system. Because uninfected cells do not make rna copies of rna
molecules, drugs which mess that process up can be lethal to the virus while not necessarily interfering
with the normal functioning of the body. Similar thinking led to the first generation of anti-hiv drugs,
which targeted the process that the virus uses to transcribe its rna genome into dna—another thing that
healthy cells just do not do.
Like those first hiv drugs, some of the most promising sars-cov-2 treatments are molecules known as
“nucleotide analogues”. They look like the letters of which rna or dna sequences are made up; but when
a virus tries to use them for that purpose they mess things up in various ways.
The nucleotide-analogue drug that has gained the most attention for fighting sars-cov-2 is remdesivir. It
was originally developed by Gilead Sciences, an American biotechnology firm, for use against Ebola
fever. That work got as far as indicating that the drug was safe in humans, but because antibody therapy
proved a better way of treating Ebola, remdesivir was put to one side. Laboratory tests, though, showed
that it worked against a range of other rna-based viruses, including sars-cov, and the same tests now
show that it can block the replication of sars-cov-2, too.
There are now various trials of remdesivir’s efficacy in covid-19 patients. Gilead is organising two in Asia
that will, together, involve 1,000 infected people. They are expected to yield results in mid- to late-April.
Other nucleotide analogues are also under investigation. When they screened seven drugs approved for
other purposes for evidence of activity against sars-cov-2, a group of researchers at the State Key
Laboratory of Virology in Wuhan saw some potential in ribavirin, an antiviral drug used in the treatment
of, among other things, hepatitis c, that is already on the list of essential medicines promulgated by the
World Health Organisation (who).
Nucleotide analogues are not the only antiviral drugs. The second generation of anti-hiv drugs were the
“protease inhibitors” which, used along with the original nucleotide analogues, revolutionised the
treatment of the disease. They targeted an enzyme with which hiv cuts big proteins into smaller ones,
rather as one of sars-cov-2’s nsps cuts its big polyproteins into more little nsps. Though the two viral
enzymes do a similar job, they are not remotely related—hiv and sars-cov-2 have about as much in
common as a human and a satsuma. Nevertheless, when Kaletra, a mixture of two protease inhibitors,
ritonavir and lopinavir, was tried in sars patients in 2003 it seemed to offer some benefit.
Another drug which was developed to deal with other rna-based viruses—in particular, influenza—is
Favipiravir (favilavir). It appears to interfere with one of the nsps involved in making new rna. But
existing drugs that might have an effect on sars-cov-2 are not limited to those originally designed as
antivirals. Chloroquine, a drug mostly used against malaria, was shown in the 2000s to have some effect
on sars-cov; in cell-culture studies it both reduces the virus’s ability to get into cells and its ability to
reproduce once inside them, possibly by altering the acidity of the Golgi apparatus. Camostat mesylate,
which is used in cancer treatment, blocks the action of proteases similar to tmprss2, the protein in the
cell membrane that activates the spike protein.
Not all drugs need to target the virus. Some could work by helping the immune system. Interferons
promote a widespread antiviral reaction in infected cells which includes shutting down protein
production and switching on rna-destroying enzymes, both of which stop viral replication. Studies on the
original sars virus suggested that interferons might be a useful tool for stopping its progress, probably
best used in conjunction with other drugs
Conversely, parts of the immune system are too active in covid-19. The virus kills not by destroying cells
until none are left, but by overstimulating the immune system’s inflammatory response. Part of that
response is mediated by a molecule called interleukin-6—one of a number of immune-system
modulators that biotechnology has targeted because of their roles in autoimmune disease.
Actemra (tocilizumab) is an antibody that targets the interleukin-6 receptors on cell surfaces, gumming
them up so that the interleukin-6 can no longer get to them. It was developed for use in rheumatoid
arthritis. China has just approved it for use against covid-19. There are anecdotal reports of it being
associated with clinical improvements in Italy.
While many trials are under way in China, the decline in the case rate there means that setting up new
trials is now difficult. In Italy, where the epidemic is raging, organising trials is a luxury the health system
cannot afford. So scientists are dashing to set up protocols for further clinical trials in countries
expecting a rush of new cases. Dr Farrar said on March 9th that Britain must have its trials programme
agreed within the week.
International trials are also a high priority. Soumya Swaminathan, chief scientist at the who, says that it
is trying to finalise a “master protocol” for trials to which many countries could contribute. By pooling
patients from around the world, using standardised criteria such as whom to include and how to
measure outcomes, it should be possible to create trials of thousands of patients. Working on such a
large scale makes it possible to pick up small, but still significant, benefits. Some treatments, for
example, might help younger patients but not older ones; since younger patients are less common, such
an effect could easily be missed in a small trial.
Come as you are
The caseload of the pandemic is hard to predict, and it might be that even a useful drug is not suitable in
all cases. But there are already concerns that, should one of the promising drugs prove to be useful,
supplies will not be adequate. To address these, the who has had discussions with manufacturers about
whether they would be able to produce drugs in large enough quantities. Generic drug makers have
assured the organisation that they can scale up to millions of doses of ritonavir and lopinavir while still
supplying the hiv-positive patients who rely on the drugs. Gilead, meanwhile, has enough remdesivir to
support clinical trials and, thus far, compassionate use. The firm says it is working to make more
available “as rapidly as possible”, even in the absence of evidence that it works safely.
In the lab, sars-cov-2 will continue being dissected and mulled over. Details of its tricksiness will be
puzzled out, and the best bits of proteins to turn into vaccines argued over. But that is all for tomorrow.
For today doctors can only hope that a combination of new understanding and not-so-new drugs will do
some good.
A common enemy
ON Sunday, Saarc representatives appeared in a video conference to discuss how they could tackle the
novel coronavirus threat (COVID-19), as the number of infected patients around the world suddenly
climbed over the weekend. In this rare attempt to highlight a common concern, Special Assistant to the
Prime Minister on Health Zafar Mirza underscored the importance of working together and developing a
regional mechanism for sharing health-related information. A common enemy presents a window of
opportunity for all countries at odds to put aside their differences — at least, for the time being — and
take on the virus on a war footing. Dr Mirza correctly labelled COVID-19 “the most serious global health
emergency in the last 100 years”. To his credit, the health adviser has tried his best to take charge of the
situation from day one. Perhaps there would have been greater awareness of Pakistan’s efforts in the
fight against the virus had Prime Minister Imran Khan participated in the video conference as his
Bangladeshi and India counterparts did.
The global death toll is over 6,500 and set to climb, and millions of people continue to be exposed to the
infection. In neighbouring Iran, one of the worst-hit countries, the total number of deaths exceeded 850
— over 120 in the past two days alone. In Pakistan, the first COVID-19 case was detected about a month
ago, when a young man who had returned from pilgrimage in Qom, Iran, tested positive in Karachi.
While he fortunately recovered due to timely detection, over 180 others have since been diagnosed
with COVID-19 in the country. Out of these, a few are said to be in critical condition. Undoubtedly, and
regrettably, this figure will keep rising in the coming days as tests confirm the worst, as they did in
Peshawar, which reported 15 cases yesterday. The vast majority of cases have been found in Sindh,
particularly in Karachi and Sukkur, where several travellers from Taftan who had returned from
pilgrimage in Iran tested positive. But this may just be because the Sindh government is taking a more
proactive, hands-on approach in dealing with the crisis, while understanding the gravity of the situation
and the crucial need for honesty.
In yesterday’s press conference, Sindh Chief Minister Murad Ali Shah did not gloss over the facts, laying
the numbers before the media, even as reports of more confirmed cases were relayed to him. While the
situation is indeed grim, the provincial government’s transparency is laudable. There is also the question
of other pilgrims from Taftan who would have returned to their homes in KP, Balochistan and Punjab.
Peshawar has just announced a number of such cases. What about Punjab and Balochistan — where is
their data? Are screening facilities adequate in these provinces? ‘Don’t panic’ does not mean one should
be paralysed either.
COVID-19 & prisoners

IDEALLY, a prison population should be easier to isolate than the general population because its
interaction with the outside world is limited and can be further restricted. The Sindh government has
taken a number of steps to ensure ‘social distancing’ to prevent community transmission of COVID-19.
However, the provincial prison authorities have a considerable challenge on their hands. As reported in
this paper, the risk is not from visitors who communicate with the inmates across a glass partition,
meaning there is no physical contact between them. The story also quoted IGP Prisons, Sindh, as saying
that among other measures, he has suggested that where possible trial proceedings should be
conducted via video link. This would address the risk of prisoners being brought to court in vans so
inadequate in number that inmates often end up being packed together like sardines.
However, the vulnerability lies in the fact that jail staff come into regular contact with those behind bars.
Unless they take proper precautions before they do so, it could ravage the prison population. Jails in
Pakistan are shockingly overcrowded. According to a report presented in November last year to the
Supreme Court, there are 114 prisons across the country with 77,275 inmates against a combined
capacity of 57,742. At the same time, onsite medical facilities are less than satisfactory. About half the
sanctioned posts for jail medical staff are lying vacant, and medical equipment and ambulances are in
short supply. This makes for an environment highly conducive to the spread of disease. As per recent
data collected by an Islamabad High Court-appointed commission, close to 2,400 prisoners already
suffer from chronic, contagious diseases such as hepatitis, HIV and tuberculosis. It is therefore vital that
preventive measures be put in place immediately such as releasing low risk prisoners who are over 65
years of age, minors, petty offenders and those with existing serious illnesses. By definition, a prison
population is a hostage group and the coronavirus could wreak havoc behind bars.
Religious precautions
WITHOUT a doubt, the novel coronavirus has affected routine life around the globe like few events in
modern history. In a globalised world few countries are left unaffected, with over 180,000 people
infected and more than 7,000 fatalities. Countries and cities around the world are opting for lockdown
to stop the spread of the contagion, as this is being seen as the best method to prevent more infections.
Schools, offices and commercial centres around the world — including in Pakistan — are closed or in the
process of shutting down, while large gatherings are being discouraged.
Keeping these developments in mind, the issue of congregational prayers needs serious attention, with
the state, ulema and common people all playing their part to adjust religious rituals in order to curb the
spread of COVID-19.
In Pakistan, as elsewhere around the Muslim world, hundreds of people attend daily prayers at large
neighbourhood mosques. This number is in the thousands during Friday prayers, especially in the larger
mosques. Considering the fact that worshippers are in such close proximity during daily prayers in
mosques, it is incumbent on religious leaders and the state to come up with a strategy that protects
people’s health and lives until the threat of the virus subsides. There have been various suggestions. For
example, the Pakistan Ulema Council has issued a fatwa calling for all political and religious gatherings to
be postponed, Friday prayers to be shortened, and prayers to be held in open spaces etc. However, the
Punjab chief minister assured a delegation of clerics on Monday that mosques would not be closed in
the country’s most populous province. Considering the severity of the situation, the state must
understand the risk to religious congregations, including those who gather in places of worship.
The state can review how other Muslim countries are dealing with the crisis. Egypt, Iran and Oman have
all suspended Friday prayers while the UAE has temporarily shuttered all places of worship. The Saudi
government, too, has stopped congregational prayers in its mosques while placing curbs on umrah. In
fact, images of the Holy Kaaba without people performing the tawaf around it have brought home the
severity of the crisis. If such stringent measures have been taken in Islam’s holiest sites, then the
authorities here should have no qualms about altering daily routines temporarily to keep people healthy
and possibly save lives. At the very least, the ulema in Pakistan must consider temporarily limiting the
number of daily worshippers in mosques and suspending congregational prayers on Friday, in keeping
with the example of other Muslim states in these trying times. Decisions need to be taken rationally, not
emotionally, which is why religious scholars and the government must come up with a plan to address
issues of public worship during the virus pandemic without further delay.
Message of unity
EditorialMarch 19, 2020
Facebook Count
Twitter Share
1
IN a recent media interview, Prime Minister Imran Khan underlined the need for global unity in the fight
against the coronavirus pandemic, which has caused a huge humanitarian crisis across the world. He
was spot on when he said that the virus would wreck developing economies, asking the richer nations to
write off the debts owed by poorer countries. In the same vein, he urged the international community to
lift the crippling sanctions against Iran, which has emerged as the epicentre of the coronavirus outbreak
in the region and is struggling to control the disease’s spread as its efforts are hampered by the
sanctions imposed by the US. There is little room for disagreement with the prime minister when he
declares Iran as a “classic example” of a country where the need to curb the virus is greater than politics.
The truth is that Mr Khan’s message of more cooperation internationally could have been backed by a
better example of unity at home. Sadly, his televised speech to the nation on Tuesday reflected the
divisions within, both in its content and in the reactions it generated. There have been concerns that the
prime minister was selective in his praise when it came to the handling of the crisis, and chose to omit
from his list those who appeared to so many others to have worked valiantly in the face of great odds. A
more generous review could have served the cause of national cohesion well in this hour of trial. The
rest of his speech was focused on what actions his government had taken to contain the outbreak of
COVID-19 and its plans to help businesses affected by the spread of the virus, as he tried to reassure the
people and allay public fears over the rising number of confirmed cases across the country. He ruled out
the possibility of locking down the cities, saying that with such a large population and a huge number of
poor, the country could not afford this extreme measure because thousands would starve. Mr Khan
urged the people to support his government in the war against coronavirus. There’s no denying the fact
that ‘we have to win this war as a nation’ as he said. With his government coming under criticism over
its slow response to the global pandemic, Pakistanis will need much more than words from its leaders as
they brace for one of the biggest health crises the world has seen.
The crisis deepens

PAKISTAN arrived at a grim, if inevitable, milestone on Wednesday in its battle against COVID-19 when
two of those known to be infected succumbed to the disease. The deaths occurred in Khyber
Pakhtunkhwa and, contrary to what appears to be the general pattern of fatalities worldwide, the
individuals were well under 60 years of age. As is the case with most of the confirmed cases in Pakistan,
they both had a recent travel history. Last week, however, we entered the next stage of this pandemic
when the first case of community transmission was confirmed in Karachi. That number is bound to rise,
perhaps exponentially, with each passing day.
This is no time for politics or platitudes. It is a moment that calls for our leadership to rise above their
differences and formulate a coordinated response that can make efficient and judicious use of available
resources. At the moment, there is a discrepancy between the numbers of confirmed cases released by
the Control and Command Centre set up to deal with the crisis and those given by provincial
governments, which are possibly more up to date. While Sindh has shown itself to be commendably
responsive to the multi-faceted challenge posed by COVID-19, and KP has begun rolling out a coherent
strategy, there is on the federal level a sense of disjointedness, a perceptible lack of direction. In a
society whose bonds are already frayed through divisive narratives, a national emergency such as this
unless handled intelligently can exacerbate pre-existing cleavages. Although Prime Ministe Imran Khan
addressed the nation on Tuesday, there should be on his part more frequent communication with the
public to inform them of the steps his government is taking in conjunction with the provinces. He must
also explain why some of the measures that may temporarily cause major disruption in people’s social
and spiritual routines are necessary in the present situation.
Rapid transmission of COVID-19 has been checked in China and South Korea through lockdowns. Such a
drastic step, given the realities of Pakistan, would cause untold misery to the multitudes that survive on
daily wages or those with small businesses dependent on a steady income to make ends meet. However,
there may come a point when the government decides it has no choice but to impose such a lockdown
at least in some parts of the country.
In any case, the closure of markets and schools — places where hawkers tend to find customers — has
already begun to impact the poor. An intervention by the state is urgently required. In concert with
provincial dispensations, the government must devise a streamlined plan of action that also co-opts the
private sector — including organisations already engaged in charitable work — so that efforts are not
replicated and equitable distribution of relief goods is ensured. Low-income families must be provided
the wherewithal to make it through this unfolding nightmare.
Iran’s crisis
COVID-19 is pushing the healthcare systems of even some of the world’s most developed states to the
edge, with governments and medical professionals battling to prevent infections from rising every day.
Meanwhile, the threat to less-developed states is even greater, as dilapidated health systems in these
countries means that unless stringent measures are taken, a disaster is likely. Considering the situation,
all states should be expected to put aside petty differences and combine forces against the coronavirus
— a foe that knows no borders. However, it is clear that some in the international community are bent
upon enforcing measures that can only be described as cruel and inhuman in such times of global crisis.
The US, for example, has refused to ease sanctions on Iran despite the fact that the Islamic Republic is
amongst the countries hardest hit by the virus. “Our policy of maximum pressure on the regime
continues,” Brian Hook, Washington’s point man for Iranian affairs, has said.
Even in normal circumstances it could be argued that American sanctions against Iran are wrong and
unjustified. But as Tehran grapples with a severe health crisis, there is absolutely no justification for the
US to bully others in order to prevent help getting to Iranians. There has been valid criticism, even from
within the Iranian establishment, that the authorities were not being transparent about the number of
infections and deaths. Indeed, if the government had been more open about the situation it may have
been easier to deal with it when Covid-19 first emerged. However, for now this is an academic
discussion; Iran needs urgent measures to combat the virus. There have been some 1,500 deaths in the
country, while the Iranian health ministry has said 50 people are being infected every hour. Keeping this
alarming situation in mind, Foreign Minister Shah Mahmood Qureshi has urged world leaders to “show
utmost compassion” and lift the sanctions against Iran. Also China, where the outbreak started, has
called for Iran to be given sanctions relief for humanitarian reasons. America’s differences with Iran are
geopolitical and ideological and go back decades. However, at this time nations must move beyond such
narrow considerations and think purely along humanitarian lines. The dire situation in Iran demands that
the world community work together to fight the contagion and let essential supplies into the country to
save lives. Politics can wait for another day.
Published in Dawn, March 21st, 2020

*Yuval Noah Harari: the world after coronavirus*
amp.ft.com/content/19d90308-6858-11ea-a3c9-1fe6fedcca75
Many short-term emergency measures will become a fixture of life. That is the nature of emergencies.
They fast-forward historical processes. Decisions that in normal times could take years of deliberation
are passed in a matter of hours. Immature and even dangerous technologies are pressed into service,
because the risks of doing nothing are bigger. Entire countries serve as guinea-pigs in large-scale social
experiments. What happens when everybody works from home and communicates only at a distance?
What happens when entire schools and universities go online? In normal times, governments,
businesses and educational boards would never agree to conduct such experiments. But these aren’t
normal times.
In this time of crisis, we face two particularly important choices. The first is between totalitarian
surveillance and citizen empowerment. The second is between nationalist isolation and global solidarity.
Under-the-skin surveillance
In order to stop the epidemic, entire populations need to comply with certain guidelines. There are two
main ways of achieving this. One method is for the government to monitor people, and punish those
who break the rules. Today, for the first time in human history, technology makes it possible to monitor
everyone all the time. Fifty years ago, the KGB couldn’t follow 240m Soviet citizens 24 hours a day, nor
could the KGB hope to effectively process all the information gathered. The KGB relied on human agents
and analysts, and it just couldn’t place a human agent to follow every citizen. But now governments can
rely on ubiquitous sensors and powerful algorithms instead of flesh-and-blood spooks.
l Colosseo - Roma webcams of Italy project. by Graziano Panfili
The Colosseum in Rome
Piazza Beato Roberto a Salle Pescara webcams of Italy project. by Graziano Panfili
Piazza Beato Roberto in Pescara © Graziano Panfili

In their battle against the coronavirus epidemic several governments have already deployed the new
surveillance tools. The most notable case is China. By closely monitoring people’s smartphones, making
use of hundreds of millions of face-recognising cameras, and obliging people to check and report their
body temperature and medical condition, the Chinese authorities can not only quickly identify suspected
coronavirus carriers, but also track their movements and identify anyone they came into contact with. A
range of mobile apps warn citizens about their proximity to infected patients.
The images accompanying this article are taken from webcams overlooking the deserted streets of Italy,
found and manipulated by Graziano Panfili, a photographer living under lockdown
This kind of technology is not limited to east Asia. Prime Minister Benjamin Netanyahu of Israel recently
authorised the Israel Security Agency to deploy surveillance technology normally reserved for battling
terrorists to track coronavirus patients. When the relevant parliamentary subcommittee refused to
authorise the measure, Netanyahu rammed it through with an “emergency decree”.
You might argue that there is nothing new about all this. In recent years both governments and
corporations have been using ever more sophisticated technologies to track, monitor and manipulate
people. Yet if we are not careful, the epidemic might nevertheless mark an important watershed in the
history of surveillance. Not only because it might normalise the deployment of mass surveillance tools in
countries that have so far rejected them, but even more so because it signifies a dramatic transition
from “over the skin” to “under the skin” surveillance.
Hitherto, when your finger touched the screen of your smartphone and clicked on a link, the
government wanted to know what exactly your finger was clicking on. But with coronavirus, the focus of
interest shifts. Now the government wants to know the temperature of your finger and the blood-
pressure under its skin.
The emergency pudding
One of the problems we face in working out where we stand on surveillance is that none of us know
exactly how we are being surveilled, and what the coming years might bring. Surveillance technology is
developing at breakneck speed, and what seemed science-fiction 10 years ago is today old news. As a
thought experiment, consider a hypothetical government that demands that every citizen wears a
biometric bracelet that monitors body temperature and heart-rate 24 hours a day. The resulting data is
hoarded and analysed by government algorithms. The algorithms will know that you are sick even
before you know it, and they will also know where you have been, and who you have met. The chains of
infection could be drastically shortened, and even cut altogether. Such a system could arguably stop the
epidemic in its tracks within days. Sounds wonderful, right?
The downside is, of course, that this would give legitimacy to a terrifying new surveillance system. If you
know, for example, that I clicked on a Fox News link rather than a CNN link, that can teach you
something about my political views and perhaps even my personality. But if you can monitor what
happens to my body temperature, blood pressure and heart-rate as I watch the video clip, you can learn
what makes me laugh, what makes me cry, and what makes me really, really angry.
It is crucial to remember that anger, joy, boredom and love are biological phenomena just like fever and
a cough. The same technology that identifies coughs could also identify laughs. If corporations and
governments start harvesting our biometric data en masse, they can get to know us far better than we
know ourselves, and they can then not just predict our feelings but also manipulate our feelings and sell
us anything they want — be it a product or a politician. Biometric monitoring would make Cambridge
Analytica’s data hacking tactics look like something from the Stone Age. Imagine North Korea in 2030,
when every citizen has to wear a biometric bracelet 24 hours a day. If you listen to a speech by the Great
Leader and the bracelet picks up the tell-tale signs of anger, you are done for.
Veduta della casa universitaria - Lodi webcams of Italy project. by
Veduta della Casa Universitaria in Lodi © Graziano Panfili
Spiaggia di Porto San Giorgio Mare Adriatico - Fermo webcams of Italy project. by Graziano Panfili
Spiaggia di Porto San Giorgio, Mare Adriatico © Graziano Panfili
You could, of course, make the case for biometric surveillance as a temporary measure taken during a
state of emergency. It would go away once the emergency is over. But temporary measures have a nasty
habit of outlasting emergencies, especially as there is always a new emergency lurking on the horizon.
My home country of Israel, for example, declared a state of emergency during its 1948 War of
Independence, which justified a range of temporary measures from press censorship and land
confiscation to special regulations for making pudding (I kid you not). The War of Independence has long
been won, but Israel never declared the emergency over, and has failed to abolish many of the
“temporary” measures of 1948 (the emergency pudding decree was mercifully abolished in 2011).
Even when infections from coronavirus are down to zero, some data-hungry governments could argue
they needed to keep the biometric surveillance systems in place because they fear a second wave of
coronavirus, or because there is a new Ebola strain evolving in central Africa, or because . . . you get the
idea. A big battle has been raging in recent years over our privacy. The coronavirus crisis could be the
battle’s tipping point. For when people are given a choice between privacy and health, they will usually
choose health.
The soap police
Asking people to choose between privacy and health is, in fact, the very root of the problem. Because
this is a false choice. We can and should enjoy both privacy and health. We can choose to protect our
health and stop the coronavirus epidemic not by instituting totalitarian surveillance regimes, but rather
by empowering citizens. In recent weeks, some of the most successful efforts to contain the coronavirus
epidemic were orchestrated by South Korea, Taiwan and Singapore. While these countries have made
some use of tracking applications, they have relied far more on extensive testing, on honest reporting,
and on the willing co-operation of a well-informed public.
Centralised monitoring and harsh punishments aren’t the only way to make people comply with
beneficial guidelines. When people are told the scientific facts, and when people trust public authorities
to tell them these facts, citizens can do the right thing even without a Big Brother watching over their
shoulders. A self-motivated and well-informed population is usually far more powerful and effective
than a policed, ignorant population.
Consider, for example, washing your hands with soap. This has been one of the greatest advances ever
in human hygiene. This simple action saves millions of lives every year. While we take it for granted, it
was only in the 19th century that scientists discovered the importance of washing hands with soap.
Previously, even doctors and nurses proceeded from one surgical operation to the next without washing
their hands. Today billions of people daily wash their hands, not because they are afraid of the soap
police, but rather because they understand the facts. I wash my hands with soap because I have heard
of viruses and bacteria, I understand that these tiny organisms cause diseases, and I know that soap can
remove them.
"a Reggia di Caserta webcams of Italy project. by
The Royal Palace of Caserta © Graziano Panfili
"Lungomare di Forte dei Marmi - Versilia. webcams of Italy project. by
Lungomare di Forte dei Marmi, in Versilia © Graziano Panfili

But to achieve such a level of compliance and co-operation, you need trust. People need to trust
science, to trust public authorities, and to trust the media. Over the past few years, irresponsible
politicians have deliberately undermined trust in science, in public authorities and in the media. Now
these same irresponsible politicians might be tempted to take the high road to authoritarianism, arguing
that you just cannot trust the public to do the right thing.
Normally, trust that has been eroded for years cannot be rebuilt overnight. But these are not normal
times. In a moment of crisis, minds too can change quickly. You can have bitter arguments with your
siblings for years, but when some emergency occurs, you suddenly discover a hidden reservoir of trust
and amity, and you rush to help one another. Instead of building a surveillance regime, it is not too late
to rebuild people’s trust in science, in public authorities and in the media. We should definitely make
use of new technologies too, but these technologies should empower citizens. I am all in favour of
monitoring my body temperature and blood pressure, but that data should not be used to create an all-
powerful government. Rather, that data should enable me to make more informed personal choices,
and also to hold government accountable for its decisions.
If I could track my own medical condition 24 hours a day, I would learn not only whether I have become
a health hazard to other people, but also which habits contribute to my health. And if I could access and
analyse reliable statistics on the spread of coronavirus, I would be able to judge whether the
government is telling me the truth and whether it is adopting the right policies to combat the epidemic.
Whenever people talk about surveillance, remember that the same surveillance technology can usually
be used not only by governments to monitor individuals — but also by individuals to monitor
governments.
The coronavirus epidemic is thus a major test of citizenship. In the days ahead, each one of us should
choose to trust scientific data and healthcare experts over unfounded conspiracy theories and self-
serving politicians. If we fail to make the right choice, we might find ourselves signing away our most
precious freedoms, thinking that this is the only way to safeguard our health.
We need a global plan
The second important choice we confront is between nationalist isolation and global solidarity. Both the
epidemic itself and the resulting economic crisis are global problems. They can be solved effectively only
by global co-operation.
First and foremost, in order to defeat the virus we need to share information globally. That’s the big
advantage of humans over viruses. A coronavirus in China and a coronavirus in the US cannot swap tips
about how to infect humans. But China can teach the US many valuable lessons about coronavirus and
how to deal with it. What an Italian doctor discovers in Milan in the early morning might well save lives
in Tehran by evening. When the UK government hesitates between several policies, it can get advice
from the Koreans who have already faced a similar dilemma a month ago. But for this to happen, we
need a spirit of global co-operation and trust.
In the days ahead, each one of us should choose to trust scientific data and healthcare experts over
unfounded conspiracy theories and self-serving politicians
Countries should be willing to share information openly and humbly seek advice, and should be able to
trust the data and the insights they receive. We also need a global effort to produce and distribute
medical equipment, most notably testing kits and respiratory machines. Instead of every country trying
to do it locally and hoarding whatever equipment it can get, a co-ordinated global effort could greatly
accelerate production and make sure life-saving equipment is distributed more fairly. Just as countries
nationalise key industries during a war, the human war against coronavirus may require us to
“humanise” the crucial production lines. A rich country with few coronavirus cases should be willing to
send precious equipment to a poorer country with many cases, trusting that if and when it subsequently
needs help, other countries will come to its assistance.
We might consider a similar global effort to pool medical personnel. Countries currently less affected
could send medical staff to the worst-hit regions of the world, both in order to help them in their hour of
need, and in order to gain valuable experience. If later on the focus of the epidemic shifts, help could
start flowing in the opposite direction.
Global co-operation is vitally needed on the economic front too. Given the global nature of the economy
and of supply chains, if each government does its own thing in complete disregard of the others, the
result will be chaos and a deepening crisis. We need a global plan of action, and we need it fast.
Another requirement is reaching a global agreement on travel. Suspending all international travel for
months will cause tremendous hardships, and hamper the war against coronavirus. Countries need to
co-operate in order to allow at least a trickle of essential travellers to continue crossing borders:
scientists, doctors, journalists, politicians, businesspeople. This can be done by reaching a global
agreement on the pre-screening of travellers by their home country. If you know that only carefully
screened travellers were allowed on a plane, you would be more willing to accept them into your
country.
Il Duomo - Firenze. webcams of Italy project. by
The Duomo in Florence © Graziano Panfili
Torre San Giovanni Lecce webcams of Italy project. by Graziano Panfili
Torre San Giovanni, in Lecce © Graziano Panfili
Unfortunately, at present countries hardly do any of these things. A collective paralysis has gripped the
international community. There seem to be no adults in the room. One would have expected to see
already weeks ago an emergency meeting of global leaders to come up with a common plan of action.
The G7 leaders managed to organise a videoconference only this week, and it did not result in any such
plan.
In previous global crises — such as the 2008 financial crisis and the 2014 Ebola epidemic — the US
assumed the role of global leader. But the current US administration has abdicated the job of leader. It
has made it very clear that it cares about the greatness of America far more than about the future of
humanity.
This administration has abandoned even its closest allies. When it banned all travel from the EU, it didn’t
bother to give the EU so much as an advance notice — let alone consult with the EU about that drastic
measure. It has scandalised Germany by allegedly offering $1bn to a German pharmaceutical company
to buy monopoly rights to a new Covid-19 vaccine. Even if the current administration eventually changes
tack and comes up with a global plan of action, few would follow a leader who never takes
responsibility, who never admits mistakes, and who routinely takes all the credit for himself while
leaving all the blame to others.
If the void left by the US isn’t filled by other countries, not only will it be much harder to stop the current
epidemic, but its legacy will continue to poison international relations for years to come. Yet every crisis
is also an opportunity. We must hope that the current epidemic will help humankind realise the acute
danger posed by global disunity.
Humanity needs to make a choice. Will we travel down the route of disunity, or will we adopt the path
of global solidarity? If we choose disunity, this will not only prolong the crisis, but will probably result in
even worse catastrophes in the future. If we choose global solidarity, it will be a victory not only against
the coronavirus, but against all future epidemics and crises that might assail humankind in the 21st
century.
*Yuval Noah Harari is author of ‘Sapiens’, ‘Homo Deus’ and ‘21 Lessons for the 21st Century’*
Lessons for the world
IN a milestone development that brings a moment of much-needed relief in the coronavirus pandemic,
China this week reported that it has no new local cases. While 39 new coronavirus cases have been
confirmed in mainland China, all of them are ‘overseas transmissions’ carried by international travellers
entering the country. This means that China’s containment measures were successful and that it was
able to effectively ‘flatten the curve’ — a term widely being used by experts which refers to slowing
down the projected number of people who will contract Covid-19 over a period of time. A flatter curve
assumes that the same number of people get infected, but over a longer period of time, which eases the
burden on hospitals and medical staff.
As China documents fewer cases, it presents an opportunity for the world to learn lessons — both good
and bad. To evaluate the country’s approach to the pandemic, it is essential to look at the facts:
between the end of December and mid-March, China reported over 81,000 confirmed cases with a
death toll of 3,255. The regime responded to rapidly rising cases with a dramatic lockdown and enforced
isolation — measures which initially were met with criticism around the globe. For instance, the world
expressed shock at the authorities’ decision to shut down Wuhan, the epicentre of the outbreak with a
population of 11m, as experts were sceptical about the success and viability of what is possibly the
biggest quarantine exercise in modern history. China was criticised as authoritarian as it went further
and locked down the entire Hubei province of 60m in a dramatic show of power. But while the regime’s
draconian measures became the focus of headlines, the country’s decisions to build temporary
hospitals, deploy scores of medical workers, establish widescale screening and isolate infected
individuals appear to have contributed largely to its successful response. In fact, its authoritarianism and
initial lack of transparency — which included threats to those who tried to raise the alarm about Covid-
19 early on — are factors which led to major deficiencies and the subsequent outbreak.
Here, it is important to look at the success of containment in South Korea, where transparency,
openness and effective public-health decisions have been at the core of the response. After the 2015
outbreak of the Middle East Respiratory Syndrome, during which South Korea recorded 186 cases and
38 deaths, the country revamped its response systems to respiratory infections. Although Korea was
criticised for its poor response to MERS, lessons learnt then were adopted during the Covid-19
pandemic: mass production of test kits, adequately equipped hospitals, infection control units, hygiene
awareness campaigns and technological innovations. Its dedication to act early, make testing available
and affordable, keep the public informed, trace and isolate and communicate social distancing kept the
spread and death rate low. World leaders would do well to follow South Korea and China’s example.
Published in Dawn, March 22nd, 2020
"Public policy to counter Covid-19" by Musharraf Zaidi

https://www.thenews.com.pk/print/630144-public-policy-to-counter-covid-19
The stark advantage of having globally recognized professionals in government has rarely been better
exhibited than in the last several weeks as Dr Zafar Mirza has fulfilled his roles as the public health lead
in this administration.
Dr Mirza’s measured and compassionate approach during the Covid-19 crisis is the work of an individual
deeply invested in the field he has been charged to lead. Luckily, Dr Mirza has not been alone. Elected
leaders in both Sindh and Khyber Pakhtunkhwa have shown that good, competent leadership in times of
crisis continues to be a Pakistani strength as it has been in recent catastrophes and crises, such as the
earthquake in 2005, the floods of 2010 and 2011, and the IDP crises of 2009, 2014 and 2015.
In Sindh, Chief Minister Murad Ali Shah has mobilized the full array of ministerial talent available to him
– from Saeed Ghani to Murtaza Wahab to Azra Pechuho. Together, a coherent Sindh government has
created both the public messaging momentum, as well as the functional preparation to try to manage
Covid-19 damage. In Khyber Pakhtunkhwa, Finance Minister Taimur Khan Jhagra has offered a textbook
lesson in clear, cogent public communication that engenders confidence that the state is prepared to
take on the responsibility of protecting the lives of citizens.
Sadly, what Covid-19 is teaching us is that even the best prepared and most capable nation-states are
powerless in the face of an unprecedented public health crisis. As the numbers escalate sharply in
Pakistan this week, the instructive statistics are those coming from countries like Iran, France and Italy.
A massive public health calamity has already arrived. There are only two things left to do now. Tie our
camel and trust in Allah.
At a March 3 cabinet meeting, exactly two weeks ago, Prime Minister Imran Khan made two important
decisions that already have grave implications, and may have even deeper and graver ones in the days
to come.
First, the prime minister expressed displeasure at the proactive manner in which Dr Zafar Mirza had
flown to the Pakistan-Iran border, to personally oversee the handling of the quarantine of at-risk
Pakistanis returning from pilgrimage in Iran. He cited health being a provincial subject as the basis for his
critique of Dr Mirza.
Second, the prime minister presided over cabinet’s rejection of Dr Mirza’s proposal to import Rs760
million worth of emergency medical equipment deemed necessary to deal with Covid-19, or the
‘coronavirus’. Both decisions merit revisiting. The National Security Council meeting on March 13 would
have been the best place for this revision, but it is never too late to correct course.
To tackle the Covid-19 crisis, like all countries, Pakistan will have to generate public policy that balances
its efforts, and limited resources across four policy outcomes: First, to limit the spread of the disease
and minimize mortality. Second, to protect the overarching capacity of the public health system and
enable it to cater to the already under-serviced demand for primary, secondary and tertiary health.
Third, to prepare for the economic impact of the Covid-19 crisis on individuals, families and
communities, and on the wider macroeconomic situation at large. And fourth, to find ways to reach a
scientific solution to the Covid-19 crisis, including the search for R&D that delivers a vaccine and/or
drugs to deal with Covid-19.
Thus far, the government has made some important and difficult decisions that have not received the
support they merit. Shuttling Pakistani students and pilgrims from virus-affected areas in Iran and China
was the unpopular but correct decision. The government needs to be supported in resisting cheap
television ratings driven demands for free movement into the country. In the days to come, the NSC
decisions to limit public gatherings, including school and wedding hall closures, will come under
immense public pressure. Not only must the government be supported in upholding these measures, it
must be pressured to do more to enforce social distancing. The only means of achieving the first policy
goal – limiting infections and minimizing Covid-19 mortality – is social distancing.
The second policy goal is to keep our hospitals and clinics (both public and private) up and running, so
that, for example, pregnant mothers can deliver babies safely, gunshot wounds can be tended to safely,
extreme food poisoning and victims of car accidents can be catered to properly, and cancer patients can
be offered chemotherapy or surgery safely.
In short, the public health system needs capacity to deal with the complexity of all the regular
challenges it faces, as the number of infections of Covid-19 escalate dramatically. This requires, above
all, capacity, which requires two things: money, and preparation. The cabinet must not only rescind its
rejection of Dr Mirza’s proposal for Rs760 million in emergency medical equipment, but must
acknowledge its mistake, and must approve a much larger package to immediately enhance the number
of functional ventilators across all cities and towns in the country. Ventilators require electricity, and
technicians and maintenance staff – an entire array of expenditure that must be designed and approved
forthwith.
The third policy goal is to prepare for the economic shock of Covid-19. The depth of the economic crisis
will exceed what happened globally in 2008-2009. There are five immediate decisions the government
must make. First, it must not reduce gasoline prices, but instead use lower oil prices to pad its revenue
(this will not play well on social media or television, but it is necessary to finance the remaining four
decisions). Second, it must double the size of BISP payments. Third, it must revise monetary policy, with
the specific intent of increasing small and medium sized business’ access to credit. Fourth, it must
announce and enforce a no-layoffs policy for all businesses. Finally, it must identify the worst hit sectors
(such as travel and tourism) and design large incentives that mitigate the impact of the Covid-19 crisis –
one that is expected to have at least two quarters’ worth of severe impact.
The final policy goal of finding a vaccine is as important as any of the other three. The Sindh
government’s announcement of a prize for successful R&D in this regard was mocked by some. But
hopefully Pakistan’s scientists, as besieged as they are by the stupidity, bigotry and short-sightedness
that defines the public discourse, spend less time on Twitter and more in their labs. The federal
government must work with the Higher Education Commission and the Ministry of Science and
Technology to design incentives for researchers.
Balancing and prioritizing between these four policy goals will be the most difficult test of Prime
Minister Khan’s leadership. There are two cross cutting secret weapons he must now deploy – both
being quite exclusive (one to him, the other to Pakistan).
The first secret weapon is PM Khan’s ability to dominate the public discourse. He must do so by jumping
headlong into the Covid-19 conversation, and engaging the challenge in a visible and aggressive way as
only he knows how. A massive public communications campaign is already three weeks overdue. He
must begin now. From personal hygiene, to social distancing, to managing pressure on hospitals and
clinics. Pakistan needs visible, aggressive leadership of the kind PM Khan excels at. It must be deployed
now.
The second secret weapon is Pakistan’s geographic and strategic intimacy with China. China has
successfully (and miraculously) fought off the first wave of Covid-19. No country will be entertained
more readily in the sharing of lessons from Wuhan, and resources from all over China than Pakistan. The
China-Pakistan relationship is now poised to deliver its most historic victory to the people of both
countries: a joint fight (and inshaAllah) victory against Covid-19.
That is how to tie our camel. After that, we trust in Allah.
The writer is an analyst and commentator.
"Income support and Covid-19 lockdown: Part- I" by

Mubashir Zaidi
https://www.thenews.com.pk/print/633516-income-support-and-covid-19-lockdown
Prime Minister Imran Khan’s refusal to announce a wholesale lockdown to slow the spread of the Covid-
19 virus is rooted in compassion. For this, his sentiment must be appreciated, not mocked. It is rare for
leaders to be able to hold firm to their convictions, but perhaps what separates good leaders from great
ones is to be able find a way past a policy impasse, with creativity and swiftness.
The problem is that the line between being firm and truthful to one’s convictions and being obdurate
and incapable of flexibility is a thin one. PM Khan’s insistence on formulating policy that puts the bottom
two income quintiles in the country at the top of his priority list is wonderful. However, this insistence
may cause a quantum of economic, social and governance damage that has a disproportionate and
catastrophic impact on those very Pakistanis down the road.
The most urgent task facing Pakistan’s leadership, including Dr Zafar Mirza, Dr Sania Nishtar, and Dr
Moeed Yousuf, is to offer policy solutions to the Covid-19 crisis that achieve three policy goals
simultaneously. First, to effectively restrict the transmission of the Covid-19 virus through social
interactions. Second, to ensure that the poorest quintile of Pakistanis (those twenty percent of
Pakistanis with the lowest income in the country) are provided with income support and essential
services. Third, to prevent the collapse of any existing public service provision system – health,
education, water supply.
The most important thing to remember in this triple-outcome framework is the self-reinforcing nature
of these three outcomes. The best way to prevent the exponential growth in number of infections is by
far the best way to keep public service provision alive and above water. And the best way to ensure that
exponential growth does not occur is to ensure that those most in need of mobility and interactions are
not forced to be mobile and spread infections, but instead are confident and assured that they will be
taken care of. The starting point for achieving these outcomes then, given PM Khan’s noble insistence
on caring for those most economically vulnerable is to manufacture a policy solution that addresses
their economic vulnerability.
Income support for the bottom quintile is challenging for two overarching reasons: one, finding those
deserving of the income support; and the second, paying for it.
Finding and verifying who is (and who is not) a deserving candidate for support is a complex and
politically challenging task. So much of the recent discourse around the Benazir Income Support
Programme has been about falsified notions of who is or is not deserving. That debate doesn’t just
disappear because of Covid-19, it colours it deeply.
Paying for it, conceptually, is a lot simpler: meaningful and impactful income support will not be cheap.
The bottom quintile or 20 percent means roughly 42 million Pakistanis. The average household size in
the bottom quintile is 8.06. This means that there are roughly 5.2 million households (and heads of
household) in the bottom quintile. If we expand our intended income support design to include the
bottom two quintiles (and as you will see below, we absolutely should), then the task is harder. There
are roughly 84 million Pakistanis in the bottom two quintiles. The average household size in the second
quintile is 7.21. This means that another 5.8 million households get added to our target income group,
for a total of 11 million households.
The average household income in the bottom quintile in the most recent Household Income and
Expenditure Survey (HIES) (which was 2015-2016) is Rs19,742. The average household income in the
next quintile is hardly much better, at Rs23,826. On average, if you are among the 84 million Pakistanis
that live in households with an average income amongst the bottom 40 percent in the country, you live
in households with an average income per month of just under Rs22,000. Now remember, this is 2015-
2016 data. Incomes have increased across the board since then, but since this is a crisis and we want to
come up with numbers that are conservative and bare bones, let’s work with the household income
level of Rs22,000. How do they spend this money?
Approximately half of all income for the bottom forty percent is spent on food (about 48 percent for the
first quintile and 43 percent for the second). This is in stark contrast to less than 30 percent of all income
for the top or fifth quintile. Half of Rs22,000 equals about Rs11,000. If we add inflation since 2015-2016,
this figure should be closer to Rs15,000 per month per household, as an absolute minimum to stave off a
major hunger crisis during any purported lockdown. At about 11 million households needing about
Rs15,000, the total monthly cost of a minimalist income support instrument is at least Rs165 billion.
That is a lot of money. Every month. To parse this into digestible numbers, perhaps we can start with 10
percent slabs within the bottom 40 percent. An income support instrument to any one segment of 10
percent amongst the poorest Pakistanis will cost roughly Rs41 billion. That too is a massive bill. But
suddenly it seems within reason to allocate that kind of money. Why?
Because last week the World Bank and ADB offered immediate support to the Government of Pakistan
in light of Covid-19 amounting to $600 million, or roughly Rs90 billion. The second question, of how to
pay for an income support instrument, thus stands answered: use around half the World Bank and ADB
money to make direct payments to 10 percent of all Pakistanis.
Now, the harder question is how to find them. There is no perfect answer and no answer that will tick all
the boxes. But one quarter of the bottom 40 percent equals roughly 2.75 million households. The BISP
programme has roughly five million households that receive BISP payments. The easiest and quickest
instrument of delivery is BISP. Simply targeting the 2.75 million households with the lowest incomes
within BISP is the fastest and quickest way of getting Rs11,000 into the pockets of the poorest
Pakistanis. It won’t be perfect. Middlemen, quacks, hacks and hucksters will steal money in ways and
means unimaginable – but BISP continues to be the most certain and least problematic tool to transfer
wealth from rich to poor in Pakistan.
As soon as this payment is made, the capacity of the state to enforce a lockdown will be underpinned by
the moral rectitude of caring for our most economically vulnerable. This in turn will reduce the sudden
surge of patients descending upon already dilapidated and dysfunctional public health facilities. Our
doctors, nurses, administrators, cops and soldiers will all do amazing work in this crisis – they always do.
But public policy has to buy time for the system to be able to flatten the curve enough to survive the
worst spike in cases of Covid-19.
Who will pay for the income support next month? We are in an unprecedented crisis. The IMF and a
host of international institutions are going make credit available in a manner unprecedented. And if
Pakistan is demonstrating the kind of compassion PM Khan insists on, inshaAllah there is no negotiation
on the planet Pakistan will not succeed in, to secure further support.
PM Khan must act now – Rs15,000 each for the bottom 2.75 million households in the BISP database.
The system can improve targeting and grant sizes next month. And improve them again, the month after
that. As the WHO has repeatedly said, in a crisis, acting fast is more important than getting the policy
perfect.
Act now, PM Khan. Issue the income support. And then lock down the country. Allah Hu Akbar.
"Income support and Covid-19 lockdown: Part - II" by

Musharraf Zaidi
https://www.thenews.com.pk/print/633962-income-support-and-covid-19-lockdown
Now that the lockdown, by any other name, has been announced. It is even more important to design
an income support instrument that we think of as much more than just a stand-alone intervention. The
instrument I proposed in my column yesterday represents a starting point for a whole-of-government
response to the economic crisis that the Covid-19 virus has instigated.
The proposal for a Rs15,000 grant to the bottom 2.75 million households that are already BISP cash
grant recipients raises a number of important questions. First, why 2.75 million? Second, how will we
know this is actually reaching poor people? Third, how will this money be delivered to these deserving
households? Fourth, why Rs15,000? Fifth, how will the government pay for this? And sixth, why not food
rations, or other forms of support, why just cash?
Why 2.75 million? The proposal for 2.75 million households is because this constitutes one fourth of the
overall, bottom two quintiles of household income in the country. Ideally, the grant should be for all
households in the bottom 40 percent, which would come to roughly 11 million households. As of right
now, there is no existing instrument to reach these 11 million households – though one can be devised
relatively quickly (more on this later).
Second, how will we know this is actually reaching poor people? The BISP database can be as big as
seven million, if needed, but is closer to about five million households, after recent filtering queries. The
2.75 million households is a good immediate target because it makes up just over half of all BISP
households, and each one of those households is amongst the bottom 40 percent of households, by
income. BISP targeting is not perfect, but it is among the best in the world, with repeated assessments
by donors and independent evaluators saying so.
Third, how will this money be delivered to these deserving households? The BISP programme already
has robust delivery mechanisms; however, the Covid-19 crisis offers an unprecedented opportunity to
scale up the technological innovations already being considered and tested in BISP and Ehsaas. Working
with JazzCash, EasyPaisa, and other telcos and banks’ mobile wallets or digital payment interfaces, BISP
can transfer Rs. 15,000 payments directly to BISP recipients, through their mobile phones. Because retail
digital transactions are still relatively rare, users would still need or want to get their hands on the actual
cash.
In such cases, recipients would simply need to go to a retailer authorized by the telcos or banks and
collect the money. Old, 2G, or ‘feature’ phones are fully capable of being recipients of the special codes
that allow money to be collected against them, as Jazz CEO Aamir Ibrahim explained to me. Of Jazz
Cash’s eight million active mobile wallets for example, 6.5 million are on the old-fashioned ‘feature’
phones, and only 1.5 million on smartphones.
Mobile companies have the full capacity to run algorithms and determine which of their 160 million
subscribers overlap with the target group of 2.75 million, further sharpening the precision of the
intervention. The most important aspect of the mobile or digital approach to targeting is that it will help
evolve Pakistan’s archaic approach to social programming, away from the post-colonial structures that
require large crowds gathering at kutchehris and DC offices, towards physical distancing enabling
solutions that limit the overhead transactions costs that governments tend to bear when government
itself is the interface.
Fourth, why Rs15,000? The average total household income in the bottom 40 percent of households by
income in 2015-2016 (our most recent official household income data) is Rs22,000. Food expenditure in
these two quintiles takes up just under half of all income, or roughly Rs15,000. Roughly rounding up for
inflation gives us the Rs15,000 number. Each month. Each household. The total bill per month for this
comes to Rs41.25 billion, or just under $300 million. It is not spare change. But it will not bankrupt
Pakistan, nor any donor (bilateral or multilateral).
Rs15,000 is also important because it is substantial and not cosmetic. In a crisis or emergency, among
poor households, it is the fear of being cash-starved that alters consumption behavior. That knock on
change in consumption affects retail sales of basic items, even food. The knock-on effect of this drop in
demand is manifest in smaller wholesale orders, less business for trucking and logistics firms, less traffic.
Less traffic reduces footfall transactions supporting the supply chains.
If 2.75 million households with an average of nearly eight people per household decide to eat less
(which they will) because of the impact of Covid-19 on their incomes, it is Rs15,000 that will pull them
back from that choice – because that constitutes their full food consumption budget. Remember, this
isn’t for lazy people who are slacking. This is for the poorest two quintiles of Pakistanis. Rs15,000 is the
minimum amount that causes enough of a disruption in the budget to re-instigate consumption habits.
Why is the consumption part of this vital? Because collectively, over 2.75 million households, such a
change constitutes a stimulus package for the small retailer in small neighborhoods across the country.
Those retailers do not have big brokerage firms, or members of the Pakistan Business Council lobbying
for them. Their only hope for survival through Covid-19 is the ability of the poor to keep buying basic
food items through the next month. Which brings us to the fifth question.
How will the government pay for this? In the short run, as in this month, we have already proposed that
just under half of the already approved WB and ADB injections of roughly $600 million go to financing
this grant. In the months to come, the extra Rs41.25 billion required for this intervention can easily be
parked within any of the large multilateral programmes that are going to be negotiated in the months to
come. An annual extra Rs500 billion is not a small matter, but it is also not an extraordinarily obstructive
number. Over time, luxury taxes dedicated to targeting high end consumption (such as business class
tickets, cars above 1200 cc, or Rolex and Omega watches, or Louis Vuitton bags) could be dedicated to a
rolling endowment for this intervention.
Finally, why not food rations, or other forms of support, why just cash? Because cash is empowering,
and it affords families living in poverty the dignity to make their own choices. Covid-19 is a catastrophic
virus that is unsettling and destructive. But it may afford Pakistan’s leaders a chance to revisit the
fundamentals of how we organize our society, our economy and our government.
May Allah protect us all from the virus, but may He also empower and enable us to use the
conversations this virus has initiated, to do better. We must do better. Better than we have before.
Better than the bare minimum. Better than Rs3,000 per month.
Concluded
"Corona Crisis: End of World or New World Order?" By Dr.

Shehbaz Gill
https://www.thedayspring.com.pk/corona-crisis-end-of-world-or-new-world-order/
From Thucydides’ Melian Dialogue of Peloponnesian War to the advent of bioweapons for the
destruction of an adversary; from the unquestioned might is the right approach to the renaissance , rule
of law and sovereign equality; from the rule of international law to the belief in the survival of the
fittest, man has made indisputable progress in developing the articles of warfare. War has remained one
of the constants of history because no one can underestimate human stupidity that indisputably
transcends the national borders.
The quest of relative gains has created fault lines across the globe. State-sponsored bloodshed, brutality
and criminal offences continue to happen across those lines for the pursuit of power. Everyone knows
that the road to power is paved with hypocrisy and casualty, but no one regrets the same. Instead,
nations interpret the whole scenario in multiple folds of religious propaganda.
when we compare the current happenings to those of WWI and WWII, the post-truth international
political narratives and the politics of accusation depict that a third world war is on its way.
The current situation of corona crisis can also be explained by analysing the world in terms of political
attitudes of leaders of some of the most powerful states. As a matter of fact, an ultranationalist US
President Donald Trump, an authoritarian Chinese President Xi Jinping and a hyper-nationalist Indian
prime minister Narendra Modi do not inspire hope. All these jingoists are not only a grave threat to the
liberal international order but are also logically anarchists.
Moreover, when we compare the current happenings to those of WWI and WWII, the post-truth
international political narratives and the politics of accusation depict that a third world war is on its way.
The US-China cross accusations of responsibility for spreading Coronavirus, a burning Middle East and
the struggle for throne at Riyadh may provide fuel to these cross country rivalries and deepen the fault
lines.
The crux of the matter is that the world is getting closer to a great war, liberal international order is in
jeopardy, a strong hegemonic Islamic-Confucius nexus is emerging and the US influence is on the wane.
The globe has survived through the catastrophic nuclear disasters and it would hopefully survive once
again. The defeat of corona bioweapon is inevitable, but many of us may perish by the time the world
comes to overcome this crisis.
The only way to mitigate this international crisis is the adoption of a pragmatic and egalitarian approach.
Closing the borders is an option but it may lead to an economic recession and obstruction in relief
efforts. However, the Chinese president’s call to help others and to lead the world from the front is a big
gesture of hope. The US must acknowledge the fact that its hegemonic behaviour is no more acceptable
to the globe. The Italian Prime Minister’s call for help, instead of accusing US and China of unleashing
biological warfare is a good omen that the world leaders are ready to formulate a consensus-based
approach to effectively deal with the Corona crisis.
"A universal passion" by Jani Alam Kaki
LIKE light, water, knowledge, love is another aspect of human life, celebrated universally. Love is a
passion that has been eulogised by all — in primitive as well as advanced societies. Poets and prose
writers, singers and dancers, mythology narrators, qissa khawans, all have sung the beauty of love — its
pains and pleasures.
In faith-based traditions, the love of God, with whatever name, and the inspirers of faith, whether
prophets or gurus, the devotees have expressed immense love for them; aspiring to live or die for them.
In Muslim tradition, the love of Allah, followed by that of the Prophet Muhammad (PBUH) have been
the core passion in all communities of interpretation. Often, this has been expressed through a whole
genre of poetry called hamd (Allah’s praise), naat (Prophet’s praise), manqabat (Hazrat Ali and Ahlul
Bayt’s praise) or the praise of Sufi masters such as Shahbaz Qalandar and Data Ganj Bakhsh.
Often all these genres have been combined in another genre called qawwali, sung with soul-nourishing
passion by a group of singers. In this regard, Maulana Rumi’s love for his murshid, Shams Tabriz, is
proverbial, and he gives the highest regard to him (Shams) to the extent of dedicating his whole divan to
him, called Divan-i-Shams Tabriz. Allama Iqbal humbly called himself ‘Murid-i-Hindi’ of Rumi.
When in intense love, it is often called ‘ishq’, the culmination of love. ‘Ishq’ is an Arabic word, which
stands for an insect. For humans, metaphorically, it means if one is touched by intoxicating love, it
culminates in the ‘annihilation’ of its beholder. In a spiritual sense, what this means is that when a
person is engulfed with love, he or she becomes ‘extinct’ as an individual, but at the same time,
resurrects itself in the Being, leading to what is known as ‘fana fi Allah, baqa bi Allah’ (Annihilating in
God and becoming Ever-living with Him). This is also called ‘enlightenment’ in a mystical sense.
Love is no monopoly of any one culture or nation, faith or community.
Love also expresses itself in human relations. Human societies are dotted with popular stories of love
between two humans. Laila-Majnoon, Heer-Ranjha, Sassi-Punnu are just a few examples. Similarly, love
of human ‘service’ is also a remarkable story in human history. Men and women have devoted their
entire lives to the service of humanity, risking even their own well-being.
Beyond religion and human relations, love expresses itself in many other ways. Love of wisdom
(philosophy) and love of exploring and investigating the secrets of the universe have been equally strong
passions. Scientists, both in social and hard sciences, researchers and writers often spend much of their
lives passionately researching, discovering and writing for the love of discovery and innovations to ease
human and animal sufferings.
In Muslim contexts, the passion of love of discovery is expressed in a complex way. It is reflection on
God’s signs (aayaat) spread from heaven to the earth. Sir Sayyed Ahmad Khan appropriately calls the
reflection on the verses of the Quran the word of God and the universe as the work of God,
supplementing each other. As the verses of God are loved so is the work of God, the living verses of God,
which the verbal verses refer to.
As one gets ‘enlightenment’ through ‘meditation,’ so does one through ‘contemplation.’ What a mystic
sees is perceived by one who contemplates. Therefore, in many Muslim traditions, these two paths of
reaching the truths have been accepted as complementary, though some have seen them as opposing
paths.
A glimpse of this complementarity (of mystical meditation and intellectual contemplation) can be seen
fused together in the Quranic verse: “Behold! In the creation of the heavens and the earth, and the
alternation of Night and Day, there are indeed Signs for men of understanding. Men who celebrate the
praises of Allah standing, sitting, and lying down on their sides, and contemplate the (wonders of)
creation in the heavens and the earth (with the thought): ‘Our Lord! Not for naught hast Thou created
(all) this! Glory to Thee! ...” (3: 190-191). This verse gives a powerful message towards remembering
God as worship and contemplating on the nature — the living verses of God — as practical worship, the
twin ways of loving and celebrating God’s creation, and through it, God Himself.
Thus, love is all-pervasive, expressed through numerous ways to quench the eternal thirst in human
beings to love all those or all that worthy of it. To love is no monopoly of any one culture or nation, faith
or community. The language of love, like that of music, and dance, art and architecture, is universal.
The writer is an educationist with an interest in the study of religion and philosophy.
"Covid-19: how are we doing?" by Samia Altaf
THE coronavirus infection is well and truly in Pakistan and is growing exponentially as predicted, with
over 400 cases diagnosed as of the time of writing — in such situations statistics are outdated by the
time they are communicated. The numbers confirmed so far could well be an under-estimate because
our capacity to track and test for the infection is limited and already thousands of unscreened people
have gone back to their communities.
All the infected will need diagnostic testing. Arrangements made by government are difficult to access
and expensive. To get free testing people need to show referrals or passports. Fifteen per cent of the
affected need hospitalisation, and 5pc will need ventilators in ICUs. While WHO recommends five
hospital beds per 1,000 population, Pakistan’s hospital bed-to-population ratio is less than one per
1,000; in fact, the bed occupancy rate is over 100pc — two patients occupying a bed is a common sight.
Government has arranged for separate beds for the coronavirus infected, who will be served by already
overworked doctors and nurses.
The infection doubles in number in six days if not controlled. Assuming there are 400 infected today,
there will be 102,400 people infected by May 6; 15,360 of these will need hospitalisation and 5,120 will
need ventilators. International standards call for 30 ventilators per 100 patients; there are at most 2,000
ventilators nationwide. How far will these arrangements of 300 separate beds take us? One can already
see these falling apart and the ensuing chaos.
Facemasks and protective gear, the critical need of health staff who are most at risk of being infected,
are in short supply. Allegedly, an infected person admitted to a Lahore hospital was not seen by doctors
for 12 hours because they did not have masks. What is Pakistan’s stockpile of masks and protective
gear? What are the arrangements for procuring and distributing these?
Facemasks and protective gear, critical to health staff who are most at risk, are in short supply.
All of these factors compound each other. As the system gets overburdened — there are also cases of
‘normal sickness’ that need hospital beds and ventilators — there will be shortages of doctors, nurses,
medicines and intravenous fluids. Within days, the caseload, demand on doctors, fatigue, and likely
shortages of protective gear will overwhelm the health system. Imagine sick people turning up in
hospitals because they cannot breathe. Imagine overworked and unprotected doctors and nurses falling
sick and depleting the workforce. One can see the inadequate medical services system disintegrate
further.
At the same time, it will become more difficult to track and identify cases. Isolation, even in homes in
Pakistan is difficult given that information about the disease is poorly communicated, and there is no
monitoring or follow-up system. On March 11, in the waiting room of a large specialty hospital in
Lahore, I asked 20 people if they knew about this infection and preventive measures. Not one person
did. Most families are crowded in one or two rooms and our cultural practices encourage shaking hands
and embracing each other. Social distancing needs culture change.
A security guard, coughing and sniffling, refused to go home. He, understandably, did not want to lose
the day’s pay. People who are day labourers will not practise isolation unless they are compensated for
their lost wages, otherwise how will their families eat?
Remain calm, trust in God, but also tie the camel. Given that there is no medicine to combat the virus,
no vaccine to prevent it, and that it spreads exponentially, the only option is to prevent its spread. For
that, there need to be meticulous, detailed plans, implemented strictly according to local challenges and
constraints, incorporating lessons learnt from other countries. Plans should be more than standard WHO
guidelines and SOPs.
The effort should be led by a special task force headed by a technical expert with experience of
managing large health programmes, of Pakistan’s challenges, and knowledge of its institutional
strengths and weaknesses. This person should be devoted full time to this task, have credibility and
authority stemming from his/her professional experience and personal knowledge and competence, and
should be answerable to the prime minister. The government’s plans and strategy should be reviewed
and monitored by technical experts representing civil society to avoid a repeat of the Taftan situation
where the government’s plan for the quarantine did not work as expected.
The prevention plan should be collective and collaborative between federal, provincial and district
governments, with clear roles for and accountability of different government departments, led by the
federal government. A budget should be announced with a facilitated release mechanism to minimise
procurement delays. The implementation should be detailed in a separate work plan that identifies the
responsible person for each activity. The current practice — where no one is accountable, where the
National Disaster Management Agency is the lead agency, while a special assistant holds meetings —
does not inspire confidence.
The plan should include:
• Cancellation of all public events including religious and commercial congregations.
• Closure of national borders, educational institutions and limitations on international air travel.
• Training of staff on screening practices. Many incoming passengers bypassed screening at airports
because the staff was not trained.
• An effective communication strategy in local languages to convey to people knowledge and

information about the disease, its dangers, and personal protective actions.
• The number of helpline staff should be increased and trained. Callers to helpline have not always
received help, which has implications for the credibility and trust of authorities.
• Clear and factual information to be given to media.
• Economic factors that affect the daily lives of people should be catered for. Sick leave is not common.
Many people with mild symptoms, if working on daily wages, are unlikely to stay home and forego
earnings needed for survival. The government should make arrangements to compensate for lost wages
to ensure compliance.
• Because homes are overcrowded, isolation for suspected infections should be arranged by the
government in empty schools, college hostels etc.
The writer is a preventive medicine and public health specialist.
Published in Dawn, March 21st, 2020
"When pandemics strike" by Arifa Noor
THERE is much talk about the Spanish flu these days, the last pandemic which swept the world the way
the coronavirus has today. The former hit the world during the First World War, which allowed it to
spread rapidly through a world which was far less connected than the present times in which air travel,
until recently, was pervasive. A century earlier, armies that moved across countries, mostly on ships,
carried the virus with them. By the time it ended in 1920, it had claimed around 50 million lives,
according to some estimates. Lower estimates place the number around 20m.
Unlike the coronavirus, however, the Spanish flu hit the young and healthy more than the elderly. It
appears that it disappeared as suddenly as it came. But as the world deals with the coronavirus, much
has been written about the Spanish flu recently, which provides for interesting reading. It was not just
the death toll or the way it travelled around the world, many of the preventive measures implemented
then sound familiar as we struggle to deal with the current pandemic.
Social distancing was in vogue then too. According to one article, ‘Flu in Washington: A Look Back at the
1918 “Spanish Flu” Pandemic’, a city county in the US ordered that “all places of public gathering, such
as schools, churches, dances etc” be closed, while a second county leased a building “for the purpose of
establishing same as an Isolation Hospital”. Later, gatherings were banned in “all places where any kind
of business is transacted... with the exception of drug stores, meat markets, restaurants, eating places,
hotels and fruit ware-houses”. People were also ordered to wear masks in all public places — they had
to cover their nose and mouth.
And yet it seems that the authorities struggled everywhere with the same issues that confront those in
Pakistan and elsewhere. Consider a health report ‘Lessons Learned from the 1918–1919 Influenza
Pandemic in Minneapolis and St. Paul, Minnesota’ on how the two neighbouring cities dealt with the
crisis. Much of it can be transposed to our environs; it does not seem as if 100 years have passed since:
“At one point, Minneapolis’s City Hospital reported that ‘nearly half of the nursing staff has been ill with
influenza in the last three weeks’.” Later, the report cites a hospital official: “[the] hospital was caring for
about 150 cases, and had about 70 on the waiting list. It had beds available for that waiting number, but
not nurses”.
In the wake of the Spanish flu, healthcare for all became the responsibility of states.
But for us in Pakistan, more familiar still will be the disagreement between the health commissioners on
a major step: one wanted to close public places (Minneapolis) while the other (St Paul) felt that isolation
was the way to go. In the words of the latter, “If you begin to close, where are you going to stop? When
are you going to reopen, and what do you accomplish by opening”?
They also disagreed on closure of schools though both cities opted for this decision as the St Paul health
official was overruled by political decision-makers. Social distancing was, however, prevalent:
passengers were limited in public transport; windows were kept open on buses; work hours were
regulated; and the use of lifts was discouraged.
Americans proved no more disciplined than Pakistanis today; schools refused to shut down as they did
not want to pay teachers or miss out on fees. Bars and restaurants flaunted orders. One man had to be
arrested because he “insisted on taking his child from the city hospital before the patient was ready to
be discharged. The mother and father and the child later were found mingling with other persons in the
neighbourhood”. Masks were widely distributed as a preventive measure.
Intriguingly, only one of the two cities practised mandatory isolation (St Paul) — influenza cases were to
be reported to a physician who told the patients to isolate at home and notify the authorities. But this
also led to hesitation in people consulting doctors and making public their illness. They preferred to hide
their condition till they became gravely ill.
St Paul was also the one with a lower death rate (645) by around 100, though its reported cases were
4,399 compared to 14,411 in Minneapolis, which did not enforce isolation. However, the rate of fatality
compared to the reported cases was higher in St Paul.
But for the authors of the report, the biggest disadvantage was that officials were trying to “conceive
and realise” plans during a health crisis. Had the plan been developed beforehand and measures taken
in advance, it might have been easier, they argue. As a result, officials were not decisive which in turn
did not translate into a single, comprehensive message for the public.
This is perhaps what we are witnessing in places in Europe, the US, and at home too. The more
authoritarian East Asian states were able to manage this better especially as the earlier scares such as
that of SARS had also improved their preparedness (it is not just about aggressive testing!).
But these important lessons were not forgotten once the Spanish flu ended — such was its devastation
that it had a long-lasting impact on public health.
In its wake, healthcare for all became the responsibility of states, and Russia is said to be one of the first
to put together a centralised healthcare system. In addition, public health leaders were given more of a
say as the objective was to “study the occupational and social conditions which give rise to illness and
not only to cure the illness but to suggest ways to prevent it”. And lastly, it led to an international
bureau for fighting epidemics in Austria, which in modern times has come forward as the World Health
Organisation.
In other words, the millions of lives lost caused a sea change. No wonder then that many now are
predicting that the coronavirus too will force a rethink of public health, even the return of the big state
— for example, the welfare states in Europe in the recent past — which has been on the retreat for
decades now. This perhaps is what we also need to push for in Pakistan. Public health needs a rethink,
and the coronavirus should force those ruling us to work on this once the immediate crisis is over.
"Incentive package" by Editorial
IT was never going to be a simple balancing act to perform, but the government seems to have done it
right. More details about the trillion-rupee-plus package announced by the prime minister on Tuesday
are needed before its true impact can be assessed. But in walking the tightrope between providing
direct assistance to the people and helping industry to weather the tough times that lie ahead, it seems
to lean in favour of direct assistance without forgetting industry. It was stated that for the construction
sector, a separate package would come later. Presumably, the lockdowns announced by the provincial
governments have halted construction activity, so coming up with any incentive package for the sector
at this time would have no beneficial impact. For industry, the package is structured to accelerate the
release of sales tax refunds and calls for deferring debt service payments. This is smartly structured
because it minimises the cash outlay on the part of the government, but will help improve the liquidity
position of the companies that benefit from it, thereby enabling them to maintain their payrolls.
The challenge now is targeting. Deferred debt-service payments, assuming the government is successful
in arranging this for the private sector, means only those who access bank credit will benefit. Likewise
with sales tax refunds. There is an allocation of Rs100bn for small and medium-size enterprises and
agriculture, but the mechanism through which this will be allocated is yet to be announced. Aside from
this, an amount of Rs400bn seems to be allocated for direct support to the working poor; half of the
sum is supposed to preserve employment. Once again, the allocation is good, but the mechanism will be
key to success. If the government intends to put this money into the pockets of rich industrialists under
the assumption they will pass it on to the workers as remuneration, then room for abuse and capture is
substantial. It would be worth its while to find ways to directly transfer these funds to the working poor.
As time goes by, it is possible these funds will seem insufficient. Once disbursement gets under way, the
government is also likely to be swamped with complaints and loud calls for more, especially from
industry. Given the unprecedented nature of the challenge we are now moving towards, it would be
entirely appropriate for the government to focus its energies directly on the people rather than seeking
to route its assistance through industry. This is a good time to rapidly increase its capacity for targeted
assistance, and given the technologies available today, especially with the National Socioeconomic
Registry of the Benazir Income Support Programme, as well as myriad other targeted support schemes,
this can be achieved. There is time enough to ramp up the targeting and it should be used for this
purpose.
"Under lockdown" by Zoha Waseem
WITH a virtually complete countrywide lockdown, Section 144 imposed in major cities, and armed forces
being deployed across provinces, policing and surveillance are likely to increase, especially in urban
areas. All police leave in Karachi has been cancelled. Their strength increased, hundreds have been
deployed outside hospitals. Traffic and station-level officers have been provided with protective
equipment, primarily facemasks.
The police have been instructed, amongst other things, to enforce a complete ban on public gatherings.
Those found in violation may face fines or even jail. There is a risk that these rules will be enforced
unequally, as a result of social stratification, leading to an over-policing of the less privileged, and an
under-policing of the affluent.
Is policing a crisis going to create a crisis in policing? What are the challenges confronting local police in
countries like Pakistan as Covid-19 spreads, impacting public order and public safety? What does ‘social
distancing’ even mean in the context of law enforcement?
For station-level officers, a lack of provisions and poor salaries means that most commute in crowded
public transport, where they are exposed and vulnerable. Extra policemen deployed at stations from
training centres are accommodated in barracks inside these stations, where up to 20 constables are
squeezed in to sleep in confined spaces. While senior officers use official vehicles in isolation, multiple
station-level officials and employees use police mobiles, often for transporting criminals and suspects.
The utility of hand sanitisers becomes futile during hot pursuit, and some stations do not have basic
facilities for washing hands.
Is policing a crisis going to create a crisis of policing?
Police officials tend to suffer from poor health given the unhygienic environments they operate in and
their long shifts. In the current climate, they are even more vulnerable. The primary police hospital in
Karachi — that is ill equipped and understaffed — is tasked with establishing an isolation ward. But in
most cases, police officers themselves choose not to get treated here due to the abysmal conditions that
prevail.
In spite of the ongoing crisis, everyday sexism continues to dog female police officers. Though police are
supposed to wear facemasks, policewomen wearing these and other protective gear are subject to
ridicule: ‘madam darr gayi hain’ (madam is scared), a judgement perhaps their male counterparts are
not as easily subject to. They are thus prone to removing their masks, exposing themselves and others.
Despite these challenges, the police need to be extra vigilant in the maintenance of public order. In the
short term, we may see an increase in assault and battery cases as panic over limited resources
increases. In the medium to long term, we may see a surge in cyber, street and organised crime, which
will be difficult to investigate as resources are diverted to operational and procedural matters.
Police officials are also cognisant of the fact that measures to prevent the spread of Covid-19 will hurt
daily wage earners, such as hawkers and vendors, who work in spaces outside shrines and schools that
have temporarily closed down. As unemployment rises, we will see an increase in crimes of opportunity,
heightening social fears and anxiety. This will increase public pressure on the police to deliver more (and
better), and the police will inevitably become overwhelmed given their already limited resources.
In certain public services, especially in the provision of public policing (which is, by definition, about
interacting with communities and maintaining order), the call for ‘social distancing’ does not apply.
Police organisations will need to learn, adapt and improvise as they go, possibly without any financial
support from provincial governments. They will need better cooperation with public health and medical
officials.
They will also need to exhibit empathy and compassion as they struggle to maintain public trust
between officers and the communities they serve. This is a tall order, and an unprecedented challenge.
One can only hope that in the ongoing crisis, police well-being and welfare are prioritised, and that
police leadership instils confidence in the workforce and protects its employees, instead of focusing on
personality-driven agendas that fragment organisations internally.
We need to prevent a crisis in local, civilian policing, lest it creates a vacuum that is filled by more
coercive security institutions. In time, we will need to analyse how the deployment of troops in cases of
public health emergencies impacts the maintenance of public order (especially in countries with a
history of military interventions), and how such deployments affect the hierarchical relationship
between the civilian police and the armed forces. In other words, what will public policing look like once
the public health emergency recedes?
The writer is a postdoctoral research fellow at University College London.

"No time for war" by Editorial
ASKING for an end to hostilities between nations, UN Secretary General António Guterres has called on
warring countries to jointly fight the battle against Covid-19 instead. “The fury of the virus illustrates the
folly of war,” he said. “That is why today, I am calling for an immediate global ceasefire in all corners of
the world. It is time to put armed conflict on lockdown and focus together on the true fight of our lives.”
From the time the first Covid-19 death was confirmed in January 2020 in Wuhan, there have been nearly
400,000 novel coronavirus cases worldwide, and over 16,000 deaths. From developed states like the US,
UK and Italy to developing countries like Pakistan, the disease is crippling healthcare infrastructure and
economies across the world. As a result, governments everywhere are forced to make difficult choices to
protect citizens. In countries such as Syria and Yemen which are torn by war, the destruction of
infrastructure means the chances of fatalities are even higher than average.
If there were ever a point in modern history that called for an immediate stop to conflict, sanctions and
political hostilities, it is now. The virus does not care about nationality or ethnicity. As Mr Guterres said,
this is the fight of our lifetimes. The situation should compel world leaders like US President Donald
Trump to demonstrate leadership instead of escalating tensions. Mr Trump has multiple times dubbed
Covid-19 the ‘Chinese virus’ and US officials have indulged in a racially tinged blame game over the
origins of the virus — words that are only dividing communities at a time when they need to be united.
China, too, has hit back with equally myopic actions, with Beijing promoting a conspiracy theory that the
US brought the coronavirus to Wuhan. Moreover, as countries suffer the consequences of China’s initial
lack of transparency regarding the disease, the latter country is expelling US journalists. Meanwhile, the
US sanctions on Iran, where Covid-19 has had a devastating impact, need to be eased immediately; such
action would help the world’s (including America’s) fight against the virus. In this regard, Ayatollah
Khamenei’s allegation that the virus “is specifically built for Iran using the genetic data of Iranians” is
counterproductive. Leaders must remember that in a globalised world, the presence of the virus in any
country will result in transmission and that if it is not curbed everywhere, it is a risk to all nations.

"A virus dilemma for the faithful" by Peter Welby
https://arab.news/5y8qz
The COVID-19 pandemic is disrupting daily life across the world. Social contact in particular is
discouraged, in a policy described as social distancing. All of which leaves the question of religious
gatherings — places where people are often close to one another, often touching.
The challenge to religious leaders around the world is that religious gatherings, congregational prayer
and worship, are not regarded as leisure, but rather as a duty of human beings toward their creator.
Some forms of worship are even mandated in scripture.
Saudi Arabia’s rapid response has rightly won praise; suspending Umrah, deep cleaning the Grand
Mosque in Makkah, and most recently closing all mosques apart from the Grand Mosque and the
Prophet’s Mosque in Madinah. These decisive actions are perhaps made slightly easier by the Islamic
jurisprudential tradition and the governmental authority that is granted to certain scholars, something
that is replicated in many Muslim-majority countries. The Fatwa Council of the UAE released a fatwa on
March 3 explaining the jurisprudential and scriptural authority for the government to prevent people
from attending prayers to prevent infection. Other countries have done likewise.
Nevertheless, with Ramadan rapidly approaching, Muslims around the world will be seeking guidance
about how to conduct the fast. There will need to be clear instructions on exemptions for those who
need to maintain their strength, and restrictions on iftar gatherings.
In Christianity the challenge is different. There is no jurisprudence to draw on, and many denominations
of churches do not even have a central authority with power to issue instructions. Much of Christian
worship revolves around the Eucharist (the sharing together of bread and wine in memory of Christ’s
crucifixion), which often involves a common cup; another common feature is the “sign of peace” (a
representation of fraternity with fellow Christians), which often involves a handshake, hug or kiss. Both
practices are obviously problematic during an epidemic of this sort.
The longer this crisis goes on, the more creative religious leaders are going to have to become in how to
maintain the integrity of worship when worshippers can’t congregate. In the meantime, if it leads to an
increase in regular personal prayer, acts of charity and community spirit, they will all be written down as
one good outcome from a terrible situation.
Peter Welby
The hierarchical churches (such as the Church of England in the UK, or the Roman Catholic or Orthodox
churches) have reacted differently. In the UK, as the epidemic grows more severe, the Church of England
announced that churches would be closed to regular public worship (apparently for the first time since
1258), although funerals and weddings may still be permitted in limited form. In Jerusalem, all the
leaders of the recognised Christian denominations called on their followers across the political
jurisdictions in which they serve to obey the civic authorities in response to the crisis. In practice, this
has meant not attending church.
Elsewhere, though, there has been some difficulty. The Greek Prime Minister called on the Greek
Orthodox church in the country to follow the science, in response to a media furore that followed a
church statement that the Eucharist “certainly cannot be a cause of disease transmission.” In response,
the Church has suspended daily services, and is discouraging its worshippers from attending on Sundays.
It has often been religious groups who have stepped into the breach in times of crisis in the past, when
political leadership has fled. Christian responses to plagues in the second and third centuries in the
Roman Empire — staying and caring for the sick, both Christian and pagan, at great risk to their own
health —accelerated the spread of Christianity across the Roman world. The point has always been that
for those who believe in the salvation that their faith offers, there should be no fear of death; but
likewise those who share in that faith have a duty to care for the living.
That lesson from early Christianity has been cited by various Christian leaders and theologians in the
past few weeks. But there is a challenge too. COVID-19 is highly contagious, and those infected do not
experience symptoms for some time after contracting it — but they can spread it to others. So visiting
the sick and the dying (whether of this disease or not) alongside health workers, as Pope Francis
encouraged Catholic priests to do, may pose a risk not only to those doing it, but also to everyone else
they visit subsequently. This poses a huge dilemma to priests in all churches, for whom tending to the
sick and the dying is a key part of their ministry.
So how is it that religious groups care for the living? The statement of church leaders in Jerusalem called
on believers to use the opportunity to “intensify personal prayer, fasting and alms-giving.” In the UK,
Churches Together, a body that most of the church denominations belong to, called for a “national day
of prayer and action” this Sunday, in which, in addition to prayer, Christians were called upon to collect
groceries for those who can’t go out, make donations to a food bank, and make contact with those who
are in isolation.
The Islamic responses have drawn on the jurisprudential principle that “avoiding harm takes precedence
over acquiring benefit,” but many of these responses have also looked at what good can be done
despite the restrictions. The British Board of Scholars and Imams suggests expanded private prayer and
recitation of scripture, “tending to the unwell in appropriate ways,” and an increase in “charitable
works.” The UAE’s fatwa called upon “all groups and individuals to extend help and support to one
another in whatever capacity they are able to do so.”
The longer this crisis goes on, the more creative religious leaders are going to have to become in how to
maintain the integrity of worship when worshippers can’t congregate. In the meantime, if it leads to an
increase in regular personal prayer, acts of charity and community spirit, they will all be written down as
one good outcome from a terrible situation.
• Peter Welby is a consultant on religion and global affairs, specializing in the Arab world. Previously he
was the managing editor of a think tank on religious extremism, the Centre on Religion & Geopolitics,
and worked in public affairs in the Arabian Gulf. He is based in London, and has lived in Egypt and
Yemen. Twitter: @pdcwelby.
"This pandemic must change states’ ideas of national

security " by Qamar Cheema
https://arab.news/vrk5s
In a contemporary strategic environment, states rely on a conventional understanding of international

politics to formulate alliances and have common security. Usually, reliable means for state security is
military power. But in the 21 century, states must understand new patterns of global security which are
not a part of traditional decision making processes. The entire concept of national security needs
revision at the national, regional and global level.
For the shared future of humanity and for collective security, states need to think about non-traditional
security parameters, which include providing security in environmental degradation, economic crises,
mass migrations, pandemics, communal and cultural identities and many other areas.
Developing countries with major investments in military power, are at a disadvantaged position to
counter emerging non-traditional security threats. These include states in South Asia like Pakistan and
India which have never brought non-traditional security threats into national security institutions. Such
states will have difficulty developing the capacity of their institutions to deal with new threats.
For the first time in the history of Pakistan, a disease has been discussed in the National Security
Committee (NSC) and the Corp. Commanders Conference has viewed it as a threat to national security.
Since the World Health Organization declared Covid-19 a pandemic, more than 186 countries have over
15,000 fatalities as of Monday.
Now, a new national security definition needs to be part of Pakistan’s national security apparatus--
covering the environment, public health, pandemics, economic crises and other areas of public interest.
Qamar Cheema
NSC is the highest body for taking measures on national security issues, and one which has never
discussed public health as a national security risk. This has given new meaning to the national security of
the country since the platform brought the Prime Minister, provincial chief executives, services chiefs,
federal and provincial health advisers and ministers, and the surgeon general of the Pakistan army and
other officials to the same table.
Meanwhile, public health is a provincial subject and provinces have to spend money on health looking at
their priorities, population and resources. Additionally, provinces and the central government may have
to ink a new agreement about how to deal with such situations because airports and borders fall into
the federal government’s domain while public health is a provincial subject.
Meanwhile, the NSC needs to develop a comprehensive strategy to bring issues of non-traditional
security into its platform. Now, all provincial governments have requested the army to assist in aid of
civil power because the civilian apparatus lacks the capability and outreach required.
Pakistan was among six countries back in 2017 who took steps to evaluate its ability against a global
pandemic according to the World Bank. Now, a new national security definition needs to be part of
Pakistan’s national security apparatus-- covering the environment, public health, pandemics, economic
crises and other areas of public interest. The army already considers the economy a national security
subject in Pakistan.
All of South Asia has been affected by Covid-19, so there must be a regional response to the pandemic.
For a time, SAARC has been largely dysfunctional in part due to India’s designs to isolate Pakistan
diplomatically.
Earlier this month, Prime Minister Modi called a special session of SAARC heads of state and pledged
$10 million toward a coronavirus emergency fund. But there remains a trust deficit among states for
cooperation. States need to sit together to address the changing nature of national security for the two
billion people of South Asia.
The international community must call a special session of the General Assembly for innovative policy
actions. The international labor organization has said that by the end of the year, workers could lose
$3.4 trillion dollars in income.
The fact is, disease outbreaks in the world have multiplied since 1980 and it is clear to see that the way
international society has responded to the current pandemic by closing down borders and reversing
globalization, countries everywhere are poorly prepared for dealing with non-traditional security
threats. When this pandemic is over, long-term measures must be taken for global society at large and
not in isolation for only specific regions.
*Qamar Cheema is a strategic and political analyst. He teaches International Politics in the Department
of Peace and Conflict Studies in the National University of Modern Languages Islamabad.
Twitter: @qamarcheema
"Pandemic an opportunity for humanity to show its best side" by Baria
Alamuddin
https://arab.news/prxtk
There is a famous quote that says, “Optimism is a moral duty.” I have pondered this quote in recent days
when speaking to friends navigating various self-isolation regimes: From one distressed lady who, after
48 hours confined to her home, told me she was ready to murder her nagging husband to others who
have embraced this as a refreshing opportunity to detox from the pressures of their professional lives.
With experts warning that the pandemic may last for 18 months or more, for the sake of our sanity —
and the sanity of those around us — we must approach these challenges with positivity and optimism.
Fifty years ago, quarantine meant absolute isolation from the world. Nowadays, we are spoilt for choice
for virtual methods of communication. I have spent so much time in touch with loved ones, enjoying the
pleasure of leisurely daily chats with my grandchildren. Young neighbors have knocked on my door to
check whether I need assistance. We have rediscovered the wartime mentality of “we’re all in this
together,” with everybody looking out for one another.
As previously unthinkable measures are enforced around the world, it is just beginning to sink in how
profoundly this crisis will impact our societies. Those who are self-employed, or who have ad hoc
sources of work, are suddenly staring into the financial abyss. A US survey found that half of small
businesses could be wiped out within three months without urgent assistance. Nations are faced with an
impossible choice of either letting the virus run its course or indefinitely stifling the economy through
draconian measures to slow the contagion.
Soon there will be a huge proportion of families who, through no fault of their own, can’t afford to feed
themselves or are left drowning in unaffordable debt. The crisis is already proving disastrous for cultural
organizations and charities, whose activities and funding sources have been radically curtailed. This is
where we discover what sort of society we really live in. Do we hoard supplies and prioritize selfish
interests or come together to ensure everyone is looked after?
My native Lebanon was already on the cusp of financial meltdown. With it expected to default on a
succession of loan payments and an International Monetary Fund bailout looking increasingly unlikely,
coronavirus is a further body blow. The number of Lebanese living in poverty now exceeds 50 percent,
with the unemployment rate for under-25s soaring above 37 percent. Since September, 800 Lebanese
food and beverage businesses have closed, ensuring thousands of further job losses. With the virus’s
inevitable economic carnage still to be fully felt, this is just the tip of the iceberg.
Meanwhile, Iraq’s hospitals are so dilapidated that those with coronavirus have avoided seeking care
until it is too late. Thus, there are many recent cases of people dying immediately after being admitted
to hospital, complicating efforts to prevent the further spread of the virus.
In neighboring Iran, where most Middle Eastern coronavirus cases have originated, official statistics
report that one citizen is dying from the virus every 10 minutes, with research warning that up to 3.5
million Iranians could die. Yet the authorities seem more interested in covering up the outbreak, while
continuing their regional warmongering and meddling. Similarly, Syrian hospital staff members were
reportedly detained by the regime for leaking information about official attempts to hide the virus’s
proliferation.
The experience of many Gulf states has been radically different. Bahrain has been the worst hit
relatively, with a rash of cases from citizens returning from pilgrimage to Qom. However, the authorities’
rapid response — chasing down possible cases and thoroughly testing all those potentially exposed —
has, for now, stopped the spread of the virus in its tracks. In one video I have seen, Lebanese citizens
living in Bahrain praised the stringent measures, noting how safe they feel compared with other
locations, where the absence of rigorous testing or official transparency makes it impossible to
comprehend the real threat level.
While most of us welcome drastic measures to keep us safe, authoritarian regimes in states like Russia
and China are arbitrarily expanding their restrictive powers. In Israel, despite losing the election, Prime
Minister Benjamin Netanyahu is exploiting the crisis to keep himself in office and indefinitely shelve the
corruption charges that could kill his political career and put him behind bars.
Do we hoard supplies and prioritize selfish interests or come together to ensure everyone is looked
after?
Baria Alamuddin
Aid agencies, meanwhile, warn that coronavirus threatens to inflict “carnage” upon densely crowded
refugee camps, whether they are hosting Syrians, Palestinians or Afghans. Many refugees don’t have
access to clean water, already suffer from poor health, and have minimal access to medical assistance.
But let’s keep matters in proportion: An estimated 25,000 people die of hunger every day — that’s more
than 9 million every year. Scandalously high sub-Saharan African infant mortality rates result in one in
nine children dying before the age of five. Malaria kills about 3,000 Africans every day. Why are these
crises of extreme poverty not also afforded top priority?
Enforced quarantine is, furthermore, a reminder of the environmental impact of our everyday lives.
Industrial pollution in Chinese cities and elsewhere has fallen dramatically. Far fewer people are taking
flights. A New York study into the impact of coronavirus found reductions in carbon monoxide emissions
(mainly from cars) of nearly 50 percent, with comparable drops in carbon dioxide pollution.
Matters could be far worse. History has witnessed deadlier and faster-spreading epidemics. Not only
should coronavirus be a wake-up call for greater readiness for the next viral threat, but also for the
necessity of working together as a planet to address pending environmental catastrophes — as well as
addressing major conflicts and humanitarian disasters plaguing substantial regions of the world.
This virus will impact our species profoundly: Our relationships with each other, the way we are
governed, and everyday behaviors. If the world comes together to identify a cure, shield the vulnerable
and prepare itself for future existential threats, then coronavirus will truly have shown humanity at its
best.
• Baria Alamuddin is an award-winning journalist and broadcaster in the Middle East and the UK. She is
editor of the Media Services Syndicate and has interviewed numerous heads of state.
"World needs a plan to prevent post-virus economic chaos" by -

Osama Al-Sharif
https://arab.news/88kwh
As the world battles the alarming spread of the coronavirus disease (COVID-19) through lockdowns, calls
for self-isolation and even by imposing curfews, the specter of an impending global recession is looming
large. Factories have closed, planes have been grounded, oil prices have plunged and stock markets are
in peril amid general uncertainty over how long the global shutdown will last.
Our region has been especially hit as a result of the pandemic. Aside from the decline in energy prices,
many sectors are already feeling the pressure — travel and tourism and capital markets chief among
them. It is not only that sectors will lose billions of dollars as a result of the lockdown, but there are
growing fears many could collapse unless governments step in with generous bailouts and stimulus
plans.
Last week, Saudi Arabia unveiled a $32 billion stimulus plan to support its economy, including a $13.3
billion package for small and medium-sized businesses. Other measures include the postponement of
tax payments and exemptions from various government levies and fees. For its part, the UAE released
its own plan, worth $27 billion, to support critical sectors such as banking and tourism. Lower oil and gas
prices have forced Qatar to cough up $23 billion in financial incentives, while Kuwait and other Gulf
countries will surely follow suit.
These countries are being realistic and are taking pre-emptive measures. The pandemic could last for
months and its reverberations will be felt for years to come. It could affect this year’s pilgrimage season
— the Umrah pilgrimage has already been suspended — and may have a negative impact on Dubai’s
Expo 2020, which is due to begin in October. Oil-producing countries will face fiscal deficits due to
decreasing global demand.
The pandemic has hit vital sectors in Egypt and Jordan, especially tourism — a main source of foreign
currency. With the lockdown, experts believe that Jordan could lose the entire tourism season for this
year, with a loss of no less than $3 billion. The tourism sector employs at least 55,000. Farmers will be
hit as well, as the curfew will affect their ability to deliver their produce. For Egypt, which has closed all
tourist attractions and museums until the end of March, losses for the tourism sector alone are
expected to be $1 billion a month.
Lebanon’s economy, which had been struggling before the outbreak because of the political impasse,
will be especially impacted by the lockdown. Last year’s political instability had already cost the tourism
sector billions of dollars. With a serious liquidity shortage, the government will be unable to come to the
rescue of ailing sectors.
One of the most serious challenges that many countries in the region face is their inability to honor
payments for foreign loans. Lebanon has already defaulted on a $1.2 billion Eurobond payment and
asked for loan restructuring. Jordan, where the debt-to-gross domestic product ratio is over 95 percent,
will have difficulty meeting its international obligations. Its main foreign currency source from expatriate
remittances, estimated at $4 billion annually, will likely be affected.
In short, no country in the region will be immune to the damage that the pandemic will have on its
economy. It goes without saying that, for the world to halt the spiral into a global recession, it must
come up with an emergency plan to speed up recovery. This is not charity: If even one country fails to
fight the coronavirus due to lack of resources, then the threat of a second wave of the pandemic will be
real.
The pandemic could last for months and its reverberations will be felt for years to come.
Osama Al-Sharif
The International Monetary Fund, the World Bank and Western governments must act together to defer
debt payments, allow for generous grace periods and even consider debt forgiveness. Countries that
have limited resources will need to borrow money in order to launch their own stimulus plans. The way
lenders did business before the pandemic will have to change. Solidarity is a must in a globalized world.
Saudi Arabia, which holds the G20 presidency, has called for an extraordinary summit of the group’s
leaders next week. As with all other gatherings in the world today, it will be in “virtual” format. On
Sunday, the Civil 20 (C20) issued a statement calling on G20 leaders to respond to changes in the labor
market and the education system in light of the ongoing coronavirus pandemic. The statement
highlighted the recent virus outbreak, as well as the bushfires in Australia, as examples of how global
systems can be challenged, leading to inequality between individuals and countries, which the C20 said
must be addressed by the G20 states.
Saudi Arabia is in a good position to speak on behalf of poorer countries whose economies are suffering
as a result of the pandemic. The issue now is how these countries will recover once the threat of the
virus has receded. The world must work on a plan now in order to step in and avoid mass economic
chaos.
"Coronavirus and Pakistan" by Atta ur Rehman
https://www.thenews.com.pk/print/630787-coronavirus-and-pakistan
The world is in the middle of the worst pandemic in recent history, as the strain of coronavirus Covid-19
spreads rapidly. Starting from Wuhan, China in December 2019, the numbers are rising rapidly with
every minute.
What makes it most dangerous is the fact that it can be spread by persons who do not show any
symptoms. So a person sitting next to you or travelling with you may appear perfectly normal with no
fever, cold or cough, but he may be infected and be able to spread the disease. This makes it impossible
to prevent its spread, except by mass isolation and close down, which is practically difficult.
Interestingly, the first National Center for Virology is being recently established as a part of the
International Center for Chemical and Biological Sciences at the University of Karachi, in collaboration
with the Wuhan Institute of Virology and three German institutions, Eberhard Karls-University of
Tuebingen, Tuebingen University, and Medidiagnost. Wuhan is the very city in China from where the
coronavirus first started. The Wuhan Institute of Virology is administered by the Chinese Academy of
Sciences (CAS), the most powerful scientific organization in China, and it is the leading centre for virus
research in China.
The need to set up a top class centre for virology was felt by the scientific leadership of the International
Center for Chemical Biological Sciences several years ago, reflecting their foresight. The International
Center for Chemical and Biological Sciences now houses some 17 buildings spread over about 70 acres
of land with some 600 students enrolled for PhD. It has been internationally awarded many
international prizes and awards and is now the Unesco Center of Excellence, providing training to many
scientists from other countries, including Germany.
The centre has been built through a number of private-public partnerships starting with the Husein
Ebrahim Jamal Foundation that has set up a number of research centers in the institution, including the
now famous H E J Research Institute of Chemistry. The Panjwani Center for Molecular Medicine was
later established by the Panjwani Foundation and has already established excellent standards. Other
donors include the Searle company led by Rashid Abdullah saheb. I also donated funds to it for setting
up the Jamil ur Rahman Center for Genomics Research established in my father’s name.
After returning from Cambridge University in 1973, I have spent all my life in its development. It is now
led by Prof Iqbal Choudhary, a leading research scientist of Pakistan. The buildings of the Virology Center
have been constructed and Special Biosafety level 3 (BSL-3) facilities are being established in it, needed
for research where work is performed with viruses and other agents that may cause serious or
potentially lethal diseases through inhalation and that may contaminate the environment. A non-lethal
form of Covid-19 was imported by this Karachi Center earlier this year, and work started in earnest to
find a cure for this lethal disease.
Already exciting progress has been made and some compounds have been discovered from the internal
Molecular Bank of about 18,000 natural and synthetic compounds present in the institute. The genetic
structure of the genome of the virus was identified earlier this year by Chinese scientists, which allows a
rational approach to drug design. Ten substances have been so far found by our research group under
the leadership of Prof Iqbal Choudhary and others, and the first international publication from Pakistan
is now under process.
Coronaviruses are enveloped RNA viruses. The most recent common ancestor (MRCA) of all
coronaviruses probably existed around 8000 BCE. Bats and birds are excellent hosts. The present types
of coronaviruses were discovered in the 1960s and they cause respiratory tract infections. The word
‘corona’ originates from Latin, meaning ‘crown’, because the virus has an outer fringe resembling a
crown.
The first lethal class of these viruses, the Severe Acute Respiratory Syndrome, SARS-CoV, was detected
in Guangdong, China, in November 2002 and it caused 8096 infections in human beings and 744 deaths.
The second lethal type of coronavirus was the Middle East Respiratory Syndrome, MERS-CoV, that was
detected in Jeddah Saudi Arabia in 2012. It caused 2494 human infections and 858 deaths, a very high
mortality rate of about 37 percent.
By far the fastest spreading of the three lethal types of coronaviruses, Covid-19, is the one affecting the
world now. It was first detected in Wuhan China in December 2019 and there are already about 162,000
confirmed cases and over 6,000 deaths within about three months. It is spreading like wild fire all over
the world which makes it the most dangerous of all varieties. It spreads by physical contact through
exposure to droplets of water emitted by infected patients when sneezing or coughing and by physical
touch to objects previously touched by infected patients.
The most dangerous feature of this virus is that patients suffering from this disease may not show any
symptoms, such as fever, cold or cough, but they may be still be able to infect others. This makes it
impossible to prevent infected persons from crossing borders across countries unless one tests every
single traveller, which is impossible.
Coronavirus is here and we cannot stop it as vaccines will take at least 12 to 18 months to be made
available on a large scale. All that we can do is to focus our efforts on early detection of infected
patients, rapidly tracing all their contacts, and isolating them as soon as possible. An even more
dangerous aspect is that it has the potential to mutate and transform into an aerial borne variety, which
will be a huge global disaster.
In order to protect people from being infected by the coronavirus, the WHO has provided a list of safety
measures that are to be carried out by every individual, particularly the regular washing of hands and
the avoidance of touching one’s face, lips, eyes etc. Since the outbreak of Covid-19, there has been great
emphasis on the usage of protective facial masks.
The protective masks are to be worn by people only when they are in close contact with a suspected
individual as Covid-19 travels in the form of droplets which are particularly formed when individual
coughs or sneezes. Proper masks of N-95 or N-100 grading are not available locally, but other masks can
also some protection.
Covid-19 is a pandemic now, and requires actions at the local, regional and global levels. However,
surprisingly there is no global action on horizon. Poor nations with weak healthcare systems and the
inability to sustain a ‘global lock-down’ will not able to fight this menace alone, and will certainly need
international assistance.
The writer is the formerchairman of the HEC, andpresident of the Network of Academies of Science of
OICCountries (NASIC).
Email: [email protected]
"Public policy and the pandemic" by Shahid Javed Burki
- https://tribune.com.pk/story/2186955/6-public-policy-pandemic/?amp=1
The writer is a former caretaker finance minister and has served as vice president of the World Bank
How should those holding the reins of power respond to unanticipated and unprecedented crises? This
is, of course, an important question as policymakers operating out of Islamabad and the provincial
capitals deal with the effect of the coronavirus and its unrelenting spread across the globe. The first
step, of course, is to gather information about the virus and Covid-19, the disease it causes. This
requires accumulated knowledge on the part of those who study these matters and work in the
institutions that specialise in the science of epidemiology — the study of disease origin and their spread.
Unfortunately, Pakistan has very few of these institutions and individuals that can inform the making of
public policy. With that being the case, we need to look outside the country and learn from abroad and
apply the gained knowledge to the design of public policy.
The second area for gathering knowledge and information is to understand how a virus causes infection
and why the resulting infection can lead to serious illnesses, even death. This information comes around
from both research and experience and there is considerable accumulation of that in the countries that
are at the forefront of managing this particular crisis. The experts in China, the country where the
coronavirus first emerged and then began to do great harm, have gained most of the knowledge. The
question why China became the birthplace of the virus still has only anecdotal answers. The generally
accepted opinion is that the vector of transmission was from birds to human beings.
Several of the known cases clustered around a food market in Wuhan, a city of 11 million people on the
Yangtze River. Boeing, an aircraft manufacturer, has a large plant in the city that makes fuselages for the
large B-787 passenger aircraft. In fact, the company gave the new aircraft that name since “8” is
considered to be a lucky number in China. Many early cases had links to a food market in Wuhan that
sold exotic animals that were meant for human consumption. Large apartment buildings and a major
train station surrounding the market helped the spread of the disease. That was a perfect setting for an
outbreak.
When I was working on China for the World Bank, I was shown a food assembly plant in the south of the
country. Birds, mostly ducks, were kept in the top tier and pigs were in the plant’s second level that
consumed bird droppings. Fish in the bottom rung ate the fecal matter produced by the pigs. Fish were
then sold in the markets for human consumption. That then was the origin of the disease called avian or
bird flu. The Chinese were not concerned by this way of producing food for human consumption since
an effective vaccine had been developed that was administered every year at the start of the flu season.
For Covid-19, it is believed — although evidence for that is still sketchy — that the coronavirus
originated with bats that somehow got into the food chain. For avian flu, the origin of the disease is
mostly of academic interest because of the developments of the vaccines. The flu virus also mutates but
science keeps one step ahead, developing new vaccines that are given at the start of every flu year. For
Covid-19, it is a different matter.
Covid-19 spread quickly in China since it appeared a few weeks before the start of the Chinese Lunar
New Year when a large number of the country’s citizens travel to visit their relatives. About seven
million people — more than half of the city’s population — left Wuhan for various destinations in the
country taking the disease with them if they happened to be infected. By then there were 363 known
cases in Wuhan.
The Chinese took time to tell the world about what was happening in their country. On December 31,
2019, they alerted the World Health Organization about the appearance of a new virus but released a
reassurance that the disease was “preventable and controllable”. On January 21, Chinese officials finally
acknowledged the risk of human-to-human transmission but by then local outbreaks were already
seeded in large cities such as Beijing, Shanghai, and Shenzhen. After the first case was reported in
Wuhan in December, the virus quickly spread to more than 300 cities in the country, infecting at least
80,000 people.
Two quite different approaches are being followed around the world in dealing with Covid-19:
mitigation and suppression. The first focuses on dealing with the extreme cases that result from being
infected by the virus. This requires timely and sometimes intensive intervention by the medical
community. The second way is to adopt measures — even extreme measures — to suppress the spread
of the disease. Most epidemiologists are of the view that mitigation is better than suppression. The first
improves immunity for those who are healthy so when the second wave of the disease arrives much of
the population would be ready and able to deal with it. In case of suppression, the population would
succumb to the second wave. Mitigation for a year or two would also buy the time to develop a vaccine
or vaccines.
Two models are being followed even when suppression is the preferred option. The first is to opt for a
centralised approach in which even large countries are using the same way of dealing with the crisis.
This is essentially what China eventually did and India has decided to do in the programme announced
by India’s Prime Minister Narendra Modi on March 23. The United States has decided to leave controls
to the states where different governors are following different approaches. The result of the latter way
of handling the crisis is to create a great deal of confusion.
Even at this early stage it would be well to focus on the economic impact of the crisis. The impact will
differ in the systems where local authorities have been allowed greater space to deal with the situation.
On the morning of March 26, the United States Senate passed a huge bill that would inject as much as
$2 trillion into the American economy with immediate effect. This includes immediate transfer of $1,250
to all tax-payers earning less than $75,000 a year. Those who have lost their jobs would be provided
more unemployment insurance. States will be given assistance to shore up their hospitals so that they
can handle the extremely ill by providing help in intensive care units. Some industries will receive
subsidies from the government in return for the government taking share in ownership.
During a video conference on March 25, leaders of the world’s major economies (G-20) said they were
committed to restoring confidence, preserving financial stability and reviving growth. They said they
were determined to resolve disruptions to global supply chains and asked finance ministers and central
banks to coordinate regularly with international organisations to develop an action plan in response to
the pandemic.
Published in The Express Tribune, March 30th, 2020.
Like Opinion & Editorial on Facebook, follow @ETOpEd on Twitter to receive all updates on all our daily
pieces.
"Withstanding health shocks" by Shehla Raza
NEVER has the slogan of global health security resounded so loudly as now. Dubbed earlier by sceptics
as the West’s right-centre agenda to keep migration and poverty out under the banner of disease, it has
come to haunt all states as they struggle with the Covid-19 pandemic. So, what is global health security?
It is about minimising the collective damage from public health events that can endanger lives across
borders, if not contained, as they are a threat to economic prosperity and national security. The mantra
is simple: prevent, detect, respond, mitigate; the response is unique as it relies on a whole-of-
government approach.
Pakistan’s score on the Global Health Security Index overall is 35 out of 100 and it ranks 105 out of 195
nations. Before the critics descend, no, Pakistan is not in the ranking of ‘least prepared’ countries, but in
that of ‘more prepared countries’. The average score is only 52 for high-income countries. No country,
even with the best health system, is fully prepared for the sudden onslaught of Covid-19, but
preparedness can determine how quickly a country can bounce back to respond, mitigate and recover —
ie how resilient it is.
Pakistan does not have a coordinated and publicised national public health emergency plan.
Pakistan’s country score is propped up by its score on laboratory capability and skilled professionals. The
least scores, close to zero, are for cross-border agreements, emergency planning, ability to track
infections, communication with health workers during medical emergencies, infection control practices
in health centres, and health system capacity.
The quarantine faux pas at the Taftan border has shown the fragility of the federal-provincial combined
planning for emergencies and cross-border situations. Several hundred suspected patients kept in
crowded, unhygienic conditions bred and transmitted the virus in multiplying loads. Quarantine requires
science but also considerable resources.
While contingency plans devised by the national and provincial disaster management agencies for
natural calamities exist, the country does not have a coordinated and publicised national public health
emergency plan or dedicated funding lines in the federal and provincial budgets for health emergencies.
In the 10 years since devolution, it is still unclear as to who will lead and fund health emergency
preparedness, with the provinces left to their own devices and relying on their own pockets and the
interest of their chief ministers. Flexible contingent financing for health ministries for emergency
situations through domestic budgets, as well as global risk financing, is critical to allow a quick response
to disease outbreaks, whether it is Covid-19, dengue or drug-resistant typhoid.
To its credit, Pakistan has produced a number of epidemiologists trained to track and investigate
infections, but none are found leading the charge at health ministries to guide the response of health
taskforces. More is being heard from the showbiz side than the scientists.
With the virus seeded in all provinces, the existing policy of track, contain and confine at home is the
best hope. The health response has to be inverted, with downstream action, discouraging a rush to
clinics and hospitals to keep people away from infecting healthcare centres or getting infected, unless
they actually require hospitalisation. And for this we must harness our overlooked potential for digital
connectivity and communication.
According to the PTA, there are 161.8 million mobile users in Pakistan and 68m users of 3G-4G internet
bundles. The current pandemic is galvanising innovations globally — some countries are using digitech
for active surveillance, contact tracking and GIS mapping, yet others for SMS check-in by self-
quarantined persons. Mobile platforms are connecting several thousand doctors and health workers for
point-of-contact guidelines, referrals and dashboards, and still others for teleconsultations supported by
remote vital monitoring platforms to measure temperature, oxygen levels and the vitals of patients
remotely. The present crisis is a test of fast-track reliance on digitech healthcare in Pakistan. It is also
time for the world to set aside copyrights on digital innovations and share solutions for the global good.
Now for the question of the capacity of emergency health services. The country’s existing healthcare
system will likely face a double burden, coping with Covid-19 as well as catering for acute events such as
injuries from road accidents and ongoing care for the chronically ill. Many of Pakistan’s doctors trained
through public-sector funding are not in active service. Nurses, paramedics and laboratory technicians
who form the backbone of intensive care and diagnostic services in hospitals are in even shorter supply.
Mobilising health workers, training and providing them with protective gear, along with priority testing
for workers who show symptoms, are critical action points. It is important to continue to fill in for health
workers who fall sick and have to isolate themselves.
Boosting health services will of course require recourse to our favourite policy buzzword — public-
private partnerships. Setting aside the IMF bind, local industry must be incentivised for production of
essential medical equipment, supplies, protective gear and simple hand-washes. Private and parastatal
hospitals must collectively rise to a call to action by postponing non-urgent procedures to free up beds
in readiness for Covid-19 cases, ramp up laboratory testing, and assist in setting up makeshift hospitals
and modular safe testing centres.
Even with full mobilisation of the public-private health system, if the virus peaks, doctors may need to
make hard choices about whom to prioritise care for — the elderly and those with underlying illness, or
the young and healthy. What must not happen is the prioritisation of the more influential versus those
with less influence in Pakistan’s ingrained power and patronage system.
While new tallies of Covid-19 cases will be headlined daily over the next few weeks, what has not been
mathematically modelled is the economic and social cost. As a famous ex-prime minister of the UK said,
“the more you intervene to deal with the medical emergency, the more you put economies at risk”.
High-income countries can take the burden of enforcing social distancing for several weeks while
straining their benefit structures; for countries such as Pakistan, the timing of social distancing has to be
early as it cannot be enforced for long. It will be a knife-edge act for policymakers balancing between
avoiding deaths at one end and poverty and recession on the other.
The writer is a graduate of Harvard University in health policy and management.

"Lessons for healthcare" by Sara Malkani, Dawn.
ALTHOUGH Pakistan faced a long-standing healthcare crisis even before Covid-19 reached the country
and began its spread, the potential scale of the pandemic’s devastation has brought the weaknesses of
its health system to the fore.
Successive governments in Pakistan have not made serious efforts to develop a healthcare system that
delivers quality and affordable services to a majority of the country’s population. While some specific
health-related issues receive heightened short-term attention from the government and media — for
example, the rise in polio cases, spread of HIV and now, of course, Covid-19 — the systemic faults in our
healthcare system remain largely unaddressed. The result is appalling health indicators, high rates of
mortality and morbidity from preventable causes, and severe financial hardships for low-income
households seeking access to health services.
While many countries in the world, including developing countries, are taking steps towards universal
health coverage, Pakistan is lagging far behind in this goal. According to the World Health Organisation,
‘universal health coverage’ means that “all people have access to needed health services of sufficient
quality to be effective while also ensuring that the use of these services does not expose the user to
financial hardship”.
Pakistan’s current health policy framework and the nature of its implementation is a far cry from the
goal of universal health coverage. Pakistan has a network of public-sector hospitals established to
provide health services free of cost. Primary health services are offered at Basic Health Units (BHUs) and
Rural Health Centres (RHCs) are spread across districts. District headquarter hospitals are designed to
provide a range of comprehensive healthcare services. At the top of the tier are tertiary-level hospitals
located in some of the larger cities that are meant to provide a range of sophisticated medical services.
The government employs a large cadre of doctors and healthcare professions to staff these facilities.
An injury or disease can be all it takes to plunge a household into deep poverty.
On paper, this is an elaborate government-administered system designed to serve people free of cost
through a multi-tiered and inter-linked network. The reality, however, is that this system of government-
provided healthcare does not work. At the lower levels, BHUs and RHCs are barely functional. They are
poorly equipped and understaffed, and many of these health centres are in fact ‘ghost facilities’.
In the absence of functioning primary and secondary healthcare facilities, our tertiary hospitals are
overloaded with patients. A common sight at Civil Hospital Karachi, for example, is patients from all over
Sindh and Balochistan, who have travelled to the hospital for treatment, having encountered many
disappointments along the way. Doctors at tertiary hospitals will tell you that by the time patients with
life-threatening illnesses come to them, it is often already too late.
The consequence of the sparse and low-quality services provided by the public sector means that most
people in Pakistan rely on private healthcare. In the absence of a state-supported health financing
system, payments for private services are inevitably out-of-pocket.
Effectively, this means that affordable quality healthcare is beyond the reach of large swathes of the
population. An injury or disease can be all it takes to plunge a middle or low-income household into debt
and deep poverty. For those already below the poverty line, sickness can deplete resources entirely. As a
result, poor people often live with chronic morbidities and face higher rates of mortality. WHO estimates
that about 100 million people are pushed into extreme poverty every year because of out-of-pocket
spending on healthcare. Many of them are likely to be from Pakistan.
Beyond piecemeal and ad hoc measures, governments in Pakistan have made no systematic efforts to
overhaul a failed system. Public-private partnerships have been initiated in some districts to fix
dilapidated public hospitals. Attempts to introduce government-supported health insurance through the
Prime Minister’s National Health Programme in 2016 and the Sehat Sahulat programme of the PTI
government have not been consistently implemented.
It is against this background that we are now confronted with a pandemic that has affected hundreds in
Pakistan and claimed thousands of lives across the globe. Around the world, the virus has revealed the
fragility of healthcare systems that have been depleted by ‘austerity’ economics. In Pakistan, we know
all too well that our existing healthcare system is entirely incapable of managing the number of cases
projected to arise.
The federal government’s response to the pandemic reflects the abysmal condition of our health
system. It was far too slow to grasp the gravity of the problem and enforce necessary precautions. Its
confusion regarding key measures such as imposition of a lockdown and suspension of congregational
prayers displayed a frustrating absence of leadership.
A silver lining through this has been the proactive response of the Sindh government. Although the
public health sector in Sindh is historically neglected, the Sindh government’s approach to the current
crisis has been decisive, systematic and evidence-based. In addition to the enforcement of precautionary
measures, provisions were made in Sindh to address the shortage of hospital beds, facilities and
equipment. This has shown that if the Sindh government chooses to address a problem decisively, it
possesses the capability to do so —and to some extent, can even muster the resources to do so.
After we and the rest of the world get to the other side of this pandemic, the Sindh government should
extend its leadership role by bringing the same dynamism and thoughtfulness to the implementation of
policies that would lead to universal health coverage. Our experience with Covid-19 will hopefully teach
us many lessons: one of these should be that it is the lack of political will — not a shortage of financial or
human resources — that stands in the way of policies that promote health and welfare for all.
The writer is a lawyer.
Published in Dawn, March 30th, 2020. #KeyOpinion.
"Preparing for a post-pandemic world" by Fahad Humayun, AlJazeera.
https://aje.io/y9m2y
Politics, people and markets are similar in how they respond to crisis, from natural disaster, to financial
slump, to the onset of war. The instinctive response is fear and uncertainty; followed by mitigation;
followed ultimately by the search for renewal in the wreckage of calamity.
While countries around the world roll out emergency measures to respond to COVID-19, and with an
estimated 50 million people in lockdown, few are actually prepared for what a post-pandemic world will
look like - the demands it will make of the societies left to populate it, and the extent to which it will
blunt the confidence and hyper-individualism that has characterised the 21st century thus far.
At the end of World War II, the need for a global framework based on shared values and
interdependence rallied political and policy elites to the cause of a liberal international order. In the 70-
odd years that followed, that framework was gradually eroded by the combined forces of globalisation,
poverty and the unresponsiveness of mainstream political parties to local discontent.
Until a few months ago, it seemed almost certain that the resurgence of the political right from Brazil to
Hungary, and India to the United States would unambiguously come to define the remainder of the 21st
century. Autocracies would consolidate. Exclusion and xenophobia would dominate election promises;
and events such as the European migrant crisis would further the logic for nativism and tougher rules on
immigration and protectionism.
But will the pandemic, the deadliest since the Spanish influenza, change all that? Or will the neo-
authoritarian character of the last two decades, culminating dramatically in Britain's exit from the EU, be
immune to the indiscriminate, deadly spread of COVID-19, and the consequences of its universal reach?
While even the liberal global north takes drastic steps to isolate, quarantine and restrict the movement
of citizens, in the long-term, the pandemic will likely demonstrate that a world without safety nets,
cooperation and deep cross-border engagement is no longer tenable. Leaders and electorates will have
to answer tough questions about why they were caught unprepared, and the sustainability of a planet
dictated by climate deniers and political chauvinists whose ascent to power has been enabled by a
tradition of misrepresentation, manipulation, and misinformation.
As a result of COVID-19, governments not just in Europe, but from Latin America to South Asia, have
been forced overnight into solidarity and cooperation: coordinating international travel rules, sharing
information about public health management strategies, fact-checking domestic news, and exchanging
scientific expertise. Like the Marshall Plan that rebuilt Western Europe, governments will soon need to
cooperate over fiscal stimulus and trade. That will be a big task for an international system that, under
America's "go-it-alone" unipolar shadow, has been largely inward-looking, driven by a lack of disruptive
innovation, and eschewed any real alignment of national plans or priorities.
Already, European leaders have responded angrily to the self-regarding unilateralism of President
Donald Trump's travel ban on its European allies. Amid a scalding oil-price war between Russia and
Saudi Arabia, oil producers are now being forced to discuss how best to stabilise the price of the
commodity against a backdrop of the pandemic.
American legislators have called on the US to revisit its "maximum pressure policy" of sanctions on Iran
that have hit the country's ability to import medical supplies. Tehran, for the first time in six decades,
has approached the IMF to help it fight the coronavirus outbreak. In the Far East, members of Japan's
ruling Liberal Democratic Party have voted to donate their monthly salaries to help arch-nemesis China
fight the outbreak. In response, Chinese social media quickly filled with gratitude for Japanese well
wishes.
As the pandemic peaks, populists in power will inevitably face a credibility crisis. Many, such as Donald
Trump in the United States and Narendra Modi in India, were sufficiently adept at dealing with
emergencies geared at otherising a convenient enemy, immigrants in the case of the former, Muslims in
the case of the latter. But in the pandemic, there is no visible, ethnically identifiable "other" to strong-
arm. Populists will face criticism for their inability to effectively respond and contain the spread of the
disease. It is for this reason, perhaps, that Indian Prime Minister Modi hurriedly turned to technology by
holding a videoconference between heads of South Asian Association for Regional Cooperation (SAARC)
member states this week. But the fact remains that India under Modi's authoritarian spell spent the last
five years working against regional integration, instead ratcheting up neighbourhood tensions, including
a lockdown and Internet shutdown for eight million people in the disputed territory of Kashmir.
Finally, in China, where the outbreak began, and where the rules against social media bloggers and
activists are strict, even the Communist Party has been forced to realise the costs of restricting the flow
of information in tackling the outbreak, and the countervailing power of social media and the digital
public sphere in daily governance.
Will COVID-19 trigger global political change? There are two reasons why it might. The first is that unlike
"shocks" such as war, earthquakes and famines, pandemics do not discriminate by geography or human
identity. By nature, pandemics are inclusionary, rendering borders futile, and requiring global responses
that are inclusionary in turn. Secondly, unlike other security crises that preceded it - the Cold War, 9/11,
wars in Iraq and Afghanistan and Syria - governments will be unable to use the spread of Covid-19 to
silence opponents, since it will be harder to label criticism in these cases as disloyal or unpatriotic. This
will make regimes vulnerable to leadership change, and offer an opportunity to marginalised political
parties to innovate.
For democracies and autocracies alike, COVID-19 will ultimately be a moral reckoning in the conduct of
foreign and domestic policy, as nations' ability to grapple with the challenges of inequality, climate
change and social mobility will stand exposed for all to see. Pakistan's Prime Minister Imran Khan has
already called on the global north to write off the debt of vulnerable countries. Whether or not that
happens, government functionaries will certainly be held accountable for lack of regulation,
commitment to social equity, and sufficiently deep cross-border engagement that preceded the disaster.
And if and when the storm subsides, new norms will likely be needed to dictate how states behave with
each other.
The views expressed in this article are the authors' own and do not necessarily reflect Al Jazeera's
editorial stance.
Fahd Humayun is a PhD candidate at Yale. ( via KeyOpinion )
"The coronavirus pandemic - A test of our courage and fortitude - II"

by Alam Brohi
https://dailytimes.com.pk/585440/the-coronavirus-pandemic-a-test-of-our-courage-and-fortitude-ii/
The coronavirus pandemic is going to shake and, may be, pulverize national, regional and international
political and economic structures and reshape the world order for peace and security. The pandemic has
hit over 185 countries touching almost all the continents. The USA has so far failed to rise to the
occasion to lead the world to a collective response to the pandemic. President Donald Trump did not
show the leadership quality of his two predecessors, – George W. Bush and Barak Obama, who
spearheaded the world campaign in the pendency of the financial crunch of 2008 and the Ebola
pandemic. President Trump has so far been muddling through long winding prophylactic measures
coming out of bureaucratic corridors in all the affected countries.
The democracies, sluggishly passing the long process of debates, consultations, and convergences, have
been found ineffective in fighting the surreptitious and stealthy Covid-19 pandemic as contrasted with
the autocracies. The democratic regimes finally opted to take recourse to some authoritative measures
to make the people realize the gravity of the situation and respect the shutdowns. The people are still
wondering how South Korea and Singapore took pretty little time to contain the catastrophe. Similarly,
the examples of courage and fortitude, discipline, resilience and selflessness of the Chinese people stand
out as a beacon light for all the nations battling against coronavirus. The Chinese nation was entirely
focused on the elimination of the treacherous enemy.What is feared is that the autocratic powers
arrogated to themselves by the democratically elected regimes as in South Korea and Singapore will be
kept even after the pandemic is over. This is quite ominous for democracies that have evolved over long
decades in different continents.
One cannot predict how long this pandemic is going to last. One thing is clear the more it lasts, the
deeper and far ranging impact it will have on the world with the possible collapse of many governments
and the regression of many strident economies. What is apprehended at the moment is that the
developed countries will slide into deeper and long economic recession; the international financial
system will undergo a massive contraction throwing the world economy into a chaos; the
nationalismwill weaken global economic connectivity and bring forth new global players for world
leadership.
The man has always lived with dangers caused by him or the nature.The catastrophes in human history
of the last three centuriescaused massive changes in the societies and reshaped the world order. The
natural calamities which are recalled as horrors in human history were the plagues that harassed human
societies for century visiting various countries until the Russian Plague (1772), and the influenza or the
Spanish flue that furiously hit the human societies in 1918-1920 devouring some 50 million lives. The
recent flues caused by an earlier strain of corona that included swine flu and SARS taking the toll onhalf
a million lives were not in any way less devastating. The man, with the tremendous breakthrough in the
medical research and inventions,has had successfully contained the catastrophic impact of many
bacterial and viral epidemics -yellow fever, tuberculosis, smallpox, polio, meningitis, Ebola – just name a
few.
The end of the thirty years war and the conclusion of the Westphalian Treaty in 1648 creating
equilibrium in the interstate relations held the world order in good stead for a century or so until the
havoc wreaked by the Napoleonic wars in Europe. The French revolution and the defeat of Napoleon
heralded a new world order structured on ‘balance of power’ spearheaded by the British Empire.The
First World War not only weakened mighty empires but also brought down some of them and shifted
the balancing power to the United States of America which held all the levers of an emerging world
power. The Second World War hammered the last nail in the coffin of the British and French empires
forcing them for a shameful flight from their possessions in Asia and Africa.
Though the world was heading to decolonization, the retreating masters were engaged in a slew of
underhand measures to safeguard their political and economic interests in the former colonies
The guns had not yet gone silent in Europe that the three tall leaders of the Allied Powers – President
Franklin D. Roosevelt, Prime Minister Winston Churchill and the USSR Secretary General Joseph Stalin
started putting their act together to thrash out the blueprint of the new world order.The French colonial
possessions, after France’s defeat, were ready to throw away the yoke of slavery. The British imperialists
were already looking for a graceful exit from their Asian and African possessions. Though the world was
heading to decolonization, the retreating masters were engaged in a slew of underhand measures to
safeguard their political and economic interests in the former colonies.
However, the new world order that came to take shape was structured on the balance of power
between two antagonistic ideological camps of capital countries led by the USA and the communist bloc
of countries that looked to the Soviet Union for strategic, economic and ideological succour. Thus, the
world was divided on ideological lines with each superpower jealously guarding its spheres of influence.
This bi-polar system exploded with the collapse of the Berlin Wall and the demise of the USSR in 1990-
91. The small countries felt more secure politically and economically in the earlier international order
structured on the balance of power between the two competing camps in the over four decades of the
Cold War. No doubt, the Soviet Union countervailed the USA.
The power of the USA, after a century or so, has considerably waned. The unnecessary long wars
particularly in Asia have taken their toll on the American power and prestige. The American leadership’s
response to the coronavirus pandemic leaves much to be desired. Many analysts are veering to the
widely held view of President Donald Trump as anincompetent, whimsical and narcissist leaderand see
his defeat in the coming elections and the decline of the USA into a second rank power if the Covid-19
spirals out of control in the USA and the world.
The author was a member of the Foreign Service of Pakistan and he has authored two books.
#KeyOpinion.
"Post-Corona World Order: Democratic or Authoritarian?" by Moeed Pirzada
https://www.globalvillagespace.com/post-corona-world-order-democratic-or-authoritarian/
Francis Fukuyama’s, End of History and the Last Man (1992) – influenced by the events triggered by
Soviet withdrawal from Afghanistan (1987), Fall of Berlin Wall (Nov, 1990) and Dissolution of Soviet
Union (Dec, 1991) – had argued that ascendancy of Western liberal democracy, over other political
models, has finally brought humanity to its final era of stability.
Fukuyama argued that world had not reached “..just … the passing of a particular period of post-war
history, but the end of history as such: that is, the endpoint of mankind’s ideological evolution and the
universalization of Western liberal democracy as the final form of human government”. Less than 30
years later, Fukuyama’s words that sounded prophetic then now appear dangerously preposterous – if
not alright ludicrous.
Responding to liberal democracy’s challenge in the wake of Corona pandemic, Henry Kissinger, ex-US
Secretary of State, in a far reaching piece, “The Coronavirus Pandemic Will Forever Alter the World
Order”, wrote that: “..when the Covid-19 pandemic is over, many countries’ institutions will be
perceived as having failed. Whether this judgment is objectively fair is irrelevant. The reality is the world
will never be the same after the coronavirus. To argue now about the past only makes it harder to do
what has to be done. (WSJ, 3 April 2020)
Two less likely options—which we couldn’t discount because the Chinese Communist Party *still* has
never revealed the virus’s origins—were the bioweapon hypotheses, with either and accidental or
purposeful release. pic.twitter.com/sI5NVekNre
— Tom Cotton (@SenTomCotton) April 8, 2020
Two less likely options—which we couldn’t discount because the Chinese Communist Party *still* has
never revealed the virus’s origins—were the bioweapon hypotheses, with either and accidental or
purposeful release. pic.twitter.com/sI5NVekNre
— Tom Cotton (@SenTomCotton) April 8, 2020
Kissinger then argued that “the contraction unleashed by the coronavirus is, in its speed and global
scale, unlike anything ever known in history” and that the United States must lead the western
democracies and allies to “safeguard the principles of the liberal world order”.
He reminded his readers that enlightenment thinkers had argued that the purpose of the legitimate
state is to provide for the fundamental needs of the people: security, order, economic well-being, and
justice and that individuals, anywhere cannot secure these things on their own. He ended by pleading
that “a global retreat from balancing power with legitimacy will cause the social contract to disintegrate
both domestically and internationally”
3. Bad science, bad safety (this is the engineered-bioweapon hypothesis, with an accidental breach)
— Tom Cotton (@SenTomCotton) February 17, 2020
3. Bad science, bad safety (this is the engineered-bioweapon hypothesis, with an accidental breach)
While Kissinger is not alone in expressing these fears; with the rise of Trumpian politics in the United
States and Britain’s painful and unnecessary divorce – Brexit – from Europe these rumblings were
occurring from universities, think tanks and media on both sides of the Atlantic. But it will be difficult to
deny that Dr. Kissinger is perhaps one of the most important, loyal, blue-blooded sons of western
establishment of the past fifty years – and when this octogenarian speaks many are forced to sit up and
listen. Liberal World Order: Questions of survival?
So, it appears that within 30 years of Fukuyama’s “End of History” western liberal democracy has
reached its most serious crisis. When Huntington came up with “Clash of Civilization” and when 9/11
happened, Fukuyama and followers had argued – and perhaps quite convincingly – that these challenges
and skirmishes will continue to exist.
Islamists – despite their exaggerated presentation by the western establishments, media and think tank
battalions – and despite their dangerous medieval tactics – suicide bombings, decapitations and
attempts to recruit armies of cerebrally challenged Muslim youth – were in reality far too primitive,
anachronistic and fragile an enemy.
4. Deliberate release (very unlikely, but shouldn’t rule out till the evidence is in)
4. Deliberate release (very unlikely, but shouldn’t rule out till the evidence is in)
Islamists were – to be fairly honest -puny of a challenge to the deeply entrenched sophisticated western
establishment and many in the Muslim world and on the left of global politics (even in most allied of
allies, Britain) kept suspecting, in conspiratorial tones, that these idiotic bearded, gun-toting
contraptions like Al Qaeda, various Al-Jihads and later day ISIS, and ferocious looking mullahs in search
of paradise and voluptuous yet modest virgins represent rich juicy imagination and scripts of CIA and
MI6, Mossad and FVEY, Five Eyes etc.
But now the powerful western establishments – and formidable scientific communities- suddenly look
impotent in this war against an invisible, microscopic messenger RNA that looks innocent and sexy with
its multiple spikes in coloured images produced from electron microscopes– Novel Corona Virus, given a
fancy name by a confused WHO as Covid-19 (March 11).
As of now, more than 100,000 people have died across the world; but almost 85% of these deaths
(almost 88,000) have happened in the United States, Italy, Spain, UK, France, Netherlands, Belgium,
Austria, Switzerland and Canada – and this attack by Angel of death continues with an untiring frenzy
creating unbelievable spectres of mass graves in a city like New York – something Fitz Gerald’s Big Apple
had not experienced even during the Second World War.
Read more: Covid-19: Failure of western model of governance
But it’s not the fear of death, loss of loved ones or health catastrophe that is worrying a cold-blooded,
calculating realist like Kissinger; it’s the economic and political repercussions of the pandemic of fear
and uncertainty – lockdowns, closures, bankrupt airlines, empty hotels and shopping malls, deserted
mass transits, 17 million filing for unemployment benefits, Boeing and others shutting down their plants,
General Motors making ventilators, AIRBNB out of business, Hollywood of “Contagion” now haunted by
the realization of its own ghastly scripts in the form of empty cinemas and so on – that has suddenly
landed a robust US economy into depression.
News from across the Atlantic are even more worrisome where French are riding on a new wave of
national reliance shunning the trans-European interdependence and they are not alone. Whole basis of
wealth generation and prosperity through mass production, consumption and trade across Europe has
been jeopardized like never before – Kissinger is right; the very basis of the post-war social contract,
around which liberal democracy has been built, is under attack. Authoritarianism works and is efficient
But threat to liberal democracy is not just the looming economic depression. Many in Pakistan and
across the world – including Europe and the United States – have been suitably impressed by a China
that has apparently opened up Wuhan – epicentre of novel corona virus – for business.
No new cases are being reported by the Chinese government. World also hears that Chinese reaction to
virus was so swift, lock downs so complete, monitoring of potentially infected so scientific, cremation of
dead bodies so stoic that virus could never effectively reach other large urban and commercial centres
like the capital Beijing – and everyone concurs that such audacious management where dead bodies
were cremated under order of National Health Commission, where mass transit systems came to a halt
and where inter-city trains deleted Wuhan – a city of 11 million – from their maps was not possible in a
liberal democracy.
China now for multiple reasons emerges as a role model of authoritarian competence and for all those –
in Middle East, Central Asia, East Europe, Africa, Pakistan and within India’s ruling BJP
in Middle East, Central Asia, East Europe, Africa, Pakistan and within India’s ruling BJP
In Italy where PM, Giuseppe Conte, suspended all flights to and from China on 31st January, it was
troublesome to reach any consensus on what to do, and how to do between its 20 decentralized
regions. Tourists, ski fun lovers, Chinese performers, immigrant families, students and lovers of all sorts
kept pouring, and rubbing cheeks, from all over Europe – rest of Europe where planes, trains, buses,
lorries and cars were crossing borders across 27 countries without terminal controls it was not much
different.
In France, President Macron had to quickly summon 100,000 troops to impress upon citizens to stay
indoors. Authoritarian Saudi Arabia and Gulf Sheikhdoms could quickly – and no doubt rationally –
decide to shut down all points of assembly including mosques – something that could not be
implemented in a relatively open society like Pakistan to this day.
In United States where more than 100 million travellers use domestic and international airports every
month and another 100 million crosses into and out of the United States from Mexico it was – in January
and February – unthinkable to stop this activity. Discipline of authoritarian decision making has thus
succeeded where consensus making institutions of liberal democracy have failed – and miserably.
Trump’s peculiar style of communication and his toxic relations with liberal dominated media have now
made him look like a buffoon– an idiot who could not understand the risks, who could not listen to his
scientific advisors. But the fact is that WHO and its DG – Tedros Adhandom– never blew the trumpet;
they were the international body responsible for coming up with a clear assessment and prescription,
but they downplayed the risks, warned against panic and protested when countries like Italy were
stopping their flights with China.
Read more: Covid-19 disaster: Will US shift its focus from imperialism to healthcare system?
WHO’s conduct in this crisis represents a textbook case for study of organizational failure and
weaknesses of global architecture and governance– and has led to allegations that Tedros and WHO
were under Chinese influence and were deliberately trying to downplay the risks of virus spread. Others
remember that Tedros, former foreign minister of Ethiopia, was tainted by charges of corruption and
inefficiency and his elevation as DG WHO in 2016 was bad news.
All this may be true but WHO’s weaknesses also reflected a loosely arranged liberal and chaotic world
order where robust decision making was difficult; WHO had prematurely declared a pandemic in 2009
HIN1 crisis (Swine Flu) and was bitterly criticised by member countries.
Bottom line is that Corona crisis has suddenly exposed the weaknesses of decentralized liberal
democracies, open societies and chaotic global architecture – and suddenly authoritarian regimes like
China, North Korea, Russia, Saudi Arabia, Singapore, and Gulf kingdoms look decisive smart and efficient
in managing crisis protecting the lives of their citizens – making all future exhortations, by west, for rule
based democracy meaningless.
It is this risk of “global retreat from balancing power with legitimacy” which haunts Kissinger. It is this
challenge, that is not only from authoritarian regimes but from authoritarian political entities and
philosophies within the countries, that demands United States and allies – Europe and beyond – to
come up with a new “Marshall Plan” for the world to defend and preserve liberal democracies and their
institutions. Kickstarting global Economy: China’s role remains important
in Middle East, Central Asia, East Europe, Africa, Pakistan and within India’s ruling BJP – who are looking
for an alternate political model to justify their aspirations of control and power grab in the name of
“efficiency”. But China was admitted into the global club – especially into WTO – on the assurances that
it will gradually bind itself into a ‘rule-based system’. Many hoped that China will gradually become a
democracy.
This entry into the Club has worked very well for China, and its continuing prosperity depends upon it.
Next few months will see huge tensions between the US lead western alliance and China on these issues
that may take different forms. China will have to make concessions to retain its good will inside the
system – otherwise instability will ensue.
Pakistani PM, Imran Khan’s appeal to UN and international financial institutions to develop an
understanding of the economic challenges now being faced by countries like Pakistan will make
tremendous sense if Kissinger’s argument is understood
tremendous sense if Kissinger’s argument is understood
Kissinger’s Wall Street Journal piece sparked a heated debate, more than 1400 comments till the WSJ
editors decided to close it – almost one third, if not more, vehemently attacked Kissinger for being a
friend of China and someone who set the stage for brining China into the global system and ultimately
into WTO – without full compliance of its regimen.
Many wondered how China (despite being in WTO) could be allowed to maintain wet markets with
unregulated wild animals (in contrast to tightly controlled food supply chains of farm animals like in rest
of the world). China’s official position is that corona virus jumped on to a human being in the Wuhan’s
Huanan Seafood market. Though increasingly western governments and key institutions fail to find it
credible.
Much has been said for and against the Dean Koontz 1981 novel, Eyes of the Darkness – that had
claimed that Wuhan-400 is a Chinese bio-weapon developed in RDNA labs near Wuhan – however,
irrespective of that it is now widely known and discussed that China’s level-4 Wuhan Institute of Virology
existed near the city of Wuhan – and viruses could have escaped through an accident or mishap due to
bad safety protocols.
US intelligence and scientific community are convinced that it was not deliberate, and virus is zoonotic –
not product of a lab. But more than 100,000 are dead, almost 85% in the US and key western countries
and a shrinking global economy is heading towards a recession – and the virus that caused it all
originated from China whether from a wet market or a lab.
Read more: Coronavirus was a ‘creation of CIA biological weapon lab of the US’?
US, Germany and Japan have come up with sizeable economic stimulus packages, but these are not
enough – developing countries need debt relief to protect them from political meltdowns. This is again
cash rich China’s opportunity to play an active role along with the US to bail out developing countries.
tremendous sense if Kissinger’s argument is understood. The risks of authoritarian ascendancy from
outside and from within – for those who can grasp – are real.
Moeed Pirzada is Editor Global Village Space; he is also a prominent TV Anchor and a known columnist.
He previously served with the Central Superior Services in Pakistan. Pirzada studied international
relations at Columbia University, New York and Law at the London School of Economics, UK as a
Britannia Chevening Scholar. Twitter: MoeedNj
"Leading in a pandemic crisis" by Maleeha Loodi
NO government in the world had a primer to deal with the unprecedented pandemic which plunged
countries into unmapped territory. However, several months into the global health emergency, lessons
have emerged from across the world to show what worked to mitigate and contain Covid-19 — and
what did not. It is never too late for a government to change course even in the midst of an uncharted
and evolving crisis, especially as more evidence emerges about how best to tackle it.
By now, the most obvious and instructive lesson is that it is “rapid, decisive and collective action that can
prevent the spread” — as an influential report from London’s Imperial College put it.
And this advice from the World Health Organisation remains imperative to fight the virus: “Countries
must continue to find, test, isolate and treat every case and trace every contact”. And “If countries rush
to lift restrictions too quickly, the virus could resurge and the economic impact could be even more
severe and prolonged”.
Informed by this perspective, the prime minister might consider taking the following five steps: 1) send
clear, coherent and consistent messages to the public; 2) act decisively; 3) lead a unified, multilayered,
national effort with close coordination with all provinces; 4) stay a firm course on social distancing; and
above all 5) be guided by the evolving medical science on the pandemic by giving a lead role to medical
specialists who understand this, not generalist bureaucrats.
Like other countries, Pakistan is navigating a crisis that will test its leadership.
Why urge these steps? To answer this, consider what has happened so far. First, on messaging, the early
weeks saw mixed signals, which did not convey the urgency or severity of the unfolding threat. Public
communication veered between saying this was little more than a flu virus that would afflict the elderly
to asserting that the virus had not hit the country as hard as other nations. If the aim was to calm and
not panic the public, the (unintended) result was to underplay the threat when people needed to be
persuaded to stay home to prevent the virus from spreading.
As the number of cases rose, the prime minister’s tone changed. But procrastination over measures
aimed at social distancing continued to send conflicting messages. Getting mired in a prolonged public
argument about lockdown vs no lockdown conveyed an impression of indecisiveness.
That brings up the second step — act decisively. If, as government leaders claim, they first “reviewed”
the looming threat in mid-January, how did they act on this? How was an under-resourced healthcare
system enabled to deal with the remorseless onset of cases? Did “rapid, decisive action” follow after the
first infection was confirmed on Feb 26?
Missteps exacerbated the situation. Much has already been said about how zaireen (pilgrims) returning
from Iran through the border crossing at Taftan were managed and cluster allowed into the mainland,
which accelerated the spread of the virus. According to the latest official figures, over 30 per cent of
current Covid-19 cases in Pakistan came via this route.
The centre’s unwillingness to move early to suspend air travel and restrict religious congregations had a
similar deleterious effect, with scores of tableeghi members spreading the virus across Punjab and
beyond. Official figures show almost 20pc of confirmed cases in the country today can be traced to the
latter. Another 24pc have been tracked to people travelling back from countries other than Iran.
The federal government also did not take the lead on a lockdown, with officials debating its economic
fallout rather than act. True, governments across the world struggled to find a balance between
restrictive measures and economic activity. But as many international experts have pointed out, this is a
false choice, because saving lives is necessary to save livelihoods. While the government’s economic
packages and enhanced Ehsaas handouts are welcome steps to mitigate the economic fallout, the
perpetual focus on this has fed the perception that the crisis is not being viewed through the prism of a
public health emergency, but its economic repercussions.
While the federal government vacillated, the Sindh government led the way and implemented a
lockdown, obliging Punjab to follow suit. Its effective communication campaign also offered a contrast
to the media strategy pursued by Islamabad.
The third step is centre-province coordination. This was found wanting weeks into the crisis. The prime
minister’s reluctance to reach out and consult provincial leaderships, especially of Sindh, prevented a
unified policy from emerging. Provinces went their own way until a National Coordination Committee
and a Command and Operations Centre were established in mid-March and early April respectively. But
provincial approaches — for example, on a lockdown — are still not harmonised. This prompted a
Supreme Court judge to urge the centre during a recent hearing to improve coordination with provincial
governments.
Four, as the federal government mulls relaxing restrictions on economic activity, it remains important to
meet clearly articulated health milestones, especially enhanced testing capability, before easing the
lockdown. According to the government’s own projections, infections may reach 70,000 by end-April, as
reportedly revealed to a cabinet meeting last week. If this projection is based on an assumption about a
degree of compliance with social distancing, then that estimate can change if restrictions are relaxed
early.
Last but not least, the determination of when to ease restrictions should be made on the advice of
health professionals. Their counsel should guide the overall policy response to Covid-19. They should be
represented in the top policy bodies established to address the crisis, not just subsidiary committees.
Membership of these bodies should be dictated by the nature of the crisis, not ministerial status.
Expertise is needed to interpret the evolving response of the global medical community. This critical gap
should be filled as the NDMA is designed to deal with natural disasters and other aspects of the ongoing
crisis, not a health emergency.
Like other countries, Pakistan has to navigate a crisis that will test its leadership. The prime minister has
used the metaphor of war to describe the challenge of fighting Covid-19. He has a chance to emerge as
an effective ‘wartime’ chief executive. Now is the time for him to live up to that challenge.
The writer is a former ambassador to the US, UK and UN.
Published in Dawn, April 13th, 2020

Yet the pandemic also puts doctors, scientists and policy experts once again at the heart of government.
Pandemics are quintessentially global affairs. Countries need to work together on treatment protocols,
therapeutics and, it is hoped, a vaccine. Worried voters may well have less of an appetite for the
theatrical wrestling match of partisan politics. They need their governments to deal with the real
problems they are facing—which is what politics should have been about all along.
"Introducing e-Health legislation" by Maheen Danani
- https://tribune.com.pk/story/2173441/1-introducing-e-health-legislation/?amp=1
Technological domination over the world has been inevitable. The interaction and integration between
people is expanding by the day with increasing globalisation and widespread use of technology,
information and communication across borders. The use of technology in healthcare is on the rise. It
was only in 1815 that the first wooden stethoscope was invented by French physician Rene Laennec.
Fast forward to 2020, the market for advanced medical robots can be seen increasing and it comes with
a broad range of utilisation benefits, which contrary to popular belief, is not only limited to surgical use.
Healthcare is meeting the growing demands of better healthcare delivery and at the rate it is growing,
the possibilities seem endless.
Healthcare is now widely supported by electronic systems which provide the basis for e-management of
an efficient and timely health system. E-Health has already begun seeping its way into healthcare in
Pakistan, and this is revolutionising the healthcare industry for the better. It has provided increased
access to healthcare in both the rural and urban areas and reduced many barriers which have been
burdening our society.
Although e-Health comes with an array of benefits such as improving patient access to healthcare and
increasing clinical efficiency and effectiveness, has patient health information privacy been fundamental
to e-Health in Pakistan? Seven years ago, the World Health Organization (WHO) conducted a survey
which concluded that Pakistan did not have any e-Health or telemedicine privacy legislations or policy
frameworks in place. Simultaneously, the global response to having an e-Health policy was at 55% and
ensuring the privacy of personally identifiable health-related data was at 70%. When conducted again in
2016, Pakistan still remained negative for a national e-Health policy or strategy while the global
percentage increased by 3%. The country, however, did establish a legislation governing the use of the
national Electronic Health Record (EHR) system in 2013, which was a great step in the right direction.
The Pakistani government since then has not made any serious efforts in the public sector to protect
health information, and how it is saved, used and transferred between healthcare providers.
Pakistan is in a unique situation in which cultural and social factors have always influenced healthcare
delivery and now continues to influence e-Health. The societal and governmental norms have to be
dealt with extensively to plan technological services, especially in the rural areas of Pakistan.
E-Health comes with many challenges and the right policies, approaches and infrastructures need to be
developed to gain the maximum amount of benefits from it which includes introducing policies for
protecting the exchange of patient health-related data, its use in research and how the health records
are released and disclosed. E-Health has been adopted for many years but the crisis here is that there
has been no investment in protecting patients’ rights and their medical records.
Adoption and implementation of these patient protection policies go a long way and thus policies must
be created to address the underlying issues. A legal framework should be implemented which would
require a patient to give consent to healthcare providers to disclose their health information, even for
treatment purposes. The protection of patient privacy is only one of the various key health-related
issues that have yet to be properly addressed by the government at the national level.
"Love for the shot" by Huma Khawar
UNDER the Expanded Programme on Immunisation, injections are administered to nearly eight million
Pakistani children every year. According to the programme’s policy, all injections are administered using
auto-disable syringes.
The immunisation coverage of children under two years of age (according to the last Pakistan Health and
Demographic Survey, 2017-18) stands at around 66 per cent. Despite being free of cost, more than a
third of Pakistani parents do not get their children vaccinated against 10 vaccine-preventable childhood
diseases. Among the excuses that are offered are that injections cause pain to their children and that
the latter fall sick after they are administered the vaccine.
On the other hand, when it comes to injections mostly intended for curative purposes and administered
to the adult population, there is overuse. With an annual average of eight to 10 injections per person,
Pakistan has the highest number of per capita injections anywhere in the world. What is of even more
concern is that around 95pc of these injections are completely unnecessary, as per experts.
The major reason for this love for the shot is that patients believe it provides them with quick relief.
Absolving themselves, the health providers claim that patients demand an injection or a drip. However,
the reality is that patients are at the mercy of the health providers and trust them blindly, never
questioning the ‘need’ for an injection. Not only that, they don’t even ask about safe injection practices,
and are oblivious to the risks associated with the reuse of injectable equipment whether syringes or
intravenous drips.
Safe injection practices are an alien concept in Pakistan.
Unsafe injections have also contributed significantly to the increase in the burden of Hepatitis C, with
Pakistan now having among the highest prevalence levels anywhere. A common denominator of blood-
borne infections is the use of unsafe injections.
The HIV/AIDS outbreak in parts of the country has also been attributed to the reuse of syringes and
intravenous drip sets. One such case was in Ratodero in Larkana district where, as of November 2019, a
total of 1,189 people out of the 36,736 screened for the virus were confirmed HIV positive. Over 80pc of
the HIV-affected population was in the under-18 category.
Most unnecessary and unsafe injection practices happen at private clinics or dispensaries. In Pakistan,
there are estimates that about 70pc of the patients go to private ‘healthcare facilities’. Sometimes the
health providers there, mostly quacks, have no or limited knowledge about injection safety. They
prescribe unnecessary injections to provide quick relief and increase their clientele and thus income.
Intravenous drips are also prescribed for conditions which can be dealt with through oral medications.
The charges for an intravenous drip literally depend on how much a patient can pay and can range from
Rs250 to over Rs1,000. Syringes and drip sets at these clinics are reused because of the inability of the
patient to pay extra, the patient’s own lack of knowledge of the risks associated with reuse and the
medical staff’s intention to save money.
Awareness is needed for both the prescriber as well as the consumer. The public first needs to know
that if a cure is available through tablets, capsules or syrup, they must avoid injections. And secondly, if
a shot is necessary, they must ensure that the syringe is new and not reused.
In order to promote the rational use of injectable medicines it is important to enable the patients and
community to go beyond patient-doctor trust and question the doctor regarding the need for an
injection in the first place to avoid the irrational use of syringes and needles. They need to differentiate
between cure and prevention.
On the other hand, the provider needs to be trained regarding syringe safety as well as the appropriate
prescription of injections.
The WHO Injection Safety guidelines of 2015 recommend that all states should switch to Reuse
Prevention (RUP) syringes. A 2019 WHO-Unicef joint policy statement strongly recommended the
systematic and exclusive use of auto-disable syringes for immunisation and RUP syringes for therapeutic
injections. It urges countries to switch to RUP by 2020.
This may help bring down the incidence of reuse especially by private practitioners. The reuse of
syringes will decrease when RUP syringes (auto-lock, auto-disable, auto-destruct syringes that get locked
and cannot be reused) gain prevalence in medical settings.
However, while imposing a ban on conventional disposal syringes, it is equally essential to ensure the
uninterrupted availability of auto-disable syringes across the country. The joint statement also urges
manufacturers to develop and improve the affordability of auto-disable and RUP syringe technologies.
The writer is a freelance journalist.

Health-WPS Office

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Health-WPS Office

Uploaded by

Copyright:

Available Formats

Health

Ensuring food safety

Published in The Express Tribune, October 15th , 2019.

Editorial | October 15, 2019

The polio problem

Editorial | October 16, 2019

Seven cases of extinct poliovirus detected

An environmental sample is declared positive if virus is found in sewage water.

Published in Dawn, November 8th, 2019

Published in Dawn, November 9th, 2019

Monitoring body terms polio in Pakistan ‘political football’

• NHS spokesperson says new strategy formulated to address the issue

Published in Dawn, November 20th, 2019

"Polio resurgence" by Dawn Editorial

Published in Dawn, November 21st, 2019

"Polio resurgence" by Dawn Editorial

Published in Dawn, December 15th, 2019

Polio mess - https://www.dawn.com/news/1525228?ref=whatsapp

Published in Dawn, December 30th, 2019

"Polio workers" by Editorial

World Food Day

Published in The Express Tribune, October 16th , 2019.

Mental health anxieties

I.A. Rehman | October 17, 2019

Exorbitant prices of drugs

"Racket of selling expired medicine" by Editorial

Published in The Express Tribune, November 18th, 2019.

A life worth living

Saadia Waheed | October 25, 2019

The writer is an advocate for persons with disability.

People with Down syndrome can lead fulfilling lives.

Editorial | October 27, 2019

The writer is a journalist.

Published in Dawn, October 28th, 2019

"Hospitality & medicine " by Mohsin Fareed

Physicians must humbly ‘incline’ towards their patients.

The writer is a Harvard graduate.

Published in Dawn, November 14th, 2019

"Battle against diabetes" by Dawn Editorial

Published in Dawn, November 18th, 2019

Countrywide dengue cases nearing 50,000

Published in Dawn, November 18th, 2019

"Resistant bugs" by Editorial

Published in Dawn, November 22nd, 2019

"Medical ethics" by Najib ul Haq

The breach of patient confidentiality in high-profile cases is an alarming trend.

The writer is dean of faculty of health sciences at Peshawar Medical College.

Published in Dawn, November 24th, 2019

"Women doctors" by Dawn Editorial

Published in Dawn, November 26th, 2019

"World AIDS Day" by Dawn Editorial

Published in Dawn, December 1st, 2019

"Health crises" by Dawn Editorial

Published in Dawn, January 2nd, 2020

"Curbing hepatitis C" by Editorial

Published in Dawn, February 3rd, 2020

The Chinese coronavirus

Time and again

"Handling crises" by Huma Yousaf

How prepared are we to deal with disease challenges?

The Wuhan crisis

An outbreak of disease caused by a new virus is causing global alarm

How bad will it get?

"Bats bite back" by Irfan Husain