With COVID-19 in Pakistan, recently there have been sounds of muted relief from some of the most critical voices within journalism. It would appear from the official statistics, those being the only ones around that Pakistan’s Coronavirus infection rates and death rates have been going down in the month of July. Even Khurram Husain, one of the finest investigative minds in Pakistani journalism, cautiously celebrated the reduction in infection rates and low deaths from COVID-19. A recent story in the Wall Street Journal (WSJ) put the seal of international approval on Mr Husain’s optimism by explaining how Pakistan is a Coronavirus bright spot. The lowering of new infection rates is apparently, unmistakable and it is borne out by less easy to manipulate falling death rates and anecdotal evidence of spare capacity opening up in the Corona wards of Pakistani hospitals.
The detractors have protested abysmally low testing rates, especially in Punjab and Khyber Pakhtunkhwa, but those have been silenced by the retort that even with less testing, the existing tests should yield higher infection rates, if the infection is spreading. Indeed, Khurram Husain proposes that “the burden of proof is now on those who wish to doubt these [happy] numbers”.
Mr Husain’s challenge is an unfair one. How can a private citizen match the resources and statistical prowess of the state? But one can question, and question I do, because what the government is saying and the explanations it is giving, have no basis in science. As much as I would like to be wrong and believe that my elderly parents and loved ones are safer, the allegiance to science and reason won’t let me.
To buy into the fundamental premise of the state’s explanations for the lowering infection and death rates from COVID-19 means buying into the premise of Pakistani exceptionalism, some secret immunity that Pakistanis enjoy, scientific nonsense of herd immunity, or the success of smart (as if there are dumb) lockdowns. Or as Muhammad Hanif eloquently put آج جانے کی ضد نہ کرو lockdown (don’t insist on leaving today). To restate, I want to celebrate some Eid cheer and happy news in this season of gloom, but I also wonder and want everyone to consider the following:
First, BBC Urdu undertook an analysis of this year and last year’s burial data in a few select municipal graveyards in Karachi and Lahore. They compared the burials with officially reported COVID deaths. It is quite clear from their analysis that the deaths from COVID-19 are most likely at least 4 times and maybe even 10 times higher than what has been reported. The official Pakistani death rate right now stands at 27 per million as compared to the world average of 85 or the UK rate of 676 per million. If one takes into account the under reporting, the death rate is more likely to be between 108 and 270. Still mercifully low, but more consistent with the world average.
Second, it is well known that Pakistan is consistently under testing despite WHO’s protests. It is testing at the same levels as in early June despite having the surplus capacity to test more. Punjab and KP particularly have abysmally low testing rates, with Sindh practically accounting for 50% of the testing in the country recently. In addition, there was evidence found by BBC Urdu that perhaps even the collected test data is not making it into the official statistics. But that under testing still cannot account for the dip in the infection rates.
This brings us to the nub of the matter. According to government’s own admission, the testing in Pakistan is diagnostic, i.e., on demand and not pro-active random testing. This means that we are talking about a self-selected sample which is likely to get itself tested. The test numbers therefore cannot be projected to the wider population beyond, the sampling frame that fits the profile of the ones who are likely to approach the formal health system and get themselves tested. And even then, because it is a self-selected, and almost certainly a repeatedly tested group, the veracity of the projection is highly dubious.
Fourth, the question arises, who are the people who are likely to approach authorities and get themselves tested? Middle and upper class people with their own transport to get to the testing sites. The official numbers can perhaps be extrapolated to that population, and I suppose that's where one could argue that the infections are coming down. If the proportions of positive tests are not going up within this very small population, then I suppose one could deduce that folks who care enough to get themselves tested (sometimes repeatedly) are also being more careful.
Fifth, not many results of random testing have been reported in Pakistan beyond the much maligned random testing in Lahore in early May, 2020 that returned an estimate of 670,800 infections in Lahore alone. A National Institute of Health random survey estimated 300,000 infections in the Islamabad Capital Territory instead of the official acknowledged 15,000 or so on August 3rd, 2020.
Leaving aside big cities, random testing in a remote village of Madak Lusht in Chitral returned 24 infections out of 40 people tested, on July 30th, 2020--a stupefying 60% infection rate! Even the Executive Director of NIH seems to have surrendered and is talking about the catastrophic herd immunity.
Sixth, all of the above does not explain empty hospital beds and surplus capacity, post Eid al Fitr bump in infections. It may be that the younger demographic of Pakistan are asymptomatic carriers, and are not getting sick enough to go to the hospital. From my own research in urban Pakistan, I know that the poor in Pakistan are much more likely to avoid hospitals for fear of humiliation at the hands of medical staff and inability to pay.
Further, women differentially have less access to health facilities even when they are close, so that's another demographic which is likely not accessing hospitals. Also, people may be convalescing more at home and also being more careful. Hence the spare capacity, despite the above.
Lastly, as per WSJ story, infections are most likely to happen in closed, less ventilated places with lots of people talking loudly or breathing heavily, like bars, restaurants, night clubs, etc. We don't have many of those venues, except mosques for indoor congregations. But they do tend to be ventilated and most people don't talk or breathe heavily in there. So just the lifestyle perhaps mitigates the type of infection rates that we have been seeing, in the West. Even the worst case scenarios discussed above, still put us at the lower end of the infections rate spectrum globally.
These are stressful times. One is anxious about one’s own health and more so of the loved ones. One wants to believe good news. One wants to believe in exceptional immunity. But more so, one wants to believe that the state cares. That it is not deliberately lying. And that its priorities are not CPEC, conflict with India, political advantage over the opposition, or showing off toxic masculinity in the times of a pandemic. One hopes that its priorities are the life and health of its citizens.
The detractors have protested abysmally low testing rates, especially in Punjab and Khyber Pakhtunkhwa, but those have been silenced by the retort that even with less testing, the existing tests should yield higher infection rates, if the infection is spreading. Indeed, Khurram Husain proposes that “the burden of proof is now on those who wish to doubt these [happy] numbers”.
Mr Husain’s challenge is an unfair one. How can a private citizen match the resources and statistical prowess of the state? But one can question, and question I do, because what the government is saying and the explanations it is giving, have no basis in science. As much as I would like to be wrong and believe that my elderly parents and loved ones are safer, the allegiance to science and reason won’t let me.
To buy into the fundamental premise of the state’s explanations for the lowering infection and death rates from COVID-19 means buying into the premise of Pakistani exceptionalism, some secret immunity that Pakistanis enjoy, scientific nonsense of herd immunity, or the success of smart (as if there are dumb) lockdowns. Or as Muhammad Hanif eloquently put آج جانے کی ضد نہ کرو lockdown (don’t insist on leaving today). To restate, I want to celebrate some Eid cheer and happy news in this season of gloom, but I also wonder and want everyone to consider the following:
First, BBC Urdu undertook an analysis of this year and last year’s burial data in a few select municipal graveyards in Karachi and Lahore. They compared the burials with officially reported COVID deaths. It is quite clear from their analysis that the deaths from COVID-19 are most likely at least 4 times and maybe even 10 times higher than what has been reported. The official Pakistani death rate right now stands at 27 per million as compared to the world average of 85 or the UK rate of 676 per million. If one takes into account the under reporting, the death rate is more likely to be between 108 and 270. Still mercifully low, but more consistent with the world average.
Second, it is well known that Pakistan is consistently under testing despite WHO’s protests. It is testing at the same levels as in early June despite having the surplus capacity to test more. Punjab and KP particularly have abysmally low testing rates, with Sindh practically accounting for 50% of the testing in the country recently. In addition, there was evidence found by BBC Urdu that perhaps even the collected test data is not making it into the official statistics. But that under testing still cannot account for the dip in the infection rates.
This brings us to the nub of the matter. According to government’s own admission, the testing in Pakistan is diagnostic, i.e., on demand and not pro-active random testing. This means that we are talking about a self-selected sample which is likely to get itself tested. The test numbers therefore cannot be projected to the wider population beyond, the sampling frame that fits the profile of the ones who are likely to approach the formal health system and get themselves tested. And even then, because it is a self-selected, and almost certainly a repeatedly tested group, the veracity of the projection is highly dubious.
Fourth, the question arises, who are the people who are likely to approach authorities and get themselves tested? Middle and upper class people with their own transport to get to the testing sites. The official numbers can perhaps be extrapolated to that population, and I suppose that's where one could argue that the infections are coming down. If the proportions of positive tests are not going up within this very small population, then I suppose one could deduce that folks who care enough to get themselves tested (sometimes repeatedly) are also being more careful.
Fifth, not many results of random testing have been reported in Pakistan beyond the much maligned random testing in Lahore in early May, 2020 that returned an estimate of 670,800 infections in Lahore alone. A National Institute of Health random survey estimated 300,000 infections in the Islamabad Capital Territory instead of the official acknowledged 15,000 or so on August 3rd, 2020.
Leaving aside big cities, random testing in a remote village of Madak Lusht in Chitral returned 24 infections out of 40 people tested, on July 30th, 2020--a stupefying 60% infection rate! Even the Executive Director of NIH seems to have surrendered and is talking about the catastrophic herd immunity.
Sixth, all of the above does not explain empty hospital beds and surplus capacity, post Eid al Fitr bump in infections. It may be that the younger demographic of Pakistan are asymptomatic carriers, and are not getting sick enough to go to the hospital. From my own research in urban Pakistan, I know that the poor in Pakistan are much more likely to avoid hospitals for fear of humiliation at the hands of medical staff and inability to pay.
Further, women differentially have less access to health facilities even when they are close, so that's another demographic which is likely not accessing hospitals. Also, people may be convalescing more at home and also being more careful. Hence the spare capacity, despite the above.
Lastly, as per WSJ story, infections are most likely to happen in closed, less ventilated places with lots of people talking loudly or breathing heavily, like bars, restaurants, night clubs, etc. We don't have many of those venues, except mosques for indoor congregations. But they do tend to be ventilated and most people don't talk or breathe heavily in there. So just the lifestyle perhaps mitigates the type of infection rates that we have been seeing, in the West. Even the worst case scenarios discussed above, still put us at the lower end of the infections rate spectrum globally.
These are stressful times. One is anxious about one’s own health and more so of the loved ones. One wants to believe good news. One wants to believe in exceptional immunity. But more so, one wants to believe that the state cares. That it is not deliberately lying. And that its priorities are not CPEC, conflict with India, political advantage over the opposition, or showing off toxic masculinity in the times of a pandemic. One hopes that its priorities are the life and health of its citizens.