COVID-19 in Pakistan: Current Practices and Associated Risks

Seven coronaviruses were identified previously and these were known to infect human beings. The eighth human coronavirus (nCoV-2019) surfaced in Wuhan, China at the end of the year 2019, exhibiting symptoms of pneumonia and other respiratory problems. As of September 7, 2020, 27 million people have been infected with COVID-19 and more than 900,000 have lost their lives. In Pakistan, the tally of COVID-19 infected cases stands at 298,509 and 6,342 people have died. Government of Pakistan has devised “The National Action Plan for the Corona Virus Disease (COVID-19) Pakistan” to efficiently tackle the pandemic. Many hurdles stand in the way of Pakistan fighting against the COVID-19 pandemic, effectively. Poverty and a low literacy rate are major obstacles in containing the COVID-19 transmission in Pakistan. Pakistan’s healthcare infrastructure is not fully equipped to deal with the pandemic. It is constrained by a very limited healthcare budget, small number of healthcare personnel and limited equipment. The number of tests conducted is very low which cannot give a proper insight into the actual incidence of COVID-19. Thus, it can be concluded that Pakistan, within the given facilities and predictions, is incapable of flattening the curve but the catastrophe can be avoided by taking proper measures in time.

COVID-19 epidemic was classified as a worldwide public health emergency of an international concern by WHO. On the 11 th of February, 2020 WHO named the virus as "Severe Acute Respiratory Tract Coronavirus-2" (SARS-CoV-2), causing disease known as "COVID-19" [12,13].
Reportedly, as of September 7, 2020, the number of COVID-19 cases stands at 27 million and more than 900,000 people have lost their lives. In Pakistan, 298,509 people have been confirmed with COVID-19 and 6,342 people have died with it [14]. The grave matter of concern is that when highly developed countries with outstanding healthcare systems are finding it difficult to contain the virus and to treat the affected, how developing countries such as Pakistan, India, Bangladesh and Iran will cope with the spread of SARS-CoV-2. In developing countries, it is a genuine consideration that if the number of infections exceeds a certain threshold, it will impart longlasting scars on people's lives as well as on the economy.
In Pakistan, the first two cases of COVID-19 were confirmed on the 26 th of February, 2020 in Karachi and Islamabad by the Federal Health Minister [15]. Initially, the number of cases increased gradually, reaching their highest number in Pakistan in the month of June, and were found to be decreasing afterwards as shown in Figure 1 [16]. To mitigate the impact of COVID-19 on the socioeconomic status of countries and to flatten the spread curve, governments and social organizations have taken active measures. Isolation protocols have been recommended in the regions with high imported as well as locally transmitted cases of COVID-19. All public gatherings, educational institutes, and ceremonial events have been severed to limit the hazardous effects of the infectious disease. The strategy of isolation and quarantine might be the only chance of Pakistan to survive this pandemic.

How Well Pakistan is Prepared to Tackle COVID-19
Government of Pakistan has taken various measures for the containment of the viral spread across the country which include the closure of all educational institutions, prohibition of public assemblies and ceremonial events, closure of western borders with Iran and Afghanistan [17], restricting international Pakistan" aimed to develop strategies to efficiently tackle the pandemic [18]. Moreover, some healthcare equipment has been imported also including face masks, ventilators, and personal protective equipment [19]. Government of Pakistan has allotted a total of 215 medical isolation facility centers with 2942 beds in total in all provinces [20]. Taking into account the situation in Italy, it should trigger an alarm in Pakistan that how will it be able to cope with the pandemic with a limited budget and inadequate healthcare facilities. However, despite all these efforts, there have been lapses and incompetence at every level which might result in cluster transmission of COVID-19.

Poverty
Pakistan is a developing country with a population of around 210 million. Onefourth of the total population of Pakistan lives below the poverty line; 13% and 31% of population in urban and rural areas respectively lives below the poverty line [21]

Illiteracy
Pakistan has a very low literacy rate of only 62.3% [22] which poses a great problem in reaching people and educating them about the implications of coronavirus. Most of them don't take it seriously at all and are not aware of the consequences if the virus spreads in the country at a large scale. Moreover, their lack of basic knowledge about the biology of viruses and viral diseases can make them deduce false conclusions. Due to inadequate knowledge and misinformation regarding COVID-19, it is difficult to educate masses with no scientific background. Thus, in such settings, cultural gatherings are difficult to control which is another aspect that can fuel the COVID-19 transmission.

Scarcity of Professional Healthcare Workers
According to the economic survey of Pakistan 2018-19, there are 220,829 registered doctors in Pakistan which makes one doctor available for 963 persons and only 108,474 registered nurses. As far as the total number of hospital beds in Pakistan is concerned, there is one bed available for 1608 individuals [22]. Keeping in view the critical condition and highly contagious nature of SARS-CoV-2, it is worth asking how many doctors will play their part in treating the infected individuals. If the number of critical cases increases, there will be an increasing need of ventilators and the persons who know how to operate it. We are apprehensive that the Government of Pakistan will not be able to do something in such cases, which will lead to the rise in the number of people dying of COVID-19 due to the unavailability of proper medical equipment. Moreover, if the already low number of healthcare professionals is not provided with personal protective equipment (PPE), there is a chance that more doctors will get infected, thus infecting other individuals under treatment and leaving no doctors to relieve the suffering.
Due to widespread concern and alarm, governments have adopted various measures in an attempt to contain the epidemic. Such measures include quarantine, isolation, and travel restrictions to prevent the introduction of the causative agent and/or its spread individuals keeping in view the social and family set up in Pakistan. It will eventually lead to the cluster of infections and its widespread dissemination.

Unavailability of Adequate amount of Diagnostic Test Kits
In conclusion, due to the spread of virus throughout the country and the existence of undetected cases, the strategy of strict isolation and quarantine in poor countries such as Pakistan is questionable. Government of Pakistan is trying its fullest to contain the virus but without the cooperation of normal people, it is quite a difficult task. It should adopt stricter strategies by significantly imposing strict travel restrictions as well as restrictions on social interaction to effectively cope with this highly contagious and serious disease. The only chance of Pakistan to survive from this pandemic is to take precautionary steps seriously.