COVID-19: Pakistan’s Preparedness and response

Posted onAuthor

Sahrish Khan1, Atiq ur Rahman2, Muhammad Imran 2

  1. Department of Biotechnology, Quaid e Azam University, Islamabad 46000, Pakistan
  2. District Head Quarter Hospital, Layyah 31200, Punjab, Pakistan

Corresponding Author: Muhammad Imran, Emergency Department, DHQ Layyah 31200 Pakistan. Contact Author.
ORCID: https://orcid.org/0000-0002-0681-5388
Submission: Feb 11, 2020
Acceptance: December 10, 2020
Publication: Mar 10, 2021

© Author(s) (or their employer(s) 2021. Re-use permitted under CC BY. No commercial re-use. Published by Pak J Surg Med. 

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Article Citation: Khan S, Rahman A, Imran M. COVID-19: Pakistan’s Preparedness and response. Pak J Surg Med. 2020;1(4):e207. doi: 10.37978/pjsm.v1i4.207

Download PDF File

Abstract

At the end of December 2019, a novel coronavirus (Covid-19) outbreak has been proclaimed in the Wuhan City of China. Several cases have arisen in other cities of China. It spread simultaneously worldwide in 209 countries of Europe, Australia, America, Asia, and Pakistan. Millions of people have been affected while cases are rapidly increasing in the world’s high mortality rate. Different controlling strategies have been adopted for COVID-19. Pakistan took rigorous measures like a field hospital, specific laboratories for testing, centers for Quarantine, awareness campaign, Ehsaas Emergency Cash Programme, and lockdown for controlling this virus. There is no antiviral and vaccine-based treatment; only preventive measures are taken.

Keywords: COVID-19, Pakistan’s preparedness, SARS-COV, MERS-COV

Introduction

The novel coronavirus (Covid-19) flare up from Wuhan city of China and spread rapidly. World Health Organization (WHO) declared it a public health emergency. The outbreak was thought to be started from a livestock market.[1] Within a short duration, the coronavirus was rapidly spread in other parts of China. Modern transport methods made it a pandemic. More than 1.4 million people were affected in the first week of April 2020, from more than 200 countries.[2] On January 30, 2020, the COVID 19 outbreak as the sixth public health emergency declared by WHO.[3] SARS-COV and MERS-COV were previously declared as outbreaks before COVID-19.[4] During the third spike of COVID-19, 1,093,449 confirmed WHO reported cases with 58,720 mortalities. On February 19, 2020, Iran faced the first two coronavirus infected persons.

Similarly, Spain, France, and Italy are at the peak of pandemic outside of China now. Fortunately, China has overcome the swiftly spreading outbreak. Since mid-March, the number of cases has been dropped. In other countries, especially the United States of America and Europe, the pandemic is at the top. Unexpected the highest positive cases in the USA, followed by Italy and Spain currently reported.[5] Only a 2% mortality rate was recorded in China.[6] In other parts of the world, people with a weak immune system due to comorbidities like carcinoma, cardiovascular disease (CVD), and the diabetes fatality rate are varied and high by the age difference. More new cases and deaths are expected in the USA and Europe.

On February 11, 2020, WHO named Severe Acute Respiratory Syndrome coronavirus 2 (SARS Cov-2) resembled the SARS-COV of 2003.[6] In 1966 First human coronavirus was identified.[7]In 2002 the first was SARS-COV (Severe acute respiratory syndrome coronavirus), and the other is MERS-COV (Middle East respiratory syndrome coronavirus), infected many countries in the world were the other two types of virus. An Outbreak of SARS-COV was spread in 37 countries and infected 8000 people. MERS-COV infected 2494 people in 27 countries. The total number of deaths was 1658 worldwide due to these two viruses that lead towards pneumonia.[8] On February 26, 2020, the Ministry of Health reported the first case of COVID-19 in Karachi while the Federal Ministry of Health reported another confirmed case in Islamabad.[9] Within a few days, confirmed cases were 25 out of 471 suspected cases in Sindh. These positive cases had a traveling history from China, Iran, London, and Syria. The situation is the worst, and positive cases are increasing daily. Different strategies have been planned by Pakistan’s government, such as quarantine centers with every city testing laboratories, public awareness, lockdown, and funding against the COVID-19 outbreak.

The Current Situation in Pakistan

According to the WHO’s current report, the province-wise breakdown of the total number of cases on April 25 was 12,227. The number of COVID-19 cases in Punjab, Sindh, Khyber Pakhtunkhwa, Baluchistan, Islamabad, Gilgit-Baltistan, and AJK was 5,055, 4,232, 1,708, 656, 214, 307, and55 respectively. Out of 256 deaths, Punjab, Sindh, Khyber Pakhtunkhwa, Baluchistan, Islamabad, Gilgit-Baltistan, and AJK were73, 78, 89, 8, 3, 3, and 2respectively. One hundred ten patients have been recovered; Sindh, KPK, Baluchistan, Punjab, Islamabad, GB, and AJK were 18, 24, 14, 29, 9, 15, and 1, respectively. In Pakistan, the recovery rate is 4.8%, and mortality is 1.3%.[10]

Table 1: Facilities of the government of Pakistan against COVID-19

The Government of Pakistan is supported by the WHO in strengthening novel coronavirus alertness and response. The WHO has provided Technical guidance, including how to treat affected people, test samples, control infection in health care centers, and communicate with people. A significant risk of transmission of the virus in the world is by air travel. Ministry of Health developed the capacity of diagnostics in the laboratories. Sample collection packing transportation kits and testing guidelines have been provided. Initially, six hospitals have been equipped with special medical supplies for infection prevention and control, such as masks, gloves, thermo-guns, gowns, and more. Isolation centers for admitted to suspect cases have been set up. WHO recommends avoiding close contact with affected, frequent hand wash, wearing face-mask in public spaces, and quarantine of patients.[11] The Government of Pakistan has arranged hospitals, quarantine centers, and facilities provided to healthcare workers and patients to fight against this outbreak. Labs are independently free testing for this virus. Pakistan pushed towards telehealth as coronavirus overcrowds hospitals. Our government has established a funding program to support the poor during the lockdown period. In Sindh, there were six hospitals for COVID-19, Punjab 8, In Khyber Pakhtunkhwa 5, Baluchistan 4, Gilgit-Baltistan 3, and Azad Jammu and Kashmir (AJK) 4 hospitals were functional.[7]

Figure 1:Hospitals for COVID-19 in Pakistan

Many institutes and private hospitals approved for testing centers provide staff equipment, diagnostic kits, medicine, and PPEs personal protective equipment under trained IPC (Infection prevention and control) team. Different strategies are followed by healthcare to prevent transmission;

  1. Early recognition, ensuring triage, and source control (isolating patients with suspected nCOV infection).
  2. For all patients applying standard precautions.
  3. Additional precautions (avoid physical contact with suspected patients, droplet, and airborne precautions).
  4. Implementing environmental controls.

In Pakistan, Isolation wards were built in all provinces, hospitals ICT-02, Sindh-05 Punjab-08, KP-6 Baluchistan-8, AJK-04, and GB-03. Twenty-three thousand eight hundred eighty-six total numbers of beds in isolation wards in Pakistan. KP 2,660 Punjab 10,948 Baluchistan 5,897 Sindh 2,200, AJK 530 , GB 972 and capital territory Islamabad 350.[3]

Isolation wards and beds capacity

Quarantine and isolation are different for public health practice and are used to protect the people by preventing infectious diseases to people who have or may not have. The hospitals used for isolation for suspected and positive people to control the outbreak of COVID-19. In Islamabad, isolation wards with a capacity of 350 beds. Baluchistan has 14 districts with medical facilities, while some tehsil has no hospitals. In the Sindh, five medical centers were functional in the four districts. In the Gilgit-Baltistan, there are 22 medical facilities available among ten districts. In Khyber Pakhtunkhwa, there are 33 districts with 110 functional medical facilities. There are 50 healthcare centers among 34 districts of Punjab. Kashmir has nine districts vary medical facilities among each district with a minimum of 15 centers. Isolation centers and medical staff and beds are varied with numbers of patients in provinces.[6]

Table 2;Isolation wards and beds capacity

Quarantine facilities

The centers used for Quarantine of COVID-19 people vary in all provinces. During a virus outbreak, self-quarantine requires that patients isolate themselves from others to reduce the risk of transmission of disease. Quarantine is not fixed for sick people only. Quarantine is not always the best solution but effective at minimizing the risk of spread. Twenty-three thousand six hundred sixty-seven quarantined in Pakistan and still searching Tableeghi Jamaat for testing and Quarantine. Quarantine is an excellent gesture to control this outbreak throughout Pakistan. The Government of Pakistan converted hundreds of institutes and hotels into temporary quarantine centers for public health care while Islamabad has 2. Baluchistan, Khyber-Pakhtunkhwa, Sindh, and Punjab have 12, 52, 4, 8, respectively. While Gilgit-Baltistan has 63, and AJK has four being functional in this critical situation.[11]

Figure 2: Temporary Quarantine Centre’s

Testing centers in Pakistan

The world has faced the most significant public health challenge, hospitals, medical centers, laboratories, diagnostic centers for free testing and screening. PCR is an easy method to test for coronavirus. PCR is an initial step to detect viral RNA in blood. Forty-five thousand tests have been conducted in Pakistan. If it is negative, no action is required; if positive, a guide for treatment—laboratories with free PCR facilities for COVID-19 in Punjab-05 Balochistan-02 Sindh-06, KP-01 AJK-01, and GB-02. Testing capacity has been increased with the spreading of the virus and varies from country to country. Ministry of Health works with the National Institute of Health (NIH) to increase laboratories for testing up to 50 in Islamabad, Karachi, Lahore, Multan, Peshawar, Quetta, Gilgit-Baltistan, Muzaffarabad, Sukkur, and in more cities. The government launched a training program for lab technologists and medical staff to resolve this new outbreak’s problems. In molecular labs, more than one hundred molecular biologists (Medical Laboratory Technologists) were recruited.

Future aspects

After SARS-COV and MERS-COV, COVID-19 spread throughout the world, but Pakistan is a developing country, much populated, the economic situation has the worst, industrial, agricultural has negative growth. During the lockdown period, the closure of essential and non-essential businesses and disruption of the domestic supply chain harm other countries. Hospitals, isolation, quarantine centers, medical staff, and medical facilities are not fulfilled as required. If these are improved, then reduce the chances of an outbreak. Controlling measures should be taken. The virus is spread by sneezing and coughing droplets. Wearing gloves, masks, washing hands frequently is the best chance to staying safe and doing well for public health. Pakistan needs more medical facilities to overcome this outbreak. It is hoped COVID-19 will end soon in Pakistan.

References

  1. Shanmugaraj B, Malla A, Phoolcharoen W. Emergence of Novel Coronavirus 2019-nCoV: Need for Rapid Vaccine and Biologics Development. Pathogens. 2020;9(2):148. Available from: doi: 10.3390/pathogens9020148. PMID: 32098302; PMCID: PMC7168632.
  2. Iqbal MS, Haider S, Essa SA, Murtaza M, Maryam S, Sabir MM, Sherwani SK. Coronavirus Outbreak and Characteristics: A Mini-Review. Pak Jou MicrobioL. 2020;1(1):37-42.
  3. Bilgin S, Kurtkulagi O, Kahveci GB, Duman TT, Tel BM. Millennium pandemic: a review of coronavirus disease (COVID-19). Exp Biomed Res. 2020;3(2):117-25.
  4. Chudhary SA, Imtiaz S, Iqbal N. Laboratory Detection of Novel Corona Virus 2019 using Polymerase Chain Reaction. Int J Front Sci. 2020 Feb 1;4(2).
  5. Jiang S, Xia S, Ying T, Lu L. A novel coronavirus (2019-nCoV) causing pneumonia-associated respiratory syndrome. Cell Mol Immunol. 2020;17(5):554. Available from: doi: 10.1038/s41423-020-0372-4. Epub 2020 Feb 5. PMID: 32024976; PMCID: PMC7091741.
  6. WHO. Naming the coronavirus disease (COVID-19) and the virus that causes it [accessed 2020 May 2]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
  7. Hamre D, Procknow JJ. A new virus isolated from the human respiratory tract. Proc Soc Exp Biol Med. 1966;121(1):190-3. Available from: doi: 10.3181/00379727-121-30734. PMID: 4285768.
  8. Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, Yuen KY. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. 2020;9(1):221-236. Available from: doi: 10.1080/22221751.2020.1719902. Erratum in: Emerg Microbes Infect. 2020 Dec;9(1):540. PMID: 31987001; PMCID: PMC7067204.
  9. Waris A, Atta UK, Ali M, Asmat A, Baset A. COVID-19 outbreak: current scenario of Pakistan. New Microbes New Infect. 2020;35:100681. Available from: doi: 10.1016/j.nmni.2020.100681. PMID: 32322403; PMCID: PMC7171524.
  10. Bukhari N, Rasheed H, Nayyer B, Babar ZU. Pharmacists at the frontline beating the COVID-19 pandemic. J Pharm Policy Pract. 2020;13:8. Available from: doi: 10.1186/s40545-020-00210-w. PMID: 32328285; PMCID: PMC7168565.
  11. COVID-19 [accessed on 2020 May 5]. Available from: https://www.nih.org.pk/novel-coranavirus-2019-ncov/

Author CRediT

SK: Data Curation, Investigation, formal analysis, Methodology
AR: Formal analysis, Validation
MI: Data Curation, Investigation, formal analysis, Methodology, Project Administration, Supervision, Validation, Writing (original draft), Writing, Writing (review and editing)

Conflict of Interest

The authors declared no conflict of interest.

E-OP

We Value your Opinions. Register your Opinion to this Perspective by Khan S et al. by clicking here.

Editorial Team

This article has been subjected to extensive editing and double blind peer review process. The following editors were involved in editing of this article;

Lead Editor: Z Sarfraz
Editor: S Ali
Proof: J Siddiq
Bibliography: A Anwer

Publisher’s Note

The views and opinion expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.