Dealing with Covid-19 in Pakistan

The metaphor “black swan” was used in Roman literature to express impossibility as it was perceived that swans were always white.

Black swans were discovered in Australia in 1697, and the metaphor remained in use to express an impossibility that was later disproven. The writer Nassim Taleb in 2007 used the phrase “black swan events” to describe events which were extremely rare, undirected, unpredictable and which would carry an extreme negative or positive impact.

The third characteristic of a black swan event, in Taleb’s words, is that after the first recorded instance of the event, it is rationalized by hindsight, as if it could have been expected. Taleb regards almost all major scientific discoveries, historical events and artistic accomplishments as “black swans”.

The spread of Covid-19 or the coronavirus is yet another black swan event. This rare virus turned into a pandemic within a few weeks of the first reported case in China. Here one may argue that China got caught flatfooted. However, the rest of the world – and especially the developed world – had time to prepare for this outbreak. Yet they failed to slow down the early spread of the disease which, left to itself, doubles every 5-6 days.

Pakistan borders two of the initial hubs of the Corona outbreak, China and Iran. Its decision not to evacuate Pakistani students from China and let the Chinese medical system take care of them would have helped contain the spread of disease in its territories. However, the incidence of virus is reported in Pakistan and so far active tracking and screening for its presence is only confined to Pakistanis (and their close family members) returning from Iran – and that too was started when Iran became a known hub for the outbreak.

One may argue that the sample size of population screened for the coronavirus in a country of 220 million inhabitants is too little and there may be potentially more undetected cases which may multiply and appear in the next few weeks after their incubation period completes.

Italy and Iran made the mistake of not enforcing an early policy of social distancing and by the time they acted, it was already too late. In that context, the recent measures by the government of Pakistan for social distancing including the closure of educational institutes; ban on public gatherings in cinemas, wedding halls, sports grounds, conferences; closing its western borders and diverting all international flights to only three airports should be helpful in containing the spread of the disease. However, these measures are not enough to cope with the pandemic.

A recent study of Covid-19 in China found that five percent of patients needed to be admitted to an intensive care unit (ICU), with many needing intensive ventilation or use of a more sophisticated machine that oxygenates blood externally. Italian hospitals offer world-class healthcare. Till last week, they were quite confident of coping with the disease. However, they underestimated the demand of ventilators and oxygen for the virus infected patients and that resulted in the highest number of fatalities by coronavirus outside China.

While one prays that there is no second wave of the virus outbreak in China, let us see what China has done so far to cope with Covid-19. It put its citizen under strict quarantine but ensured that no one was deprived of basic food commodities while in quarantine and off from work. It went for mass testing and screening. It did intensive contact tracing to disrupt the transmission chain and it provided ample human and financial resources for hospitals. Realizing that Covid-19 was not only a medical emergency, it also instructed the banks and revenue collecting agencies to go soft on their borrowers/clients.

Pakistan is neither an authoritarian nor a social welfare state. Hence, it cannot confine its citizens to their homes and provide them with free food and other utilities. This implies that strict precautionary quarantine would not work here. In the absence of ‘sick pay’ for most of the employees and especially the self-employed, voluntary isolation of those with mild symptoms is not possible as they cannot miss their daily earnings. This is where federal and provincial governments will have to join heads and hands to devise a mechanism for providing relief to the lower income segment of society who may face further destitution as a result of social distancing and voluntary isolation.

Screening of potential patients of Covid-19 at the mass level should be another priority to fight against this pandemic, especially when the outbreak is small and possible to contain. The government has announced a helpline –1166 – where any suspected patient of virus may contact for screening and treatment. However, instead of waiting for patients to come forward for testing, health authorities need to be more proactive and do random screening at potential hotspots of this disease.

After identifying patients through screening, the next step would be to treat them. We have a limited number of hospitals in each province with isolation facilities and those hospitals too are understaffed and under resourced. Here a supply-demand gap analysis, not only of human resources but also of supplies such as externally-blood-oxygenating machines is crucial. Bridging the gap through diverting public funds, through engaging the private sector in a public-private partnership mode and inviting individual philanthropists for donation of hospital supplies and equipment would come handy. Remember, the well-resourced healthcare system of Italy failed to provide too many ventilators in too short a period of time. Hence, the aim here is not just to raise funds but to ensure that ventilators are available in isolation centres.

Going beyond the medical aspects, there is a valid demand for reduction in interest rate to increase our economic resilience in the context of the coronavirus. However, the bearish performance of stock markets in the UK, Europe and US implies that mere lowering of interest rates would not rescue economies. Businesses and employers would need temporary relief on tax and wage costs too. One may argue that Pakistan neither has the fiscal cushion to provide tax cuts and wage costs, nor a policy space to significantly reduce interest rate in an IMF programme.

However, these are unusual times. Pakistan should use this pandemic as force-majeure to revise its targets and get some fiscal cushion from the IMF. Multilateral lenders have established a special fund to cope with Covid-19. We should also approach the Fund to contain the transmission of this disease in Pakistan.

At the external front, we need to keep in mind that the mere term ‘pandemic’ signifies its global nature. No single country/nation can deal with it in isolation. Countries need to work together on treatment protocols, what worked, what did not work (and why) to cope with Covid-19.

On the domestic front, facemasks and hand sanitizers have already vanished from markets. The PM’s advisor on health also indicated possible shortages of food supplies in the weeks to come. To keep supplies normal, consumers would have to resist panic buying, while the governments (at all levels) would have to control hoarding of essential commodities. Smooth supplies of essential commodities would lessen the pain of troubled times.

While hinting upon how to cope with black swan events, Taleb suggests that what may be a black swan surprise for a turkey is not a black swan surprise for its butcher; hence the objective should be to avoid being the turkey by identifying areas of vulnerability in order to “turn the black swans white”. One needs to see how far and how quickly Pakistan can reduce its vulnerabilities to turn the black swan of the coronavirus into a white swan of safety.

The writer heads the Sustainable Development Policy Institute.

Twitter: @abidsuleri