ISLAMABAD: The sharp rise in COVID-19 cases in Pakistan exposed failures in the coordination mechanism between federal and provincial health authorities, experts have said.

With around a dozen cases reported in 48 hours, the country has also moved from the containment phase to the mitigation phase of the spread of the novel coronavirus.

Special Assistant to the Prime Minister on National Health Services (NHS) Dr Zafar Mirza took to Twitter at midnight on Tuesday to confirm nine new cases of COVID-19 in Karachi.

“All these cases are contacts of an already confirmed case. Further contacts are being traced and tested,” he stated.

However, Dr Mirza’s statement was contradicted by the Sindh government, which claimed that five people who are confirmed to have contracted the disease travelled from Syria and the other three came from the United Kingdom.

Experts say more attention should be paid to surveillance, identifying clusters and community mobilisation

An NHS ministry official who asked not to be named said the public contradiction exposed flaws in the coordination mechanism between the two authorities.

“It is an alarming sign because it shows that health departments are not on the same page despite the fact that COVID-19 is a very sensitive issue. It also raises questions about the other arrangements, such as the federal departments’ duty to inform the provinces about passengers with a travel history of virus-hit countries who are arriving in different parts of the provinces,” he said.

He added that although Pakistan’s main focus has been border control, it has been proven that the role of border control is limited. Once the virus reaches the country, surveillance should be increased to identify clusters where it is present.

“The community needs to be mobilised so people can keep an eye on individuals with that travel history. In other countries, most cases have been diagnosed within the community rather than at airports,” the official said.

He said clusters had begun to emerge in Pakistan. It must be ensured that every person suspected of having contracted the virus is placed in quarantine, either at home or in designated locations.

“We could have more cases in the coming days, as cases were reported from Karachi and Hyderabad on Tuesday,” he said.

“This shows that the virus has reached different areas. We should also hope that temperatures rise in Pakistan soon and that the virus cannot survive at around 30°C. The virus would be eradicated in April and hopefully a vaccine will be invented before cold weather arrives, as the virus may return again once the temperature starts to drop,” he said.

University of Health Sciences Vice Chancellor Dr Javed Akram said that a standard operating procedure (SOP) needs to be introduced under which anyone suspected of having COVID-19 is quarantined for 14 days, which is the virus’ incubation period.

“In other countries whole cities have been quarantined. Why can we not contain [suspected patients] at home or in designated places? Those with a travel history should not visit their offices, public spaces or attend social gatherings for around two weeks after arrival. People should wash their hands and face frequently with soap,” he said.

Dr Rana Safdar, who is an expert on infectious diseases, said that Pakistan has done well in terms of controlling the spread of the disease.

“There has not been a single mortality and two patients have recovered fully from the disease. Coordination between departments will increase further with time,” he said.

Microbiologist Dr Javed Usman said it was possible that a person could be infected with COVID-19 and not show any symptoms.

“Every person with a travel history should be tested and if a case is confirmed all the people who have been in contact with the patient should be tested. People need to understand the difference between isolation and quarantine; confirmed patients are put in isolation and suspected patients are kept in quarantine, which can be anywhere,” he explained.

People with a travel history and symptoms of the flu or cough should self-quarantine, he said. They should stop meeting people, particularly the elderly for whom the virus can be fatal.

Dr Waseem Khawaja from the Pakistan Institute of Medical Sciences added that the tendency to greet travellers warmly upon their arrival should be halted for some time.

“Do not meet those who come from virus-hit countries and suggest that they stay in a separate room for two weeks. Stop shaking hands with everyone, as it is a major reason for the spread of the virus,” he said.

Dr Mirza said on Tuesday that Pakistan was ready to deal with any emergency.

During a meeting of the Emergency Core Group for COVID-19, he said that all necessary measures were being taken.

“There is efficient coordination between the federal government and the provinces and steps are being taken to curb the disease. A policy has been made for every person, coming from abroad, and every suspect is being put in quarantine for 14 days.

“Moreover provincial governments are also being informed regarding passengers who come from abroad and they are being monitored,” the special assistant said.

The outbreak of the novel coronavirus was first reported in Wuhan, China, on Dec 31, 2019. It has since spread to more than a hundred countries. A total of 116,657 cases have been reported including 4,091 deaths and 64,750 recoveries.

Update: Dr Zafar Mirza's tweet from Tuesday saying "all cases are contacts of an already confirmed case" has since then been deleted.

Published in Dawn, March 11th, 2020