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LOOK at the number of tests for the coronavirus that have been performed around the country and the number of positive cases and you will notice something. Take the number of positive cases as a percentage of total tests done in each province and you will discover that there is wide variation in this percentage among the provinces. More specifically, Punjab scores the lowest percentage whereas KP, Sindh and Balochistan are more or less the same. This is meaningful because the testing capacity of the country is limited whereas the demand for tests is rising as more and more people come to be infected, and especially if we are talking of pivoting towards ‘smart lockdowns’ because those are underpinned by a massive and rigorous testing regime. Without smart testing, you cannot have a smart lockdown.
Here is the percentages breakdown between the provinces, based on May 25 data from the World Health Organisation Situation Report for Pakistan. Punjab scores 9.9 per cent, meaning this is the percentage of people who have tested positive from among the entire population of those who have been tested. Sindh scores 14.4pc, KP comes in at 15.3pc and Balochistan at 16pc. Islamabad reports its data separately and scores 4.9pc. For the country as a whole, the percentage is 11.75pc.
What this percentage tells you is how well the provinces are using the limited testing capacity available to them. A higher percentage means the criteria to determine who gets tested and who doesn’t are rigorous and being applied properly. A lower percentage means the criteria are either too loose, or not being applied correctly.
If we are to move towards ‘smart lockdowns’, two things will be necessary. First, the number of tests being performed on a daily basis will need to rise sharply. Currently, as per the same WHO report, Pakistan’s current testing rate is 2,227 per million, and it has 262 reported cases per million. This is slightly better than Mexico, Egypt and Indonesia, to take three examples, but considerably below Brazil and Argentina, where tests per million are 3,461 and 2,956 respectively.
The old reflex to carve out islands of respite for the elites from all pressing public health problems is starting to kick in.
Second, after raising the number of tests per million sharply, it will be necessary to apply rigorous criteria as to who gets tested and who does not. Notice, for example, how Islamabad scores 4.9pc — which is far below the national average — for its testing regime. The capital city is quite literally burning through testing kits with little to no thought to how to apply this capacity smartly. Punjab scores very low as well, because it is one province that began offering private testing against payment, meaning no criterion was being applied at all. This is the reason why there was a discrepancy in the provincial and federal data regarding Punjab in the early days, and when the National Institute of Health (which at the time was responsible for data reporting on Covid-19) began to report the full numbers of tests from Punjab, they reported private and publicly performed tests separately.
What worries me is that the old reflex of this country to carve out islands of respite for the elites from all pressing public health problems is starting to kick in. It is this reflex, for example, that is at work when the elites buy their way out of bad water quality, or poor public education. They simply buy their water from private companies, and send their children to private schools. One after another matter of pressing public urgency is thus brushed away.
If the same reflex kicks in when dealing with the Covid-19 emergency, it will mean the elites will retreat further behind their walls, hoard the testing capacity for themselves and those who work for them, and will get priority treatment in private hospitals while the masses are told to report back to work in crowded buses.
One indicator that will be revealing if and when this begins to happen is positive cases taken as a percentage of the total population of those tested. The purpose of any testing regime should be to try and raise this percentage by applying rigorous criteria. A higher percentage will mean the country’s health system is doing a superior job of hunting down the virus. A lower percentage will mean most tests are missing their mark even as the virus spreads.
Asad Umar has been quoted as saying that in his opinion 30,000 tests per day should be enough to control the spread of the virus, and in the same report he promised that this number would be reached towards the end of May or in the early days of June. At the moment, the highest number of tests conducted in the country was on May 21 — 16,387 according to the government’s Covid-19 dashboard. Eid has seen a significant dip in the number of tests carried out, but this is expected to pick up now that the holidays are over.
If they are serious about ‘smart lockdowns’, a lot of numbers need to change very fast. Better targeting of the testing regime is critical, as is significantly ramping up the number of daily tests being performed. Another problem, as highlighted by Haris Gazdar in an article in this newspaper published on Wednesday, is the “weak private benefits and high perceived costs” that come with targeted lockdown efforts, and suppress demand for testing. What the state calls ‘smart’ measures will appear to those targeted by these measures as punitive, thereby reducing the incentive of those who show mild symptoms to get tested.
If we don’t see an improvement in the testing regime then we can be reasonably sure that what the government has in mind is to basically slink out of its obligation to safeguard public health, and that they are using fancy words to justify their actions. The whole idea behind lockdowns was to buy the time necessary to put in place all the elements with which the state would safeguard public health. Now comes the time to redeem that sacrifice.
The writer is a member of staff.
Twitter: @khurramhusain
Published in Dawn, May 28th, 2020
