STATISTICS tell a grim story of the third wave of Covid-19 ravaging the urban centres of Pakistan. With the government struggling to enforce SOPs, manage critical care load and acquire vaccines, senior officials say the four weeks of Ramazan will be crucial in determining if the rising curve of the infection can be successfully flattened and eventually brought down.

A comparison of the three Covid-19 waves presents some stark lessons of both success and failure. The first wave, according to official data available with Dawn, was recorded at reaching 1,000 patients on April 22, 2020. It peaked in 53 days when on that day it infected 5,884 patients. The second wave started on October 3, 2020 and peaked in 65 days when the number of patients recorded was 3,262. The third wave started on February 22, 2021 and on the 50th day shows no signs of peaking yet though the highest number of patients infected in a single day in the third wave has already touched 5,329. The third wave’s scale of rise is much steeper than the previous two.

Strangely enough, the intensity of response by both the government and the people is not matching the gravity of the third wave. The government bemoans flagrant violations of SOPs by the people but is shy of enforcing drastic measures like it did in the first wave, while behavioural change among citizens is affected by a general apathy towards the pandemic. To make matters worse, the original timelines for the government’s procurement of vaccines have also been pushed back due to delays in the availability of vaccine from the global alliance GAVI.

“Our window of worry is from now till mid-May,” says Asad Umar, who is leading the government’s Covid-19 operations as head of the National Command and Operations Centre (NCOC).

NCOC aims to ensure vaccination of 15-20m Pakistanis in next two to three months

There is good reason for worry. With the graph of the third wave rising ominously and the delayed availability of vaccines sufficient to quell the speed of the infection, fears of the pandemic spiking during Ramazan have added to concerns about the situation. Prime Minister Imran Khan has declared categorically that the country cannot afford a lockdown, which means that increased attendance in mosques during the holy month could flare up the rate of infection. Officials say improved availability of vaccines after Eid would speed up the process of inoculation, but for now the figures are telling a grim story.

One such figure is the positivity ratio that explains the percentage of people testing positive as a ratio of the total number of tests conducted in a day. According to official figures, the positivity ratio has increased more than three times in the last four weeks or so. It was 3.3 per cent in the end of February while today it hovers around 10pc. While this is less than the peak positivity ratio in the first wave – recorded at 22 per cent on June 14, 2020 – it is rising dangerously. Significantly, the highest positivity ratio is being registered in urban areas.

The highest positivity ratio is in Peshawar (22.3pc), followed by Gujranwala (19.7pc), Lahore (18.6pc), Muzaffarabad (18.6pc), Faisalabad (16.9pc), Rawalpindi (15.2pc), Swat (14.3pc), Multan (12.2pc), Mirpur (10.6pc), Islamabad (9.1pc), Hyderabad (9pc) and Abbottabad (8.5pc).

The three urban exceptions that have low positivity rate are Karachi (4.6pc), Gujrat (4.4pc) and Jhelum (1.6pc).

According to healthcare officials, these positivity rates, when translated into actual number of patients, are further categorised into those patients who quarantine and recover at home, and those who require hospitalisation. The first category of patients do not put a strain on the national health system, but those who require critical care become the highest priority. This is why the statistics of these patients paint a vivid picture of the gravity of the situation.

In this third wave, the number of critical care patients has already surpassed those at the peak of the first wave, even though the positivity ratio in June last year was much higher than what it is today. According to the latest figures, there are currently 4,200 critical patients across the country, whereas during the peak of the first wave in June last year, the maximum patients in critical care were 3,308. This is why there is increasing anecdotal evidence today that patients are struggling to find hospital space.

The official statement puts a brave face on this situation: “No emergent feel of saturation due to capacity enhancement in health care system across Pakistan after the 1st wave. NCOC is continuously monitoring critical care occupancy across the country for any ramp requirements and hospital management. Recently capacity enhancement carried out in Lahore, Peshawar, Swat, Gujranwala, Gujrat, Multan and Islamabad.”

However, there is a correlation between the number of patients in critical care and the mortality rate, i.e. the number of deaths every day. During the first wave, June 21, 2020 had witnessed the highest one-day death toll of 124. Since last week, the death toll has spiked dangerously and went into triple figures (103) on April 6, 2021, the first time since June last year. Officials fear this high toll may continue because of the very high number of people in critical care in hospitals. One grim statistic is translating into another.

The vaccination process is also progressing at a pace that is slower than required. Two months ago, in the early stages of the process, the NCOC had crunched numbers and had come out with estimates. Here’s how Prime Minister’s Special Assistant on Health Dr Faisal Sultan had explained these numbers: Pakistan’s approximate population is taken at 220 million people. It is an accepted fact globally that people under the age of 18 will not require a vaccine. If we take out all Pakistanis under the age of 18 from the total population, that leaves roughly 100 million people. Experts believe a population reaches herd immunity if 70 percent of the people have either been infected with the virus or administered the vaccine. In approximate numbers this means of the 100 million Pakistanis above the age of 18, 70 million will need to be vaccinated (this does not take into account all those who have already had the infection and recovered from it).

As of last week, a little more than 1.1 million Pakistanis had been vaccinated.

The government is facing rising criticism for being slow in acquiring vaccines and falling behind regional countries in vaccinating its citizens. In his defence, Asad Umar argues that the developed countries pre-booked massive orders from all pharmaceutical companies during the early stages of vaccine development. Most developing countries, including Pakistan, could not afford this and therefore are behind in the queue. In addition, he argues that vaccine procurement has increasingly become a foreign policy issue as evidenced by how India is prioritising those countries for vaccine export that fall within its sphere of influence. “China is our primary source for vaccines today,” he says.

Foreign Minister Shah Mehmood Qureshi, who is currently on a visit to Germany, tweeted on Monday: “Following my meeting with Foreign Minister @HeikoMaas, I am happy to announce that Pakistan will receive 15 million doses of #COVID vaccine under COVAX, with a commitment for these to be delivered by May.”

NCOC has a plan. Question is, how accurately and speedily will this plan translate into injections on the ground, and in the arms? The plan says 15-20 million Pakistanis should be vaccinated in the next two to three months and this would mean all the population over the age of 50. Asad Umar said last week the government plans to open registration for all age groups after Eid. The vaccines included in this plan are: SinoPharm, CanSino, Sputnik-V and AstraZeneca. By June, the government plans to have acquired 34 million doses of these vaccines. But the problem is that of these 34 million, 14.6 million doses are of AstraZeneca through the global vaccine alliance GAVI. This was supposed to have been delivered in March but is now expected in June.

According to an NCOC statement, “The Ministry of Health is continuously engaged with GAVI authorities to sort out the issue; the MOH/NCOC is pursuing the matter through MOFA (Ministry of Foreign Affairs).” The statement further explains: “There are sufficient funds available, procurement hiccups created due to global supply and demand and the gap is being resolved through engagement at the highest level.”

Asad Umar says: “Our aim is to swiftly reach a stage where we can vaccinate 250,000 Pakistanis each day, and by mid-May we should be in a position to vaccinate between 125,000 to 250,000 daily.”

That is a tall challenge. The grim situation of the third wave requires nothing less.

Published in Dawn, April 13th, 2021