With the coronavirus "outbreak" progressing into "internal transmission" and upon us, most Pakistanis are moving from a fatalist position to the adaab and elbow bump. However, they are still refusing to stop mingling altogether. Concerned by this, the country's top infectious disease specialist, Dr Faisal Mahmood, says it is incumbent upon every Pakistani to practice social distancing.

Yet most citizens continue to live as they did a few weeks ago and continue going about their daily businesses. Of course many gyms and parks have closed down but the current measures are still not enough with some arguing for curfews and forced social separation as the only effective way to stem the spread of coronavirus.

Lessons from Italy

"Ours is a good example and lessons can be learnt from us," said Aliya Salahuddin, speaking to Dawn.com from Monza, in Lombardy region in northern Italy. "Till two weeks ago, some Italians were not taking the 'stay at home' advice by the government too seriously and look what happened."

Today, Lombardy is the worst affected region in Italy, where the death toll is over 2,500 and positive cases over 31,000. Yesterday alone, 345 deaths were reported and the entire country is in lockdown since March 9.

Italy now accounts for more than half of all the cases recorded outside China. The latter, through its aggressive measures of massive lockdowns and electronic surveillance was able to turn the tide when the virus swept across the country back in January.

Also read | 'All is well'. In Italy, triage and lies for virus patients

But it must not be forgotten that Italy is facing a demographic recession and has a fairly high percentage of the elderly. In 2019, 22.8% of the population of Italy was over 60 years old. 90% of the more than 1,000 deaths that occurred there were those aged 70 or older. Smoking is another factor associated with poor survival and 24% of Italians smoke.

"If you ask me, I'd say social distancing is your best bet to keep the virus at bay," said 42-year old Salahuddin, a business trainer and mother of a five-year-old, who has now been living in Italy for seven years. Living in the red zone and despite hearing intermittent ambulance sirens, she says the lockdown also brought "a peace of mind" that "nothing untoward will happen and that we are safe".

Some 500 kilometres away, the same feeling of relief that she is safe inside her apartment envelops Sarah Kakal, a 20-year-old Pakistani student based in Rome, when the lockdown was announced. But the initial feeling of freedom from her previous routine has waned a week on. "It is the uncertainty that is more stressful as I do not know how long this will continue and I cannot even return home," she told Dawn.com.

Still, like Salahuddin, she feels safer "at home". Although it is getting lonelier now that her Italian roommates have left for their homes, she said, "every evening, at a scheduled time, people come out on their balcony and sing songs" which is very reassuring that we are all in this together". But what Kakal finds surreal are the empty, ghost-like roads of Rome. "I find it so strange; whatever time of the year, Rome was just abuzz with tourists," she told Dawn.com, adding that she misses that.

"We were told not to spread panic and that everything was under control; but I think we needed to panic and that happened after the deaths started; maybe Pakistan would do well with a bit of panic," says Salahuddin, adding that forced confinement was the only way to stem the spread of the virus.

More on this | 'Can I go to the park, can I eat out, can I meet my friends?': Social distancing explained

"Today nobody dares leave their home without a form in hand which they have filled to state the reason for leaving their residence — for groceries, health reasons, to go to the bank. People have also been penalised for not following the orders through."

For Pakistan, the panic button has been pressed

In Pakistan, as coronavirus cases are on the rise, the narrative has also changed from business as usual to reassurances to some serious mulling and now it seems that the panic button has been pressed.

The government initially closed schools, then banned mass gatherings starting with stopping spectators from watching cricket matches in stadiums. Next came closing down of shrines and wedding halls and events that would mean huge public gatherings, including some religious congregations as well. Next on the list, at least in Sindh for now, is the closure of malls, shopping centres, restaurantes, cafes, public parks and the beach.

While global statistics show that death from the virus was skewed towards the elderly and the fragile, it is important that young people do not get complacent. They must understand that they could end up spreading the virus which in some cases means one is asymptomatic.

Read further: What is 'flattening the curve'?

"It is the responsibility of the young that their elderly parents do not get sick because of them; that they do not pass the virus," says Dr Mahmood when asked if younger Pakistanis should be concerned about contracting the virus, which he says is more lethal than the average flu.

"Everybody has got to take this seriously; even the young and we must all realise that the government alone cannot curb the spread."

However, World Health Organisation's Director General Tedros Adhanom Ghebreyesus says social distancing alone would not help and has called for the global response of "test, test, test".

He says every suspected case should be tested.

"If they test positive, isolate them and find out who they have been in close contact with for up to two days before they developed symptoms and test those people too."

The late-to-the-table testing in Italy is being blamed for the disease getting out of hand there. However, with limited testing capacity in laboratories in Pakistan, health practitioners are urging people to only get tested if needed. "We don't have enough kits and it is not physically possible with limited number of health practitioners to test everyone. In addition, we keep updating our definition of who needs to be tested," explains Dr Mohammad, adding: "It's not that we are changing our minds, but with constant change in situation, we are trying to find newer ways of dealing with it."

"No country in the world except China has been able to clamp down and that too with great difficulty," says infectious diseases expert Dr Bushra Jamil of Aga Khan University Hospital, who fears hospitals will be swamped with patients.

"Even with resources, infection with a potential of spreading so rapidly cannot be contained by government efforts alone," she emphasises.

Iran has warned its citizens that its already strained health system could collapse if people do not follow state advisories. In Europe, health authorities are warning of critical shortages of medical supplies. Seeing what's happening in the world, it is time for us to act responsibly, for those around us and for ourselves.