Not only has the rapid spread of the coronavirus engulfed the entire world, it has posed a tremendous challenge to healthcare providers and health policymakers. It has also exposed the criminal disparity between expending on health and so-called “national security” in both developing and developed countries, somewhat creating a health vs defence scenario.

The current situation certainly poses a threat to many countries, where the options available to governments are slim, to make decisions to save lives as well as the economy. It is not as simple a decision as is often perceived, particularly for planners in Pakistan.

The Covid-19 virus arrived in Pakistan in March after first appearing in Wuhan, China, in December last year and spreading exponentially in China and the world over. But despite having almost four months to study and prepare for it, the response of our prime minster was rather nonchalant and pacifying — there is nothing to worry about, he told us, because it is as simple as the flu. That statement overshadowed all advised and precautionary measures developed by that time, i.e. to stay home, to wear masks, to ensure social distancing, and repeatedly to wash hands and use the lesser-known sanitiser.

Such a sudden change in our everyday life and our behaviour was unconsciously resisted by the masses because of three main factors: denial, ignorance or religiosity. Our ability to perceive a threat / danger is, in fact, a process that runs in the following manner: information is assessed at a cognitive level (appraisal) and, if a threat is recognised as immediately life-threatening, it arouses emotion, which then leads to fight (anger), flight (fear) or apathy (indifference). If the information is not perceived as a serious threat, however, there is only indifference.

Here, we are not even considering the mental state of those in self or forced quarantine. Stress of this magnitude with no end in sight will reveal a kind of disorder not known to classical psychiatry — an advanced kind of post-traumatic stress disorder.

Instead of lax and nonchalant policymaking, a strict enforcement of rules and regulations for controlling the spread of Covid-19 is needed

“Prevention is better than cure” was a revolutionary slogan in the pre-vaccination era. But before it could be elaborated and people learnt to change their habits, inoculation and vaccination came through major medical milestones and the above slogan remained just a slogan. The discovery of antibiotics also blocked the development of strategies for a safer environment and healthier lifestyles.

Worries about sustenance for daily wage labourers, hawkers, small shopkeepers and businesses were expressed for the first time by the PM and became the foremost reason against the lockdowns being advocated by health professionals. Yet all the provinces eventually enforced lockdowns, some smart and some soft and lenient. Maulvis and muftis added to the chaos, and they were supported by the president, who promised standard operating procedures (SOPs) for taraveeh congregations during Ramazan, even though both parties knew well that monitoring SOPs was not possible. The required distance between those praying shrunk to three feet, even though even six feet distancing may not be safe, as recent studies show. So that was the end of the SOPs.

Our people take great pride in breaking the law (minor or major) as there is always a loophole or a facility to get away. And this is a learnt behaviour. For Eid-ul-Fitr, markets were allowed to open, again with the promises of following SOPs, but no observance of SOPs happened in reality. Hence people shopped in crowded markets countrywide. This was almost the end of the importance of social distancing and SOPs. Knowing the psyche of our people, they should have been given a minimum task that could be monitored closely and enforced strictly.

Now as a result of reckless policies, the prediction of medical and allied professions has come true. The virus is spreading exponentially. The Chief Minister of Sindh announced on June 10 that “2487 new cases have emerged in Sindh — out of 9100 samples tested — and [there were] a record 42 deaths in 24 hours. Hospitalisation has increased four times what it was 15 days ago.” According to Dawn June 11, Pakistan reported 6,343 cases and 101 deaths during the previous 24 hours. Those numbers have only climbed since. By June 17, Pakistan already had over 154,000 confirmed cases and nearly 3,000 fatalities.

Now, our prime minister has announced that the peak of the virus will come in August (as against his earlier prediction of April, perhaps through his own personal/spiritual assessment). Simultaneously, he has advised the people that they have been given SOPs and it is up to them to adopt them, signalling a total abdication of state responsibility.

Now what should be done in this critical situation? Of course, first things first. This is a pandemic and the biggest calamity, much worse and potentially more fatal than the 2005 earthquake in Kashmir and the 2010 floods in Sindh put together.

Firstly, our prime minster should set aside his ego and call all the opposition parties to formulate a workable policy that suits the genius of our people. Secondly, the coronavirus situation in Pakistan should be declared a “national calamity” the likes of which we have never seen before. Our nation’s psyche is such that a law or simply advising them does not change their learned behaviour. Therefore, all policymaking must have the consent of all stakeholders (healthcare personnel, political parties and relevant NGOs).

A massive campaign should be formulated by professionals and disbursed using the print and electronic media. Huge posters should be pasted at prominent places, with pamphlets printed in all the written languages and distributed all over the country.

A large force of volunteers should be deployed all over the country along with police, rangers, and other law-enforcing agencies, with special consideration for specific areas of population clusters. While the media campaign is waged and posters and leaflets flood the streets, the volunteers would be the key to help change the behaviour of the masses.

It is true that the majority of people are at least trying to take correct preventive measures, but there is a sub-group of people on the streets without a care for masks or distancing. These are the main transmitters of the virus. A recent international study has shown that 80 percent of the infections are caused by 10 percent of those infected. According to an estimate, each infected carrier transmits the virus to at least 5-6 people at home, bazaars and crowded places such as mosques.

The practical SOPs should be as follows: Masks and gloves should be made mandatory. Initially, people on the streets should be given masks and gloves free for at least 15 days all over the country and, after this period, fines should be announced and strictly enforced. Masks and gloves should become part of everyone’s normal dressing routine. You shouldn’t be able to go out without these as you can’t go out without clothes.

Queuing up with social distance should also be made compulsory. Police, rangers, scouts, volunteers, NGO and shopkeepers have to be mobilised on a massive scale and trained to politely request people to queue up with a distance of at least three feet. This is the only means to conquer or flatten the curve. It will take some time, but people must be taught to queue up rather than acting like an unruly mob. The Italian government is mobilising 60,000 volunteers to enforce social distancing. We will need several hundred thousand volunteers for all of Pakistan (urban and rural) for many months. This is finally a chance for the PM’s Tiger Force to show its worth.

In the meantime, the National Command and Operation Centre should chase the target of 50,000 daily tests proposed by WHO. The proposal by WHO of a two-week full lockdown should also be considered seriously. If all rules are followed and the spread is controlled, people can then be rewarded by opening markets from 9 am to 9 pm.

The writer is president of Pakistan Association of Mental Health

Published in Dawn, EOS, June 21st, 2020