Khurum Khan

COVID-19, also referred to as coronavirus, has again highlighted with all its vim and vigour, vitality and essence, enthusiasm and exuberance that we as Pakistanis, love controversy and burgeon on it! Whether this represents polarisation in our society or is just second nature to us, is trifling, trivial, and moot at this stage!

One point on which polarisation and ambiguity, however, perseveres in our society with remarkable viscosity and inexhaustible consistency remains Coro-na or Na Karo-na!

COVID-19 first emerged on international arena as a health challenge in December 2019, when first case of pneumonia of uncertain aetiology was established in Wuhan, the capital city of Hubei province in China. “Chinese disease” fast emerged as a global pandemic and was as such declared by World Health Organisation (WHO) on 11th March 2020. At this stage, controversy theories on biological war, rested in peace, at least in public arena invariably and almost unanimously - the debate however started in Pakistan at this point - we were a few months late!

Believe that this is a pandemic- Coro-na or naaKaro-Na? Doctors, whether practicing or retired, politicians whether on the scene or in self-proclaimed isolation for months, civil servants whether lazy or hard working, sportsmen whether high calibre or de-skilled, religious scholars whether conventional or modern, media anchors whether financial or political experts - everyone had their opinions, as firm as a rock, but as frail as a breath!

As of 3rd April 2020, more than one million people around globe have been infected with this disease; more than 55,000 deaths within this short time period have been attributed to the virus. 2500 people in Pakistan have at least contracted virus, up to 1/3rd of the world is in self-isolation and we are debating: Quarantine Coro-na or Na Karo-Na! Without further being mordacious, a few points below are worth pondering for us as a society:

1) Epidemiological projections: Neil Ferguson’s epidemiological theory from Imperial College London is not a Protagoras Paradox! Whilst, it’s based on computer modelling rather than real life data, the numbers projected in his paper are as alarming as a loose-lipped politician. That he said: “Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges.

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option.”

As to whether this theory meets its projected morbidity and mortality, cannot be established at this point - the fact that high resource health system such as UK and US are on their knees - is no more a conundrum. Identifying the magnitude of the problem, whether scrupulously or not, is the minimum requirement. Let’s come out of this perplexity of Coro-na or Na karo-na and let’s all agree that COVID-19 is a global reality and the epidemiological projections are not mendacious.

2) Prevention is better than cure: The above phrase is true on most occasions but has no substitute when there is no established cure for the disease!

It’s high time that authorities in Pakistan, provincial vs. federal government; establishment vs. government; government vs. opposition; doctors vs. epidemiologists; hakeems vs. doctors; religious scholars vs. researchers - unanimously ought to agree on one point agenda - self-isolation!

3) Testing or not testing:Most international data on COVID-19 are encumbered by variety of issues including heterogeneity in testing protocols across the globe. One thing that consistently remains an area of incertitude is the dominator! All cause mortality from COVID-19, is of course dependent upon the number of people/patients tested for the virus. For example USA that is currently offering tests to even healthy population demonstrates lower percentage mortality (2100/123,000= 1.71%) compared to the UK (1228/19,522=6.30%), where test is only offered to highly symptomatic patients.

In a health-constrained environment, a balanced approach could be akin to UK approach of offering tests to most deserved individuals with either moderate to severe symptoms such as shortness of breath on exertion, persistent temperature spikes, or frail patients with other co-morbidities or have known contact with COVID-19 positive patients. Notwithstanding, questionable sensitivity of available kits, these still need to be utilised as best as possible.

4) Prophylaxis or not: To this date, no drugs including hydroxychloroquine have demonstrated any value in prophylaxis against COVID-19, and thus should not be readily available to general public - for that matters - our physicians should abstain from experimentation in the absence of any concrete evidence.

In summary, COVID-19 is a global health reality and we need to switch our gears from the philosophy of Na-Karoo-Na to Coro-na!

–The author is an honorary associate professor and consultant medical oncologist in London.