As the risks posed by the Covid-19 (novel coronavi­rus) outbreak become clear­er, the public health threat arising from the pandemic has consumed policy-makers worldwide. In Paki­stan, the Government has the un­enviable task of ensuring that its public health system, already un­der-resourced and overburdened, is urgently strengthened to tackle this rapidly expanding pandemic.

Globally, more than 100,000 cas­es of COVID-19 have been con­firmed, including over 80,000 in China. While the number of new cases in China is on the decline, the virus is spreading quickly in other countries, particularly in It­aly, Iran, South Korea and the Unit­ed States. Covid-19 has already led to 10 times more cases as the SARS virus in a significantly shorter pe­riod of time. Using mathemati­cal modelling, Harvard epidemi­ologist Dr. Marc Lipsitchestimates that between 40-70% of the glob­al adult population is likely to con­tract the virus. With a case fatality of approximately 3%, this suggests that50 million fatalities might oc­cur globally. Mortality risk is di­rectly linked with age, and rises to 10- 15% for patients aged 65 and above. How can authorities in Pa­kistan ensure an adequate level of preparedness against the virus?

At highest risk are the elderly (ages 65 and older) and immune compromised patients - a popula­tion of around 10 million people in Pakistan’s case. By conservative estimates, based on the epidemiol­ogy data available, we should pre­pare for possibly 400,000 of these people needing hospitalization and treatment.

The following three steps need to be taken urgently:

1. Ensure adequate availability of diagnostics and effective screen­ing:

Symptom-based screening, the method being employed at our airports, is simply not accurate enough to prevent spread of the vi­rus. Properly validated tests from quality-assured sources need to be made available, quickly and in sufficient quantities, and uti­lized under a thought-out, respon­sive screening strategy. The cur­rent screening criteria used by the US Centers for Disease Control (CDC) are based on recent trav­el history and the presence of fe­ver and severe respiratory illness. Our screening strategy will need to evolve as case patterns emerge, but as a first step, ensuring the avail­ability of quality diagnostics at scale must be a priority - a million tests for use in at-risk populations should be the target. Covid-19 is an RNA virus, and in such viruses, the quantitative Polymerase Chain Reaction (qPCR) tests are the most accurate determinant of infection.

2. Take Adequate Preventive Measures:

While closing schools and busi­nesses may not be warranted at this stage, social gatherings where peo­ple are in close proximity should be discouraged, and the importance of thorough hand washing must be re­peatedly communicated. Surgical face-masks or even the N-95 mask and will not protect the public from the virus. These should be reserved for use by healthcare providers in hospital settings.

3. Develop Capacity for Timely Regulatory Approvals and Stock­piling for Drugs and Vaccines:

It is critical that the government ensure fast-track approval and ad­equate stockpiling of Vaccines and Therapeutics as soon as they be­come internationally available. Our history in this regard is not encouraging: not a single new drug or vaccine was approved by the Pa­kistan authorities in all of 2019. Hundreds of badly needed new medications, including vaccines for highly endemic diseases, med­icines to prevent blindness and drugs to treat cancer remained pending for approval at the level of the Federal Cabinet during the year, causing unnecessary public suffering. A pandemic as rapid in its transmission as covid-19 would test the capacity of even the most efficient of regulators.

While a preventive vaccine will take a year to develop at the earli­est, multiple anti-virals are in late-stage clinical trials international­ly, and may be approved for use as early as next month. It is abso­lutely critical that the Ministry of National Health Services not only take urgent measures to clear its current pendency of drug regis­trations, but adopt a new pathway to process fast-track approvals for vaccines and therapeutics for Covid-19 on the basis of approvals by any of the stringent regulato­ry authorities abroad, such as the FDA or the regulatory bodies of the EU, Australia or Japan. Once treat­ments are approved, proactively entering negotiations with man­ufacturers and stockpiling treat­ment for at least 100,000 patients would be a sensible first target.

From the substantial savings aris­ing from the drop in oil prices, the government should urgently look to set aside $50-100 Million to in­vest in healthcare capacity, screen­ing and treatment of coronavirus patients. Bill Gates, in his excellent article “Responding to Covid-19 – A Once-in-a-Century Pandemic?” published in the New England Jour­nal of Medicine, underscores the need for urgent international col­laboration in vaccine development and approvals, and longer term public health measures, including investing in disease surveillance and strengthening healthcare de­livery systems at the primary level. He sums up his call to action thus: “these are the actions that leaders should be taking now, There is no time to waste.” Let’s hope our lead­ers are listening.

– The writer is a medical doc­tor who is an expert in paediat­ric services