PAKISTAN FACES TWIN THREATS OF PANDEMIC AND FAMINE

The following issue brief was released by PPLDM on 26/04/2020

“We should therefore be hugely alarmed that Pakistan is in the throes of what is very likely the worst pandemic and worst food crisis of the twenty-first century both at the same time. The outbreaks of coronavirus and locusts may together overcome our modern defenses against disease and starvation and, because the rest of the world is so badly affected, Pakistan should not expect much relief coming from abroad.”

Pakistan, along with a large number of other countries, is currently battling two major outbreaks. One is the novel coronavirus causing the disease called COVID-19, currently sweeping the entire world. The other is the desert locust, which has been ravaging large areas of Africa and Asia for some time.

COVID-19 has so far infected nearly 3 million people globally and killed around 200,000, with the numbers continuing to rise. The virus was first discovered in Pakistan at the end of February. Since then it has been spreading rapidly throughout the country. Over 12,000 Pakistanis are now infected and no one can tell how it will turn out. In China, it appears to be dying down after two months of successful containment measures that can be tolerated by countries that have the resources to compensate for periods of low productivity. Some predict that Pakistan will see tens of millions of infections by June (https://www.dawn.com/news/1542651). The death toll could be in the hundreds of thousands.

Meanwhile, the locust swarms are being referred to as an “unprecedented threat to food security” by the UN’s Locust Watch (http://www.fao.org/ag/locusts/en/info/info/index.html). Swarms originating in East Africa started to rampage in countries including Pakistan in mid-2019 but really kicked off after 2020 began, prompting Pakistan to declare a state of national emergency when February began. The infestation has been steadily increasing in Pakistan, causing huge crop losses, and continues to persist without signs of dying down, while countries to the west are being devastated. Experts predict the coming of rising temperatures and summer rainfall might cause locust populations across the region to further explode 400-fold by June (https://www.reuters.com/article/us-africa-locusts/running-out-of-time-east-africa-faces-new-locust-threat-idUSKCN20L1TY). Who knows how much they will grow in South Asia when the summer monsoon comes.

So we now have two severe crises at the same time, one attacking our health and the other our nutrition. Our government has declared that a national lockdown policy is not feasible because the country is too poor to afford its supply chains shutting down, so the virus spread must be countered through other measures. The locust outbreak is wreaking massive economic damage and driving people to hunger, vastly aggravating this conundrum. In turn, the COVID-19 pandemic is hampering international efforts to fight the locust outbreaks. Together the calamities present Pakistan with an unprecedented challenge.

In fact, the danger looming ahead may be something greater than we could ever imagine. Pakistan is facing both an epidemic and a famine at the same time and, throughout history, epidemics and famines have both consistently been the greatest threats to human lives and well-being (besides intra-human war and violence).

Disasters in which people died of other causes usually have minute casualties by comparison. The 1556 Shaanxi earthquake in China, the deadliest known earthquake in history, killed around 830,000 according to historical accounts. The deadliest tsunami, Boxing Day 2004, killed nearly a quarter of a million in the Indian Ocean. Cyclone Bhola, which killed anywhere from a quarter of a million to half a million in East Pakistan in 1970, is the deadliest tropical storm on record. In the same region, a tornado that killed 1,300 people in 1989 is the deadliest known tornado. The deadliest flooding, the 1931 Yangtze floods in China, is believed to have killed more than 150,000 people directly. The deadliest known volcanic eruption, 1815 eruption of Tambora, directly killed perhaps more than 10,000.

All of this is nothing compared to the enormous death tolls of history’s worst epidemics and famines, not to mention the suffering and havoc inflicted alongside. As a side effect of the above calamities, in fact, the 1815 Tambora eruption resulted in epidemics and famines that killed 60,000 people in the local region and more than 90,000 people worldwide, the so-called Year Without a Summer, while as many as four million Chinese may have died from the disease and starvation that stemmed from the 1931 Yangtze floods.

The deadliest pandemic in history is either the 1918 Spanish Flu, which may have killed as many as 50 million people, maybe even 100 million people, worldwide, or the 14th century Black Death, which killed probably as many as 200 million people across Eurasia, including perhaps as much as 60% of Europe’s population. Both pandemics were similar to COVID-19 in that they involved spread of pathogens new to the world. The worst epidemics in history were those of diseases brought to the Americas by European visitors after 1492, which wiped out 90% of American Indians, turning the continents into pristine wildernesses. The sixth century Plague of Justinian may have killed 25 million in the Eastern Mediterranean. 5 million Romans may have been killed by the Antonine Plague of 165 to 180 AD. In the late 1950s, Asian flu killed 1 to 2 million worldwide.

The deadliest famine in history is the Great Chinese Famine of 1959-1961. Caused in part by outbreaks of insects like locusts as well as governmental mismanagement, both concerns for Pakistan right now. Upper estimates of the death toll are 36 or 45 million. As many as 25 million people may have died from the 1907 Great Qing famine in China. Three famines in India in the late 1700s killed at least ten million people. That includes the Great Bengal Famine of 1770 which may have killed a third of Bengal’s population. From 1315 to 1322, more than 7 million were killed in widespread famine across Europe. 5 million Russians starved to death during the famine caused by the Russian Civil War in 1921-22.

With this kind of record, it is clear that epidemics and famine are immensely deadly forces, even if they have been somewhat calmer in modern times. We should therefore be hugely alarmed that Pakistan is in the throes of what is very likely the worst pandemic and worst food crisis of the twenty-first century both at the same time. The outbreaks of coronavirus and locusts may together overcome our modern defenses against disease and starvation and, because the rest of the world is so badly affected, Pakistan should not expect much relief coming from abroad. Both the virus and the locust multiply extremely rapidly and have the potential to infect all people and consume all crops respectively.

All indications, therefore, are that Pakistan is in for what may be the biggest calamity in its history. We need to wake up to the unprecedented danger we are in and we need to do something. Putting Pakistan on a war footing immediately, along with the rest of the world, is perhaps our only choice. Importantly, we have to apply our minds to the task, because discovering innovative solutions that could save us will be an epic endeavor. The severity of the crisis at this stage may be nothing compared to what is coming. We need to avail this time for preparation, which will significantly improve our chances. Every effort will be worth it, for the very survival of our nation is at stake.

THIS ISSUE BRIEF HAS BEEN PREPARED BY SHAHZEB KHAN, DIRECTOR PPLDM.
Pakistan’s People Led Disaster Management
PO Box 552
Islamabad PC 44000

EASING THE BURDEN ON HEALTHCARE DURING COVID-19 PANDEMIC

COVID-19 is not a very dangerous disease as far as diseases go. Many who contract the virus don’t seem to be affected at all. Of those with symptoms, 80 percent end up modestly ill. Among those who do come down with severe illness, only five percent end up in critical condition. We are quite good at treating the disease. If people get adequate medical care, chance of survival is high.

Yet, this virus is plunging the world into chaos for two reasons. First, from the start of the pandemic, nobody in the world had natural immunity to it. Second, the world has no medication that can cure and no vaccination that can prevent the disease. The virus suddenly emerged a few months ago and is spreading rapidly through the world, infecting people in huge numbers and overwhelming health care systems of nation states.

Where the pandemic is in full swing, hospitals are being filled to the brim with patients. In some areas, hospitals lack enough room to take in the surge of patients and new facilities have to be built hastily.
The inability of healthcare systems to cope with the scale of the pandemic is a factor behind the severity of the COVID-19 crisis. When the pandemic gets into full swing in the developing world, which it is likely to do, a massive globe-spanning catastrophe will likely ensue.

Relieving medical systems from the burden is necessary. As preventing people from ever contracting the virus is not likely, the goal most of us hope to achieve is preventing too many people from being infected with the virus at the same time, known as flattening the curve (the curve on the diagram showing the prevalence of infections over time). Most people might still end up getting infected by the time the pandemic is over, but at least patients aren’t streaming into hospitals too fast.

To achieve flattening of the curve, highly restrictive measures are being imposed upon society. Mass gatherings are done away with, people are made to stay home, and non-essential economic activity is halted, but the economic slowdown adversely impacts the capacity of the medical sector itself. Even in the most advanced countries, such measures have often not eased the severity of the medical crisis. Healthcare systems are still feeling tremendous strain in the midst of the pandemic. Italy, for example, turned itself into a ghost country yet ventilators were still rationed for a period of time. As the virus continues its expansion across the world, we will need to find ways to solve this issue.

The overburdening of healthcare is terrible not only for people suffering from COVID-19 but people suffering from other illnesses that requires urgent treatment. People get injured, get cancer, suffer heart attacks, strokes, kidney failure, respiratory distress, etc., and as coronavirus spreads, none of this stops.
This means that this pandemic further endangers people who need medical treatment for ailments besides COVID-19. Conversely, people who have coronavirus find it harder to get treatment because hospitals are busy treating other conditions. It’s happened in Italy. It’s happening in India. Reportedly, it has started happening in Japan. Patients suffering from another disease also run the risk of being infected with COVID-19 if they go to hospitals. If they contract COVID-19 in addition to the conditions they already have, the consequences can be severe. Lockdown measures also make it difficult for them to access treatment.

The situation is the worst for people needing treatment for respiratory ailments, because they need the same equipment and personnel used for treating COVID-19. Ventilators are essential not just for COVID-19 but for a lot of conditions. Most people with severe medical conditions have therefore become indirect victims of the pandemic. It is a grave issue.

We need to find a solution to the conundrum of healthcare systems buckling under COVID-19.

A solution can be found in the alteration the global education system is currently undergoing while in the throes of COVID-19 pandemic. The globe is turning to online education as temporary response to Covid-19 till vaccine is found. All over the world, including Pakistan, buildings that were being used for imparting education to people are shutting down as students are made to stay home and turn to online lessons.

PPLDM has already written about how online education provides cure to many of the fundamental faults in Pakistan’s education system while simultaneously freeing capital for investment in other sectors to accelerate our economic progress. Bill Gates has extrapolated that online education is the future of education because this pandemic will make families afraid to send their children to school and online education will evolve to be of too much convenience to be set aside.

Pakistan can convert its nation-wide school buildings into hospitals where Covid-19 patients are treated. Each room can isolate and serve a single patient, mitigating intra-hospital spread. We can convert some of the local school buildings into testing facilities. Some should be utilized for stockpiling of PPEs. Imran Khan wants to reopen the construction sector to boost economy. Let us start with converting our schools in our urban metropolis, and our rural areas, into general hospitals, hospitals that treat only Covid-19 patients, and medical test facilities including separate Covid-19 test facilities and for stockpiling of Personal Protection Equipment. Part of the buildings in far flung rural areas can be converted into safe housing for doctors with security that includes CCTV cameras. We are currently using our police to strong arm people in urban areas for lock-down enforcement. Police should be instead appointed to ensure security of school buildings thus converted into medical facilities, medical professional’s residences, testing facilities, labs, hospitals and stockpiling facilities. Military can collaborate in this endeavor.

Let us equip our school buildings with state-of-the-art medical machinery. Let us convert them into Covid-19 test facilities for now, and other essential medical facilities for population’s long term benefit. Let us use some of the school buildings as labs and some as PPE manufacturing factories. Let us spend the money international donors are providing Pakistan to fight Covid-19 pandemic in this manner. We will ease the burden on our health care system. We will also provide health care facilities to far-flung areas where Covid-19 is breaking out and where health care is either non-existent or in short supply.

Needless to mention, we have to make 4G and 5G technologies available to our areas where the same is hitherto nonexistent. We have to do this on war footing because these technologies are indispensable for online education/ home schooling to keep students safe from the pandemic without halting our human resource development because we are driven to halting our educational system.

The lawmakers will have to make emergency laws to mandate doctors to work in designated far flung areas during health emergency. Many of those who have recently graduated from medical hospitals in Pakistan, but have opted out of working in the health care sector, should be drafted to work under enforced medical emergency and penalized for not doing so without good reason. In fact, many of our medical graduates do not go on to working in health care sector for no good reason at all. The state spends a huge amount on training of these individuals, but because the state is lax and has no laws for ensuring this crucial sector is staffed with adequate personnel, dropping out is easy and the rate is high. One NGO has estimated the dropout rate among female medical graduates and young workers to be 80%. This high rate is the rate of drop out only among medical doctors and does not include nurses. This practice must be discouraged and the Covid-19 emergency is an apt time to make laws to discourage this practice, indeed, a crime against society because a poor state’s precious capital is wasted by such irresponsible conduct. Those who don’t want to work as medical professionals should not avail the precious seats in Pakistan’s medical colleges and those who have availed them should be committed by law to give a specific period of their post-graduation life to serving in medical profession inside Pakistan. They can go out for further training, but work in Pakistan they must.

The contact tracing is an essential part of containing the spread of Covid-19. It helps collect essential data for researching the pandemic. For instance those who were in contact with a Covid-19 positive person but did not contract the virus are needed for researching if there are natural immunities to the virus.

Pakistan should utilize its students, including medical students, to carry out contact tracing. It can use teachers to supervise how students are carrying out their contact tracing responsibility. Contact tracing can be done from home through emails, cell phone text messaging and mail systems. Those who are entrusted with the job of tracing will have to work in close liaison with the police. Local police stations can make field visits to the residences or work places to help collect data on those who were exposed to the virus. A contact tracing hub should be established where data is collected and shared within Pakistan and with the international community. Pakistan’s software engineers should be mobilized on war footing to establish the hub and its operational mechanism should include local and provincial government, the education sector, the medical sector and the law enforcement, among other necessary personnel.

Infection prevention and control policy at local levels will be enhanced through buildings which have been converted from schools into health care and testing facilities. We should aspire to test as many as we can. We can instruct people in safety measures at testing facilities. We can enter into an arrangement with China and other friendly neighbors whereby we collect samples in Pakistan but send them for testing to labs in friendly neighboring countries that have capacity to do so. China has offered to help. Establishing testing labs in Pakistan and helping with test results is where we should ask China to help. We can also seek help from any friendly neighbors where domestic testing labs are not overburdened.

Testing our population, providing adequate medical treatment to our population and equipping our population with protection against the virus is the most effective way to overcome this calamity.

If our state follows the guidelines provided in this policy brief by converting our education system into online system and converting our existing school buildings in urban and rural areas into healthcare facilities, we would have a long term solution to the most fundamental problems in two critical sectors of our domestic economy; our health care system and our education system.

This PPLDM policy brief has been authored by Zeenia Sadiq Satti & Shahzeb Khan.

Questions about the Coronavirus Pandemic

COVID-19 is a disease completely new to the world. The virus that causes it, SARS-COV-2, evolved recently and was first detected only a few months ago. The pandemic it is causing so far appears to be only beginning. There is a lot we need to find out concerning the COVID-19 pandemic.

There are therefore many questions that we have to ask that urgently need to be answered. Some of these questions the experts may already know the answer to, so they just have to explain it to the general public. But many questions nobody knows the answer to yet. There remains a lot for us to discover about the virus, the disease it causes, its spread around the world, and what we can do about it. There also seems to be a great deal of confusion in the information being given out. Many questions, of course, are widely asked and researchers are trying their hardest to find answers to. But we should also keep thinking of new questions to ask. Asking questions is the most important thing we can do. It helps to guide the research.

So, to aid in the world’s struggle against COVID-19, presented here is a list of questions about the new coronavirus, most of which are rarely asked and none of which are clearly answered. You can present them to local experts or you can disseminate them broadly.

The first questions we need to ask are about the viral disease itself, of course.

•(1) Is it possible for some people to be exposed to the virus but not get infected? Is there immunity that we don’t know of?

•(2) How clearly is the distinction made between illness, which is people being affected by the virus, and infectiousness, which is people being able to transmit the virus to others? For example, when they say that sick people have recovered from COVID-19, do they mean those people are also safely non-contagious?

•(3) When the virus is detected, whether inside the human body or not, how do we distinguish between finding live viruses and the remains of viruses that once were?

•(4) Can it be indicated how people who have the virus got infected?

•(5) There are indications that some people have died of COVID-19 without them being known to have the virus. If an infected person dies and is buried and significant time passes, is it possible to examine their remains to detect if they had the virus?

•(6) Exactly where in the human body is the virus to be found and how many types of bodily fluids can harbor the virus?

•(7) There are some hints about the virus being able to infiltrate the circulatory system. Some infected people display cardiovascular symptoms and sources say some of these cases are from the virus infecting the heart. Also, the virus attacks cells with the ACE2 receptor, which are found in the lungs but also in the blood vessels. This raises the serious question: can the virus be found in blood?

•(8) Can you get the virus through a cut on your skin?

•(9) Could the virus possibly then be vector-borne, like by mosquitoes or ticks?

•(10) They say the virus cannot be contracted by eating food. Presumably, this is because, while the mouth leads to a respiratory tract, it closes when eating. But after food passes by, doesn’t it leave behind virus particles sticking to the walls of the throat and esophagus which can then go into the respiratory tract?

•(11) Also, aren’t gastrointestinal symptoms of COVID-19 a sign that the virus can infiltrate the digestive system?

•(12) Does the likelihood of contracting the virus increase if there are a lot of dust particles in the air and they carry the virus?

•(13) They say that sneezing is not a common symptom of COVID-19, but can people infected with COVID-19 also have another condition at the same time that makes them sneeze, like another infection or an allergy attack, and can this sneezing transmit the virus?

•(14) Does being exposed to any other virus in the past give people a level of immunity to SARS-CoV-2, like how contracting cowpox used to protect people from smallpox? The virus that caused SARS back in 2003 is similar to the virus causing the current pandemic. Are people who were infected with SARS back then less affected by COVID-19 now?

•(15) Can people be immunized against COVID-19 by being exposed to such a low infectious load of the virus that it does not progress to any significant illness but results in antibodies being created?

•(16) We hear that people with underlying health conditions are especially vulnerable to contracting the virus. What happens when people are infected with COVID-19 and with other infectious diseases (of the kind caused by viruses, bacteria, etc.) at the same time? Do other diseases have the same effect they normally do?

•(17) Does COVID-19 leave healthy people with new morbidities, which is to say that they have lingering health damage they did not have before?

•(18) How does childhood stunting affect a person’s vulnerability to COVID-19?

•(19) The old and those in poor health are who usually succumb to Covid-19. Is there any indication that most of the people who died from COVID-19 were already going to die shortly of old age or health complications?

•(20) We understand why the virus goes hard on the old, but not why it spares the very young. The immune systems of young children are yet to fully develop, rendering them vulnerable to many diseases. Why isn’t COVID-19 one of them?

•(21) Are there any conditions which allow the virus to survive for a long period of time outside the human body?

•(22) Can the virus be transmitted through water, rendering COVID-19 a waterborne disease?

•(23) What is the longest length of time a person has been infected or ill with COVID-19?

In a similar vein are the questions about the pandemic, the way the infection is spreading through the world and its impact.

•(24) What is it exactly that makes the pandemic such a severe crisis for people? Is it the mortality from the pandemic that people are mostly concerned about or is it also the debilitating or damaging effects of so many people falling ill (similar to how the recent Australian bushfires and the 2010 Pakistan floods are considered huge disasters despite their very low death tolls)?

•(25) If infections from the virus are undetected, can we find evidence of them by noticing a rise in the general rate of illness?

•(26) How is the COVID-19 pandemic, and our response to it, impacting the treatment of other diseases?

•(27) Are the measures being taken against the pandemic, including lockdowns and keeping people home, resulting in smaller numbers of people falling victim to other illnesses and injuries like car accidents, workplace accidents, violence, and respiratory ailments from pollution, thus compensating for the burden the pandemic is placing on healthcare systems?

•(28) Does the coinciding of the COVID-19 pandemic with flu season and allergy season in many parts of the world worsen the spread of the virus by resulting in many virus-infected people also having flu or allergic reactions and therefore sneezing/coughing the virus out?

•(29) If the virus can be found in human feces, does it have potential to become another one of those diseases spread through the fecal-oral route i.e coming out through feces, contaminating water, therefore food that is ingested?

•(30) What are the implications of the two disasters co-coinciding – the desert locust outbreaks in Africa and Asia and the COVID-19 pandemic?

Then, of course, we need to know all about the actions being taken against the spread of the virus. The ways we are responding to it have to be thoroughly scrutinized and suggestions need to be given as to what can be done.

•(31) Why is it going to take a very long time to develop a vaccine for the virus? Simply exposing the virus to soap causes it to burst open, rendering it inactive but leaving its individual components, like the RNA and spike proteins, intact. These are all that are needed to provoke the needed immune response in the body. Why not collect enough of the virus particles, split them open, and inject the remains into people?

•(32) In the bat species that harbors the ancestral virus, do the bats have antibodies or anything that could be used to help humans?

•(33) They say that flattening the curve could result in the same number of people being infected in the end anyway. The goal is just to make sure too many are not infected at the same time. But in China, the epidemic (at least its first wave) seems to have petered out after two months. How it is that they have so far shortened the curve in addition to flattening it and could this work for other places?

•(34) We have two ways to respond to the pandemic. One is to slow the spread of the virus, flattening the curve, and the other is to do nothing. It is generally believed that the former option will result in the outbreak lasting a longer time while the latter option will result in the outbreak quickly running its course, as was demonstrated by St. Louis and Philadelphia during the 1918 Spanish Flu. But there seem to be indications that blocking the spread results in the epidemic quickly coming to an end, including the fact that it seemingly happened in China, and that letting the virus spread unabated may result in the epidemic lasting a very long time. So which is it? Will flattening the curve prolong or shorten the duration of the outbreak?

•(35) Since COVID-19 patients are being concentrated in hospitals, do those hospitals become highly hazardous places where anybody present is at risk of contracting the virus, including patients hospitalized for other conditions? For that reason, shouldn’t separate facilities and clinics be set aside for COVID-19 patients?

•(36) The severity of the pandemic means that people with limited qualifications are being called upon to help treat the virus, including medical students being allowed to graduate early. But providing the wrong care can be much worse than providing less care. How do we safeguard against these sorts of dangers?

•(37) In hard-hit places, medical practitioners of every specialty are being recruited for the fight against COVID-19. But how qualified are they for the job and how does each medical field provide the ability to deal with COVID-19?

•(38) Given the enormity of the disaster, is there any possibility of resorting to using human experimentation to make inroads into treating the disease?

•(39) We are told that making the immune system healthier can improve our chances of fighting off COVID-19, can immunity boosting for that purpose be done quickly enough through injections of nutrients to keep people safe in this current pandemic?

•(40) Can we coat surfaces everywhere with copper if it is an effective anti-microbial agent against the virus?

•(41) Can dogs or other animals sniff out coronavirus infections?

•(42) Why can’t static electricity be used to filter out tiny particles, like the virus we are all concerned about? Electrostatic forces act on small objects but not on air. So if a facemask has a net static charge, which can easily be created, couldn’t it either make virus particles stick to the fiber or keep virus particles away from the mask while allowing air to flow through?

Lastly, we need to broaden our scope and delve into the more general subject matter that surrounds this current pandemic.

•(43) Why is it that viral infections are such a widespread phenomenon anyway? Viruses do not force their way into cells. What goes on is basically the cell sensing virus proteins, letting the virus in, coming into contact with the virus genome, and deciding to follow its instructions. It appears that cells allow themselves to be victimized by viruses. If nature did not do it, can humans simply design cells to keep viruses out?

•(44) The perfect recipe for a pathogen with high potential to go pandemic includes a long incubation period, high virulence, and hosts with no immunity. But if a pathogen has a very long incubation period, during which time it is present in the human body while causing no harm, doesn’t that give time for the immune system to develop antibodies against it, therefore compromising the pathogen’s ability to progress to causing serious illness? (Might this explain SARS-CoV-2’s low virulence?)

These questions will hopefully serve as useful guidance for both researchers and ordinary folks trying to understand Covid-19. There will be many more we will be asking as we proceed on the voyage of discovery alongside this pandemic.

REVOLUTION IN THE MAKING AS GLOBE TURNS TO ONLINE EDUCATION

For the first time in history, the world is implementing an entirely new teaching model – online education. Necessity is the mother of this invention but unlike other adaptations to survive the Covid-19 pandemic, this one could last. It is a new pedagogical approach and when it develops fully, both teachers and students will find it indispensable.

In Pakistan, every educational institution should have a department dedicated to advances in learning and should conduct R&D for developing further expertise in using new technologies in education to make adaptation easier.

Though online education is called distant learning, it is actually a more intimate experience than class room learning, where a large number of students sit at a distance from their teacher. Online learning screens show a student’s close up, show facial expressions, display the name of the student in a box under the face as the student talks, making it easier for teachers to know students by their names. Students, who sit at home in their comfort zone are less shy of speaking than they are in class rooms inside a school building. Discussing Zoom, Harvard gazette writes, both students and faculty have been discovering all of its benefits. Break out groups and chat rooms are enabling much of the small group interactive pedagogy.

For science education, where labs are necessary instruments of learning, classes are being deferred during corona emergency till students have access to lab facilities. It is this aspect of online learning that requires development of sophisticated virtual programs that create lab like environment for students and teachers both. I see it happening one day.

For Pakistan, the benefits of online learning are enormous. Students and teachers save time commuting to and from schools. They also save capital that is spent on transportation, uniforms, school bags, etc. Families can save substantial portion of their earnings that is spent on children going to school. National savings rate can rise, making more capital available for industrial activity. All the time consumed in getting ready to go to school can be diverted to research and learning. Online learning is of great environmental benefit as it cuts carbon emissions from vehicles used to drive children and staff to and from schools. Carbon emissions have become one of the greatest hazards of our time and cutting down will continue to be the priority of human beings.

Online learning is also the best method of preventing drug trafficking and drug addiction in youth. Educational institutions are places where drug pushers find their markets. Peer pressure, curiosity about popular drugs and social conformity are prime causes of addiction in Pakistan. In online learning, students stay home, research on the internet, take care of the elder members of their family and spend quality time with their seniors. The latter have student’s best interest at heart. They can exercise parental controls to monitor internet usage by young adults and keep them out of harm’s way.

During corona emergency, an unintended consequence of online learning is community-connect on how to respond to the pandemic. Online learning not only allows students and teachers to care for those at home who are at higher risk, the forum can be utilized discussing how society can equip itself for responding to emergency situations. Chat rooms can become forums where personal situations are discussed to establish patterns that underlie issues, and ideas can be discussed to find innovative solutions.

One day, online learning will be able to break the ‘school’ barrier and become more inclusive. The practice may one day establish an online learning community in Pakistan that is nation-wide. Globally, it can erase the north-south divide in education. Already, some of the great educators in top western universities have made themselves available to impart free education to students in developing countries. This movement is likely to grow in strength and will withstand capitalist tendency to make profit by imparting exclusive education. It is, in fact, a great revolution in the making that owes its existence to triumph of higher human ideals, upheld by great philosophical minds of our time, who want to uplift humanity from the darkness of ignorance and find it most satisfying that they can reach out to far off corners of the globe and can impart enlightenment to people with less resources.

Online education is the only means to breaking exclusive barriers in education system of our country. Imran Khan has specifically focused on this problem, in the book he authored during his political campaign and in his policy emphasis after becoming the Prime Minister of Pakistan. A remote teaching hub can create teachers’ teams for different subjects and an inclusive online community of students and teachers can be built across provinces and far flung areas of the country. The urban rural divide can shrink, to the benefit of human resource development in the entire nation. The hub can be designed around a subject, instead of a school.

Online education can only improve the ethics in educational practices. Because of its transparency, teachers are likely to be more motivated to be accurate in their content and competitive in their methods. Abuse of students by teachers is not possible online.

Online education is not vulnerable to terrorism, school shooting, and other disasters such as earthquake or epidemics and pandemics.

Online education will free governments from having to spend on bricks and mortars to educate their people. Only higher professional learning institutions can be built to draw students to a premise. For all other school and college level education, from Kindergarten to Bachelors, online education can be availed as the system of education that gives results without costly investments that have nothing to do with development of human brains. Eco systems in rural areas would benefit because most trees in rural areas are felled to make roads just to access educational institutions. National energy consumption demand would be eased. Money saved from having to construct school buildings can be utilized for providing other services, including tele health.

For post-colonial world, online education is a great way to cement national bonds and keep divisive ethnic prejudice at bay. In greater humanity, it can be means to overcoming racial prejudice and propagating humanitarian justice. Online education can allow for instant translation. Imagine a child in Europe, conversing, up close, with another child of same age somewhere in Africa and both growing up learning ideas together.

Virtual libraries are easier to manage, easier to access, and cheaper to avail. Think of how many trees would be saved if humanity stopped printing books?

The benefits of online learning are many and far out-weigh disadvantages. The only disadvantage in online learning is system’s vulnerability to hacking. Online learning would have to evolve to safeguard against hackers.

Online education is a global revolution in the making. While describing this transformation in learning, I must say that history is ending – and is about to be made.

My country should take this revolution very, very serious. Here, there are to be found solutions to some of the most enduring problems in our education system.

A Strategy to Fight Coronavirus without Damaging Economy

Lockdown is only the most immediate response in controlling the spread of Covid-19, and is meant to buy time, every moment of which is precious and must be utilized to make a nationwide policy for infection mitigation and prevention. Center has to take lead and center-provincial co-ordination is critical to the successful implementation of national pandemic strategy.

If we lock down economy as the sole means to preventing the spread of covid-19, we run the risk of spreading all kinds of fatal social and political ailments, to the detriment of our polity. We make our state hollowed within. The state loses its weight as a functional polity. No political system can afford to pay the price of continued lock down for prolonged unspecified periods, least of all a developing state.

The first and foremost goal of pandemic survival strategy is to prevent the spread of infection. It is infection we must lock down, not ourselves and our economy. It is the spread of infection that must be contained, not economic activity that makes us strong as a polity. So what should we do?

We can take cues from prolonged observation of the foremost social interaction during the global struggle for pandemic survival – between health care professionals and patients. The health care professionals are surrounded by Covid-19 stricken individuals, interact with them from morning to evening, some-time even beyond, and manage to survive at a very high rate. The infection rate among the health-care providers themselves is a decimal fraction of the infection rate amongst unprotected masses who interacted with each other without protection. The death rate due to such infection is even smaller. How do the health care professionals manage this? By covering themselves with personal protection equipment to prevent getting infected and by having access to good health care when and if they have contracted Covid-19. The most necessary part of protection equipment during Covid-19 pandemic is respiratory masks called face masks made of fabric, (our most versatile industry is textile), goggles or face shield, (made of transparent plastic, another cheap material our industry is thriving in), and sanitized hand covering such as surgical gloves (Pakistan is self-sufficient in latex glove production). Shoes and gowns follow after the first three in priority. If medical professionals survive a high rate of infectious load with PPE, think of what ordinary masses can accomplish by doing the same.

The above mentioned first three PPEs need to become the covid-19 survival gear for our entire population. Equipped with the same, amidst added precautionary measures taken during daily interaction such as social distancing (one meter or two) recurrent hand sanitization, avoiding handshakes, coughing and sneezing into folded elbow or tissue, nipping sneeze and cough in the bud by learning how to, (military can share its little training secrets) foregoing unnecessary outing, and keeping our retired elderly population and our children at home and providing for their needs would suffice as the essential anatomy of mass survival strategy during covid-19 health emergency, till the time a vaccine is out and ready to permanently empower humans against the viral enemy.

Needless to mention, we can not rely on global supply chain for PPE. And why should we? Every thing that is required medically for making the PPE, even the ventilators, is available here. We do not require the technology and the raw material that goes into the making of stealth bombers or anti-aircraft missiles. We don’t need iron and steel or lithium. We don’t need extensive mining capacity or advanced hardware and software technology. The raw material required for the PPE is plastic, the cheapest product of modern economies. The social interaction regulation requires legal frameworks, which too is within our means to conceive and enact during pandemic emergency. The enforcement of human behaviour, luckily, does not rely on police only. People’s instinct of survival and psychological fear of the viral enemy is far more powerful and effective a force than any policing mechanism can be. We need to develop awareness raising narratives and spread the same through our 24/7 electronic media which we thrive in as well.

We are spending state’s precious capital resource on providing food to the needy, who we have stopped from fending for themselves by preventing them from working to earn their daily wages. The same capital ought to be spent on increasing the capacity of the manufacturing sector in Pakistan to produce PPEs like the mask, the face shield and the gloves in numbers enough to fulfill the national requirement. Fortunately, unlike India, Pakistan is not plagued with a huge population of one billion plus people. Another luck factor is our youth bulge, the segment that is most capable of surviving Covid-19. In our neighboring countries such as the Middle East and Central Asia, the population is even smaller and more manageable and state’s capital accumulation is far greater due to steady supply of petro dollars for decades. Our region should be able to survive the pandemic better than others if it follows the above mentioned recommendation.

We need to equip our work force with PPEs – not just health care workers but every kind of adult worker. We need to manufacture the PPEs ourselves. We have cheap labour, unlike the west. We need to increase the capacity of our manufacturing sector, through mandatory rules, not polite requests, for production of the required PPEs. We need to arrange for what the WHO calls a “centralized request management facility” to avoid wastage and unnecessary stock piling at one place and desperate need and short supply at another. We need strict stock management regulation to avoid breakage, ruptures, and wastage. We need to provide speedy transportation for nation-wide supply of PPEs. We need to make rules for transporters and freight carriers, create subsidies for them to make timely delivery of items. We need to make laws to compel every kind of transportation available in our economic system, including airlines, trains, buses, trucks, delivery vans, to dedicate vehicles to maintain the PPE supply chain.

Instead, we are thinking of consuming our precious national funds for creating ‘Corona tigers’ to deliver food supplies to our masses, who we have locked down for unforeseeable period till some one in some foreign country invents a vaccine, or till herd immunity is developed. This is the road to stock piling of dead bodies and deadening of our economy. This is the road to decimating our statehood because if an enemy invades us after we are at an advanced stage of stifling of our economy, our ability to combat the enemy will have decreased substantially from the levels at which it stands today. In short, locking down our masses or carrying on our usual economic activity without personal protection against the virus is the road to becoming a vulnerable state – or worse – a failed state.

We need to isolate the virus. We need to lock Covid-19 down. We need to develop infection prevention and control policy that is realistic and allows us to thrive instead of emaciating our economic capacity. Till a vaccine is developed, we need to regulate human behaviour to prevent the spread of infection. We need to make emergency laws to enforce the behaviour that is required for survival. Social interaction laws during Pandemic emergency must be made by our law makers at federal level and enforced through-out the nation with penal penalties because lives are at stake. Enforcement mechanism should be applied nation-wide because the very nature of emergency requires center provincial administrative demarcations to be removed and a holistic, unified policy to be enforced.

We are opening the construction sector. Steel, cement, concrete, bricks do not make PPE. The benefit of construction is long term. Whats more, we face an added danger in following orthodox construction techniques. The danger of climate change induced pandemics and biological warfare requires us to rethink technology that creates high risings. A Harvard professor has expressed apprehension that people who were locked down in western metropolis in high risings were infected through the air ducts whose inadequate filters became means of circulating viral spores in the buildings and caused infection to spread among people who work and live in such buildings in places like New York. Pakistan wants to make affordable housing in the shape of high risings. What kind of filters are we going to use? Can we afford anti viral filters? Can we afford their maintenance? How will we enforce maintenance? Besides, in this time of crisis when every one is praying to God for forgiveness and salvation, we are choosing to follow the path that defies God. Our holy book Quran Shareef tells us not to make permanent concrete structures for living. There is a good scientific reason for this. During natural disasters such as earthquakes, it is the buildings that kill us, not the tremors. While Imran Khan is credited with being the first one to even think of affordable housing, pandemic emergency is not the time to focus state’s energies on this sector. PPLDM has reiterated time and again that the sectors of economy we need to focus on are manufacturing and services. There will be plenty of time to construct buildings when we are out of this crisis.

A cabinet of experts, working on war footing, needs to prioritize sectors of economy that must be made operational. It needs to decide how to expand their capacity to fulfil pandemic fighting requirement. Once we have built our capacity to survive pandemics, we will equip ourselves for all times to come against not just viral attacks but also biological warfare, chemical warfare and hazards of the kind modern humanity is faced with. We will only grow stronger as a nation-state.

If we continue with lockdowns and spend our energies and resources trying to feed people, we will become a state with rapidly shrinking capacity for survival in a competitive world.

Pakistan’s Coronavirus Crisis and Response Strategy

The COVID-19 pandemic is severe and the only way it seems that nations can curb it is by either subjecting the general population to strict lockdown or to extensive testing, monitoring, and treatment, neither of which is easy for Pakistan.

Lockdown is the more feasible option here and many provincial and local governments have implemented it, Sindh being early at it. But Pakistan does not have any total lockdown policy yet. Prime Minister Imran Khan has rejected the idea. In late March, he said that imposing it on the entire nation will cause economic hardship that the nation cannot afford. With 25 percent of the population below the poverty line (before the virus struck), it could result in more people suffering and dying than from the virus itself. Enforcing total lockdown is also something the authorities might not be very capable of. Imran Khan has therefore suggested self-imposed lock down by people deciding when to go out for the most essential reasons. Working class people continue spending time outside their homes interacting with other people regularly in order to put food on their tables, but otherwise, everybody is advised to take strict precautions.

This is, in theory, a good policy. When a contagion spreads through the population, how each individual responds to it depends a lot upon that individual’s situation, which can be difficult for police enforcing lock down to take into account. Some countries battling the pandemic created a policy of requiring people to submit in documented form their reasons for going out, but this is unreasonable as circumstances may require people to instantly leave home in an emergency.  Leave it to the people themselves to handle the situation, and as long as they have their hearts and minds set on protecting themselves and everybody else, they will mount an effective response to the outbreak tailored to their own personal circumstances.

Try translating this idea into practice, though, and you come up against the cold, messy reality. You cannot ever expect everybody to fully cooperate in the right manner. Sure, they might start doing so when the outbreak becomes severe and everybody becomes afraid, but the point is to prevent or forestall just such a situation by taking measures before the virus spreads widely. Getting people involved in that is notoriously difficult as people often don’t have the urge to take action against a threat before it arrives.

Social distancing and other measures to avoid spreading the virus require a lot of discipline. Our is a nation of more than 200 million people. Most of them live in poverty and endure hard circumstances. Millions are not very much in touch with current affairs. Media itself is not well versed in current affairs. A lot are prone to believing and spreading misinformation. Getting them fully onboard the national response to the pandemic is a tremendous challenge.

In the same speech in which he announced no lockdown, Imran Khan had a go at it by imploring his citizens to keep themselves in isolation when they can. But a lot more is needed. Coronavirus is rapidly turning out to be an unprecedented crisis. Our capacity to cope is limited and what we can do may be very costly. To solve this conundrum and find the best strategy to respond to the emergency, let us take a look at just what this pandemic is all about.

Diseases that infect human beings abound in the world, but their prevalence is limited by many people having strong immunity, as well as by modern medical innovations. COVID-19 is a disease that has just come into existence. This means that nobody in the world at the start of 2020 had complete immunity and there was no specific treatment that could effectively counteract it. As a result, the virus is spreading everywhere very rapidly. Anybody exposed to the virus gets infected and becomes a carrier likely to infect lots of other people. The virus’s explosive spread means that you have lots of people who are infected at the same time and this means that anybody runs a good chance of contracting the virus.

As for people who do, in known cases, which is mostly symptomatic cases, the majority of people come down with only mild illness which may require just bed rest. But in around 20 percent of cases, the infected people have to go to the hospital and receive care. Around 5 percent of infected people end up needing intensive care and there are indications that many of them end up with long-term or lifelong complications. The number of infected people who die from COVID-19 varies regionally from 1 to 4 percent. Chances of survival depend mostly on the level of medical care received. Altogether, this is not a very serious disease as far as diseases go. But the speed of its spread and the huge number of fatalities is a catastrophe in the making for the world.

For Imran Khan, and for every leader of a country where poverty is widespread, a big concern is the economic devastation that could result from taking action to arrest the spread of the virus. So it is important to understand what the consequences of not doing so are and just what the impact of the pandemic will be.

Currently, we don’t have any experience to draw upon. The countries where the outbreak has so far been in full swing, and where it has apparently reached its peak, are all rich and developed. The pandemic seems to be only beginning in the Third World. Two Asian countries with different systems that were affected early, China and South Korea, seem to have taken successful measures to stop the outbreak, but it is impossible for Pakistan to replicate their achievements.

We do know fairly well the impact the pandemic can have on people. If a lot of people end up getting infected with the coronavirus, and if they do so in a short period of time so that healthcare systems are overwhelmed, there will be a lot of deaths. Obviously no one wants that.  If 4 percent is the highest death rate (case fatality rate, technically speaking) that this pandemic can wreak here, almost everybody in Pakistan getting infected means that close to ten million people may die before this contagion runs its course. That would be a super-devastating calamity, comparable to calamities suffered by some of the countries worst-affected by World War 2. This scenario is extremely unlikely, but if a good-sized chunk of our population gets infected, which could very well happen, fatalities will run into hundreds of thousands or a few million. No disaster in Pakistan’s 73 years of existence comes close to matching this death toll.

One thing perhaps worth mentioning is that most of these deaths will be of people who are elderly or living with severe health complications, which limits the economic impact of their demise.

Disaster management is not just about saving people from deaths, of course. One issue to keep sight of is people ending up with long-lasting or permanent damage. I wouldn’t use the word “disability” here at all, but doctors have observed that some recovered COVID-19 patients have ended up with what will likely be permanent health complications, including damage to the respiratory system. We could conceivably end up with millions of people in this state. The economic cost of paying their medical bills throughout their lives is there.

We might think that it is okay to be infected with COVID-19, be ill for some time, and then get back to normal. However, the sheer scale of the coronavirus outbreak means that you have lots and lots of people who are ill at the same time, which means that they will not be working and they will be receiving costly medical care. The statistics tell us that 20 percent of people infected and symptomatic will be severely ill.  Laborers who skirt isolation to do essential work will be among the worst affected. The economic consequences of this alone could be devastating.

Not taking measures against the spread of the virus could wreck Pakistan’s economy more than drastic lockdown measures will. Combine that with the human tragedy of scores of people being dead and disabled, the reasons for taking the most stringent emergency measures to arrest the spread of COVID-19 in Pakistan are compelling.

But so are the reasons that counter it. The economic circumstances of millions of Pakistanis are dire and with this pandemic, matters have only gotten worse, with rising food prices and a persistent locust outbreak decimating crops. This will make our response to the coronavirus much, much harder. Pakistan is truly trapped in a dilemma right now.

To find a way out, we first need to understand the basic nature of the pandemic. This coronavirus outbreak is a disaster that relies upon speed. Firstly, the chance of survival for people infected with COVID-19 is reasonably high if they receive adequate medical care, but so many people are getting infected at once that healthcare systems are unable to cope, forcing doctors in many countries to choose who gets to live and who dies.

Secondly, the faster the infection spreads, the more widely the infection can spread. When a lot of people are infected at the same time, it is more likely that they will spread it far and wide. If the virus spread slowly, some people would get infected and then recover and likely acquire immunity, and become non-contagious. The number of infected people at any given time would be low and there would be many immune people. But what is happening all over the world, unfortunately, is that the coronavirus contagion is pouring in much faster than it is draining out and, as a result, the bucket that is the human population is filling up.

Lastly, the enormous and pervasive disruption brought on by the pandemic is something that governments and societies need a lot of time to prepare for. It is best if they have time to prepare before the virus arrives on their doorstep, but once it does, the quicker the virus spreads, the faster the scope of crisis grows, and the less governments and people are able to respond effectively, such as by boosting medical facilities.

That is why governments are so eager to make it as hard as possible for the virus to spread. The whole point of “flattening the curve” is to slow the spread. And as we have just learned, slowing the spread also means containment of spread.

To better understand how this happens, say you are a person who is afraid of contracting the virus. If 30 percent of the people around you are infected and all of the remaining 70 percent are capable of contracting the virus at any moment (are susceptible, in other words), you are in great danger. If only 10 percent of the people around you are infected and another 20 percent are immune because they already had the virus before, you can breathe easier. Even if this goes on for a long time, the more infected people there are, the more immune people there are, and the harder it is for the number of infected people to increase, while the number of immune people continues to increase. This will work out perfectly provided everybody who recovered from the virus has total immunity and can never pass the virus to others again, though, unfortunately, there are doubts about this. Still, if we can manage to reduce the breakneck speed with which SARS-CoV-2 is spreading through human populations, the benefits will be numerous and immense.

Everyone agrees we cannot let this virus freely sweep through our country. But with our current options, the more we are to slow the spread of the virus, the more we have to slow the economic activity that provides people with their livelihoods. We have to try to find the perfect balance in-between flattening the curve and keeping the supply chains running. Imran Khan has said that the agricultural sector is open and he also wants to keep the construction business open so livelihoods can be sustained. That might be a bad idea, because the best strategy during this pandemic should be to only keep those sectors open which are needed for responding to the crisis. It has worked perfectly well in South Korea, where they put manufacturers into overdrive instead of society into lockdown. Constructing buildings is too long-term an endeavor. But agriculture is vital because people need to eat during the pandemic. Also, farming is a type of work which does not require lots of people to be near each other. Manufacturing sector is required for making medical and related equipment.

Pakistan is a nation with limited means, where poverty is widespread. We have nowhere near the ability that America, China, and Italy have for shutting down. The developed nations, where the outbreaks have emerged first, have plenty of resources to get through a period of reduced production. But if we don’t keep producing, not only will most of our 200 million people suffer very badly, but our ability to manage the pandemic will be compromised.

There is one strategy to protect both human well-being and the economy in the face of the pandemic which is well within our means. Not everyone is equally vulnerable to the coronavirus. Only a minority are at high risk of dying or becoming critically ill if infected. They are the elderly and those with underlying health conditions. We need to carefully examine all the statistics for known COVID-19 infections in the world to get a clear picture of just what kind of people are at high risk, what makes people vulnerable. Then, instead of the “keep everybody isolated” idea that many countries are trying, we can only keep those people isolated who are very vulnerable. The infection is likely to spread very widely among the sea of young, healthy people if we are to go with Imran Khan’s “keep society running” idea, but it will lead to Pakistan gaining herd immunity that will safeguard against future spread of the virus while casualties will be minimal.

This strategy will serve the goal of maintaining economic productivity so that Pakistanis don’t sink into destitution. It is the young, healthy adults who are the backbone of the economy and elderly people, as a rule, contribute little muscle power to productivity (their power is confined to intellectual mostly). Also, like most developing countries, Pakistan’s population is skewed towards youth. That means there are a lot of young people who can continue working, and only a small number of old people who will have to stay home. But what about the category of people with underlying conditions? People suffering chronic ailments are usually the minority in any society, so keeping them indoors is also manageable. However, poor health conditions are widespread in Pakistan, which could make this task harder.

Yet, this is going to have to be our strategy, if Pakistan is to make it through the worst pandemic in a hundred years. It has enormous potential. Those who are in the prime of their life and in fit condition should minimize the risk of coronavirus exposure by equipping themselves with personal protection (dressing up differently) as they keep the lifelines of the nation running, while the most vulnerable should be locked down and receive utmost protection. Manufacturing sector will have to be regulated towards manufacturing goods required during pandemic life style.

The practice of dropping supplies at door steps should be implemented with the elderly and the chronically sick.  They should be isolated and locked down, and government should help create infrastructure for their protection.

We can not have any hope of containing the epidemic in just a few months, like China seems to have done, so the outbreak in the nation will probably last a long time, possibly even two years, unless medical breakthrough comes first. That is a long time for any human being to be confined, but in that period, we can develop ways to enable the isolated segment of our nation to live fuller lives while still staying safe. Even  the elderly and those suffering ailments who live life locked in their homes can contribute during health emergency by making masks at home for distribution to the nation.  The know-how and equipment can be supplied to them.

Ultimately, defeating the coronavirus threat will require the will of the people. It can’t just be done by the authorities controlling everything. The masses of Pakistan will respond to Imran Khan’s call to do what they can to keep the virus and the disease at bay, if their options are properly explained to them. It will require methodical social management and effective public communication to inspire cooperation and enable efficient collective action.  For this to happen, the authorities must follow a singular scientific approach, based on the advice of professionals and experts.

To conclude, our advice is: isolate and lock-down the vulnerable and gainfully provide for them. Equip the young and sturdy with personal protection against virus and let them continue with their work. Carefully nurture sectors of economy needed during pandemic outbreak. Manufacturing and agriculture sector, not construction, should be encouraged to be of use during pandemic economy. When we have managed to successfully get our nation through the pandemic by keeping everyone safe, we will be better able to recover and build back Pakistan better than it was before.

An Age of Storms: COVID-19 Pandemic and the Weather

It’s been raining a lot in Pakistan these days. For the last several days, it has been constantly raining hard in Islamabad. It is often raining in the morning and then again in the night. There has also been heavy rainfall in other parts of the country through the month of March. Unfortunately, these rains have caused a number of deaths and serious injuries. They have even been so severe as to make houses collapse. Reportedly, 7 people in Khyber-Pakhtunkwha have recently died because of the storms. In early March, up to 24 people were reportedly killed across Pakistan.

A lot of damage has also been caused because of these rains and various other forms of severe weather occurring across the nation. Pakistanis in many areas have had to contend with heavy snowfall, freezing temperatures, hail, landslides, and minor floods. As a result, they have suffered significant agricultural losses. Wheat harvests in Bahawalpur appear to have been completely devastated. In addition, roads have been blocked, structures have been damaged, and people have suffered major disruptions of gas and electricity supply (Source: https://tribune.com.pk/story/2171627/1-24-killed-heavy-rain-wreaks-havoc-pakistan/).

Of course, such spells of bad weather are right now seemingly the least of our concerns as Pakistan battles the COVID-19 pandemic. Though it has not yet affected us severely, fear of how bad it could ultimately get is goading the nation towards extreme measures like imposing lockdowns on the population. The consequences of this contagion could be devastating for the entire country. But in this difficult time, in which everything is changing in ways we could never have imagined, experiencing the familiar sight of spring rainstorms got me thinking about what it can mean for us in our present situation.

For starters, people everywhere are supposed to stay home and limit how much they go out, including in Islamabad. The rain and cold makes it a little bit easier. People always stay indoors during rainy days. Perhaps, then, rain could be a boon for us during this pandemic. Whenever bad weather is happening somewhere, the spread of the virus probably slows down there. The rain, the cold, and the snow are keeping many Pakistanis indoors and preventing them from traveling. Landslides have also blocked a few transportation routes, which could limit the spread of the disease. We cannot rely on this weather to be any kind of saving grace, but the authorities might utilize it and formulate their coronavirus strategy in conjunction with the spells of severe weather happening across the country.

For example, they can relax their virus response in areas suffering bad weather, diverting resources and personnel from there to other places, trusting nature to keep people quarantined for the time being. Or they can send workers to weather-stricken areas to fix things up for the virus response, expecting that other people won’t go outside and potentially infect them. But it may not be all that good. The pandemic is already severely straining the country and the occurrence of any extreme event like severe weather in such a time can be disastrous.

When I took one of my rare excursions outside my home in Islamabad during one of the recent rainy days, I saw that water was flowing across the streets. I wonder if this gives us a sort of beneficial cleansing for these times. As infected people move around outside, the coronavirus they shed may end up contaminating the streets by the landing of respiratory droplets, people spitting, and the littering of objects people were touching. People who go out can get the virus on their shoes and then bring it into their homes. So if rain comes and gives the streets a cleansing, what sort of effect does this have on possible coronavirus contamination? Does the rain wash the virus away and make the ground safer? Does it also, on the other hand, spread coronavirus contamination? Does the water get to be contaminated and be therefore a COVID-19 hazard? I have no idea but I think the ecology of the virus outside the human body is more complex than we realize and we really should study it more and seek to fully understand how SARS-COV-2 moves through the environment.

In this time of unprecedented crisis, when it seems that any feasible solution is out of our grasp right now, we will need to think outside the box and get really creative. Some unusual solutions could help us in the fight the pandemic and one we should look into is welcoming the landslides. It is a regular occurrence in Pakistan’s mountainous areas. A landslide occurs, blocks travel, and then we rush with bulldozers to clear it out. But if the virus spreads through people traveling, then maybe the blocking of roads due to landslides, avalanches, rock falls, and floods could be a lifesaver. The virus outbreak is severe in Gilgit-Baltistan. If we give nature free rein to block roads there and even help it to do so, then we may have fewer of these spreaders introducing the virus to new communities while our efforts remain devoted to the handling of the pandemic.

This tactic, however, has potentially huge downsides. When people do get infected, medical care needs to be delivered to them and bad weather getting in the way of delivery is a recipe for disaster. The spread of the virus may be less but the danger it poses may be more. Also, aid workers need to be sent around to help communities safeguard against the outbreak. Lastly, keeping people supplied with the necessities of life is one of the biggest issues in this epidemic. As travel is restricted and national production slows down, bad weather closing the roads can further add to the deprivation that people already face due to COVID-19.

So if we have landslides or storms or snow blocking traffic in Pakistan, what is its net impact on society during this pandemic? Does the good it causes outweigh the bad or does the bad it causes outweigh the good? We need to conduct comprehensive situation analysis to find out and then let it inform our decisions. We are treading on a thin line in almost everything when it comes to COVID-19. It has just been announced that the authorities are sealing off one part of Pakistan, the mountainous area of Chitral, where no cases of COVID-19 are known yet (Source: https://www.aa.com.tr/en/asia-pacific/pakistan-seals-northern-region-with-no-covid-19-case/1788194). This is a sensible measure for any place where the virus has not gained a foothold. But where the virus has already reached and is spreading, there has to be a flow of some people there to bring aid. It wouldn’t really matter if any of them carry the virus because the virus is already there.

Sealing off travel can be quickly implemented and quickly reversed by the authorities at will. But if some untoward phenomenon like the weather gets involved in this, we can only observe what will happen. I wonder what would be the consequences of an event like the 2010 Attabad landslide happening right now (https://earthobservatory.nasa.gov/images/43175/landslide-lake-in-northwest-pakistan). The impounding of the Karakorum Highway and the trapping of entire communities behind a dammed lake could be a saving grace for the region, containing the virus or at least hampering its spread. But on the other hand, the people suffering this incident while the pandemic is already coming upon them could have devastating consequences.

Weather forecasting may potentially be of great use to us during the pandemic. Weather likely plays a big role in how COVID-19 spreads and how we can react to it. So if we know what the weather will be like in the days ahead, we may be able to make predictions about the course of the pandemic and what measures we should prepare. The weather may slow the spread of the virus by itself and make it easier for us to do so or it may worsen the spread of the virus and the illness of those infected by it and hamper our response to the pandemic. Whatever the case, we got to watch out for whatever weather is coming and figure out how it may interact with the virus outbreak.

It is very important. Pakistan is a country very prone to natural hazards. We might be used to it, but as stated before, an extreme event occurring during this pandemic can result in calamity. We just won’t be able to handle so much. Right now is a pretty dangerous time. Severe weather often occurs in Pakistan in the spring, including cyclones. But in this part of the world, the season for hazardous weather does not kick off until the arrival of the summer monsoon.

Widespread flooding frequently happens in Pakistan during the summer monsoon. It can often be very severe, such as in the years 2010-2014. When such a thing happens, people’s lives can be turned upside down and their homes can be destroyed and they can be displaced. In such circumstances, Pakistanis would not stand a chance against the COVID-19 pandemic. In a mild flood scenario, people may be stranded at home and prevented from moving about, acting to hamper the spread of the virus. But in severe flooding, social distancing, sanitation, medical care, and everything needed to fight the virus can become impossible. If large numbers of people are displaced, they can travel long distances and congregate together. Whether in a refugee camp or a small piece of land remaining above the water, people can crowd and live together very densely in filthy conditions with no ability to wash their hands or wear protective gear. People who are sick may not be able to be quarantined in any way. Their access to medical treatment may be impossible. Floods are very good at blocking access to supplies. Plus, the floods themselves can create a large number of people needing medical treatment in addition to COVID-19 patients, overburdening the healthcare system.

The healthcare system being overburdened is a huge concern, and so, unfortunate to say, disease outbreaks are very common in Pakistan during the summer monsoon, especially during floods. The mosquito-borne disease dengue is a particularly big concern. A dengue outbreak in 2011 strained the nation’s healthcare system, requiring military help and the construction of field hospitals (Sources: https://dailytimes.com.pk/477797/dengue-and-how-it-was-controlled-in-2011/, https://tribune.com.pk/story/250366/emergency-measures-army-joins-dengue-fight-on-sharifs-request/). If a major epidemic of dengue or cholera occurs while we are coping with the COVID-19 pandemic, the consequences could be very bad.

The summer monsoon always plays Russian roulette with the livelihood of millions of Pakistanis. It sometimes brings less rain than usual, resulting in water shortages that farmers can’t handle. Sometimes, full-scale droughts occur. If devastating floods occur, that can also cause immense damage to the agricultural sector, as well as all kinds of other damage. Transportation can be blocked and infrastructure can be destroyed. Life can grind to a halt for millions. It is not a good idea for any of this to happen when Pakistan is in the throes of this coronavirus. Treatment for coronavirus and measures to stop its spread can be hampered, for one thing. Also, deprivation will be pushed on Pakistanis by many people falling sick and by measures being taken to stop the disease spreading. Deprivation caused by floods will be added to this.

Our biggest famine threat right now comes from the locust swarms currently ravaging Africa and Asia (Source: https://www.csis.org/analysis/africa-and-asia-have-several-hundred-billion-more-problems-besides-covid-19). Generated by heavy rainfall in East Africa, it has been going on for a long time and seems to only be getting worse, as locusts are breeding within and around Pakistan (Source: https://www.iol.co.za/business-report/international/our-children-will-starve-say-pakistan-farmers-as-locusts-breed-45118469). The summer monsoon is a good time for locusts to breed because they abound when heavy rainfall causes vegetation to bloom. Flooding could therefore bring us further locust plagues and with some crops smothered by water and other crops devoured by the insects, there could be severe food shortages. People will then have to go out and interact with each other as they work harder to get food, social distancing will be impossible, and the virus will spread. Also, locust outbreaks can often be controlled with modern techniques, but it will be hard to apply them when there is also a severe pandemic to fight.

Even if the monsoon rainfall up ahead is not severe enough to cause flooding, it could worsen the locust outbreak, along with causing outbreaks of dangerous mosquitoes. People can’t stay home. They have to go out to struggle to get food, contracting COVID-19 or a mosquito-borne disease along the way and too many people fall sick for hospitals to handle. Not a very good situation all around. There is just so much that can go wrong in the months ahead.

Right now is the beginning of April. The monsoon rains usually arrive at the end of June. That is only three months away. Some experts predict that, without strict containment measures, 20 million people in Pakistan could be infected by June of this year. (Source: Coronapocalypse! https://www.dawn.com/news/1542651.) This would truly be a catastrophic situation. Then the summer monsoon will begin shortly afterwards and if it gives us any trouble, we simply won’t be able to cope. Plus, the outbreak could expand even more and millions more could end up infected. Assuming we do adopt strict containment measures and keep the virus under control, if we have to continue doing so during the monsoon season, severe monsoon weather could make it much, much more difficult. We might be forced to yield and then cases of infection will explode.

Every single South Asian monsoon season is unpredictable. We never know what it will bring us and that is why we should be really concerned right now. The worst monsoon flooding ever to happen in Pakistan was in 2010, when a fifth of the country was flooded and 20 million people were affected. If 20 million really do fall sick from COVID-19, then a comparably severe disaster will ensue after the passage of ten years. But let us imagine that both of these disasters occurred at the exact same time. Imagine that 20 million Pakistanis are infected by June and then the 2020 summer monsoon brings the same sort of rainfall to Pakistan that the 2010 summer monsoon did. I imagine the result would be apocalyptic for our nation.

This is very unlikely to happen though. The monsoon was recently behaving in an unusual manner. We had these unprecedented floods in 2010 and then more flooding every monsoon up to 2015. But after that, the summer monsoon has been relatively calm every year. But judging by its historical patterns, the probability is very good that Pakistan will be struck with severe flooding in the months ahead.

We cannot prevent this if it were to happen. But is there any chance or any way that we can avoid the COVID-19 outbreak happening during that time so that Pakistan doesn’t have to fight a two-front war? In China, the epidemic raged for three months, starting in the beginning of January. Now, it is dying down, new local infections are rare, and life in China is starting to come back to normal. If the same thing happens here in Pakistan, then the epidemic, which began at the beginning of March, will go away in time for the arrival of the monsoon. But China successfully contained the virus by enforcing strict lockdown measures and it is a very prosperous country. Pakistan has very little capacity to do any of the things China did. PM Imran Khan has said that locking down Pakistan will cause more harm through impoverishment than the virus will, especially with the economic problems and rising food prices happening right now. So it is expected that the virus outbreak will progress to a very high level in Pakistan. That means that it should go on for a long time.

Now, hold on a minute, the epidemic going on for a lengthy period of time is also what everyone is clamoring for. This is the whole “flatten the curve” protocol. With proper medical treatment, people have a high chance of recovering from being ill with COVID-19. But the pandemic is wreaking so much havoc because it is causing so many people to be infected so rapidly that healthcare systems around the world cannot cope. So if we slow the spread of the virus, the burden on the medical sector is kept low, even if it persists for a long time until the virus runs out of fresh people to target or a medical breakthrough that can fight it is achieved. Therefore, if Pakistan successfully flattens the curve, the coronavirus outbreak will be kept under low intensity, but it may continue going on and on for a long time, most likely well into the monsoon season. If that season brings severe flooding or some other disturbance, everything could break down and Pakistan will have a convergence of calamities on its own.

(Note: Reading the two paragraphs above might be confusing, as the first one says lack of containment measures will prolong the epidemic and the next one says that it is containment measures that will prolong the epidemic. But there is an explanation of the confusion several paragraphs down. Also, by the end of this article, you will hopefully understand the perplexing nature of the subject.)

We may therefore be standing on the cusp of a profound quandary. If we let the virus run rampant, it will infect huge numbers of Pakistanis in a short period of time. Medical services will be overwhelmed and many, many people will die. But the virus will have probably run its course by the end of June.

If we put roadblocks in front of the virus, then the number of people who fall ill every day is very low, so hospitals can take in the steady stream of patients and save many lives. But this goes on for months on end and then the monsoon season begins. If it brings widespread flooding to Pakistan, then “flattening of the curve” will come to an end as we cannot fight the pandemic and the floods at the same time. This will cause the spread of the virus to skyrocket, leading to a flood of infections at the same time the country is dealing with a flood of water. Locusts may be swarming everywhere and we cannot fight them effectively because we are fighting coronavirus at the same time. Mosquitoes may be biting everyone, clogging the hospitals even harder. We cannot deliver essential supplies and lifesaving medicine to people across the floodwaters while flood-stricken people who desperately wade through these waters will spread COVID-19. Pakistan is smothered under the combined burden of all these events and, in the end, many, many more people could end up dead and the survivors will be left to struggle in a devastated nation.

So do we flatten the curve or do we let it grow? The idea of foregoing “flattening the curve” has already been considered elsewhere during this pandemic. The alternative is achieving “herd immunity”. It involves letting the infection spread unhindered and Britain originally planned to do this. The idea is that only a small minority of people will die if infected by the virus, but they all run a big chance of contracting the virus because everyone around them is being infected and is passing on the virus. The virus is spreading through the general population because they lack immunity, but they will gain immunity to it after recovering from the illness. So the epidemic, if unhindered, will run out of steam after a short period of time. During that short period of time, people who are especially vulnerable if they get infected can be kept well-protected. Afterwards, they will be protected by the herd immunity of their country.

Sounds like a plan crazy enough to work, but by now, it has been generally rejected as too risky. But in Pakistan, where we have to deal with the contingency of a very erratic rainy season from June to September, is it possible that “flattening the curve” is actually the riskier option? Perhaps if we go with seeking to achieve herd immunity, we can make the coronavirus outbreak as brief as possible. Then, when the summer monsoon arrives, we can concentrate on preparing for whatever trouble it brings us without having also to deal with the coronavirus. If done right, we can successfully minimize the number of people who die or are seriously harmed.

Flattening the curve could be considered as being for rich countries, while a country like Pakistan may conceivably have to go with the tougher option of herd immunity. Imran Khan’s rationale is that the country has to keep working. Now, the people who are most vulnerable to coronavirus are the elderly and those with health problems. Such people usually do not work anyway and are a minority in Pakistan where there are so many young people. Our strategy may to identify everybody who is at high risk and have them isolated from the rest of society. All the young, healthy people can continue working and will be trusted to come down with only mild symptoms. Once enough of them have been infected and recovered to achieve herd immunity, the partial lockdown can be ended. Hopefully, this can all be finished before the possibility of floods.

But not containing the spread of the virus is still a drastic course of action. Perhaps we should only resort to trying to make the epidemic end by July if there are indications that the upcoming monsoon season will be hazardous. And just when you thought this year 2020 couldn’t be getting any worse, there are. Floods in Pakistan often occur when there is a La Nina weather condition in the Pacific Ocean. Many meteorologists predict that a La Nina system could develop by late summer or fall. One meteorologist, Dr. Michael Ventrice (http://www.atmos.albany.edu/student/ventrice/documents/Resume.pdf), suggests that it could be the strongest La Nina since the one of 2010-2012 (which caused those severe floods in Pakistan).

(Source: https://www.nbc12.com/2020/03/31/la-nia-may-develop-by-fall-could-mean-active-intense-hurricane-season-ahead/)

Clearly, there are some very dangerous times right now for us. And the worst part is our inability to determine what will happen. There is a lot of uncertainty about the outcomes of whatever option we take. We should expect that containing the virus means the outbreak will last a very long time and letting it spread means the outbreak will last a short amount of time. But in China, where they were containing it, they were able to relax after just two months and the outbreak, so far, seems to have died out. Meanwhile, it is Pakistan not being able to suppress the spread of the virus that is supposed to lead to 20 million infections three months from now if. The fact is that the same phenomenon may lead to different outcomes depending on the situation. Also, in the “20 million by June” scenario, the epidemic might just end there. So there are no more new cases of the coronavirus during the monsoon but the nation will have to take care of a lot of sick people. Also, monsoon floods might add in extra input that leads to even more people being infected. But this is a really big question that we need to resolve. Does containing the spread prolong or shorten the epidemic, or more to the point, where does it do what?

If Pakistan does what China does and achieves the same outcome China did, it would be the best scenario. As few people as possible would be infected and the monsoon season will hopefully be coronavirus-free. But it seems that Pakistan can’t do it. It is impossible. What we could try is deliberately getting most of the population infected very quickly. Maybe we can go and inject the virus into millions of Pakistanis (who are carefully chosen). But, really, it is just very drastic.

If Pakistan does not have hopes of making the epidemic come to an end before the monsoon season is in full swing, then at least we can prepare for a combined coronavirus-monsoon crisis starting right now. A long period of preparation appears to be key. If countries around the world started a full-scale response to the coronavirus as soon as news of its outbreak in China came in late January, then they probably would not be suffering so much right now. Pakistan did not do anything during the whole month of February. Let us not make the same mistake right now. We need to be concerned about any eventuality and we need to build-up our capacity to respond to them. Then, we might be able to respond effectively to disasters possibly coming in the months ahead. We must not be complacent and decide to respond to problems only when they come. At the very least, thinking of solutions to the problems described in this article is a really hard task in itself, so the longer we have the time to do it, the better it is, so we better start thinking now.

Our best strategy, as always, is to hope for the best and expect the worst. Let us hope that nature remains friendly for the duration of the epidemic and doesn’t give us further concerns to worry about, that the rains come in the right manner to allow our agricultural harvests to bloom, and that any bad weather that does happen only has the effect of confining people to their homes and to their local areas so as to restrict the spread of the virus. Let us expect that weather-related disasters could come along and strain our country’s emergency response capacity to the limit, that the locust infestations will get worse as time goes on and produce a severe food crisis, that disasters will turn people into refugees that act as the ideal conduit for the virus and prevent us from delivering the means to fight it, and that the projected La Nina will bring back the monsoon catastrophes of 2010-2012 at a time when our nation is already fighting some of the worst kinds of crises possible.

In the meantime, let us remain calm. We got to think rationally about our situation and our outlook and all of Pakistan has to be united in getting things under control. We are already struggling a lot but much worse is likely to come, both with the current trajectory of the virus and with other circumstances coinciding with it. We must not regard this pandemic as existing in a vacuum, as being an issue separate from all our other issues. When you have a crisis of a nature and a magnitude like the COVID-19 pandemic, a lot of different events and circumstances, including other disasters, are going to interact with it and could create a sort of multi-faceted crisis that Pakistan needs to mount an integrated response to.

We may think that because the coronavirus is such a big menace, it should be our
foremost concern and everything else can take a backseat, but actually, this is a time that we especially have to be on the guard against other menaces. We are going through a time of crises. We need to think of a broad strategy to handle what we are faced with. Speed is of the essence, above all else.

These are stormy days. Sitting and listening to the rainfall and thunderstorms outside can give one either a calming sensation or a sense of gloomy foreboding. Our prospects are very uncertain. Maybe we don’t realize that enough. We don’t know if anything that happens makes things better or makes things worse, but we do know that we have to act. As we brace ourselves for the massive storm that is the pandemic, experiencing these real storms should be a reminder for us of how just about anything can happen and we have to get ready for anything. We might have many things coming together to create a perfect storm. If we are to keep our people safe in these dangerous times, if Pakistan is to weather whatever storm comes our way, let us make sure that we are one step ahead.

About the Author:
Shahzeb Khan is a journalist, environment activist, and co-director at PPLDM.