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Pakistan - Coronavirus - COVID-19

Pakistan's public healthcare system is among the worst in the world. In 2019, the Pakistani government allocated only 13 billion rupees (€0.16 billion, $0.174 billion) for its federal health budget. With a population of 220 million, a ramshackle health and hygiene infrastructure and densely packed urban neighbourhoods, Pakistan was considered by many to be a prime candidate to see the worst of the coronavirus pandemic.

Pakistan's countrywide tally of cases stood at 1,005 by 24 March 2020, with 14 patients having recovered and seven fatalities, according to government data. The number of cases has more than tripled in a week. Authorities have been scrambling to control the spread of the virus, although they did not yet appear to be at a level that could overwhelm Pakistan's fragile healthcare system.

Pakistan's government imposed varying restrictions across the country, in part, Prime Minister Imran Khan has said, to safeguard the incomes of daily wage workers. In Islamabad, public gatherings are banned, schools are closed and all shops other than those selling groceries or medicines have been shut down. in Islamabad, the streets of the capital were largely deserted, with shops in normally busy commercial areas shuttered and police enforcing lockdown orders. Other provinces and regions followed a largely similar model, with Sindh province, which has the highest number of cases - at least 410, enforcing a stricter lockdown with full city shutdowns mandated between 8pm and 8am every night. "A lockdown is not a curfew," PM Khan reiterated in a news conference on 24 March 2020. "When you enforce a curfew, what will your poorest segment of society do?"

In Pakistan, Islamic authorities resisted state pressure to close mosques, and the government refused to take strong actions against them. The politics around Islamic authority in Pakistan is an immensely competitive space, and this competition shapes the refusal of the ulema to implement the closing of mosques despite the dire threat of Covid-19. Nobody wants to be seen as backing down from the commitment to a foundational religious practice like congregational prayer. In the competition for being the authentic and true representatives of Islam, admitting the need to close mosques is to cede the symbolic value of Islamic faith to others.

By 28 March 2020 Pakistan had crossed 1,200 confirmed cases of COVID-19, and the actual infected was likely significantly higher. Yet, unlike other countries like Kuwait, Saudi Arabia, and Egypt, Pakistan had not banned congregational prayers that pose a clear threat to public health. In mid-March, thousands thronged to Raiwind for the annual congregation of the Tablighi Jamaat, a transnational Islamic piety movement. The Federal Government requested that the congregation be suspended – but only on the second day. For weeks, congregations in mosques continued despite dire warnings. On 26 March 2020, a council of the country's most prominent Islamic ulema met and all but one, a Shia representative, proclaimed that mosques should remain open and that Friday congregation prayers should proceed, albeit shortened.

The government announced that while mosques would remain open, mosque congregations should not exceed three to five, a welcome policy, to which a few prominent Islamic scholars have acceded. But, many others insist that mosques remain open and congregational prayers continue. Congregational prayers are, of course, a pillar of Islam and understood by many as a mandatory requirement, but throughout the world, Muslims are adjusting their religious duties to save lives.

The mosque economy depends on alms and is therefore tied to the flow of bodies in the mosque. To demand a closing of mosques can, then, potentially invite the ire of one's constituency. The ruling Pakistan-Tehreek I Insaf (PTI) government led by Imran Khan has been notably reluctant to take bold action. This is because the PTI has placed Islam at the centre of its populist politics. To override the collective body of ulema is very difficult for a government that routinely affirms its Islamic credentials.

There were 41 hospitals across the country offering more than 119,000 hospital beds in isolation wards, according to government data. In addition, hospitals and ad hoc facilities are offering more than 162,000 beds in quarantine facilities, the data shows. Badly managed quarantine facilities, however, have been at the centre of the coronavirus outbreak in Pakistan. At least 51 percent of all cases in Pakistan can be traced back to the Taftan quarantine camp, where thousands of Pakistanis returning from Iran - one of the countries worst-hit by the virus - were pooled together in a single space, without adequate screening.

Thousands of Pakistanis, mostly pilgrims, were placed into quarantine at the Taftan border crossing in the southwestern province of Balochistan after returning from Iran, one of the world's worst-affected countries. However, at least 119 of those people who were released have since tested positive after entering other regions of the country, officials said.

The chief minister of Balochistan said the area had housed some 5,000 people who had reentered Pakistan in early March. Amid the steep rise in known cases, Pakistani authorities have moved to discourage crowds and gatherings. Islamabad on March 17 announced that all gyms, swimming pools, religious shrines, and children's parks will remain closed for three weeks. Health officials in Punjab, Pakistan's largest province, on March 17 urged the public to avoid unnecessary social contacts or traveling and to stay indoors. Pakistan also postponed its Super League cricket tournament.

On April 6, police used force against protesting doctors in the western city of Quetta. The doctors were demanding that authorities provide them with protective gear in hospitals. Thousands of health workers are on the frontline to battle the pandemic, but a lack of PPE and other health facilities have exposed them to the risk of contracting the disease.

On 14 April 2020 the Pakistani government extended the countrywide lockdown for two more weeks but eased some restrictions. The country's clerics say they will hold congregational prayers and will no longer follow government orders against mass prayers. As the Islamic month of Ramadan was around the corner, special mass prayers could hamper Pakistan's efforts to slow the spread of COVID-19. Pakistan has recorded close to 7,000 coronavirus cases and 128 related deaths.

The government has extended the nationwide lockdown till May 9. However, it switched to a so-called "smart lockdown" from 25 April 2020 under which it will implement targeted tracking and tracing of cases while allowing some industrial and commercial activities to begin under safety guidelines. "Isolating these cases and their contacts will improve our ability to contain the disease alongside allowing the economy to function and people to get employment," said Asad Umar, Pakistan's planning minister, who also oversees the coronavirus national response body. "This upcoming month of Ramadan will be decisive," he said, emphasising that adhering to the government's virus containment measures will allow other parts of the economy to restart.

The government of Pakistan lifted a weeks-long lockdown designed to curb the spread of the coronavirus. The government began to ease restrictions in phases on 09 May 2020, allowing smaller stores and companies to restart operations. Temporary closures of stores and factories had taken a toll on the country's economy. The government required owners of enterprises that reopen to implement thorough preventive measures against the virus. Pakistan reported more than 27,000 coronavirus cases and the number was still rising. But the government chose to reopen the economy to address rising unemployment despite fears of a further spread of the virus.

In June, things were looking decidedly different. Weeks after the Eid al-Fitr Muslim festival, ahead of which the government had lifted most restrictions on businesses and public movement, the country saw an explosion of cases. In June, the number of cases almost tripled over 30 days, going from 76,398 to 213,470. Hospitals began to reach capacityin major cities, with ventilators becoming scarce and patients dying because they were unable to get access to critical care beds.

Six months after registering its first case, by August 2020 active cases in Pakistan continued to steadily decline, with the number of deaths recorded in a day often down to single digits. The country had seen 293,261 confirmed cases of the novel coronavirus, with 6,341 related deaths, according to official data. Save for single-day blips, active cases have been steadily declining since hitting a peak in June, currently standing at 10,091, their lowest level since late April. Critics say testing had been low, resulting in an underestimation of cases. On Sunday, Pakistan conducted 23,655 tests, with 496 of them returning positive. The government said it has the capacity to conduct up to 67,340 tests a day, but people are simply not seeking them.

Several factors - including the phased implementation of lockdowns, effective hospital case management and treatment protocols and demographic and cultural factors - may have interacted to help achieve the outcome. Pakistan's extensive polio vaccination program, which consists of more than 265,000 community health workers and vaccinators, helped provide infrastructure to track and trace cases early on in the epidemic.

Pakistan's age demographics may have played a part in lower death rates, too. An estimated 64 percent of the country's 220 million population is under the age of 30. Worldwide, older patients have proven more susceptible to serious complications from COVID-19, and in Pakistan, the data is similar, with 76 percent of deaths among patients aged 50 or higher. In addition, researchers have been gathering data since the start of the epidemic on possible higher physiological immunity among South Asian communities, where the mortality rate from the coronavirus has been markedly lower than in the Americas and Western Europe. Pakistan's case mortality rate - the percentage of patients who died after testing positive for coronavirus - is 2.16 percent, compared with 12.7 percent in the United Kingdom, 13.7 percent in Italy and 11.1 percent in France.