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Homeland Security

COVID-19 Deaths, Patients Grossly Under-Reported in Pakistan

By Ayesha Tanzeem June 18, 2020

When Saifullah Khan's friend and his father in Quetta got sick after going to a funeral in Chaman, a town bordering Afghanistan, he asked them to get tested for the new coronavirus. His friend refused.

Two weeks later, his father died.

"He had all the symptoms of COVID-19, but they never got him tested and never disclosed it to anyone even after his death. They had a regular funeral," said Khan, a resident of the capital Islamabad who has most of his family in Quetta.

This may be one of millions of cases in Pakistan of people not getting tested for coronavirus and not getting recorded in the national database of infected persons.

Several statistical models, official statements, leaked government documents, and interviews with people in various cities suggest that the number of COVID-19 patients and deaths in Pakistan are grossly under-reported.

"The actual numbers will be two to three times more than what the government is reporting," Atta ur Rahman, chairman of Prime Minister Imran Khan's task force on science and technology, told Bloomberg news Wednesday.

The current official figure puts the countrywide infections at approximately 160,000 and deaths as approximately 3,000. However, data scientists and other analysts fear the real number may already be in millions of infections and tens of thousands of deaths.

Random testing in Pakistan's second-largest city, Lahore, by the health department of Punjab province in May showed that at least 6 percent of all tests came back positive for COVID-19 while in some areas the percentage was as high as 14 percent.

Based on the city's population and the sampling data, the health department working group, comprised of epidemiologists, public health specialists, applied economists, statisticians, and public policy specialists, calculated the number of cases in Lahore to be 670,800 on May 15.

The rate at which the infection was spreading alarmed those involved.

"Our calculations said the numbers were doubling every two weeks," said Dr. Waheeduzzaman Tariq, a senior virologist who was part of the group and sits on multiple government committees dealing with the coronavirus pandemic.

According to those numbers, on June 15, the figure should be approximately 2.7 million infected people in Lahore city alone.

The summary of the sampling project was presented to the Chief Minister Usman Buzdar and was later leaked to local media and circulated widely in several WhatsApp groups. VOA has a copy of the document.

This week, the government declared Lahore, along with 20 other cities, a coronavirus hot spot and locked down multiple areas in the city.

Last Sunday, a senior health official in Balochistan province claimed that 40 percent of the population of the province was already infected. According to a 2017 census, Balochistan's population is 12.3 million people. Forty percent of that would be close to 5 million. The officially recorded number of infections in Balochistan are still under 9,000.

"People are not informing the government about infected patients, and deaths are occurring in various parts of Balochistan," said Dr. Saleem Abro, the director general of health in the province.

Health experts worry the lack of accuracy in data collection was misleading people and creating apathy about the disease, a problem the prime minister himself acknowledged.

"Common people thought this was not even a disease. When they saw so many people getting sick in the world, they thought Pakistanis don't catch this disease," PM Imran Khan said in an address to the nation Sunday.

His critics, however, blame him for creating confusion about the pandemic and sending out mixed signals to the public.

In his earlier addresses, like one in March, the prime minister called the pandemic "a kind of flu" that spreads quickly but "97 percent cases recover completely, and out of those 90 percent get really mild symptoms."

Toward the end of April, he reiterated that Pakistan's case was not as bad as other countries and the death rate was "lower than expected."

Outside of big cities, awareness about the prevalence of the disease has been slow to take hold. In Peshawar and other parts of Khyber Pakhtunkhwa province, multiple eyewitnesses reported lack of social distancing, masks, or other safety measures. Some said their friends got offended when they defied local traditions of shaking hands or hugging.

Toward the end of May, VOA's Urdu Service reporter based in Peshawar, Shamim Shahid, noticed that people in various villages of Tehsil Khadukhel in district Buner of Khyber Pakhtunkhwa province suddenly started dying in large numbers.

"Every day you would hear of five to six deaths. People said they were dying of typhoid, but no one got tested for coronavirus. I cannot remember a similar breakout of typhoid before," said Shahid, whose family lives in that area.

When one of Shahid's brothers got sick and got a test, he came out to be COVID-19 positive. He has since recovered.

The shortage of free government testing facilities has also contributed to the lack of testing. Getting tested by a private lab is expensive for ordinary Pakistanis, approximately $50 per person. Pakistan's average salary is less than $200 per month, according to CEIC that collects macro and micro economic data. Twenty-five percent of the country's population is below the poverty line. In many parts of the country, especially smaller towns and villages, no testing facilities are available.

According to the website of Pakistan's National Command and Operation Center, set up to deal with the pandemic, the country has 111 labs to handle coronavirus tests, including private labs. Forty-two of them are in three cities: Karachi, Lahore, and Islamabad. The country has a population of around 207 million people.

The lack of data collection in Pakistan adds to the difficulty of gauging the current scenario, according to Syed Tajammul Hussain, CEO of Love For Data (LFD), one of the largest data analysis companies in Pakistan.

"We have not had a mortality census in a while. Since we have limited COVID testing (testing per million compared to other countries) we have a very high possibility of under-reported cases and deaths as well," he said.

Another apparent deterrent to testing is widespread conspiracy theories about the virus. One such theory, shared frequently through social media, is that hospitals are killing suspected COVID-19 patients with poisonous injections and then selling the bodies to the United States for experimentation.

"They give the family a casket full of nothing to bury that no one is allowed to open whereas the real body is sold for ten thousand dollars," one such posts on Facebook claimed.

A doctor in Islamabad's Shifa hospital, who spoke to VOA on the condition of anonymity, said a patient he suspected of being infected with coronavirus refused testing despite his repeated insistence.

Some people fear that if tested positive, local health authorities may force them into dirty, over-crowded quarantine centers or hospitals wards filled with COVID-19 patients and few facilities. Videos of such places have circulated on multiple social media platforms like Facebook, Twitter, and WhatsApp. Many say they would rather isolate themselves at home.

Then there is the social stigma.

People think that if someone dies of the disease, few will come to his or her funeral. In parts of Pakistan, the number of people attending one's funeral are supposed to reflect his or her worth as a person – the larger the number of attendees, the more respected the person and the family.

In addition, Pakistanis traditionally bury loved ones in a family graveyard close to their ancestral homes. Even those living in other countries often fly bodies of dead relatives back to their hometowns for their last rites and burial.

However, if a death is linked to coronavirus, government health and safety protocols make transporting a body across city lines and back to ancestral homes difficult.

A VOA Deewa Service reporter said he knew of at least two deaths in Peshawar due to COVID-19 where the families bribed the hospitals to declare the patients coronavirus free to be able to bury the bodies in their family graveyards and to have big funerals.

Without accurate data, many fear that the health system, which is already fragile, would not be able to prepare for the onslaught of critical patients that may require hospital care, leading to an even higher number of deaths.

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