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Dawn Editorial 24 April 2020

Stark warning

THERE is palpable alarm among Pakistan’s medical community, a sense of foreboding that the country could be on the cusp of an unmanageable crisis. Three times this week, they have urgently asked the government to reconsider its decision to ease lockdown measures. On Wednesday, eminent health experts and representatives of major physicians and surgeons’ associations addressed a press conference in Karachi, warning that any laxity in enforcing social distancing now “would prove disastrous” for the country. The day before, around a dozen doctors had written to the government asking it to withdraw its permission for congregational prayers during Ramazan. Yesterday, the Punjab chapter of the Pakistan Medical Association made the same request. On April 22, Pakistan passed the grim milestone of 10,000 Covid-19 cases; the day ended with a total of 10,513 cases, including 224 deaths. One of the doctors at the press conference revealed that as per projections, turning a blind eye to people congregating, whether inside mosques or at markets, could result in 70,000 coronavirus patients by May 15.
Medical professionals are putting their lives on the line each day they come into contact with those infected by the virus, from the initial testing stage and throughout treatment. A single breach in protocol — perhaps an N95 mask reused once too often or an accidental mistake in wearing or removing personal protective equipment — can expose them to the contagion and its consequences. In Spain, healthcare workers comprise 14pc of Covid-19 patients, largely on account of insufficient PPEs for medical staff. In Pakistan, over 160 healthcare providers in Sindh alone have so far tested positive. Sadly, those armed with expertise are not only up against bull-headed ignorance, which is bad enough, but also deliberate disinformation. The crass allegation by the Punjab chief minister’s former spokesman, that the presser in Karachi was held at the PPP’s behest, is precisely the kind of cynical ‘pandemic politicking’ that deflects from the stark warnings by medical personnel.
Pakistan’s underfunded health sector is barely able to cope with the regular caseload, let alone an exceptional emergency like the present. If we do not ‘flatten the curve’ by enforcing a strict lockdown — the only way proven to be effective — the amplified pressure on this creaky edifice could be its undoing. In what may be a sign of things to come, the doctors at the presser said that hospitals in Karachi were running out of beds to cater to Covid-19 patients. Also consider that around 10pc of those infected need respiratory support, but public hospitals in Punjab alone have only 1,245 ventilators — and 77 of them are out of order. With the caseload rising exponentially in the past few weeks, health personnel could be faced with wrenching decisions about which Covid-19 patients to treat with the limited resources available. We are on a knife edge. Listen to the experts.

 
 

The primary dilemma

EVEN in more ‘normal’ times the state of education in this country has left a lot to be desired. But now, with Covid-19 decimating schedules and routines, the education sector in Pakistan is finding it even more difficult to cope. Of course, we are not alone; according to a Unesco count over 1.5bn children the world over have been affected due to school closures caused by the pandemic. Thus the challenge before the education authorities in Pakistan is considerable. Where the higher education sector is concerned, the response to the crisis has been mixed. Some of the more proactive universities have been holding online classes, while many large public-sector tertiary institutions are still scratching their heads, trying to figure out how to proceed. The HEC has issued some SOPs for varsities to follow, but genuine questions about internet access and quality connectivity for students in far-flung areas arise. The situation with the primary and secondary sector is not much different. While many elite private schools are holding classes through apps, most schools have simply given their students an extended break. Here too there are issues of access, as many lower-income children don’t have smartphones, tablets and high-speed internet connections that online education tools require.
Considering the strong element of the unknown, provincial education authorities need to plan ahead for the future now. For example, both Sindh and Punjab plan to reopen schools in June. But that deadline should not be considered final, as the coronavirus situation remains extremely fluid. If the closures are extended, the authorities need to figure out how to continue the learning process with maximum children having access. The launch of an educational TV channel by the state is one response; the days ahead will reveal the impact this has had on learning. But beyond the immediate future, those in charge of education policymaking in Pakistan should use this break to analyse the poor teaching and learning outcomes in the country, especially in the public sector and specifically in primary schooling. The sad fact is that around 22m children are not in school in this country; an equally sobering reality is that those in school, particularly government institutions, are not learning much. Experts and stakeholders should use this time to devise ways to reboot Pakistan’s education system, and perhaps adapt new methods and technologies — distance learning, studying at home, etc — to bring quality education to every child in this country.

 
 

Medicine shortage

PARTS of the country, especially Sindh and KP, are reported to be facing a shortage of a number of life-saving biological products used to treat cancer, angina, diabetes, etc, as well as vaccines for measles, rabies, tetanus, typhoid and hepatitis B. Apparently, the National Control Laboratory has not been processing their certification since March 13. The failure of the government to appoint a new chief federal analyst at the NCL, who signs approvals for such products, is said by pharmaceutical firms to be the reason for the delay in the issuance of the certificates. No importer or manufacturer can market these drugs and vaccines without the NCL’s permission. It is indeed mind-boggling to see the government dragging its feet on such an important appointment, thus increasing the risk for critically ill patients who number in the thousands.
It is feared that the disruption in the supply chain of life-saving products and vaccines will trigger a new health crisis alongside Covid-19, which is now spreading fast. This is especially worrying given the fact that the government, in order to divert its resources to Covid-19 patients, has shut down OPDs at public hospitals, which is a precarious situation for people requiring urgent medical treatment. Allowing shortages of life-saving drugs at this time owing to bureaucratic lethargy is unforgivable. The approval and registration of new products has always been a cumbersome process in Pakistan because of bureaucratic obstacles. The industry has to wait for months — and in some cases years — to obtain permission to market the drugs being used effectively elsewhere in the world. The industry, for example, is awaiting permission to import and market certain new drugs to treat cancer and other serious diseases for the last 14 months, depriving patients of a chance to try new treatments. It is, therefore, necessary for the government to reform the entire process of registration of drugs and issuance of certification of life-saving drugs to ensure the latter’s quick and easy availability, especially in desperate times like these.

 

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