Feature image - Voicepk.net

by Asra Haque

South Asian countries have had a long-standing image in the international community as being hubs of diseases and pestilence, coupled with a crippled healthcare system that is unable to address the healthcare needs of its people.

With the spread of a pandemic that has infected over 6 million and snuffed out nearly 400,000 lives, affluent countries with sturdy and extensive healthcare systems have had to bear the greatest loss of lives.

Meanwhile, South Asian countries have borne fewer losses – in Pakistan in particular, severe COVID-19 cases are few and its existing health units, far behind those of developed nations, hold the capacity to treat and tend to critical virus patients at the current rate of infection.

What is the distinction between South Asian countries and others miracle in relation to the ongoing pandemic? Is there a combination of various factors and coincidences that have allowed Pakistan amongst other South Asian countries to escape the brunt of the contagion so far?

Lower Testing Rate And Other Statistical Factors

Pakistan’s testing capacity is currently capped at a meager 16,000 daily tests for a population of over 220 million. Limited testing also means limited detection – with its current numbers, around 12% of total tests carried out in a day are diagnosed as positive. Health experts believe that it is highly likely that such low daily testing numbers cannot possibly ascertain the true extent of the spread of the pandemic. If testing capacity is raised to, say, 100,000 a day, statistically Pakistan’s COVID-19 cases may drastically increase.

Fewer tests also mean that possible COVID-19 deaths may go undetected as well. Currently, Pakistan’s coronavirus tallies do not account for death due to unknown causes. Furthermore, a critical shortage of precious resources and equipment required to detect the virus means that people who died due to unknown causes are not tested post-mortem to determine whether or not they may have been killed by the contagion.

Existing numbers may also reflect only urban infection rates while rural infections may be going severely underreported. Government testing in designated COVID-19 facilities is mainly concentrated in urban centers, making access extremely difficult to Pakistanis in rural and far-flung areas, who must forgo limited funds to travel great distances to undertake a test. Moreover, a disproportionately poor population means that many Pakistanis are unable to afford COVID-19 tests through private health units, leaving many to either book an appointment with a public health facility which may take days on end or forgo testing entirely.

According to health experts, it is highly likely that Pakistan may not have a miraculously low COVID-19 fatality rate as limited testing makes it impossible to determine truer numbers. There is a possibility that Pakistan may still be in an earlier stage of the contagion, and that it may spread more aggressively and claim even more lives in the months to come, especially since social distancing protocols have been lax as the lockdown continues to ease across the country.

Pakistan demographical distribution in 2016 - Voicepk.net
Pakistan demographic distribution in 2016

Climatic Conditions

Initial expectations that the virus would either slow down or be snuffed out completely as temperatures rise were discredited when Iran, a semi-arid country characterized by long and extremely hot summers, became one of the worst hit nations by the pandemic. Even today, Iran’s COVID-19 infections are emerging in the thousands, with a total of 151,466 confirmed cases till date. However, despite the frightening infection rate, 118,848 infected Iranians were able to recover while 7,797 could not survive. These numbers show a highly successful recovery rate of 78.47% against a virus fatality rate of 5.15%.

The USA in general enjoys a far cooler climate than which prevails over the Middle-East and South Asia, and has a similar virus fatality rate as that of Iran, around 5.8%. However, the region has a comparatively dismal recovery rate, with just 23.36% of total cases managing to recover. Other northern territories have shown similar trends, where the COVID-19 fatality rate is much higher compared to South Asian and Middle-Eastern territories.

COVID-19 fatality rate by country - Voicepk.net
COVID-19 fatality rate by country

Pakistan experiences an arid to semi-arid climate, and like many countries with similar climatic conditions has surprisingly fewer COVID-19 fatalities in comparison to cooler regions.

Demographics And Population Distribution

Although people of all ages, sexes, and ethnicities can be infected by the virus, an influx of situation reports and current data show that the elderly, and people with preexisting morbidities and other health conditions are more vulnerable to the contagion. Statistics across various countries show that people aged 45 and above are at a higher risk of succumbing to the virus. In Italy where over 33,000 patients lost their lives to the virus, a significant proportion of those fatalities were people aged 50 and above.

COVID-19 fatalities by age in Italy as of May 25 - Voicepk.net
COVID-19 fatalities by age in Italy as of May 25th

Pakistan’s lower COVID-19 deaths may be explained by its demographical distribution – the median age in Pakistan is 22.8, which points towards a much younger, and to some extent, less vulnerable population.

Immediate Response

Pakistan was among the first countries to immediately suspend cross-border activities with the spread of the contagion in neighboring China and Iran. International transmissions currently account for barely a fraction of the national tally, while local transmissions stand at a rough 90%. It is possible that had Pakistan not closed its borders as quickly as it did, the infection count and subsequent fatality rate would have been much higher than it is today.