Making sense of the numbers: Virus prevalence in Pakistan

Coronavirus PCR testing in Pakistan

21st August 2020

By Asra Haque


Pakistan seems to be on the road to recovery from the SARS-CoV-2 (also known as the novel coronavirus or COVID-19) pandemic whose first few cases were reported in the country in late February, infecting a total of 291,588 and killing 6,219 till date. The virus hit its peak in the country in mid-June, due to a combination of eased COVID-19 restrictions and mass violations of health protocols in the days leading up to Eid-ul-Fitr on May 23.

However, almost as suddenly as it began, the spread of the potentially fatal disease has managed to slow down to a snail’s pace with a noticeable reduction in transmissions. Although daily testing had also considerably declined past June (an oft-cited detail when it came to criticism of government transparency in national and provincial numbers), an exponentially reduced positivity rate, that is the number of positive diagnoses against the number of samples taken, was plenty proof that Pakistan was successful in “flattening the curve”.

A total of 23,670 tests were carried out on August 19 – Pakistan has a maximum testing capacity of 71,780 according to numbers provided by the National Command and Operations Center (NCOC). In the 32nd week of the outbreak (August 3 to August 9) of the novel coronavirus in the country, an average of 16,693 daily tests were recorded, with the highest number of tests that week being 24,366 on August 8 and the lowest being 10,690 on August 4.

The average daily positive cases stood at 632 for that week, the highest number of infections (842) emerging on August 8, while the lowest were recorded for August 3 (330). An average of 14 daily deaths were reported, with August 6 proving to be the deadliest day of the week with 31 deaths and August 3 least deadly with eight lost to the virus.

The average daily case positivity was 3.93%, with the highest number of cases per tests carried out reported on August 5 with 5.67% and the lowest on August 9, at 2.71%.

Compared to the previous week, average daily tests fell by 18%, daily cases by 33%, daily deaths by 36% and case positivity by 15% in the period between August 3 and August 9.

Averages for the nine-day period of August 10 to August 18 reveal a further decline in numbers. The average number of daily deaths for this timeframe were 11.56, with the greatest amount of fatalities (17) recorded on August 11 and the lowest (6) recorded on August 15. There was a 17.43% decrease compared to the period between August 3 and August 9.

An average of 21,387.44 daily tests were performed in the same period, an increase of 28.12%, while average confirmed cases also rose to 642, a percentage increase of 1.58% compared to the week before. It should be noted however that these figures are derived from a nine-day window between August 10 to August 18 compared to seven days between August 3 and August 9. However, despite the higher numbers in daily testing and confirmed cases, case positivity declined to 3.04% compared to the period before, a decrease of 22.65% from the previous week.

What could possibly be the reason why the virus has slowed down so considerably despite a complete relaxation of lockdown restrictions throughout the country, and the occurrence of two possible super-spreading events, Eid-ul-Azha on July 31 to August 2 and Independence Day on August 14?

Dr. Fahim Yousuf, a Pakistani-born infectious diseases expert in Maryland, USA, says there is not enough data to draw any conclusions on whether or not Pakistan has claimed “victory” over the virus, or if the pandemic will return with renewed destructive potential.

“Pakistan is only conducting eight to 9000 tests per million populations, and these numbers are too scant to understand the wider picture,” he stated. “The decision to reopen businesses, schools and whatnot should be based on disease prevalence through antigen and PCR testing, which help to identify hotspots.”

As a result, Pakistan is lacking in the required data to make solid conclusions regarding the state of the contagion. Therefore, it is imperative to increase daily testing, in spite of the deflating case positivity rate, to gain clarity on the prevalence of the disease. Until then, Dr. Yousuf predicts, it may take another six to seven months before we can have a real grasp on where the country stands in terms of the fight against SARS-CoV-2.

Dr. Kaiser Sajjad, Secretary General of the Pakistan Medical Association (PMA) expressed his worry over the possibility of a second wave, citing Australia, New Zealand, the USA and the UK as unfortunate examples of where the virus was believed to have receded, prompting easing of restrictions.

“People saw that cases did not bloat after Eid-ul-Azha and Independence Day, like they had bloated post-Eid-ul-Fitr. They may become complacent, disregarding all SOPs entirely. There is a strong possibility that such complacency and carelessness may usher in a second, perhaps even more powerful wave of infections. This is especially worrying, because Pakistan’s hospitals that nearly crumbled during the peak of the virus in mid-June will most certainly not survive a more dangerous resurgence of the disease,” he posited.

The federal government has announced the reopening of schools on September 15 after months of an education limbo imposed due to the threat of the pandemic. Experts and political critics, such as Sindh Health Minister Dr. Azra Pechuho, argue that it is near impossible to ensure SOPs are implemented, especially among primary-school age children. The decision to allow masses of young children to assemble may not only expose them to the risk of contracting the highly infectious virus but also transmit it to risk groups such as their elderly grandparents or relatives with underlying health conditions.