Investigating the volatile testing trend in Balochistan

While the latest report by Imperial College, London (ICL) recognizes Pakistan as one of the few countries with declining COVID-19 cases, many remain concerned that the official tally is greatly underreporting the active cases and the deaths caused by the novel virus. The study suggests that Pakistan is currently reporting 82.3% of the actual cases. Many, however, assert that the actual death toll is a lot higher, especially in Balochistan, and that there is not adequate testing to determine whether people are infected, asymptomatic or simply refusing to get tested. The officials on the other hand claim that the virus is under control and on its course to fade out.

To investigate these theories, Brecorder interviewed the following from Balochistan to analyze the on-ground realities: Dr. Tariq Marri (in charge of wards, Civil Hospital), Ata ul Mohsin (Manager PDMA) and the private laboratories operating in Quetta (Aga Khan University Lab, Al-Shiffa Lab and Excel Lab).

Evidently, the hub of CPEC investment is exhibiting a volatile trend of positivity rate (the proportion of infected people that test positive out of the total number of tests conducted). As compared to other provinces, Balochistan has conducted lesser tests due it its lower population density (12.5 million), resulting in a higher positivity rate. In the last week, the positivity rate of the virus in Balochistan on average has been 0.11. It is also pertinent to note that almost all of the medical infrastructure is centered around Quetta, the capital of the province.

According to the PDMA official, responsible for collecting and uploading daily provincial tests on the government portal, Balochistan has a testing capacity of 2000 to 3000 daily. He states, “Almost all PCR tests to date have been conducted by the Fatima Jinnah Hospital Laboratory and Sheikh Zayed Hospital Laboratory in Quetta. Private labs have started their operations in Quetta only recently but are mostly testing for antibodies – a trend that has recently developed as those infected want to see whether they are immune to the virus at present. However, most people cannot afford to pay the high costs and prefer to get tested in designated hospitals”.

Brecorder reached out to several private labs that operate in Quetta to gauge how many tests they conducted yesterday, 24 July 2020. Shaukat Khanam Lab and Ziauddin Hospital Lab stated they do not offer PCR test services, but they do offer antibodies test service. Al-Shiffa Lab, Excel Lab, Chugtai Lab and Aga Khan University Lab conducted 0 PCR tests on the said date. The official from Al-Shiffa Lab opined, “The government labs at the designated hospitals have predominantly carried out PCR tests here. Private labs, including both of our branches in Quetta, have only recently started offering these services. In the month of July, we have carried out a total number of 5 PCR tests and 30 antibodies tests”.

There is simply not enough demand for private PCR tests due to high costs of testing in Balochistan. Additionally, the overall number of people getting tested has reduced. According to the official PDMA, many more people were getting tested till June as the Zaireen were made to quarantine in Balochistan and many locals were exhibiting symptoms of the novel virus. Reportedly, the government made arrangements for isolation wards in Fatima Jinnah Hospital and Sheikd Zayed Hospital. Many people remain isolated at home in fear of isolation at the ward. “To date, 55,674 PCR tests have been conducted in Balochistan, out of which 7,285 have been repeat tests and 10,877 have reported positive. So far, 48,019 people have recovered, while 127 people have died”, he reported.

The PDMA official explained how the situation is now largely under control in Balochistan. “On 14 July, there were 210 positive cases in Balochistan as compared to 22 positive cases today. The ventilator use has also dropped exponentially. In June, roughly 200 ventilators were being demanded in the designated hospitals, now the demand does not exceed 17 ventilators. Even during the June peak, the beds were never fully occupied as many people preferred to isolate at home”.

The Ministry of National Health Services reported on 24 July that no patient in AJK or Balochistan is currently on the ventilator. While Federal Minister Asad Umar hailed the present situation in Balochistan as satisfactory, Chief Minister Jam Kamal Khan stated, “A smart lockdown policy is being implemented in all other districts including Quetta to curb the spread of the disease and is yielding positive results”. He also reported the government of Balochistan has allocated 10 billion rupees for healthcare in the budget 2020-2021.

Brecorder sought the expertise of Dr. Tariq Marri to highlight the ground realities of hospitals in Quetta. “Since the beginning of July, on-ground cases have reduced. At least five infected people used to visit my clinic daily. Since 2 weeks, not even one infected patient has visited me. There are not more than 20 active patients in the designated hospitals currently”, he stated, “There are many reasons for the decline of the virus. Either the valency of the virus has decreased or our immunity has increased. Many people were infected in May and June, most of whom were elderly who have either expired or recovered. I believe there are many asymptomatic cases among the younger population”. He adds that many in Balochistan naturally live in social distancing. Big houses prevent families from interacting with neighbours. “In central Quetta, houses are roughly 4,000 sq. feet, whereas on the periphery houses are up to 10,000 sq, feet".

Dr. Tariq also opines against Pakistan developing herd immunity while warning about the imminent surge in winters, "There are currently not more than 50,000 actual cases in Pakistan. Roughly 35% of the total population has been infected to date which is simply not enough for us to develop herd immunity against the novel virus. I do believe roughly 60% of elderly people have been infected, some of whom recovered while others passed away. The NDMA has been able to navigate how to deal with the virus through smart lock-downs, aided by the summer heat which is considered a universal stabilizer. But the real danger lies ahead of us in November and December when respiratory diseases tend to increase. We must be prepared".

Dr. Tariq Marri (FCPS Medicine) is a consultant physician and a senior registrar PGMI. For more information, he can be contacted at [email protected]