If we do nothing, COVID-19 could infect 206 million Pakistanis and kill 691,000.
This is the estimation of researchers from the Imperial College London COVID-19 Response Team who have published country-wise projections in a March 26 report ‘The Global Impact of COVID-19 and Strategies for Mitigation and Suppression’
Furthermore, using an infection fatality rate from China, this means 4.4 million Pakistanis would require hospitalisation and from among those, 917,000 individuals would require critical care. Pakistan has a population of 220 million people.
The research is based on the infection fatality rate from China, country health care system capacities and that one person with coronavirus is likely to infect 3 others. (You can find the excel sheet with Pakistan numbers here: Imperial-College-COVID19-Global-unmitigated-mitigated-suppression-scenarios.xlsx)
Forty-seven researchers crunched the numbers and made these projections to give countries, including Pakistan, some idea of what to expect depending on their preparation. They took the data from China and rich countries but carefully explain how they used it to try to sketch a projection for poorer countries or lower middle-income ones.
The study gives countries four options, which simply described are: they do nothing, the population does social distancing, social distancing of the elderly by reducing 60% contact and, suppression, in which they talk about the impact if governments act when confronted with two death rates.
Why elderly social distancing
If Pakistan has a strategy of enhanced social distancing for its elderly people, the number of the infected Pakistanis can be brought down 30% to 145 million and deaths 34% to 454,000 by the end of this year.
What is unique to countries like Pakistan is that they have fewer elderly people than high-income countries but its elderly do not live as isolated. Simply put, your nana and nani are probably living with a family and not in an old age home so they can come into contact with more people. The elderly populations of richer countries (65 years) have different contact patterns.
At what point to act
The researchers did an interesting future projection by modelling scenarios on the point in the number of deaths at which governments choose to act.
In the first trigger, it would be early in the pandemic, when there would be 0.2 deaths per 100,000 people. For Pakistan, they say the math comes to 441 deaths per week. (Please note, we have not reached that level yet). If suppression strategies were adopted at this weekly death rate, Pakistan could restrict its total infections to 19 million people down from 206 million in the scenario that it did nothing at all. This is a 91% projected drop, which can be counted as significant. (For more details on the second scenario please click through to the full paper).
Hospital beds
According to the latest figures available by the start of this year, Pakistan had 0.13 million hospital beds and 2,200 critical care beds (not all of them were functional). Since then field hospitals have been set up with a capacity of 2,200 beds. One hospital in Karachi can be scaled up to add 9,000 more beds. Recent National Coordination Committee data says the number of ventilators has increased to 3,800. Some hospitals are using splitters so that one ventilator can be used to treat four patients. Pakistan has set a target of 10,000 ventilators in the next few months.
This study could potentially also help Pakistan gain a sense of how much hospitalisation would be needed under different conditions.
If we move beyond that baseline and say our governments implemented a suppression strategy early on in the pandemic when we hit the 441 deaths a week, we would see an estimated 90% reduction in the number of infected individuals requiring hospitalisation from 4.3 million to 434,000.
Similarly, the estimated number of Pakistanis needing ICU beds would drop 90% to 95,000 from 914,000.
The number of deaths would drop 89% to 73,000 from 689,000.
The researchers noted that reducing positive COVID-19 cases eases the shortage of hospital beds substantially but the gap between demand and supply of critical care still would remain high. They found that peak demand for critical care would outstrip supply by 7 times in high-income countries and 25 times in low-income countries. This could lead to more deaths in poorer countries if their healthcare systems collapse.
Global outlooks
In a nutshell, the researchers said that if countries do not intervene, they estimated that globally 7 billion people could be infected. But the good news is that this burden can be halved with “mitigation strategies focussing on shielding the elderly (60% reduction in social contacts) and slowing but not interrupting transmission (40% reduction in social contacts for wider population).” This could save 20 million lives, but the researchers stressed that even in such a scenario, the health systems of all countries will be “quickly overwhelmed”. The idea should be that hospitals can’t cope and that government and society should do what it can to reduce their burden.
“[H]ealthcare demand can only be kept within manageable levels through the rapid adoption of public health measures [to reduce transmission],” they say. Testing. Isolating. Social distancing. Basically, this is the formula the Sindh government has pushed to adopt, which is good news. It is a no-brainer that if countries delay there will be more deaths. The suppression strategies have to be implemented until vaccines are on the market or other effective treatments surface.
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