Pakistan teeters on the edge of potential disaster with the coronavirus

As of March 26, coronavirus cases in Pakistan — the world’s fifth most populous country — climbed to 1,190; nine people have died. Pakistan currently has the highest number of cases in South Asia, more even than its far larger neighbor, India. In this densely populated country of more than 210 million, with megacities Lahore and Karachi each teeming with more than 10 million people, the government took important steps early to stop the spread of the disease, and each of its provinces implemented varying levels of lockdown in the past week as the number of cases rose.

But the country also gravely mishandled the return of coronavirus-infected pilgrims from Iran, and its prime minister has waffled on messaging and implementing a full, federally mandated lockdown. While many Muslim-majority countries, including Saudi Arabia, have cancelled communal prayers, Pakistan’s mosques remain open. The country’s health system — with dated and limited public health facilities, and costly private hospitals inaccessible to all but the rich — is woefully unprepared to deal with COVID-19 and its influx of critically ill patients. Doctors lack personal protective equipment; at least one of the nine victims so far is a doctor.

The consequences of letting the disease spread further would be devastating. And Pakistan’s initial coronavirus response is already exposing concerning political patterns — including the powerful army asserting competence over the civilian government— that will persist beyond the pandemic.

An influx of cases from Iran

Before Pakistan had any cases of the virus, it made the decision to not allow 800 Pakistani students stranded in Wuhan, China to return to the country. Pakistan’s government did not want to risk them returning and spreading the disease at home, and it also hoped that the move signaled support for China at a time when it was embarrassed in front of the world. (Pakistan and China are steadfast allies; Pakistan is the flagship location for Beijing’s One Belt One Road.)

The country’s first coronavirus case, a returning pilgrim from Iran, was diagnosed on February 26 in Karachi. He was quickly isolated and his contacts traced. As of March 12, two weeks ago, Pakistan only had 21 confirmed cases of the virus. On March 13, the government announced a number of aggressive steps, including closing the country’s western border (with Iran and Afghanistan), shutting down all public and private educational institutions, and canceling the Pakistan Day parade set for March 23. A National Coordination Committee was set up to deal with the coronavirus on a federal level, and the National Disaster Management Authority was tapped to implement the response.

At the same time, the state prevailed on the Tablighi Jamaat, a pan-Islamic body that holds an annual religious gathering outside Lahore, to pack up and go home. It may have been too late: More than 150,000 people were gathered there until March 12, and a number of them were later diagnosed with coronavirus — some of them were diagnosed after they returned to Islamabad, and two Palestinian men who returned to Gaza became the first known coronavirus positive cases there.

In the days after these steps were announced on March 13, the problem of returning pilgrims from Iran ballooned. All returnees were “quarantined” together in reportedly squalid conditions at a camp in Taftan after crossing the border into Pakistan in remote Baluchistan. There was no testing, and those with symptoms were not isolated. Instead of containing the virus to those who had it, it spread to others at the camp, and people at the camp were also allowed to leave to shop at markets in the town. After two weeks, they were “returned” to their provinces. It is unclear what precautions were taken as they traveled, but they were tested by the provincial governments once they arrived, and those who tested positive were re-quarantined at centers created in those provinces. Thousands of returnees remain in quarantine centers across the country; a number of them have reportedly attempted escape. Nearly 600 returnees in total have tested positive.

The first death

The path of the first Pakistani who died from the virus is instructive. He returned to his village in Khyber Pakhtunkhwa on March 9 from a pilgrimage in Saudi Arabia. He traveled while he was sick. His family held a 2,000-person feast to commemorate his pilgrimage, during which many people embraced him. For the next week, while he was ill, his sons continued his “health” practice — he was not a certified doctor — while they lived with him. After he was tested for the virus on March 16, he went home to his extended family of 13 people, despite the doctor asking him to stay. The next day, his test came back positive; he was placed into isolation, and died on March 18. His entire village of several thousand people is now under quarantine.

In a country of people living in huge extended families, with many refusing to self-quarantine, the virus will be hard to contain. And in overcrowded areas, social distancing may prove impossible.

The limits of Khan’s populism

On March 17, Pakistan’s Prime Minister Imran Khan gave his first national address on the coronavirus. The bottom line was his signature phrase: “Ghabraana nahi hai,” meaning “Not to worry.” He ruled out the possibility of imposing a lockdown, saying that Pakistan’s poor — especially daily wage earners and city laborers — would die of hunger if he did so. He spoke plainly and urged social distancing, but in his bid to avoid panic, he failed to convey the gravity of the matter.

The 18th amendment to Pakistan’s constitution (passed in 2010) provides the provinces with significant decision-making autonomy. In the past few days, they have implemented varying degrees of lockdowns. Sindh, Pakistan’s hardest-hit province — which had received many of the Taftan returnees, is home to the country’s largest city, Karachi, and is led by the opposition Pakistan People’s Party — imposed a lockdown on March 23, and requisitioned the army to help carry it out. Baluchistan, Punjab, and Khyber Pakhtunkhwa, the three other provinces, have followed with varying levels of a lockdown, prohibiting public gatherings. The interior ministry has approved the deployment of the army across the provinces. Earlier this week, the country suspended all international flights; it has now also banned all domestic ones.

But Khan has continued to push back against the idea of a lockdown — arguing that a curfew, or “last stage of a lockdown” as he calls it, would devastate Pakistan’s poor more than the virus could. His populist leanings are at play here. Khan inherited a debt-ridden economy that was just beginning to stabilize, and he doesn’t seem to want to shut it down (not dissimilar to President Trump, although Khan bases his argument on concern for the common man). His government has already approved an economic aid package worth 1 trillion rupees to help Pakistan’s vulnerable in the wake of the crisis.

Khan has opened himself to Pakistan’s press, but his message is undermined as he argues against a lockdown when the provinces are already implementing their own versions, and as he gets caught in back-and-forth semantics around the meaning of a lockdown versus a curfew. Before imposing any full lockdown, he said, he would want to ensure he could get food to the most vulnerable. In his model of an incomplete lockdown, he assumes that the daily wage laborer can still get work, which is difficult when many businesses are closed.

Khan doesn’t seem to grasp that there is no tradeoff between livelihoods and a spread of the pandemic, because the latter would shatter livelihoods much more than a shutdown. He also doesn’t acknowledge the extent to which younger, non-vulnerable populations may require hospitalization and thus impose a burden on the health system. Khan has also said that he hopes the hot weather in a few weeks will reduce the spread of the virus, and highlights that Pakistan is not in the same position as Italy. (The virus’s unseen spread could mean that it is headed in that direction, of course.) In general, the prime minister is not known for his ability to listen, or to change his mind.

Khan’s handling of the COVID-19 crisis reveals the limits of his populism, the precariousness of his position, and his lack of experience in dealing with a crisis. He needs to tread carefully, because Pakistan’s army, always waiting in the wings, is all too willing to swoop in to gain the population’s sympathy, reassert its role as the country’s one competent institution, and further consolidate its already considerable control. It did exactly that on Monday, when the director general of the Inter Services Public Relations gave a somber televised speech underlining the gravity of the situation. It stood as a counterpoint to Khan’s approach, and even liberals on Twitter pointed out how prime ministerial the director general sounded. Opposition leaders have also called for a full national lockdown.

Religious matters

Last week, even as Pakistan’s coronavirus cases shot past 400, communal Friday prayers were held across the country with the usual huge number of attendees. In this deeply religious country, the federal government has waffled on what to do about prayers at mosques, held five times a day. The state, which has cultivated its citizens’ religiosity over the decades, is afraid of issuing a decree against communal prayers and has bowed down to the country’s powerful ulema (Muslim scholars), who refuse to shut down mosques — although most other Muslim countries have canceled such prayers, including ultra-religious Saudi Arabia (Saudi Arabia also canceled the Umrah, a religious pilgrimage, early on).

People interviewed at mosques either believe that turning to God is even more imperative now, or say that the fact that the government has not closed down mosques for prayers means that the pandemic is not serious. On March 26, after extensive, belabored consultations, including with religious leaders in other countries, Pakistan’s religious affairs minister announced that prayers can be said at home, but that mosques would not be shut down. Communal prayers would be “restricted” to staff and limited numbers of the young and the healthy — missing the key point that the healthy can carry and spread the virus. Immediately afterward, the Sindh government announced that communal prayers would be banned in the province starting March 27. Baluchistan and Punjab followed, limiting prayers to mosque staff of up to five people.

China steps into the gap

On March 16-17, Pakistan’s president, Arif Alvi, visited China on Xi Jinping’s invitation. The two men spoke about the lessons learned from China’s fight against the coronavirus. Beijing pledged to offer Pakistan support as it now deals with a rising number of cases. In the past few days, China has stepped in to provide Pakistan with masks and medical equipment. A plane carrying one million masks, including N95 masks, arrived in Pakistan on March 25.

The need for lockdown mode

Is there any reason for hope? Little. Internal government projections are dire. Should a federally mandated lockdown be put in place, Pakistan’s army and police can be effective enforcers — in Sindh, which has the strictest measures in place, 300 people have been arrested for violating the lockdown — but they may not be able to reach remote parts of the country, and will likely be ineffective in overcrowded areas such as slums. The relative youth of Pakistan’s population may also be beneficial for keeping the number of critical cases and death rates relatively low — 64 percent of its population is below the age of 30 — but the youth may contribute disproportionately to the virus’s spread.

Pakistan’s prime minister is losing precious time to act decisively, and his dawdling is confusing the citizenry. In recognition of this fact, perhaps, the government’s press conference on March 26 did not feature Khan, but was led by Asad Umar, his planning minister. The provinces are picking up Khan’s slack. What Pakistan needs now is for Khan to back a lockdown wholeheartedly, including shutting down mosques, rather than hope for a miracle. The alternative is a disaster no country, least of all Pakistan, can afford.