Recently spoke to the Special Assistant to the Prime Minister on National Health Services Dr Faisal Sultan about the second wave of the deadly coronavirus in Pakistan, the country’s testing capacity, and its plans to procure a vaccine next year.
By Benazir Shah
The interview has been edited for brevity and clarity.
Pakistan is in the grip of a second wave of the coronavirus. How bad will this wave be?
Right now, it [the wave] is nowhere near what it was in June. But you really can’t say where this will go. In June, people were asking if [Pakistan] is at the peak? But a peak is only visible in your rearview mirror. You can only tell you are past the peak once you have crossed it.
So, no one can say how high the peak will be this time, or will it be more or less severe. It is important to remember that all mathematical and epidemiological models have broken down. Those following these [models] knew that much of the mathematical extrapolations were incorrect and were bound to be.
Pakistan was using the Susceptible-Exposed-Infectious-Removed (SEIR) model to project the spread of the virus. Are we still using it to forecast the curve?
The [SEIR] model assumes that there are certain people who are non-immune versus those who are susceptible. Based on these proportions and numbers, you draw a curve. Now, that works within a closed space or in a limited environment which is homogenous. But the model breaks down in large countries, which are not homogenous.
So, these models — like the SEIR — assume a lot of homogeneity. It relies on certain assumptions which are not necessarily true when you are talking about multi-connected and large countries.
What are the projections telling us now?
If it was hard enough to predict the curve in the first, clean wave, it is much harder to predict in the second wave. Why? Because the epidemic has already gone through the community. Then, there are additional confounding variables, such as the people who have become immune to the virus.
So, the short answer is that no one knows.
As per data by the NCOC, the total testing capacity is a little over 50,000 per day. But the NCOC website places it at an estimated 74,000. Where do we stand?
The capacity, if you were to push it, is 70,000-plus per day. If push comes to shove, and Pakistan needs to do about 70,000 tests in a day, we could do it.
Are we testing enough to know the actual spread of the virus?
Testing is like Mirza Ghalib’s aam(mangoes). The more and the sweeter, the better of course. The number of [tests required] is based on the idea that if tomorrow there is a demand to test 50,000 people in a day and you say we can’t do over 30,000.
Therefore, it is important to have the capacity over what you thought was the projected need for tests. It is triggered by, fundamentally, the person [who tests positive] and their contacts.
So, our testing policy is that you must meet the symptomatic criteria to be tested. When you are tested, then the contact tracing goes into effect.
The PCR testing (also known as polymerase chain reaction testing) is a precious resource. We have now also okayed rapid antigen tests too.
But are rapid antigen tests reliable?
I can tell you that I have remained a sceptic of antigen testing because it is not the same as a PCR test. But at the end of the day, the whole world said that some proportion of our testing should be rapid antigen.
Now rapid antigen tests have a good specificity, which means that if a test is positive then, by and large, the result is correct. But the problem is that in certain situations it will miss a true positive. So, it can be used in far-flung areas where you need to screen a large number of people.
There have been discrepancies and inconsistencies in COVID-19 data coming out of Punjab, specifically. The data, at times, doesn’t match up. Have you noticed this?
There is a catch up of data. Now, when a positive test is fed into the system, the NCOC picks up the information. But I am not aware of any grandmaster sitting in a room saying that let’s change the statistics. When you are looking at large amounts of data coming from 100 or so laboratories, for example, you are bound to have some blips in the system.
Have government officials reached out to Opposition political parties to get them on board, or to get them to postpone their public rallies?
We discussed this in the NCOC very frankly, and I was very glad that the prime minister said we won’t hold our [gatherings]. I am happy to talk to them [the Opposition] as well.
We have actually written to the COVID committee of the National Assembly. It will be nice to have a chat with senior leaders from all political parties there. Look, I can’t imagine why they [the Opposition] won’t think of it. They are not enemies of the state.
Which vaccine do you think we would be able to get at the earliest?
We have two committees. One is an experts’ committee that looks into which vaccine we should get. This committee gave us names of around six which showed potential. The other committee will decide the future course of action.
Now, you have to see whether a vaccine is even available to you or not. And let’s say you have a vaccine but its technology is something you don’t have. To be honest, none of the options is off the table. We will see which vaccines are earliest available to us.
What we have decided is that our priority is front-line workers and people who are aged over 60. They will get the first available set of vaccines. While we have not placed any orders as yet, we are in very active negotiations with five or six manufacturers.
Ideally speaking, what is our timeline for the vaccine?
The timeline for a widespread vaccine, for the globe, is going to be, in very optimistic approximations, quarter one of 2021. Or more likely quarter two of 2021.
There have also been cases of reinfection in Pakistan? How concerning is that?
It is a well-known phenomenon that for some viruses and some individuals, the immunity will end and you may get a second episode.
Look at it this way. If second episodes were the norm, we would have gone berserk with reinfections. The situation definitely exists. Maybe one out of 1,000, or one out of 100,000. As an exceptional phenomenon, it is very much possible but in a few days, we will have enough data about it.
I don’t have any difficulty in accepting its presence, but I do not think that it is a particularly worrying thing. The first infection confers a durable immunity of many months, or perhaps longer.
Originally published at Geo tv