Public health and national security
With well over 2000 deaths the novel coronavirus (nCoV2019) from Wuhan, China, is responsible for infecting around 75,000 people so far. This epidemic has joined the ranks and files of bubonic plague, small pox, syphilis, AIDS, scarlet fever and other devastating epidemics that resulted in instilling fear and dread among the hoi polloi. The World Health Organization has called nCoV2019 a global health emergency.
Evolutionary insights into the ecology of coronaviruses suggest that bats are the natural hosts for all presently known coronaviruses, including the Human Severe Acute Respiratory Syndrome (SARS) coronavirus as well as Middle East Respiratory Syndrome (MERS). Since the onset of the SARS epidemic in early 2003, intense scientific effort has focused on identifying the zoonotic source responsible and its mode of transmission to humans. Various surveys in Southern China have revealed that civet cats, raccoon dogs and ferret-badgers from wet markets are intermediate vectors for spread of disease from bats to humans. Coronavirus infection causes respiratory symptoms such as cough, shortness of breath and fever. It spreads through respiratory droplets of an infected individual during coughing and sneezing.
Originating from the wet markets in Wuhan, China, this contagious infection has transcended borders and positive cases have been reported in 25 countries around the world. Various cruise ships have been quarantined in different parts of the world to prevent spread of the disease.
How does coronavirus (nCoV2019) infection translate for health security in Pakistan? A report carried in the Express Tribune on 9th February highlighted the fact that five passengers on Air China flight landing in Islamabad had symptoms of coronavirus and were rushed to the PIMS hospital. In another report published on 4th February in the Economic Times, a suspected case of coronavirus was detected in Sindh province following his return from China. Another positive case was detected in Multan and subsequently admitted in Nishtar hospital.
With no reliable screening and isolation during the incubation period, people arriving from China pose a serious threat of spreading the infection among the general population.
Dr. Mehreen Mujtaba
Pakistan is at a risk due to its geographical location. We not only share a border with China, but also have deep economic and business ties, with a large number of Chinese residing in various cities of the country who fly back and forth frequently. Around 50,000 Pakistanis reside in China, including 28,000 students studying in various universities across the country, with 500 students stranded in Wuhan alone, out of which 40 were evacuated and landed in Islamabad in early February.
Earlier this month, Pakistan resumed flights to and from China after closing them for three days amid scares of spread of the deadly virus. Though the slogans of Pak-China friendship are nice to hear while we as a nation face an economic crunch, the price of this friendship termed “higher than mountains, deeper than the ocean” could be costly for Pakistan in terms of dealing with the immensity of the problem. With no reliable screening and isolation during the incubation period, people arriving from China pose a serious threat of spreading the infection among the general population. While the Health Adviser to the prime minister is confident about the airport screening system being adequate, I personally question the wisdom of this move to reopen flights with China after landing in Islamabad on a QR flight from Doha on 4th February and being subjected to the cursory trigger of a scanner on my forehead by a technician who was busy talking on his cell phone and who did not bother to check the monitor.
Showing solidarity with China at the cost of jeopardizing the health of our own people is not a wise decision. Pakistan faces a myriad of issues with its health system. We have a weak infrastructure, not capable of coping with any sort of epidemic, let alone such an infectious and deadly one. After facing harsh criticism for failing to evacuate its citizens, Zafar Mirza, adviser to the prime minister on health, had an irrational explanation: “We stand in solidarity with China. If we act irresponsibly and start evacuating people from China, this epidemic will spread all over the world like wildfire.”
A medical health expert in Islamabad told the South China Morning Post that “we don’t have any facility to properly test suspected cases.” Novel Coronavirus outbreak serves to remind the global public health community that we must be relentless in our efforts to prevent, detect and respond to new emerging biological threats. The government needs to take policy measures to prepare for and respond to biological threats, which seem to be getting more common. Renewed efforts to develop the capabilities to rapidly develop and manufacture new medical countermeasures are more important now than ever, given the speed with which infections travel globally.
We need to strengthen our healthcare system to ensure that it is robust enough to treat a large number of patients in case of an epidemic and build fully equipped medical centers in order to evacuate and quarantine patients such as Pakistani citizens and students stuck in Wuhan. National security should also include guidelines and way forward for health security, which is imperative in today’s world faced with the emergence of new biological threats.
Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health