LAHORE: Two months after Pakistan detected its first coronavirus patient on February 26, the country’s senior most health official, Dr. Zafar Mirza, admitted in a press briefing that the state could only test 6,500 samples of the virus in a day.
A recent report by the World Health Organization (WHO) insisted that Pakistan should be conducting over 50,000 tests per day.
Pakistan had fallen short of the ambitious April 7 target set by federal minister Asad Umar who chaired the National Command and Control Center (NCOC), the central body for decision-making about COVID-19 in the country.
Umar had promised to push the testing beyond 25,000 per day by end April — a target that couldn’t be met.
Even by May, the capacity was low, and the actual tests being conducted were even lower, below 14,000 per day.
Test numbers were barely crawling at a time when the government had begun phasing out restrictive measures for the population of over 207 million.
But the month of June saw a major turnaround. Pakistan registered an astronomical rise, both in its testing capacity and the specimens it was diagnosing.
On June 17, it listed its capacity as 32,000 tests per day for active cases. Four days later, that number almost doubled.
Pakistan now has the infrastructure to test over 71,780 samples in a day at 132 commercial and public laboratories, according to the NCOC.
There are three functioning labs each in Azad Jammu and Kashmir and Gilgit-Baltistan, five in Balochistan, 16 in Islamabad, 17 in Khyber Pakhtunkhwa, 26 in Sindh, 33 in Punjab, 26 run by the armed forces and three by the National Disaster Management Authority (NDMA).
But a closer examination of the data by Arab News highlighted discrepancies in the official tally of each province and that of the central body.
According to the data on the NCOC website, there are three medical labs in Gilgit-Baltistan with a capacity to diagnose 200 samples daily.
But Faizullah Firaq, the spokesperson for Gilgit-Baltistan, told Arab News that of these, there are only two civilian testing labs for the whole federating unit, with a maximum output of only 70 tests per day.
Similarly, the NCOC notes down 16 laboratories in Islamabad, even though Dr. Hasan Orooj, the director general health in the capital city, told Arab News there were only 13 labs in the capital.
The capacity of the laboratories according to the NCOC totals to under 15,000 tests, much below the proclaimed 71,780 capacity.
Although, it is unclear how many samples can the labs run by the Pakistan military diagnose. But the military added seven new labs to its tally in a single day on June 22.
Even with the increase in test capacity, as claimed, Pakistan has only managed to hit the 31,681 tests per day mark, its highest to date, on June 19.
A senior health official, who sits in the meetings of the NCOC, credited the increase in testing to the government quickly rolling out new laboratories. “In fact, we can test over 78,000 per day,” he said, over the phone on Tuesday, requesting not to be named. “The NCOC website has to be updated,” he added.
Further adding to the confusion was a statement by Pakistan’s information minister. In a press briefing on Tuesday, the minister said the country’s testing capacity was 50,000 tests daily from 129 labs.
While Pakistan’s testing numbers are ambiguous, how many people should the country ideally be testing per day?
“At a minimum, the number of tests should reflect the number of suspected new cases that appear each day,” Frederico Guanais, the deputy head of the health division at the Organization for Economic Co-Operation and Development (OECD), told Arab News via email, “Everyone that has flu-like symptoms, plus all of the people that were in contact with them within the previous 14 days.”
One good metric is provided by France.
The European nation starts from the number of new cases it is recording, Guanais explained.
It then assumes that on average one person has 25 contacts. Finally, it adds one-third of that number to the total and sets a target for its testing campaign.
Using the French formula, if Pakistan is recording 6,000 new cases per day of Covid-19, that should equal to 200,000 tests per day, “which is significantly lower” than the upward to 30,000 tests it is carrying out right now, Guanais adds.
Another guiding principal, to determine a testing benchmark is through the positive-test approach.
The positivity of tests is the percentage of tests that come back positive. As a rule, countries should aim to keep this number low.
According to the WHO in March, countries where testing has been done fairly extensively the positivity percentage ranges between 3% and 12%.
Frederico Guanais agrees. He cites the findings of Our World in Data, which shows that in South Korea and Germany, the positive tests never crossed 10%, even at the peak of their infections. Moreover, their latest percentage is below 1%.
“Higher positive rates suggest that tests are being conducted only on people with very high probability of having the infection,” Guanais said, “Many people with mild or no symptoms are probably not being detected.”
Pakistan’s positivity rate, as per a WHO report, is 16%. “Pakistan is above the 3% to 12% indicated by WHO. This suggests that Pakistan should probably be testing more,” the OECD health official added.
“It is important to test quickly, but also test in a targeted fashion. In a way that can be described as hunting the virus, instead of chasing after it,” Guanais said.