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Pakistan came up with great digital solutions …But its policy leaves much to be desired

It’s not the pandemic vs. digital tools, it’s people vs. digital tools.
by Luavut Zahid

Shmyla Khan had spent around a week and a half isolating when she got a message from the government asking her to get tested for covid-19.

The message, which was sent to her phone in both English and Urdu, told her she had been in contact with a confirmed case in the last 14 days. She was requested to take the required steps to self-quarantine and included a list of the most common symptoms to look out for.

The text that Shmyla got was an example of one of the many solutions that have either been rolled out, are currently in their beta phase, or are about to be officially launched.

Data from the Pakistan Telecommuni-cations Authority (PTA) and National Database and Registration Authority (NADRA) is cross referenced to isolate covid-19 cases on a map.

“This information is then used to alert those at risk of getting infected.” explained Sarmad Sohail, a business analyst with National Information Technology Board (NITB) leading the digital solutions team.

Pakistan has been criticized for its slow and inconsistent policy response to covid-19. However, the same cannot be said for the different IT-oriented initiatives it has undertaken.

Text Message sent by the government asking people to get tested for covid-19.

To put things into perspective, Pakistan’s first two cases were confirmed by Special Advisor to the PM on Health, Zafar Mirza, on February 26. The team had already launched its first solution close to two weeks before that.

The first thing that the team developed was a chatbot for the Ministry of Health. The bot is built on artificial intelligence and has been plugged into the ministry’s official website and the Facebook page.

Work for these digital solutions began as early as February 1. The chatbot itself was live by February 14, and was officially launched by February 27.

“When people say the response was slow from the government, I want to show them all the work that our team has done,” Sarmad said.

Alongside the chatbot, the team has already rolled out a covid-19 app for Android and iOS. Users can do a whole host of things on the app. They can find the nearest health facilities and testing centers, perform an assessment to see whether their symptoms are linked to the novel coronavirus, watch awareness videos, and talk to the chatbot.

The team has also helped create the National Command and Operation Center (NCOC), which is being used by the top level leadership in the country to manage decisions to tackle the pandemic. It provides an overview of where cases are on the rise and includes hospitals.

A Resource Management System (RMS) was also developed for the National Disaster Management Authority (NDMA) and Provincial Disaster Management Authority (PDMA) that could help them manage hospital resources better. It integrates MedTrack (which allows authorities to track covid-19 patients and suspected cases), Hospital Infrastructure Management System (HMS) and Inventory Management System (IMS), which includes information on their beds, doctors, ventilators, etc., from all public, private and military hospitals. The system puts up a literal count of the covid-19 resources going in and out of a hospital.

The data from the RMS allows the NCOC to make more informed decisions. For instance, if a hospital in Larkana says they need more ventilators, someone at the NCOC will check the RMS to see whether the request is genuine. This tool allows for better allocation of resources.

A call center was also created for the NCOC, which is used to call the patients so that their symptoms can be assessed. Their information is taken and forwarded to the concerned departments so that they can be guided further.

The Islamabad City App, launched in March, was altered so it could include a coronavirus complaint form, which people could use to flag problems such as overpriced masks or hoarding. Similarly, The Pakistan’s Citizen’s Portal was altered to include forms where people could sign up for the Corona Relief Tigers Force.

Another initiative called Yaran-e-Watan was also developed. The website works as a connecting platform, bringing together overseas Pakistani healthcare professionals with those that need their help. “The services are entirely free of cost and based on volunteers. Some people opt to fly to Pakistan to help while others help remotely,” Sarmad informed.

The team also developed a Central Information Dashboard for the Prime Minister’s Office to help them manage their PKR 12 crore relief package, which has been handed over to 12 different ministries. This dashboard keeps a track of where every single rupee is spent and provides information down to the smallest Tehsil that has been given the funds.

There are many other solutions in the works, and the team is constantly focused on evolving the ones that have already been deployed.

The team, which consists of over 12-15 members, has been working around the clock. “We don’t get much sleep, and we no longer go home to our families. There is no weekend for us, and it’s the same whether it’s a man or a woman,” he said.

Despite it undertaking multiple apps, websites, and systems simultaneously, the team was not given any new resources to work with. This is the same team that was already working on existing projects for the Federal Government.

But is it enough?

The short – and unfortunate – answer is no. The most robust digital solutions cannot push back against weak policymaking.

“The IT team can come up with the solution but cannot ask for policy changes. The work is restricted to making sure the different platforms, apps, etc., that were created continue to run smoothly,” a government official shared anonymously. And therein lies the rump.

Starting from Prime Minister Imran Khan and going all the way up to the Supreme Court, official stances and statements about the pandemic have been confused at best. Despite dozens of countries having to look towards lockdowns as the only solutions, Pakistan only imposed half-hearted quarantine measures.

In a study on the effectiveness of regional lockdown policies in Pakistan, researchers Hamza Umer and Muhammad Salar Khan note that complete and partial lockdowns had not been effective in containing the virus in three of the largest provinces in the country.

For instance, it was immensely difficult to close mosques down during the lockdown period. Mosque-goers even attacked police officers imposing the restrictions – and PM Imran Khan only made matters worse by asking authorities to be lenient in their dealings with such people.

The quarantine period should have been used to seriously increase testing and people should have been kept under strict control. While countries such as Malaysia, South Korea, New Zealand, etc, eased their lockdowns only when they had a good grip on the infection, Pakistan seemingly did it at the worst time. The restrictions were pulled back on May 8, at which point there were around 26,000 confirmed cases. The number post-lockdown has swelled to over 213,470 and counting.

On March 1, when Pakistan had only reported two cases, the World Health Organization (WHO) praised the government’s response. WHO’s Pakistan Representative Dr Palitha Mahipala said: “I am impressed by the swift and diligent way the Government has handled the crisis so far, and WHO is committed to support them every step of the way.”

Fast forward to June 10, and WHO’s confidence seemed to have taken a serious hit. “As of today, Pakistan does not meet any of the prerequisite conditions for opening the lockdown”, the WHO said in a letter to the provincial governments.

The organization confirmed that over 25 percent of all tests in Pakistan were positive for the virus, indicating that the actual rate of infection is dangerously high.

The government has repeatedly defended its decision to ease lockdown, citing the need to allow people to earn their livelihood. While the WHO recommended implementing intermittent  lockdowns i.e.  complete lockdown for two weeks followed by no lockdown for two weeks. The country instead opted for ‘selective’ or smart lockdowns.

Using the NCOC tools, infection hubs are isolated by geotagging people who have tested positive. A selective lockdown is then implemented in this area for 14 days.

While the smart lockdown has eased numbers, the change is not significant enough. In spite of these new measures, Pakistan continues to inch higher and higher into the list of countries with covid-19 infections. At present, it ranks 12 on the global list of countries – and its ascent has not stopped yet.

Instead of flattening the curve, we have given it wings to fly.

Preparing to be unprepared

No digital solution that has been created at the NITB can tackle the misinformation and lack of access to good information that is plaguing Pakistanis.

Zohaib Faridi learned the hard way that covid-19 is as real as a pandemic can get. “People who are not accepting covid-19 and think it’s a joke I’d like to tell them to wake up,” he  recalled. Finding a hospital bed became an uphill battle for his aunt who tested positive. After visiting five different hospitals, the family was forced to bring her back home and manage whatever care possible.

“I used to think that it was a hoax, but I see what this has done to my family. I can’t believe it. My aunt’s x-ray showed her lungs completely darkened. When we tried to talk to the doctor, he refused to even see her in person because of the risk of infection. All we can do is pray for her now,” he added.

Zohaib’s story is no longer unique. Hospitals across the country are running out of space for patients. Ansa* (name changed to protect privacy) shared a similar experience of being turned away by multiple hospitals before finding a bed for one of her relatives.

“I am fully aware of how lucky we were, because as cases rise this will only get worse. We found a bed, I’m sure there are many others who didn’t,” she said.

“We haven’t even peaked yet. I’m not sure what will happen to us next. I can still see people going about their days as though nothing is wrong. We must think of the people in our lives who are at risk. One person can recover but many others can literally die,” she added.

On one hand, the lack of available healthcare options has created a new storm – one where only those with access to the right resources can survive.

On the other hand, the entire situation has overwhelmed the healthcare system. Doctors are working round the clock without breaks, often facing the risk of not just getting infected but also beaten up by confused relatives of the patients they are treating.

According to World Bank data, for every 10,000 people, Pakistan has just 10 physicians, six hospital beds, seven nurses and midwives, and one community healthcare worker. Covid-19 will kill hundreds before it peaks – and the death tallies include health workers who are on the frontlines.

Data issued by the National Emergency Operation Centre (NEOC) mid-June shows that at least 3,858 health workers tested positive. This number included around 2,327 doctors and 476 nurses. Over 36 healthcare workers have died after contracting the virus.

The same small pool of resources that is killing the public is also killing healthcare workers.

Misinformation woes

On an average day, Pakistani social media is ripe with discussions on how ‘real’ the pandemic is. A plethora of conspiracy theories exists, each one more imaginative than the one before it. The lack of a clear message from the government has also had a chilling effect in egging on myths and fake news.

“All of the information that you see on the TV tells you that lockdowns are bad for the poor, they’re bad for the people. There is no clear outline on what the SOPs are or why we should follow them. An average person isn’t going to be doing research into staying alive when they think it’s all a lie,” Zohaib said.

In the absence of an actual widespread campaign to dispel misinformation, several citizen-led initiatives have popped up on social media to help. One such group is Doctor Consultation & Health Advice, which was created by OlaDoc.

Talking about his role in the group, Dr. Asher Hasan, Co-Founder & Executive Chairman, doctHERs and NayaJeevan explained: “We have a large network of female doctors who are active in our clinical network. We felt they can contribute to the nation’s efforts to combat the coronavirus by providing complimentary advisory services to their end-users.”

There are a lot of conspiracy theories swirling around when it comes to the pandemic. When the death rate wasn’t as high people thought it was a hoax, and now that people have started to die some believe it’s a deliberate plot.

The bombardment of myths and downright fiction related to the pandemic revealed the need for information from health practitioners. The idea was to get doctors involved so that there is real information being introduced to counter problematic information.

“If you look at some of the questions our doctors get asked on this group, you’ll get a sense of the paranoia and distortions which have been circulating around social media. To avoid perpetuating these myths, all clinical questions are only responded to with evidence-based responses by PMDC-licensed doctors,” Dr. Asher said.

Dr. Murwah Tariq from doctHERs answering queries from home.

Zoraiz Riaz Syed runs Corona Recovered Warriors, another group on Facebook, where plasma donors and seekers can find each other.

The experimental treatment has become popular in Pakistan as a solution for covid-19, with hope that antibodies from those cured of the virus can be used to treat other patients.

Despite Pakistan’s government insisting this route of therapy is of no use, the FDA released recommendations for researchers looking into convalescent plasma in May. The body went on to encourage those recovered to donate their plasma to help others. “One donation of convalescent plasma has the potential to help up to four patients,” it noted.

And as plasma therapy began getting more attention as a possible means to tackle covid-19, more and more people looked to find recovered patients.

But when no one knew where to start, Zoraiz created the group to help save lives. “I have a dream that one day this group has more donors than recipients,” he said.

When the pandemic first hit, Zoraiz felt that it was obvious that it would spread and that the numbers would rise by a huge margin. “It was then that I realized that there was no portal from the government where details of covid-19 survivors who could donate plasma could be found. The group was made to lighten the government’s load,” he explained.

Despite both the government-led and community-led efforts to use IT-based tools to answer the pandemic’s problems, their impact continues to fizzle out against the tide of new cases.

In between the digital solutions, misinformation, and lethargic policy making, the only thing most people in Pakistan can do is brace for impact. The sad reality is that when it comes to the novel coronavirus the worst is yet to come.

As for Sarmad’s team, they will continue the work they are doing. “If our solutions help someone find a bed or a ventilator then it’s all worth it,” he said bleakly.

Luavut Zahid is a freelance writer based in Lahore.

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