Sunday, July 5, 2020

Declining COVID19 Reproduction Rate in Pakistan Now Among the World's Lowest

London's Imperial College estimates that COVID19 pandemic in Pakistan is "on course to fade out", a testimony to Prime Minister Imran Khan's government's effective handling of the the ongoing global health crisis.  At just 0.74, the effective coronavirus reproduction rate (Rt) in Pakistan is among the lowest in the world. An Rt of less than 1 indicates each infected person is infecting fewer than one person.  Only Italy (0.63), Netherlands (0.62), Canada (0.50) and Spain (0.02) have lower reproduction rates than Pakistan's. However, this is no time to relax. Pakistanis need to continue to take all precautions, including wearing face masks, to ensure that COVID19 fades out in the country.

COVID19 Effective Reproductive Rate. Source: Imperial College, London, UK

Pakistan's coronavirus transmission rate is lowest in its region. Neighboring India's Rt is 1.14, Iran's 1.12, Bangladesh 0.96 and Afghanistan's 0.93 are all significantly higher than Pakistan's 0.74.

COVID19 Effective Reproductive Rate. Source: Imperial College, London, UK

The latest numbers vindicate Pakistan government's "smart lockdown" strategy of requiring face masks and selective lockdowns of hotspots. Pakistan's strategy has been aimed at balancing lives and livelihoods in the middle of a deadly pandemic that has infected more than 11 million people globally, and claimed over 4,500 lives in Pakistan and more than half a million lives around the world. Developed western nations, particularly US and UK, have been among the worst affected by it.

akistan COVID19 Weekly Death Decline to 577 Now From Peak of 869 Last Week

Weekly COVID19 deaths in Pakistan have declined to 577 this week from 869 last week. To put it perspective, about 4,000 Pakistanis died everyday from various causes before the current pandemic.

Positive Test Rate Declines to 1 in 6.36 (15.7%) From Peak of 1 in 4.47 (22.3%) on June 4, 2020

The number of people testing positive in Pakistan has declined to 1 in 6.36 (15.7%) from the peak of 1 in 4.47 (22.3%) on June 4, 2020.

From the beginning of the pandemic, Pakistan's strategy has been aimed at balancing lives and livelihoods. The latest numbers vindicate Pakistan government's "smart lockdown" strategy of requiring face masks and selective lockdowns of hotspots. However, this is no time to relax. Pakistanis need to continue to take all precautions, including wearing face masks, to ensure that COVID19 fades out in the country.
Talk4Pak host with Faraz Darvesh discusses this subject with Misbah Azam and Riaz Haq:



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Pakistan Pharma Among World's Top 3 Fastest Growing

Pakistan pharmaceutical industry and market are among the world's top 3 fastest growing, according to IQVIA health market research firm based in the United States. Pakistan’s domestic pharmaceutical firms sales have grown 13.1% compounded annually in the last 4 years, outperforming multinational companies (MNCs), which saw global growth of 9.34% CAGR. Pakistan's pharma sector is growing faster than in other emerging markets like Bangladesh, Brazil, India, Russia and Vietnam.

Emerging faster than the MNCs, the quarterly revenues of the local Pakistani pharmaceutical companies surged to Rs. 320 billion in the quarter ending March 31, 2020, compared with Rs. 195.75 billion as of March 31, 2016. Similarly, MNCs increased their quarterly sales in Pakistan to Rs. 143.2 billion at the end of the first quarter of 2020, up from Rs. 100.2 billion in Q12016, according to Pakistani media reports. Pakistan exported $217.04 million worth of pharma products during 2019, according to the United Nations COMTRADE database on international trade.

Pakistan Pharma Growth Among Top Fastest in the World. Source: IQVIA

Medicine spending growth in the emerging pharmaceutical  ("pharmerging") markets continues to slow compared to the past five years and is projected to grow at 5–8% through 2023, according to US-based global market research firm IQVIA.

Pakistan Pharma Exports

Although China, Brazil and India have the largest medicine spending within the pharmerging markets, Turkey, Egypt and Pakistan are forecast to have the greatest growth between 2019 and 2023. Pharmerging market growth continues to derive primarily from increasing per capita use, but some markets are seeing wider uptake of newer medicines as patients’ ability to afford their share of costs improves with economic growth.

Pakistan's top 5 pharma companies, including GSK, Abbott, and AGP Pharma,  saw their profits jump 37% in Q1/2020 over the same period last year, to Rs2.6 billion. In the same quarter, profits of 13 consumer giants, including Nestle, Packages, Pakistan Tobacco and Colgate, remained flat amid COVID19 pandemic.

In growing recognition of Pakistan's pharmaceutical sector, the  US-based Gilead Sciences recently chose to license COVID19 drug Remdesivir to Pakistan's Ferozsons pharmaceutical company. Other Remdisivir licensees include pharma companies in India. Gilead said it signed non-exclusive licensing pacts with 5 generic drugmakers based in India and Pakistan, allowing them make and sell Remdesivir for 127 countries.

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Friday, July 3, 2020

Pakistani-American Actor Kumail Nanjiani to Star in Marvel's New Movie

Karachi-born Pakistani-American actor Kumail Nanjiani plays Kingo,  one of the title characters in "The Eternals", Marvel's new movie scheduled for release in 2021. Kingo is a 16th century Japanese master swordsman and a film star and producer. The Eternals are a race of immortal superheroes. The movie also stars Angelina Jolie, Salma Hayek, Richard Madden, and Kit Harington.

Kumail Nanjiani 

Nanjiani is a comedian. Prior to The Eternals, Nanjiani has not played any muscular hero roles. He had to train for a year to get in shape for this role. Posting a photo showing his killer abs on Instagram, Nanjiani said: "I found out a year ago I was going to be in Marvel's Eternals and decided I wanted to transform how I looked. I would not have been able to do this if I didn't have a full year with the best trainers and nutritionists paid for by the biggest studio in the world".

One of constant themes of his media coverage the fact that he is among the few men of color in the mostly white world of Hollywood.  In a recent Hollywood Reporter roundtable with Ricky Gervais, Ramy Youssef, Kenan Thompson and Dan Levy, Nanjiani said Sometimes I feel like there are these two buckets: There's white people, and everyone else is "people of color," and there's this idea that there's a monolithic thought in there.

Kumail Nanjiani's first starring role was in HBO comedy "Silicon Valley" in which he plays a Pakistani-American software engineer. Nanjiani says that "I feel more Pakistani than I have in the last 10 years". "I feel way more defined by my ethnicity now," Nanjiani says. "If there's an ethnicity that is maligned and attacked and demonized ... I'm with you. I stand with you. Because it's unavoidable that people are seeing me a certain way, I kind of want to own it. I feel more Pakistani than I have in the last 10 years", he told USA Today.

Kumail interspersed his 2017 movie The Big Sick with a running presentation on his country of birth that shows him singing the first few lines of Pakistan's national anthem out loud. Nanjiani also brings out his love of cricket and the fact that Pakistan has the world's largest contiguous farm irrigation system.


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Riaz Haq's Youtube Channel

Monday, June 29, 2020

Are American and Pakistani Responses to COVID19 Pandemic Flawed?

Did the pandemic surveillance system fail in early detection of the Coronavirus in US and Pakistan? What are the problems in this system? What needs to be done to correct the problems?

Positive Test Rate Declines to 1 in 6.36 (15.7%) From Peak of 1 in 4.47 (22.3%) on June 4, 2020

How are Prime Minister Imran Khan of Pakistan and President Donald Trump of the United States handling the COVID19 pandemic? Are both their responses fundamentally flawed? Are absolute total lockdowns as recommended by the World Health Organization necessary in Pakistan? Can Pakistan handle the economic and human consequences of extended total lockdown?

Pakistan COVID19 Weekly Death Decline to 577 Now From Peak of 869 Last Week

Weekly COVID19 deaths in Pakistan have declined to 577 this week from 869 last week. To put it perspective, about 4,000 Pakistanis died everyday from various causes before the current pandemic.

The number of people testing positive in Pakistan has declined to 1 in 6.36 (15.7%) from the peak of 1 in 4.47 (22.3%) on June 4, 2020.

What does the coronavirus data show in terms of coronavirus cases and fatality rates in the US and Pakistan? Is the positivity rate the right gauge of the true extent of the spread of the virus? Is antibodies testing data a better indicator of it? Why is the COVID19 death rate in Pakistan among the lowest in the world? Is it grossly understated?

Despardes with Faraz Darvesh host discusses these questions with Pakistani-American epidemiologist Dr. Rashid Chotani and analyst Riaz Haq (www.riazhaq.com):


https://youtu.be/_fJk6GH_-GE






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Tuesday, June 23, 2020

Opioid Crisis: Indian-American Pharma CEO Jailed

Dr. John Nath Kapoor, Indian-American CEO of Insys Therapeutics, has been found guilty of conspiring to recklessly and illegally boost profits from the opioid painkiller Subsys, a fentanyl spray designed to be absorbed under the tongue, according to multiple media reports.


Dr. John Nath Kapoor
In 2018, data showed that opioid overdoses killed an average of 128 Americans everyday.  Last year, nearly 70,000 Americans died of opioid overdoses.  Opioid abuse has become a public health crisis with devastating social, economic and health consequences in vast swathes of America.  In spite of knowing the dangers opioids posed, drug companies like Kapoor's Insys heavily promoted such drugs by paying physicians to overprescribe, resulting in enormous company profits.

Kapoor has received five and a half years jail sentence.  CBS has reported that others working for him have been sentenced to serve from 12 to 33 months, in part because of the testimony of the government's star witness: Alec Burlakoff, the senior vice president of sales at Insys, who had pled guilty and cooperated with prosecutors.

Kapoor, billionaire entrepreneur and former CEO of Insys Therapeutics, was born in Amritsar, India. He studied pharmacy at Institute of Chemical Technology in Mumbai, India. He received a doctorate in medicinal chemistry from University of Buffalo, New York, in 1972. He became a major American success story until he was arrested and charged in 2017 under RICO (Racketeer Influenced and Corrupt Organizations) laws.

Earlier in June, 2020, three Indian-American physicians were found to have faked results of a hydroxychloroquine (HCQ) study they published in New England Journal of Medicine and The Lancet. Both journals were forced to retract it.

Last year, an Indian-American operator and several Indian-American and other doctors participating in a home health care business in Silicon Valley were charged by US federal prosecutors with fraud.

India and Pakistan are among the top three sources of foreign medical professionals in the United States.

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Sunday, June 21, 2020

Impact of COVID19 Pandemic; Biden vs Trump; Modi's Blunders

What is the global impact of COVID19 pandemic? How has it affected the United States? How is Prime Minister Imran Khan handling the coronavirus crisis in Pakistan? Are complete lockdowns absolutely necessary to contain the spread of coronavirus?

Impact of COVID19 Global Pandemic

Has President Trump's handling of the COVID pandemic and its devastating economic impact hurt his re-election chances?  Who is better for Pakistan? Biden or Trump? Was President Obama's hostility toward Pakistan shared by Joe Biden who served as his vice president from 2009 to 2017? Why did Biden say "Pakistan is 50 times more important to US than Afghanistan"?

Have Prime Minister Modi's policies backfired? Why has Modi not succeeded in isolating Pakistan? Why do almost all of India's neighbors from China to Nepal to Pakistan have problems with India? Why is Modi under India so isolated? Why has President Trump not strongly backed India in Ladakh?

Despardes with Faraz Darvesh discusses these questions with Misbah Azam and Riaz Haq (www.riazhaq.com).


https://youtu.be/4REeQjTDHvw






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Saturday, June 20, 2020

Can India Afford Economic Boycott of China After Ladakh?

Indian consumers are hooked to a whole range of Chinese products. India's industry sources critical components from China. Indian startups rely on Chinese venture capital. Can Indians really afford to boycott China without seriously hurting themselves after the killing of Indian soldiers by the Chinese Army in Ladakh?  Let's look at the data.


China-India Lopsided Trade. Source: Times of India

Volume of China-India Trade:

India accounts for $70 billion of China's export,  less than 3% of the country's $2.5 trillion in exports. Chinese products make up about 18% of India's total imports.

India imports almost seven times more from China than it exports to it, according Indian media reports. India runs huge trade deficit with China – its largest with any country. In 2018-19, India’s exports to China were mere $16.7 billion, while imports were $70.3 billion, leaving a trade deficit of $53.6 billion.

Indian Industries Dependence on China:

Indian industry depends on China for a range of raw materials. About a fifth of  components used by Indian automobile industry come from China. 70 percent of all electronic components used by Indian companies are imported from China.

Over 45% of consumer durables, 70% of APIs (active pharmaceutical ingredients) come from China. Nearly 75% of the telecom equipment used by Indian carriers is from China, according to the Sunday Guardian.

Chinese Venture Capital in India. Source: Economic Times

Indian Startup Venture Capital:

China is the biggest source of venture capital in India.  Chinese VCs have poured about $4 billion in 90 startups in India. Two-thirds of Indian start-ups valued at more than $1 billion have at least one Chinese investor.  High-profile startups like Byju, Flipkart, Ola, PayTM and Zomato.

India's startup ecosystem continues to be dependent on large swathes of foreign funding given the ongoing absence of home-grown pools of capital. It will face significant near-to-medium term cash constraints if investors from the world’s second-largest economy walk away, according to Economic Times. 

Summary:

With growing Chinese trade and investment in India, the Indian economy has become significantly dependent on China.  Chinese VCs have poured about $4 billion in 90 startups in India. Two-thirds of Indian start-ups valued at more than $1 billion have at least one Chinese investor About a fifth of  components used by Indian automobile industry come from China. 70 percent of all electronic components used by Indian companies are imported from China. Similarly, 45 percent of consumer durables, 70% of APIs (active pharmaceutical ingredients) come from China. Nearly 75% of the telecom equipment used by Indian carriers is from China, according to the Sunday Guardian. Indians can not boycott China without seriously hurting themselves.

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Sunday, June 14, 2020

Indian-American COVID19 Researchers Face Fraud Charges Over HydroxyChloroquine (HCQ) Study

Top two international medical journals, New England Journal of Medicine (NEJM) and The Lancet, were recently forced to retract two papers on COVID-19 due to obvious fraud committed by the coauthor Sapan Desai, Chicago-based Indian-American surgeon and businessman, whose analytics company Surgisphere claimed to have stored clinical data from thousands of patients of hundreds of hospitals as part of HydroxyChloroquine (HCQ) study. Dr. Amit Patel and Dr. Madeep Mehra, both of whom are American-Indians, claimed to be the lead authors of the papers published in The Lancet and NEJM. The drug was promoted by US President Trump as a way to treat COVID patients. The study claimed to have looked at data from 671 hospitals across six continents related to 96,000 patients. The authors claimed that 81,000 hospitalized patients were not given HCQ but 15,000 were given HCQ which has been widely used to treat malaria patients.

It all turned out to be fake. But it forced World Health Organization (WHO) to suspend its clinical trial of the drug's effectiveness in treating coronavirus patients, a serious setback to finding a treatment for the highly contagious disease that has put a big chunk of the world in lockdown.

India-American Doctors Amit Patel, Mandeep Mehra, Sapan Desai


On June 4, 2020, The Lancet issued the following retraction statement:

“Today, three of the authors of the paper, “Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis”, have retracted their study. They were unable to complete an independent audit of the data underpinning their analysis. As a result, they have concluded that they “can no longer vouch for the veracity of the primary data sources.” The Lancet takes issues of scientific integrity extremely seriously, and there are many outstanding questions about Surgisphere and the data that were allegedly included in this study.”

Dr. Amit Patel and Dr. Madeep Mehra, both of who are American-Indians claimed to be the lead authors of the papers published in The Lancet and NEJM. Dr. Patel has had his faculty position terminated by the University of Utah, where he was the chief of Cardiothoracic Surgery. Dr. Mehra has offered an unconditional apology and confessed that he lent his name as lead investigator to several research papers without looking at the data supplied by Desai.

Apparently, Mehra and Patel designed a study and then asked Desai to provide them some results out of thin air to support their predetermined conclusions. Medical Journals are often keen to publish scientific studies on COVID-19 that help them increase their earnings via subscriptions and advertising. The authors would probably have gotten away with the fraud if the study had been something not as high profile as the search for COVID19 treatment.

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Racism in America; Coronavirus in Pakistan; China in Ladakh

Is the killing of George Floyd by a white Minneapolis Police Officer symptomatic of a deeper problem in American society? Is the Trump phenomenon the result of ingrained racism in America? Is racism rooted in America's original sin of slavery?  Is it time to openly acknowledge and address it? Is it time for greater social change beyond the emancipation proclamation of 1860s and the civil rights legislation of 1960s? Is wide participation of white American protesters in recent marches a clear call for action by top leadership in the White House and the US Congress?

George Floyd Memorialized By Pakistani Truck Artist Haider Ali

What is the status and the trajectory of coronavirus pandemic in Pakistan? How widespread are the infections? What does COVID19 and antibodies testing tell us? Is easing of lockdown justified? How long a lockdown can Pakistan's poor afford? What is the alternative? Can mandatory face mask slow down the spread? Is there a right balance between lives and livelihoods?

Why is India so isolated? Have Modi's actions contributed to Chinese aggressive response in Ladakh? Did revocation of article 370 provoke China? Where does America stand on the situation in Ladakh? Will Trump before his offer to mediate between India and China? Is the current China-India standoff an opportunity for Pakistan like the one in 1962 when the Indian military was on the run? Can Pakistan take advantage of it?

Despardes with Faraz Darvesh host discusses these questions with Raza Rumi, Misbah Azam and Riaz Haq.

https://youtu.be/sTUrkPh5zeU






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Tuesday, June 9, 2020

About 5% of Confirmed COVID19 Cases Currently Hospitalized in Pakistan

Pakistan has so far had just over 100,000 confirmed cases of COVID19. About 5,000 are currently in hospitals, including 1,000 in critical condition and 278 on ventilators, according to the World Heath Organization representative in Pakistan. Over 32,000 have recovered and 2,000 have died. Data from multiple countries shows that only a few of those who go on the ventilators survive. It takes highly skilled pulmonologists to insert the ventilator, a skill that is not widely available. Meanwhile, antibodies testing in Karachi indicates millions in Pakistan may have already been infected with COVID19 without any symptoms or sickness. More testing is uncovering more of those already infected but only have mild symptoms and unlikely to get sick or die.

Pakistan Hospitalization Data. Source: WHO
Hospitalizations in Pakistan:

About 5,000 Pakistanis are currently in hospitals, including 1,000 in critical condition and 278 on ventilators, according to World Heath Organization representative in Pakistan. Over 32,000 have recovered and 2,000 have died. Data from multiple countries shows that only a few of those who go on the ventilators survive. It takes highly skilled pulmonologists to insert the ventilator, a skill that is not widely available.

Nearly 2,000 of the 100,000 confirmed coronavirus cases have died, bringing Pakistan's fatality rate to about 2%, among the lowest in the world. The number of deaths are now doubling every 18 days, a period three times longer than at the start of the pandemic.


COVID19 Testing and Cases:

Media headlines tend to highlight record single day spikes in confirmed cases. What they don't tell you is the record spike in tests almost every single day in Pakistan. It is very simple: The more you test the more cases you will confirm as long as the virus is in the community.  More testing is uncovering more of those already infected but only have mild symptoms and unlikely to get sick or die.


COVID19 Tests and Cases. Source: Pakistan Ministry of Health

Antibodies testing in Pakistan's largest city Karachi has revealed that 15% of the citizens are asymptomatic carriers of the coronavirus, a figure close to WHO's estimate of 16% for the global population.

Coronavirus Antibodies
Serological Testing:

Antibodies testing of 7,000 adults in Karachi reveals that as many as 15% of them have already been exposed to COVID19 without experiencing symptoms, according to a study by Dr. Wajiha Javed, an epidemiologist and head of public health and research at Getz Pharma in Pakistan. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus. It takes at least 40% of the population to be exposed to build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

Human Immune Response:

Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. Serology tests can detect body's immune response to even a low-level viral load. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. However, the most vulnerable population such as the elderly must be isolated until herd immunity is achieved. It takes at least 40% of the population to be exposed to build herd immunity.


Getz Study:

Getz Pharma's Dr. Wajiha Javed told me in the latest update on her ongoing work that serology tests have so far been administered to 7,000 adults aged 18-65 over the last 6 weeks in Karachi. 15% of them have tested positive for COVID19 antibodies. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers.

Antibody testing kits detect the response of the body rather than the virus or antigen itself. These tests do not have the issue of low viral load. Antibody tests can detect exposure to Covid-19 even in asymptomatic cases. Generally, antibody testing kits have a high level of accuracy, especially on sequential testing. The kit Getz Pharma has been using has a sensitivity (the ability to correctly detect positive cases) of 95.3% and specificity (the ability to correctly detect negative cases) of 98.7% for IgG, and the sensitivity is 86.48% and specificity is 95.18% for IgM, according to Dr. Wajiha Javed.

Pakistan COVID19 Death Rate Among The World's Lowest. Source: Our World in Data 

Asymptomatic Carriers: 

Over 90% of those who tested positive in Karachi did not have any symptoms or had only mild symptoms, Dr. Wajiha Javed recently wrote in Dawn newspaper.  But some were infectious and they were spreading the virus to others. Because of their non-existent or mild symptoms, they had not reached out to a PCR testing facility to get tested for Covid-19, and were only incidentally picked out for the antibody test during Getz's study. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus.

Summary:

About 5% of the 100,000 confirmed COVID19 in Pakistan are currently hospitalized. About 2,000 of the 100,000 confirmed coronavirus cases have died, bringing Pakistan's fatality rate to about 2%, among the lowest in the world. The number of deaths are now doubling every 18 days, a much longer period than at the start of the pandemic.  As many as 15% of Karachi adults have been exposed to COVID19 with over 90% of them showing no symptoms, according to a Getz Pharma study in Pakistan. This is close to WHO's 16% of the global asymptomatic carrier population. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. It can even detect body's immune response to a low-level viral load. Getz Pharma's antibodies test data suggests the possibility that millions of Pakistanis may have already been exposed to coronavirus.  Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

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Coronavirus Lockdown, Lives and Livelihoods

Can Pakistan Effectively Respond to Coronavirus Outbreak? 

How Grim is Pakistan's Social Sector Progress?

Pakistan Fares Marginally Better Than India On Disease Burdens

Can Imran Khan Lead Pakistan to the Next Level?

Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

Conspiracy Theories About Pakistan Elections"

PTI Triumphs Over Corrupt Dynastic Political Parties

Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel

Thursday, June 4, 2020

Antibodies Testing in Karachi Reveals COVID19 Exposure Runs in Double Digits

Antibodies testing of 7,000 adults in Karachi reveals that as many as 15% of them have already been exposed to COVID19 without experiencing symptoms, according to a study by Dr. Wajiha Javed, an epidemiologist and head of public health and research at Getz Pharma in Pakistan. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus. It takes at least 40% of the population to be exposed to build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

Human Immune Response:

Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. Serology tests can detect body's immune response to even a low-level viral load. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. However, the most vulnerable population such as the elderly must be isolated until herd immunity is achieved. It takes at least 40% of the population to be exposed to build herd immunity.

Coronavirus Antibodies

Getz Study:

Getz Pharma's Dr. Wajiha Javed told me in the latest update on her ongoing work that serology tests have so far been administered to 7,000 adults aged 18-65 over the last 6 weeks in Karachi. 15% of them have tested positive for COVID19 antibodies. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers.

Antibody testing kits detect the response of the body rather than the virus or antigen itself. These tests do not have the issue of low viral load. Antibody tests can detect exposure to Covid-19 even in asymptomatic cases. Generally, antibody testing kits have a high level of accuracy, especially on sequential testing. The kit Getz Pharma has been using has a sensitivity (the ability to correctly detect positive cases) of 95.3% and specificity (the ability to correctly detect negative cases) of 98.7% for IgG, and the sensitivity is 86.48% and specificity is 95.18% for IgM, according to Dr. Wajiha Javed.

Pakistan COVID19 Death Rate Among The World's Lowest. Source: Our World in Data 

Asymptomatic Carriers: 

Over 90% of those who tested positive in Karachi did not have any symptoms or had only mild symptoms, Dr. Wajiha Javed recently wrote in Dawn newspaper.  But some were infectious and they were spreading the virus to others. Because of their non-existent or mild symptoms, they had not reached out to a PCR testing facility to get tested for Covid-19, and were only incidentally picked out for the antibody test during Getz's study. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus.

Summary:

As many as 15% of Karachi adults have been exposed to COVID19 with over 90% of them showing no symptoms, according to a Getz Pharma study in Pakistan. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers. Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. It can even detect body's immune response to a low-level viral load. Getz Pharma's antibodies test data suggests the possibility that millions of Pakistanis may have already been exposed to coronavirus.  Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

Related Links:

Haq's Musings

South Asia Investor Review

Vast Majority of Pakistanis Support Imran Khan's Handling of Covid19 Crisis

Pakistani-American Woman Featured in Netflix Documentary "Pandemic"

Coronavirus Lockdown, Lives and Livelihoods

Can Pakistan Effectively Respond to Coronavirus Outbreak? 

How Grim is Pakistan's Social Sector Progress?

Pakistan Fares Marginally Better Than India On Disease Burdens

Can Imran Khan Lead Pakistan to the Next Level?

Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

Conspiracy Theories About Pakistan Elections"

PTI Triumphs Over Corrupt Dynastic Political Parties

Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel

Friday, May 29, 2020

Are Lockdowns Absolutely Necessary to Contain the Coronavirus Pandemic?

Many countries have imposed strict lockdowns to control the spread of coronavirus.  Marko Kolanovic of JP Morgan claims that numbers had declined because the virus "likely has its own dynamics" that are "unrelated to and often inconsistent lockdown measures".  He cites as evidence a number of places whose infection rates, or "R" values, have continued to fall despite restrictions being lifted.

Coronavirus Transmission Rates Before & After Lockdown. Source: JP Morgan


Are these absolutely necessary? What are its costs and benefits in terms of lives and livelihoods, particularly in developing countries like Pakistan with young populations?  Over 40% of all coronavirus deaths in Europe and America have occurred among the elderly living in nursing homes. Pakistanis age 60+ account for 19% of cases but 58% of deaths. Like US and Europe, older people are much more likely to die from coronavirus in Pakistan.  But average life expectancy in Pakistan is just 67 years and the median age in the country is only 22 years. The explanations offered for low death rates in South Asia include younger populations, more sunshinehigher temperature and humidity, universal BCG vaccinations etc. Yale researchers have argued in a recently published paper to consider universal mask adoption and increased hygiene measures as an alternative to complete lockdown.

Coronavirus Infections and Death Demographics. Source: Pakistan Health Ministry


Are there other tools such as compulsory face masks which can preserve both lives and livelihoods? In a recently published paper tiled "The Benefits and Costs of Social Distancing in Rich and PoorCountries", Yale researchers support universal mask adoption and increased hygiene measures as a alternatives to social distancing and complete lockdown.

What will be the impact of coronavirus lockdown on global economy?  European Union foreign policy chief Josep Borell has said "Analysts have long talked about the end of an American-led system and the arrival of an Asian century. This is now happening in front of our eyes," he said. "If the 21st century turns out to be an Asian century, as the 20th was an American one, the pandemic may well be remembered as the turning point of this process."

Does it impinge on civil liberties of the people? Could such lockdowns cause various physical and mental illnesses leading to deaths and high rates of suicides?

Despardes with Faraz Darvesh host discusses these questions with Ali Hasan Cemendtaur, Misbah Azam and Riaz Haq.

https://youtu.be/3HtPH8cnEPM




Related Links:

Haq's Musings

South Asia Investor Review

Vast Majority of Pakistanis Support Imran Khan's Handling of Covid19 Crisis

Pakistani-American Woman Featured in Netflix Documentary "Pandemic"

Can Pakistan Respond Effectively to Coronavirus Pandemic?

Can Pakistan Effectively Respond to Coronavirus Outbreak? 

How Grim is Pakistan's Social Sector Progress?

Pakistan Fares Marginally Better Than India On Disease Burdens

Can Imran Khan Lead Pakistan to the Next Level?

Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

Conspiracy Theories About Pakistan Elections"

PTI Triumphs Over Corrupt Dynastic Political Parties

Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel

Thursday, May 28, 2020

Yom-e-Takbeer: US Efforts to Stop Pakistan Nuclear Tests in May, 1998

"Believe me when I tell you that my heart is with you. I appreciate and would even privately agree with what you're advising us to do (abandon nuclear tests)", said Pakistan's Ex Prime Minister Nawaz Sharif to US Deputy Secretary of State Strobe Talbott on May 16, 1998

The order to conduct Pakistan's nuclear tests came from Mr. Nawaz Sharif who was Pakistan's prime minister in 1998. It came on May 28, just over two weeks after India's nuclear tests conducted May 11 to May 13, 1998. Pakistan went ahead with the tests in spite of the US pressure to abstain from testing.  US President Bill Clinton called Prime Minister Nawaz Sharif immediately after the Indian tests to urge restraint.  It was followed up by Deputy Secretary of State Strobe Talbott's visit to Islamabad on May 16, 1998.

In his 2010 book titled "Engaging India: Diplomacy, Democracy, and the Bomb", Secretary Talbott has described US diplomatic efforts to dissuade Pakistan in the two weeks period between the Indian and Pakistani nuclear tests. Here are a few excerpts of the book divided into four sections covering Clinton's call to Sharif, Talbott's visits to the Foreign Office (FO), general headquarters (GHQ) and Prime Minister's House:

Clinton's Call to Sharif: 

Clinton telephoned Sharif, the Pakistani PM, to whet his appetite for the planes, huge amounts of financial aid, and a prize certain to appeal to Sharif—an invitation for him to make an official visit to Washington.

“You can almost hear the guy wringing his hands and sweating,” Clinton said after hanging up.

Still, we had to keep trying. Our best chance was an emergency dose of face-to-face diplomacy. It was decided that I would fly to Pakistan and make the case to Nawaz Sharif.

Meeting at Foreign Office in Islamabad:

On arrival in Islamabad, we had about an hour to freshen up at a hotel before our first official meeting, which was with the foreign minister, Gohar Ayub Khan, and the foreign secretary (the senior civil servant in the ministry), Shamshad Ahmad.

When we got to the foreign ministry, we found that the Pakistani civilian leaders had finally figured out how to handle our visit, and the result was a bracing experience. My two hosts rolled their eyes, mumbled imprecations under their breath, and constantly interrupted.

They accused the United States of having turned a blind eye to the BJP’s preparations for the test.

As for the carrots I had brought, the Pakistanis gave me a version of the reaction I had gotten from General Wahid five years earlier. Offers of Pressler relief and delivery of “those rotting and virtually obsolete air- planes,” said Gohar Ayub, were “shoddy rugs you’ve tried to sell us before.” The Pakistani people, he added, “would mock us if we accepted your offer. They will take to the streets in protest.”

I replied that Pakistanis were more likely to protest if they didn’t have jobs. Gohar Ayub and Shamshad Ahmad waved the point aside. The two Pakistani officials were dismissive. The current burst of international outrage against India would dissipate rapidly, they predicted.

Visit to General Headquarter (GHQ) in Rawalpindi:

We set off with police escort, sirens blaring, to (Chief of Army Staff) General Karamat’s headquarters in Rawalpindi.

Karamat, who was soft-spoken and self-confident, did not waste time on polemics. He heard us out and acknowledged the validity of at least some of our arguments, especially those concerning the danger that, by testing, Pakistan would land itself, as he put it, “in the doghouse alongside India.”

His government was still “wrestling” with the question of what to do he said, which sounded like a euphemism for civilian dithering. There was more in the way Karamat talked about his political leadership, a subtle but discernible undertone of long-suffering patience bordering on scorn.   For example, he noted pointedly “speculation” that Pakistan was looking for some sort of American security guarantee, presumably a promise that the US would come to Pakistan’s defense if it was attacked by India, in exchange for not testing. “You may hear such a suggestion later,” Karamat added, perhaps referring to our upcoming meeting with Nawaz Sharif. I should not take such hints seri- ously, he said, since they reflected the panic of the politicians. Pakistan would look out for its own defense.

What Pakistan needed from the United States was a new, more solid relationship in which there was no “arm- twisting” or “forcing us into corners.” By stressing this point, Karamat made clear that our arguments against testing did not impress him.

Meeting at Prime Minister's House:

I shared a car back to Islamabad with Bruce Riedel and Tom Simons to meet Nawaz Sharif.

What we got from the Prime Minister was a Hamlet act, convincing in its own way—that is, I think he was genuinely feeling torn—but rather pathetic.

On this occasion Nawaz Sharif seemed nearly paralyzed with exhaustion, anguish, and fear. He was—literally, just as Clinton had sensed during their phone call—wringing his hands. He had yet to make up his mind, he kept telling us. Left to his own judgment, he would not test.

His position was “awkward.” His government didn’t want to engage in “tit-for-tat exchanges” or “act irresponsibly.” The Indian leaders who had set off the explosion were “madmen” and he didn’t want “madly to follow suit.”

But pressure was “mounting by the hour” from all sides, including from the opposition led by his predecessor and would-be successor, Benazir Bhutto. “I am an elected official, and I cannot ignore popular sentiment.” Sharif was worried that India would not only get away with what it had done but profit from it as well. When international anger receded, the sanctions would melt away, and the BJP would parlay India’s new status as a declared nuclear weapons state into a permanent seat on UN SC. I laid out all that we could do for Pakistan, although this time I tried to personalize the list a bit more.

Clinton told me two days before that he would use Sharif’s visit to Washington and Clinton’s own to Pakistan to “dramatize” the world’s gratitude if Sharif refrains from testing. This point aroused the first flicker of interest I’d seen. Nawaz Sharif asked if Clinton would promise to skip India on his trip and come only to Pakistan. There was no way I could promise that. All I could tell Nawaz Sharif was that Clinton would “recalibrate the length and character” of the stops he made in New Delhi and Islamabad to reflect that Pakistan was in favor with the United States while India was not. Sharif looked more miserable than ever.

Toward the end of the meeting, Sharif asked everyone but me to wait outside. (Foreign Secretary) Shamshad (Ahmad) seemed miffed. He glanced nervously over his shoulder as he left. When we were alone I gave the prime minister a written note from Secretary Albright urging him to hold firm against those clamoring to test.  The note warned about the economic damage, to say nothing of the military danger, Pakistan faced from an escalating competition with India. Sharif read the note intently, folded the paper, put his head in his hands for a moment, then looked at me with desperation in his eyes.

At issue, he said, was his own survival. “How can I take your advice if I’m out of office?” If he did as we wanted, the next time I came to Islamabad, I'd find myself dealing not with a clean-shaven moderate like himself but with an Islamic fundamentalist “who has a long beard.” He concluded by reiterating he had not made up his mind about testing. “If a final decision had been reached I'd be in a much calmer state of mind. Believe me when I tell you that my heart is with you. I appreciate and would even privately agree with what you're advising us to do.”

Summary:

It is clear from Secretary Talbot's description that Prime Minister Nawaz Sharif did not want to go forward with the nuclear tests but he had no choice.  Fearing that he would be removed from office if he decided not to conduct atomic test, he told Talbott, “How can I take your advice if I’m out of office?”  Summing up the failure of the US efforts to stop Pakistan's nuclear tests, US Ambassador to Pakistan Ann Patterson said the following in a cable to Washington in 2009 :  "The Pakistani establishment, as we saw in 1998 with the nuclear test, does not view assistance -- even sizable assistance to their own entities -- as a trade-off for national security vis-a-vis India".

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