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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Did GOP's Dogwhistle Politics Produce Trump?

Coronavirus, Lives and Livelihoods in Pakistan

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

Pakistani-American Woman Featured in Netflix Documentary "Pandemic"

Coronavirus Antibodies Testing in Pakistan

Can Pakistan Effectively Respond to Coronavirus Outbreak? 

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Pakistan Fares Marginally Better Than India On Disease Burdens

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Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

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Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel

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.

Related Links:

Haq's Musings

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Indian-American COVID19 Researchers Face Fraud Charges

Indian-American Operator Charged With Fraud By US Federal Prosecutors

India and Pakistan Among Top Sources of Foreign Medical Professionals

Howdy Modi Rally Exposes Indian-Americans to Hypocrisy Charges

Silicon Valley India-American Congressman Rejects Hindutva, Joins Pakistan Caucus

H1-B Visa Abuse By Indian-American Body Shops

Silicon Valley Indian-American Congressman Ro Khanna Defeats Pro-Modi Candidate

Riaz Haq's Youtube Channel

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






Related Links:

Haq's Musings

South Asia Investor Review

Can India Afford to Boycott China?

Has Modi Succeeded in Isolating Pakistan?

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Coronavirus, Lives and Livelihoods in Pakistan

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

Pakistani-American Woman Featured in Netflix Documentary "Pandemic"

Coronavirus Antibodies Testing in Pakistan

Can Pakistan Effectively Respond to Coronavirus Outbreak? 

How Grim is Pakistan's Social Sector Progress?

Pakistan Fares Marginally Better Than India On Disease Burdens

Modi's Kashmir Blunder

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

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.

Related Links:

Haq's Musings

South Asia Investor Review

China in Ladakh

Pakistan's Startup Ecosystem

Consumer Durables in India and Pakistan

Digital BRI and 5G in Pakistan

Pakistan Tech Exports Exceed Billion Dollars

Pakistan's Demographic Dividend

Pakistan EdTech and FinTech Startups

State Bank Targets Fully Digital Economy in Pakistan

Campaign of Fear Against CPEC

Fintech Revolution in Pakistan

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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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Antibodies Testing Results in Karachi

Pakistan is the Third Largest Source of Foreign Doctors in America

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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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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

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.

Related Links:

Haq's Musings

South Asia Investor Review

Antibodies Testing Results in Karachi

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

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