JMIR PUBLIC HEALTH AND SURVEILLANCE Akhtar et al Viewpoint Pakistan's Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic Hashaam Akhtar1, PhD; Maham Afridi2, MPhil; Samar Akhtar1, PhD; Hamaad Ahmad1, MPhil; Sabahat Ali3, MBBS; Sundas Khalid4, MSc; Sajid Mahmood Awan1, DPharm; Shahzaib Jahangiri1, DPharm; Yousef Saleh Khader5, PhD 1Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan 2Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan 3Department of Gynecology and Obstetrics, Paf Hospital, Islamabad, Pakistan 4School of Chemical and Materials Engineering, National University of Science and Technology, Islamabad, Pakistan 5Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan Corresponding Author: Hashaam Akhtar, PhD Yusra Institute of Pharmaceutical Sciences Yusra Medical and Dental College Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main GT Road Islamabad, 44000 Pakistan Phone: 92 3165163945 Email: [email protected] Abstract The COVID-19 outbreak started as pneumonia in December 2019 in Wuhan, China. The subsequent pandemic was declared as the sixth public health emergency of international concern on January 30, 2020, by the World Health Organization. Pakistan could be a potential hotspot for COVID-19 owing to its high population of 204.65 million and its struggling health care and economic systems. Pakistan was able to tackle the challenge with relatively mild repercussions. The present analysis has been conducted to highlight the situation of the disease in Pakistan in 2020 and the measures taken by various stakeholders coupled with support from the community to abate the risk of catastrophic spread of the virus. (JMIR Public Health Surveill 2021;7(5):e28517) doi: 10.2196/28517 KEYWORDS community health; coronavirus; COVID-19; epidemic; epidemiology; Pakistan; pandemic; public health emergency of international concern COVID-19 pandemic continues to be a major global public Introduction health concern [4]. COVID-19 started as an outbreak of a series of unusual pneumonia cases in Wuhan, China, with the earliest cases Pakistan: Epidemiologic Profile reported to the World Health Organization's country office in COVID-19 cases were reported from Islamabad and Karachi China on December 31, 2019. By January 12, 2020, the on February 26, 2020 [5]. Pakistan being one of the most densely causative agent was identified as a novel coronavirus, initially populated countries in Asia, with a population of 204.65 million, termed ª2019-nCoV,º and up to 41 cases had been preliminarily and Karachi being the largest metropolitan city in Pakistan, has diagnosed [1,2]. The virus has since been renamed as been greatly vulnerable to this outbreak [6]. Owing to its present SARS-CoV-2 and spread drastically, and COVID-19 was economic condition, health care resources, and the occurrence declared as pandemic by the World Health Organization (WHO) of previous outbreaks, the Centers for Disease Control and on March 11, 2020 [3]. Having currently affected more than Prevention had already issued a level 3 warning for international 210 countries and territories, with 19,550,650 active cases and travelers to Pakistan [7]. The administration had a huge a mortality rate of 2.85% as of December 31, 2020, the responsibility to constrain the spread through a timely response https://publichealth.jmir.org/2021/5/e28517 JMIR Public Health Surveill 2021 | vol. 7 | iss. 5 | e28517 | p. 1 (page number not for citation purposes) XSL·FO RenderX JMIR PUBLIC HEALTH AND SURVEILLANCE Akhtar et al and the adoption of appropriate measures to avoid any major catastrophe. The disease was initially difficult to contain, Public and Community Response to the especially because of noncompliance of the general population COVID-19 Pandemic to the necessary measures and timely reporting of symptoms. Within 45 days, on April 10, 2020, Pakistan reported 4601 There was a mixed response from the community. Few people confirmed cases with a death toll approaching 66 individuals paid attention to the news and some even considered it fake. [8]. News of the virus being a hoax or propaganda spread greatly worldwide and countered the efforts of governments and other agencies that made marked efforts to tackle the spread of the pandemic [9,10]. Common rumors on COVID-19 emergence and treatment through the media and social media resources are presented in Table 1. Table 1. Rumors related to COVID-19 emergence and treatment. Rumors Source The virus is no worse than the one that causes common cold WHO's COVID-19 advice for the public: Mythbusters [9] Hand dryers are effective in eliminating the coronavirus Chinese social media pages [9,10] Coronavirus originated with people eating bats in China YouTube videos, conservative tabloids, blogs, and Twitter [9,10] There is a vaccine or cure for coronavirus, which the government will not Facebook post containing a screenshot of a patent CO-V vaccine by the release Centers for Disease Control and Prevention on January 22, 2020 [9,10] Coronavirus will disappear by the summer WHO's COVID-19 advice for the public: Mythbusters [9,11] Vitamin C can help you ward off coronavirus A popular social media post [12] A ªmiracleº bleach product can cure coronavirus Far-right conspiracy theory QAnon misinforming people to drink Miracle Mineral Solution, a bleach-based product [13] Dean Koontz predicted the coronavirus in his 1981 novel The Eyes of Dean Koontz's 1981 novel The Eyes of Darkness became very popular Darkness on Twitter [10] Osaka flu shown in the television show The Simpsons Screenshots allegedly from the ªMarge in Chainsº episode in 1993 on social media [10] If you cannot hold your breath for 10 seconds without coughing, then you Self-check coronavirus tests on social media originating in March 2020 have coronavirus [10] The country will be placed in a nationwide quarantine effective immedi- Text messages claiming the implementation of a country-wide lockdown ately [10] Government's Initiatives to Tackle the Containment Measures Once primary and secondary contact-tracing was delineated, Pandemic the foremost step taken by the government was to control the The government of Pakistan has been lauded by international borders [18]. This was a crucial decision, owing to the organizations including the WHO (and rightly so) for taking consideration of a large number of Pakistani students and the necessary precautions and measures against the COVID-19 pilgrims studying in and travelling from China, Iran, and Europe. pandemic to guarantee not only the containment of disease The government gained the confidence of the affected spread but also to fulfill its responsibility as a state toward its individuals and their families. It was almost unfeasible to restrict people and their safety [14]. such individuals outside the country because of the strong public response; nonetheless, it was necessary if the spread of the virus Immediate Response to Contain Disease Spread was to be controlled quickly. To tackle this problem, the One of the first steps taken by the government was to develop government took the initiative of designating quarantine houses functional emergency operations centers and to detect the route near borders and airports to isolate people entering Pakistan for of disease spread in Pakistan. The origin of the virus was the a short period to make sure they were not infected before they first question; hence, detailed history-taking of patients was moved out in the community [19,20]. crucial not only in understanding the outbreak but also in Border Control determining the contacts of patients with other people in the community [15]. This helped in cordoning off areas or The WHO reported that the number of new cases increased by home-bounding people who came in close contact with a patient the minute, and disease spread was now not only limited to with COVID-19. In addition to this, patients with a recent people who had a recent travel history in the regions highly international travel history were monitored closely. This made affected by the pandemic. Disease spread within the community sense because many cases and massive spread was reported in was alarming and called for drastic steps to be taken not only the countries neighboring Pakistan [15-17]. by local governments but also by countries and states at large. https://publichealth.jmir.org/2021/5/e28517 JMIR Public Health Surveill 2021 | vol. 7 | iss. 5 | e28517 | p. 2 (page number not for citation purposes) XSL·FO RenderX JMIR PUBLIC HEALTH AND SURVEILLANCE Akhtar et al All necessary services and measures are still being used in to a notification issued by the District Magistrate Islamabad, maximum capacity till date to ensure the safety of people's lives the city administration decided to cordon off areas to ensure in the country. Since all cases initially had a history of recent public safety after the number of infections increased [30]. travel, it was speculated that transmissions were imported from Samples were tested by the National Institute of Health, outside of the country. Therefore, travel restrictions were Islamabad, and analyzed by epidemiologists of the deputy imposed to limit the spread of virus from other countries to commissioner of the COVID-19 Nerve Centre after which the Pakistan [21]. notification was issued. This helped in