Everywhere in world when Covid 19 hits people in power say “We should have acted earlier”. However before the virus hits a nation the general sentiment of leadership is “We dont have to act now. It will be managed”. Even the greatest economy in the world the United States which had more time to prepare compared to South East Asian nations and Europe is not immune to this thinking. From March 22ndto March 28th positive cases more than tripled in US in an epidemic that has seen the US become the country with the most cases worldwide. What does this mean for Pakistan, a country which is a perfect storm for this healthcare led crisis? It has weak healthcare systems owing to spending on health that has been less than one percent of GDP for decades. It has poor liquidity meaning its spectrum of response options are accordingly limited. Finally, it is a large complex country driven by social mores and economic realities like daily wage workers where enforcement of social distancing, a key tool in the fight against the virus, will always be difficult. By some estimates economic lockdown costs to keep daily wage workers and families at risk fed will be USD 1.5 Billion a month. Our immediate aim as a nation should be a soft landing that takes us away from the economically debilitating lockdown led mitigation strategy, and towards surgical interventions as and when needed to manage viral outbreaks on a district by district or region by region basis. To do that we need to make sure our infection rate is under 1 i.e. each person with Covid 19 is on average infecting less than one patient a day. However, to do that we need data on infection clusters and our own transmission rates. That will only come from testing. A two week lockdown not give us that data as our kits haven’t arrived yet. Lifting it will also increase spread and death. Here is an indicative simulation from US: Social distancing for 14 days = 128M total infections. Social distancing for 2 months = 14M total infections. The amount of deaths will be proportionate as well. Pakistan should go into lockdown until June 1st. That allows the heat to come blazing in, which historically has dented spread of similar viruses. This family of viruses has a lipid bilayer coating which has been known to break down faster in heat and thus lessen the time it stays active on a surface. These two months also allow us to test maniacally and use that data to identify cluster areas so we can strategically lift lockdown, allow provinces to break transmission chains and limit uncontrolled spread. To get to this ideal situation we will need “aggression” on the healthcare side and a digital strategy called sentinel surveillance. Aggression will result in surge capacity of healthcare system with more beds and ventilators, more PPE equipment for doctors, and point of care kits for field diagnostics. Cross-contamination and resulting overwhelming of medical system will spike deaths from Covid 19 and non-Covid 19 causes both. This is why as much as possible and feasible we need to set up medical facilities dedicated to Covid 19 patients which are either completely standalone or fully cutoff extensions to hospitals with no interchange of staff, patients and equipment. Dedicated staff mean less use of PPE equipment as they do not have to switch between virus and non virus patient groups, and greater individual and collective expertise in managing Covid 19 patients. Sentinel Surveillance will require several things based on Pakistan’s existing capabilities: 1. High Quality Data from specific location to cut transmission chains so small pockets of infections do not become regional or larger outbreaks. 2. This data comes from rapid testing. Anyone with symptoms should be tested immediately and free of cost. The result of one recent study has shown that 17% of patients do not have cough as a symptom and instead have diarrhea with fever. A combination of these symptoms will also need to be actively tested. This data strategy is at the heart of fighting back which is why Germany is right now doing 500,000 tests a week. South Korea at its peak was taking 18,000 tests a day. 3. Serology tests will be needed which identify areas with large levels of immunity to help with local lockdown decisions. These are also called antibody tests as they test antibodies in blood which occur in response to virus. This way you can identify asymptomatic people who had virus and never knew they had it. More antibody tests are now becoming available and soon cheap reliable versions will be orderable. 4. Telecom data: You can find nearly all possible patients by tracking their movements through cellphones in coverage areas. Metadata analysis using AI can reveal even more, including links to infections where there is no telecom coverage. The result of this tracking should not only used by health authorities but also made public via national and local government websites, free smartphone apps that show the locations of infections, and text message updates about new local cases. This help citizens avoid hotspots of infections and helps them practice social distancing more diligently. This is also why strategic communications is key. Constantly communicating with authority and trust is how you recruit public involvement and induce behavior change, which is needed for this lockdown to succeed. Without this disclosure and communication people will panic as anecdotal evidence and rumors outweigh official communications. Recently viral video of a purported Lahore head of a nationwide charity saying they are picking up over six Covid 19 related dead bodies a day is the first significant example of this. The hope based on similar longer lockdown results is that our cases should peak before May end, and transmission rates will go under 1, meaning the virus spread is decreasing. By August the world may get both anti-viral drugs and recombinant antibodies as solutions to help Covid 19 patients recover. Anti-viral drugs like a combination of chloroquine and azithromycin, are under trial to help with quicker recovery. Recombinant antibodies are lab grown. They are basically like heat seeking missiles for viruses with little or no side effects. These will help lower death rates further. Innovative companies like Regeneron are at the forefront of developing those. We need to be clever and hustle in getting our share of supplies including generics manufacturing locally where applicable. If we combine diagnostic data with technology for rolling lockdowns mapped to infection clusters and use aggression to upgrade healthcare system, we should hope to be in a state of controlled panic by September this year. We will need to stay in this state and vigilant until a vaccine is made and produced. That is probably between December 2021 to February 2022. Taimur Khan Jhagra over in KPK and the Chief Minister of Sindh Syed Murad Ali Shah have been doing good work in this crisis. Under NDMA a team has been formed with visualization of data mandate to be used by all concerned parties. Shabahat Ali Shah is working on a war footing to enable the technology platform to manage a cross ministry and cross department response, and power relief efforts. These heroes have an uphill task and it is critical that the country stands behind them in this time of need, united beyond politics. Tough decisions may need to be made including possible temporary nationalization of key value chains like supply chain and food. The alternative to this is bleaker. Longer lockdown will result in unmanageable social unrest. Early lifting of lockdown before infection rate comes under 1 will mean a death rate three to four times higher than otherwise. Whatever course we end up taking, at the heart of the solution will be digital and data. The writer is a Contributing Editor for Daily Times on all things digital