In the last two decades, we have ordinarily experienced unprecedented growth in urbanisation. Due to the spiralling exodus from rural areas into urban suburbs in search of a more sustainable livelihood and career prospects, rampant unemployment and moderate levels of poverty continue to escalate in big cities. Over the years, changes in lifestyle, and financial and economic aspects imply that rural and urban economies are now more closely connected. And amid a crisis, for example, the present COVID-19 pandemic, we can only hope that Pakistan will not have to remorse over the fact that we have not gone timely into a more extensive countrywide lockdown mode. The effect of the present pandemic is distinctive because it is an issue that, in the principal stage, has struck urban communities that predominantly have stronger global linkages. The next stage is probably going to be the most troubling where this pandemic may make inroads into rural areas. The substance of our economic linkages implies that once the pandemic converts into an implacable community infection stage, its ramifications may be detrimental for both urban and rural masses. Notably, millions reside in our overflowing urban communities, but it is frequently neglected that many more millions continue visiting the urban areas every day for satisfying their economic needs. Invariably, Pakistan’s large urban communities (like our eight major metropolitan cities) have multiple entry and exit points through which thousands of migrant/daily wage-earning workers residing in nearby cities and villages enter and exit daily. The distance traversed depends upon the size of the urban centre, accessible transportation facilities, geographic location, and available opportunities. Once the pandemic converts into implacable community infection stage, its ramifications may be detrimental for both urban and rural masses According to one estimate, urbanisation in Pakistan is growing, on average, at three percent per annum. This rapid exodus is giving rise to multifarious gruelling challenges that barely find their place in the policy discourse. As our economic challenges are mounting, it is almost impossible to survive in the isolated weak rural economy. The example of Lahore in itself is illustrative: thousands of workers travel from the adjacent cities like Kasur, Muridke, Kamonki, Sheikhupura to work as daily wagers and lower-level employees in the city. This excludes the enormous influx of street vendors and service providers who visit for selling their products or offering their services because of the better price discovery prospects in bigger markets. All metropolitan cities remain a host to many migrants who have settled here permanently for economic reasons; they are from far-flung areas of KPK, South Punjab, Gilgit Baltistan, and Sindh. These workers remain connected to their native rural districts with their remittances and periodic visits on social events, celebrations, and festivals. Visits to metropolitan areas fluctuate and depend on economic prospects. Once the lockdown is taken off, there will be a massive movement of people and goods from urban to rural areas. There is an impending risk of rapid expansion of this pestilence if this movement is left unchecked. It is an understatement that Pakistan’s healthcare infrastructure is inadequate. The current health budget accounts for a meagre one percent of the GDP, sharply declining from 3.9 percent of the GDP in 2005. Taking a holistic overview, the country currently has 1,211 public sector hospitals along with 5,508 basic health units and 676 rural health centres that are inadequate. There are only 127,859 doctors, which means there is 1 doctor for 957 people, and only a single bed for 1,580 citizens. This aptly paints the dismal picture of our healthcare system. Municipal hospitals are devoid of basic equipment, are largely understaffed, overcrowded with patients, and lack oversight and proper supervision by the relevant authorities. Rural areas are deprived of basic healthcare facilities. Owing to the impoverished state of rural healthcare infrastructure, visits to hospitals from local villages invariably tend to be across different areas, beginning with the most adjacent small town and ultimately, leading to the district hospital or large hospitals in cities, thereby leaving a footprint and even distribution across large areas. Taking into account the unpreparedness to cope up with the forthcoming formidable challenges in the upcoming months, pervasive financial troubles, economic chaos, and the gravity of the problem, citizens and government must realise that social distancing and self-isolation are good theoretical concepts but may be utterly impractical in a country where on average 38 percent of the total houses consist of a single room. Only about 24 percent of the total houses comprise three or more rooms. The dilapidated healthcare system of Pakistan is way below the WHO standards. Many doctors are getting infected because of the paucity of personal protective equipment. The testing kits are insufficient to test all suspected cases. There is insufficient space in hospitals to construct isolation wards. The government needs to act on war footings to upgrade the healthcare facilities, control rural-urban linkages and address economic challenges to curtail this pestilence before things get out of control. The writer is a chartered accountant working in the public sector of Pakistan. He can be reached at arsyed09@gmail.com and on Twitter @SyedAbd90588948