With so much information floating around and being absorbed or otherwise, I will not bore you with the numbers but simply provide a distillation of our on-going discussions focused on “should we be testing everybody in Pakistan?”
This is an important discussion as it impacts other on-going discussions around the cost of testing, the mode of testing (which test), access to testing kits, delivery of these tests (citizen goes to test or test comes to citizen), and handling of those testing positive.
From the discussions I have been a part of the consensus seems to be emerging towards testing through symptomatic targeting and, definitely, against universal testing! Here is the logic leading to this conclusion.
The cost of universal testing is a prohibiting variable but not primarily due to the outright fiscal burden but rather the procurement aspect. Even if delivered cost of the testing was around USD 50 (~PKR 8,000) per unit, we are looking at 3 to 4 percent of GDP as the cost (same as the annual defense spending of Pakistan). Then is the issue of procuring and delivering over 200 million tests.
This does not stop here, as this is followed by a review of how these tests will be delivered. Whether the citizen is asked to approach a test delivery site, or the test is delivered to the citizen’s doorstep, the universal testing process is time un-wieldy and impractical based on simple back of the envelope calculations.
Should the universal testing somehow become practical, there are daunting social challenges. Since more than 95 percent either fall in the no effect plus recovered bracket, and almost half the population will eventually be infected (based on present predictions), knowing that a citizen is positive will create a social stigma and a social pandemic in the ability of society to deal with each other.
Symptomatic and citizen responsibility driven testing as opposed to universal testing is thus the right approach which also appears to be followed by most including by the Pakistan government. We suggest using technology in both push and pull modes supplemented by radio and TV broadcasts and further supplemented by the volunteer (the “Cororna Tiger Force” being assembled by the Prime Minister).
A mind-mapping exercise around the symptomatic and citizen responsibility driven testing shows that with these options working in parallel, we can cover almost all of Pakistan in about 45 to 60 days and really understand the magnitude of the pandemic allowing us to rapidly assemble coping and mitigation strategies!