Intended for healthcare professionals

Letters Covid-19: turning the world upside down

Covid-19 in Pakistan and potential repercussions for the world: is the infection on the verge of endemicity?

BMJ 2020; 369 doi: (Published 14 May 2020) Cite this as: BMJ 2020;369:m1909
  1. Amjad Ali, assistant professor,
  2. Ma Zhongren, professor,
  3. Zulqarnain Baloch, associate professor
  1. Biomedical Research Center, Northwest Minzu University, Lanzhou, China
  1. znbalooch{at}

Kickbusch and colleagues have rightly indicated that South Asian countries are important in shaping global health.1 Elaborating further, we discuss the emerging covid-19 scenario in Pakistan.

Since the first imported case of covid-19 in Karachi,2 the number of infections has soared to over 7000 with 135 deaths (as of 17 April).3 Inappropriate response from the government and public resulted in the establishment of infection in Pakistan. This is a matter of serious international public health concern because of several factors.

Firstly, with over 207 million inhabitants4 and only 25 diagnostic laboratories5 with limited capacity (84 704 tests in total, 1700 tests per day on average),3 the population of Pakistan are becoming potential carriers, particularly because of the asymptomatic transmission of infection6 and a lack of proper surveillance.7 Further, because of disease, injuries, road accidents, poverty,8 and a low health budget,9 the health system will not be able to bear the brunt of covid-19. Consequently, a large population remains undiagnosed and untreated, implying that the number of carriers and of those infected will be much higher than the official version.

Secondly, Pakistan has the fifth highest burden of tuberculosis in the world, 154 per million measles cases, endemic status of malaria, and 6% of its population carries the hepatitis C virus.10 Ischaemic heart disease, cancer, and lower respiratory infections are the leading causes of death11 and, with the approaching dengue season, covid-19 may bring devastation beyond imagination to the nation and could become endemic without proper intervention.

Hence, a unified and consolidated approach from local and international authorities is urgently needed to curtail the viral infection in Pakistan and prevent it from becoming an epicentre for covid-19, and to safeguard humanity in the long run.


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