Amidst Omicron surge, Pakistan’s government declares war on poor, moves to close hospitals

Pakistan Prime Minister Imran Khan conceded Wednesday that the country is now in the grip of a fifth wave of the COVID-19 pandemic, fuelled by the highly contagious Omicron variant. Yet Khan immediately ruled out imposing a lockdown or indeed any concerted action to stop the spread of the virus, citing the need to boost economic growth.

A man holds his 10-month-old baby daughter who suffers from polio, in Suleiman Khel, Pakistan, May 6, 2020 (AP Photo/Muhammad Sajjad)

Repeatedly during the course of the two-year pandemic, Khan and his Islamic populist Tehrik-e-Insaaf (PTI) government have cynically invoked the desperate plight of Pakistan’s workers and rural toilers to justify keeping the economy “open” amid successive waves of infections and deaths.

The reality is the government and ruling class as a whole are single-mindedly focused on increasing investment and profits by intensifying the exploitation of the working class and rural poor. Their prioritizing of corporate profits over workers’ lives goes hand-in-hand with austerity and the sell-off of public assets, including much of the public health system.

As Omicron has been sweeping the globe in recent weeks fuelling unprecedented levels of infection, Pakistan’s government has been preoccupied with securing and winning parliamentary approval for the revival of a $6 billion International Monetary Fund (IMF) bailout program negotiated in 2019. Release of the next tranche of funds, slightly more than $1 billion, is conditioned on Islamabad slashing electricity and petrol subsidies, eliminating sales tax exemptions, and passing legislation to prevent the government using central bank funds to finance social spending.

Yesterday morning, the authorities reported 6,808 new COVID-19 infections, the second-highest total recorded during the entire pandemic. Government data show new COVID cases increasing sharply for the past two weeks, with the number of daily infections rising four-fold since January 10.

As in previous waves, the official figures are a gross undercount that give only the faintest indication of the true extent of the health crisis. In a country of more than 225 million people, the authorities are administering little more than 50,000 COVID tests per day.

Karachi, Pakistan’s biggest urban agglomeration and the epicentre of the Omicron outbreak, recorded a shocking test positivity rate of 40 percent last weekend and again on Wednesday. Of the 7,670 diagnostic tests for new COVID infections administered Wednesday in Karachi, a city of 15 million, 3,149 were positive. Other major urban centres—in three of Pakistan’s four provinces as well as Pakistan-held Azad Kashmir— also reported test positivity rates Wednesday well in excess of the 5 percent benchmark the World Health Organization says indicates infections are out of control, signalling that the virus is spreading rapidly across the country. Lahore had a test positivity rate of 14.25 percent, Islamabad 15.4 percent, Peshawar 11.2 percent, and Muzaffarabad in Azad Kashmir 25 percent.

Media in Karachi are now reporting that there has been a sudden spike in hospitalizations with the Sindh Infectious Disease Hospital admitting 32 COVID-stricken patients directly to its Intensive Care Unit on Tuesday, and the Aga Khan University Hospital saying an influx of COVID patients is forcing it to add new beds every hour.

The surge in Omicron cases has already overwhelmed health facilities in numerous economically advanced Western countries whose health care systems, whilst inadequately funded, are day and night when compared with Pakistan’s ramshackle public hospitals.

Yet all Pakistan’s government could bring itself to do in the face of what clearly is an impending tsunami of COVID infections was to announce Wednesday that in cities with a test positivity rate of 10 percent or higher a handful of new, utterly inadequate social distancing measures will be enforced. Under the latest orders from the government’s anti-COVID National Command and Operations Centre, in-class schooling is to continue in the areas hardest-hit by Omicron, and most businesses will function as normal, although some capacity limits may apply.

Pakistan’s population is especially vulnerable to COVID-19 due to poverty, squalid living conditions, and a lack of access to health care including vaccines. According to a 2017 study, 80 percent of the country’s population does not have access to clean drinking water. Tens of millions are forced to live in cramped quarters in slums. In line with its prioritizing of profits over lives, the PTI government has largely relied on foreign donations to provide lifesaving COVID vaccines to the population.

As a result of inadequate supplies and public infrastructure, more than half of all Pakistanis have yet to receive even one vaccine shot. According to Our World in Data, as of yesterday, 46.5 percent of the population had received one shot and just 35.5 percent two shots. Not until the first week of January did Pakistan begin administering booster shots, which are essential to protect against serious Omicron infections and possible death.

Pakistan’s anti-COVID immunization campaign has also been undermined by the Islamic fundamentalist right, which Khan and his PTI have long appeased and courted.

Officially, Pakistan’s pandemic death toll stands at just over 29,000—a figure the government cites to promote the monstrous lie that the PTI’s COVID-19 response has been a “success.”

Given the lack of basic health care in rural areas, where more than 60 percent of all Pakistanis live, the huge financial and social barriers that the urban poor face in accessing health care, and the general dearth of public infrastructure, including in the compiling of death records, it is impossible to know how many people in Pakistan have succumbed to COVID-19. However, Our World in Data, based on the findings of the Economist, puts the number of excess deaths in Pakistan during the pandemic at between 300,000 and a million, with 796,000 deaths as of January 17 considered the best estimate.

In the midst of this catastrophe, the PTI government is moving to further dismantle a public health care system that is already on life-support. Earlier this month, Prime Minister Imran Khan announced that his government intends to shut down the country’s entire system of state-run District Headquarters Hospitals or DHQs, which play a critical role in providing health care in rural areas. Cynically, Khan claimed this will open the door to the private sector to provide health care to rural Pakistan. As a pretext for the ruinous closure decision, Khan pointed to a chronic shortage of doctors at DHQs, which he attributed to doctors not liking to live in rural areas. He omitted to mention that DHQ doctors make only a tiny fraction of the salaries paid those who work at the private hospitals in Karachi, Lahore and other urban centres that cater to the ultra-rich and upper middle class.

Further underscoring that Khan and his PTI his government are determined to intensify their class war assault on the working class and rural poor, last week they rushed through parliament their mini-budget imposing the latest round of IMF-ordered austerity measures. These measures will impose an additional financial burden of $3.4 billion on working people over the next six months, and many billions more in every subsequent year.

The elimination of price subsidies for electricity and petrol is a double blow, as it will drive up the price of food and virtually all goods and this at a time when inflation is already surging at more than 12 percent per year.

As around the world, the pandemic has vastly intensified social inequality. While the companies listed on the Pakistan Stock Exchange recorded their largest after-tax profits in a decade in 2021, the incomes of working people have been squeezed by inflation, job losses, and the refusal of the state to provide compensation to those unable to work due to the pandemic.

Khan and his PTI government long-resisted imposing a lockdown when COVID first surged in the country in March-April 2020, and when their hand was ultimately forced by the military and various provincial government they provided famine-style relief and only to the poorest of the poor. Under conditions where the World Bank estimated half of the population lost income or were rendered jobless, some 12 million families received the equivalent of $77 each in pandemic relief.

According to a report issued by the UK-based international aid agency Oxfam last week, 78 percent of women living in poverty “could have been excluded” from Khan’s Ehsaas Emergency Cash program. At the same time, up to 73 percent of “intended recipients were excluded” from the pre-existing Benazir Income Support Programme.

It is not clear from the report if Khan’s emergency “assistance” program was in fact funded by pilfering from other welfare programs. But the state of social distress in Pakistan, as well as the extent to which the pandemic’s impact is covered up by the authorities’ phony COVID statistics, is underlined by Oxfam’s finding that in May 2020 50 percent of Pakistanis were unable to receive medical attention for want of money.

Pakistan’s opposition parties are complicit both in the Khan government’s criminal mishandling of the pandemic and the implementation of its anti-working class social-economic agenda. The Pakistan People’s Party (PPP), which heads the provincial government in Sindh, stands out in this regard. Amidst the unfolding catastrophe in Karachi, it is refusing to order any serious measures to suppress the spread of the virus, beginning with the closure of non-essential businesses and in-person learning at schools. More than 500 health care professionals have been infected during the current COVID-19 surge in Karachi, further straining the limited health facilities.

The opposition parties, beginning with the PPP and its traditional main political rival, the Pakistan Muslim League (Nawaz), have imposed brutal IMF restructuring programs whenever they have held office. Hoping to exploit the growing popular anger against Khan in the run-up to the 2023 national elections, the opposition parties made a brief noisy show of opposition to the mini-budget, then allowed it to win quick parliamentary approval. As Fahd Husain, the Dawn’s resident editor in the national capital, Islamabad, noted, “All political stakeholders had been communicated that returning to the IMF fold was a strategic necessity at this point in time. None had disagreed.”

Khan and his PTI won office in 2018 with phony promises of an “Islamic welfare state,” then quickly pivoted to imposing austerity. Last July, he conceded that hunger and malnutrition impede the physical growth and cognitive development of 40 percent of Pakistani children. The US Department of Agriculture’s International Food Security Assessment in July, which noted that Pakistan has been “severely impacted” by the pandemic, found that 91 million people or more than 38 percent of all Pakistanis were food insecure in 2021.

Malnutrition is a major contributing factor to the huge number of pneumonia deaths among Pakistan’s children and also a huge COVID-19 risk factor. In Tharparkar, an especially impoverished district of Sindh, at least 32 children have died so far this month due to viral infections and malnutrition. Estimates of the number of children killed annually by pneumonia in Pakistan range from 60,000 to 90,000.