Yes! I don't know what the WHO or the statisticians are going to say, but I wanted to break this "Wonderful News" a few weeks before. However, I was not sure of a second spike due to Eid-ul-Adha, as most people predicted.

Is the COVID-19 outbreak in Pakistan really over?

I work in one of the biggest government hospitals in the Capital of Pakistan. We are a team of a few internists who are in charge of the main isolation wards here. Just a month ago, and especially, after Eid-ul-Fitr, we were not able to accommodate our patients in four different wards.

Each ward has around forty beds and the flow of patients was so high that the beds were full all the time. I remember people begging us to accommodate their patients and we were so embarrassed when we were asking them to go to some other nearby hospitals.

However, the scenario totally changed just a few weeks after Eid-ul-Fitr. Thanks to the untiring efforts and determination of our government, healthcare workers, and the people. Currently, the maximum number of patients in our two isolation wards is around two or three.

Most of these patients are either stepped down from the intensive care unit or have been hospitalized for some other chronic conditions, have heart diseases, or are immune-compromised. The total number of admitted patients has declined dramatically.

The hospital administration has asked our medical team to restart emergency services for other medical conditions as there are very few patients. The number of dedicated wards for COVID-19 infection is being reduced to one single isolation ward.

WHO COVID-19 Statistics:

Although, based on the WHO's estimation, COVID-19 was thought to be less contagious.  The number of individuals infected by an infected person suffering from any of the diseases mentioned above.[/caption] There are serious miscalculations here.

As other experts suggested previously, the proportion of affected patients may be as high as 60 - 80%. This is the percentage required for herd immunity. Most countries report less than 1% of the actual cases.

Even developed countries like France are reporting only 30% of their cases. so the actual number is very high. As per the WHO latest numbers, the situation is still beyond control in most countries.

The percent of reported cases in our setup may have been even lower. Furthermore, COVID testing has only a sensitivity of around 60%. This means that out of 100 patients who have the disease, only 60 people are picked up and the remaining 40 people are labeled falsely as negative for COVID-19.

Forty percent of the falsely negative patients are contributing to the spread of the disease. The false satisfaction of being negative makes them more careless about following the SOPs, social distancing, wearing face masks, and using sanitizers.

How did the COVID-19 outbreak in Pakistan end?

The virus is there! Beware! Like influenza, malaria, Typhoid fever, Pneumonia, and Tuberculosis, sporadic cases are going to occur. Most patients in our setup remained asymptomatic. Some people don't even believe it.

However, fatalities occurred in the group of patients with comorbid conditions. And sporadic cases in this group can be fatal later as well. But, nevertheless, the outbreak is over. Some people may question that we are not reporting it.

This may be true but here I am not talking about the number of cases reported or patients testing positive. I am working in a hospital and seeing the number of admitted patients.

These include all patients who require oxygen even though their PCR reports are negative and are labeled suspected or probable. Some factors that could have resulted in the lower rates of admission and the rapid decline in the number of COVID-19 cases may be a result of the strong immunity of our patients and public awareness.

Seasonal Influenza is not considered a disease here!

Strong immunity? Yes. People get all sorts of infections here. Seasonal influenza is not considered a disease here and is managed with herbal tea and other home-based remedies.

The term "Premunity" may be better used here. This is partial immunity because of repeated exposure to certain infections such as malaria. Premunity needs to be defined but may be implied here as partial immunity to one infection while getting exposed to another infection.

It is important to note that we rarely used remdesivir or tocilizumab. Supportive care, oxygen, antibiotics, and glucocorticoids were all that we offered our patients.

Above all, the end of the COVID-19 outbreak could be the result of better government policies.

Better Government Policies:

The most important factor that resulted in a reduction in positive cases is the way our government responded to the situation with honesty and determination. These efforts and guidelines can be viewed in detail here: http://covid.gov.pk/guideline

• Social distancing guidelines during COVID 19 outbreak.
• Priority testing guidelines - First, second, and third priority as per the clinical and demographic situations.
• Home Quarantine Guidelines - definitions and instructions
• The Zoning of Hospitals and the establishment of different clinics and wards. Importantly, these included the "Fever Clinic" and the "Isolation Wards".
• Preventive measures for industrial staff including administrative staff and personal protection guidelines while working in the industry.
• Guidelines for the prevention of COVID-19 in local shops and stores (Guidelines were made for both the staff and customers).
• Guidelines for construction workers including guidelines for visitors and contractors.
• Establishing a quarantine facility and how it is going to function including logistics.
• Guidelines during Ramazan including guidelines for "Taraweeh Prayers"
• Guidelines for neonates of suspected or confirmed COVID-19 positive mothers including SOPs during the labor room and handling of symptomatic and asymptomatic neonates.
• Comprehensive guidelines for the use of PPE (personal protective equipment) for healthcare workers.
• Guidelines for dentists and dental care during COVID 19 outbreak.
• Preventive measures at railway stations for passengers and staff.
• Guidelines for cleaning and disinfection of environmental surfaces
• Guidelines for public transport 
• Guidelines for proper and safe burial and funeral prayers in Urdu and English.
• Guidelines for air transport of COVID 19 positive dead patients.
• Guidelines for international travelers arriving at airports in Pakistan.
• Guidelines for international passengers departing from Pakistan.
• Guidelines for domestic air travel for passengers and staff.
• Guidelines for Home isolation of suspected confirmed cases including symptoms-based and time-based strategies.
• Guidelines for Ethical healthcare decision making in the wake of COVID 19 infection.
• Guidelines for healthcare workers working in outdoor facilities including guidelines for screening, personal protection, and telemedicine.
• Guidelines for Government employees and working in a safe environment including disinfection of the working area.
• Guidelines for the care of elderly patients including psychosocial support.
• Guidelines regarding the compulsory use of face mask especially in public places and healthcare facilities.
• Guidelines for the use of convalescent plasma (including guidelines for donors, recipients, public, and healthcare workers).
• Details of oxygen facilities for COVID-19 patients [Ref].
• Guidelines for law-enforcement agencies in the wake of COVID-19 infection.
• Guidelines for the management of COVID-19 infection in specific situations:
  • General Clinical Management Guidelines.
  • Clinical management of COVID-19 patients during pregnancy.
  • Management of Children with COVID-19 infection.
  • National Testing Guidelines (Real-Time PCR testing)
• Functioning of courts in the wake of COVID 19 infection
• Guidelines for reproductive and maternal health services including antenatal and postnatal checkups and guidelines regarding breastfeeding.
• Guidelines for holding sessions in the national and provincial assemblies and senate [Ref].
• Guidelines for the prevention of COVID 19 infection during Eid-ul-Adha and the cattle market [Ref-1, Ref-2, Ref-3]
• Cleaning of environmental surfaces including fumigation and disinfection [Ref].
• Screening of Non-COVID admitted patients in the hospital for COVID-19 and screening of asymptomatic healthcare workers [Ref].
• Guidelines for celebrating "Independence Day" in the wake of COVID-19 infection.

There are guidelines at every step. The concept of "Smart Lockdown" was introduced in Pakistan that was followed later on by other countries as well. Contrary to what the WHO says, I don't believe there could be a second epidemic of COVID-19 here. Even if it does, we are already prepared for it.