ARE we in the midst of the sixth wave of the Covid-19 global pandemic? This question is ubiquitous these days. However, while the question may have journalistic value the reality is that cases have indeed started increasing, whether or not you call it a sixth wave. More important than naming waves is to understand what is going on and how to address it. What timely steps the government should take and what protective measures the people should adopt.

Cases are increasing in Pakistan though their total number is still relatively small. At the time of writing on Tuesday, June 28, Pakistan had a total of 333 confirmed cases in the last 24 hours. This number does not look like a lot, but in the previous week, on Tuesday, June 21, the same number was 113, that is, cases had almost tripled in one week. On Tuesday, June 14, however, the new cases over the last 24 hours were a mere 54. In two weeks, the number of cases increased more than six times in Pakistan.

Thankfully though, a growing number of cases has not meant more hospitalisations, at least not until now. There is generally a lag of two to three weeks in hospitalisation growth following an increase in the number of cases. But this was when there were few or no vaccinations.

Today, more than 85 per cent of the eligible population of Pakistan, ie those above 12 years of age, are fully vaccinated with two doses and 21.7 million have received a booster dose. These are impressive numbers, especially when all the vaccines had to be imported. The former PTI government deserves full marks for this. Vaccinations combined with immunity acquired through infection provide a major barrier against the virus, especially preventing illness severe enough to require hospitalisation. So, unlike the first three waves, this time around, even in the case of the high spread of infection, hospitalisations are expected to be much fewer than before. Let me quickly add though that no vaccine provides 100pc immunity. We do come across people who were vac-cinated and still get infected many actually. But it is also true that the infection usually remains mild and does not advance to moderate or serious illness.

Vaccination is critically important but not a perfect barrier against the infection.

With the benefit of hindsight, having dealt with five waves, and with a vigilant National Command and Operation Centre now more firmly established in the National Institute of Health, Pakistan is generally in a good state of preparedness to deal with the next ripples and waves of Covid-19. This should not mean complacency though as there is still a lot to worry about.

Polymerase Chain Reaction (PCR) testing has drastically gone down in Pakistan and our disease surveillance system needs much more strengthening.

On June 28, the total testing figures for the last 24 hours was 13,759 out of which PCR tests accounted for 12,752 tests, while the rest were rapid antigen tests. This was already an improvement from the total of 9,371 tests reported on June 14 for the last 24 hours. There are multiple factors for the decline in testing: people ignoring mild symptoms, the high price of tests, home testing not being reporte d in the national data, the government not paying enough attention to testing, etc. With the growing number of cases, this laxity needs to change.

Karachi seems to be an outlier in the current situation and also shows problems of data. Although Sindh in general and Karachi in particular always had a higher number of cases, currently, going by the positivity rate, it can be considered an outlier. Few tests and a positivity ratio fluctuating drastically between 9pc and 23pc in the space of a few days says a lot about data issues. Our data surveillance system needs a sustained effort to build on a sound basis. It continues to be wobbly and unreliable.

The current variants of the Covid-19 virus (SARSCoV-2) are BA.4 and BA.5. The exact figures are not known because of limited genetic sequencing facili-ties in Pakistan but epidemiologists` educated guess is that their circulation is rising. The evidence about the speed of the spread, lethality and the responsiveness to existing vaccines is also not conclusive though there is some evidence showing that BA.4 and BA.5 can evade the existing vaccines.

The rise in cases in Pakistan is not an isolated phenomenon. A surge is being witnessed in India and other countries in the region and also in some European countries and the US. So, a sixth wave of this global pandemic is inching its way up.

No panic but stronger vigilance is in order. The NCOC seems to be on top of things. According to its recent advisory, and rightly so, masks have been again made mandatory on domestic flights and in trains and buses. There may be more restrictions in the coming days. Experience has shown that compliance with preventive mandates is low in Pakistan.

Until and unless the government and the people work in unison, issuing advisories won`t work, anywhere.

People should start taking matters seriously now.

There are high chances that with high rates of vaccination, including boosters, and adherence to precautionary measures, the spread of infection won`t go out of control; even if the virus spreads, moderate to severe cases are likely to be rare. Having said that, there is always the possibility of something unpredictable happening in the course of the epidemic.

Avoid unnecessary mingling indoors, ensure fresh air by keeping the windows open, start wearing a mask in closed places where people have to sit close to one another, complete your vaccination course of two doses if you haven`t as yet and get your boosters if you haven`t. It is time to be alert please! Stay safe.• The wifter is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.

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