Empowered Field Epidemiologists Take the Lead in Pakistan's Response to COVID-19

World Field Epidemiology Day (#WorldFieldEpidemiologyDay) is a global movement to recognize and raise awareness of field epidemiologists’ vital role in protecting the health of populations and advancing global health security, and to advocate for increased investment in field epidemiology training, research, and professionals. 

The COVID-19 pandemic has brought unprecedented challenges to many countries’ public health systems. The Pakistan Field Epidemiology and Laboratory Training Program (FELTP) is a successful case of how FETP institutionalization and empowerment of field epidemiologists have led to strong, effective, immediate responses to public health emergencies within the country.

 

The health department of Pakistan’s Balochistan province started its surveillance activities for COVID-19 in January 2020. The Provincial Disease Surveillance and Response Unit (PDSRU) in Balochistan engaged in contact tracing and outbreak surveillance of travelers who arrived from China and abroad. On February 19, 2020, Iran reported increasing cases of COVID-19 infections and deaths. Three days later, the Health Department of Balochistan decided to send a public health specialist team to the Pakistan-Iran border and start the screening process. The specialists chosen by the provincial health ministry for the Taftan border task were a team of FELTP alumni, including Dr. Ehsan Ahmed, Dr. Jan Inayat, and Dr. Naqeeb Niazi. They became the first-line defenders at the Taftan border to protect Pakistan’s 220 million people from the novel coronavirus by setting necessary control measures to prevent further spread.

    At the point of entry at Taftan, the FELTP Balochistan team analyzed the situation while focusing on the following points:

    • The 2 to 14 day incubation period of the disease
    • The severity of the outbreak in Iran
    • Arrival and return of more than 7,000 Pakistani pilgrims and students in Iran
    • Taftan’s position as the main border crossing point between Iran and Pakistan
    • The lack of Infection Prevention and Control (IPC) departments in the tertiary care hospitals and health departments
    • The lack of facilities for screening, quarantine, and isolation for travelers and infected persons at the far-flung border of the province 

    After situation analysis, detailed assessment, and spot mapping of the area were conducted, a meeting was held of all stakeholders involved in the closure of the border. On February 23, 2020, upon the FELTP Balochistan team’s recommendation, stakeholders unanimously decided to close off the Pakistan-Iran border and implement quarantine as a public health strategy to prevent the spread of COVID-19 infections in Pakistan.

    The details of the proposed preventive model at the Taftan border included:

    • Quarantine every person coming from the Iranian side for 14 days.
    • Establish a screening counter and health desk at the very first office of immigration services a traveler encounters upon entrance into Pakistan.
    • Use thermal guns and travel (health declaration) forms to determine whether a traveler needs isolation (suspected cases) or quarantine (healthy travelers).
    • Healthy travelers would be screened for COVID-19 symptoms on a regular basis for 14 days while in quarantine. Any suspected cases would be shifted to isolation units until the traveler’s test results are negative.

    The Pakistan FELTP briefed the Federal Minister of Health and Advisor to CM Balochistan about the arrangements made at points of entry. Due to the huge influx of pilgrims and travelers, the field epidemiologists of FELTP Balochistan recommended quarantine measures and establishments to provincial and federal departments and institutions, including the army, levies, customs, Federal Investigation Authority (FIA), Central Health Establishment (CHE), and National and Provincial Disaster Management Authority (NDMA, PDMA). However, there weren’t enough facilities to quarantine every individual traveler at the points of entry. Additionally, the army personnel who were deployed to protect borders and around the compound of the quarantine area were not trained in IPC practices, which are essential for COVID-19 outbreak management. There were also no permanent doctors on the far-flung regions of the border. Overall, there is a significant shortage of capable human resources. 

    Federal and provincial teams streamlined many issues and operationalized the proposed FELTP model for preventing COVID-19 infections in Pakistan. COVID-19 training and awareness sessions were conducted for the health, army, customs, FIA, administrative, and quarantine staff. Psychosocial and IPC practice sessions were conducted for the individuals in quarantine. Simulation exercises were also conducted to screen suspected cases with a thermal gun and a suspected questionnaire form. These screening, training, and simulation exercises at the Taftan border helped further equip the field epidemiologists and public health professionals involved with more experiences and knowledge while at the same time growing Pakistan’s public health workforce and capacity.