During the last week of January 2020, the Pakistan Field Epidemiology and Laboratory Training Program (FELTP) was assigned the task of setting up COVID-19 screening and referral mechanisms at all international airports and ground crossings in Pakistan. I was deputed to lead this process. It was a challenging and different experience to work with many stakeholders and bring them all onto one page. I was very apprehensive, as this was a big job to cover five big airports and four main ground crossings across the country. I was given 15 days to make all of the arrangements on the ground. I worked day and night with my team and focused on accomplishing the tasks that could make the biggest difference.

At all of the sites, there were no screening counters nor dedicated staff. I started with my teams from scratch. We met all the relevant stakeholders, requested them to provide sufficient space and the necessary furniture, along with dedicated staff. I arranged trainings for the immigration, security forces, and civil aviation teams. I requested additional health staff and availability of ambulances around the clock. A few of the border crossings were very much security-compromised, and at every moment, I felt myself in danger.

Keeping in view the rapid upsurge of cases in Iran and risk of importation of infection through Pakistani pilgrims, I was deputed to rush to Taftan for ensuring and strengthening of essential services and prevention and control measures at the Taftan border with Iran. I arrived there with my team, including two laboratory professionals and two FELTP-trained epidemiologists, on February 22, 2020. We assessed the situation and available facilities. There was only one doctor at the adjacent Basic Health Unit, and two paramedics. There was no infrastructure for screening at the point of entry. The district headquarters hospital was 150 kilometers away from the border, and there was no laboratory facility around. The area was security-compromised as well.

It was really a challenging job. I selected appropriate spaces for screening counters and examination rooms. I managed to build the counters at some sites, and it was another challenge to make the administration agree to any additional renovations and temporary partitions. I trained the health staff and the staff posted at the security, immigration and border gates on self-safety, infection control and screening. I made an improvement plan for the quarantine facility. I established a screening counter at the immigration building and deputed staff there for two shifts. I conducted a simulation exercise and trained the Rapid Response Team (RRT). I visited unregulated border crossings to ensure proper screening at every entry point.

The border was closed temporarily until further orders by the federal government, which created another big challenge for us. Border crossings with Afghanistan and Iran are mostly used for the regulated and unregulated transport of goods, and interrupting the million-dollar business happening across the borders for years was another big challenge and risk. The residents at the border areas were agitated because of their businesses and risk of transmission of the virus and came out on the streets in protest against the government.

I boosted my energy and promised myself to knock every door for help and finally succeeded in establishing screening counters at the immigration and quarantine facility at the border as well as a screening and transportation mechanism for the suspected patients. A mobile BSL-3 lab, along with three laboratory professionals, were shifted from the National Institute of Health in Islamabad to Taftan for on-the-spot, free PCR testing.