1 | INTRODUCTION
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing pandemic of viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak was first emerged in Wuhan, China in December 2019. Global confirmed cases of COVID-19 have been reached over 10 million (Worldometeter.info 2020), and people around the world are facing extraordinary changes to their daily life due to the restrictions imposed to slow the spread of virus. The majority of countries around the world, including Pakistan, find themselves between two circumstances: the economic well-being and medical care of the population, both of which are threatened by ”Covid-19” virus. Leaders across the globe are facing this dangerous situation and making decisions about lifting lockdown policies, with anticipated healthcare, environmental, socio-economic, and political consequences (Gilbert et al. 2020).
According to recent COVID-19 spread data, Pakistan has not only passed the neighboring China but also ranked 12th country with highest COVID-19 confirmed cases (Worldometeter.info 2020). The nationwide tally of Covid-19 patients stands at 198,833 with 72,880 cases in Punjab, 76,318 in Sindh, 24,943 in Khyber-Pakhtunkhwa, 10,116 in Balochistan, 1,417 in Gilgit-Baltistan, 12,206 in Islamabad and 1,003 in Azad Jammu and Kashmir, as of June 28, 2020, 07:25 GMT+5 (Covid.gov.pk 2020).
In response to the COVID-19 pandemic, in addition to the more routine public health measures, Pakistan implemented “lockdown”, as an important tool to curb virus spread. On February 26, Pakistan reported its first case of COVID-19 in Karachi, the capital city of Sindh province. On March 13, the federal government announced a nationwide response, including closing borders with Iran and Afghanistan, prohibiting large public gatherings, closing schools, screening of passengers at airports, and establishment of isolation centers with basic facilities. A few days later, the province of Sindh went into complete lockdown while Punjab partially started from March 24. The military supported provincial governments, in the implementation of stringent measures to deal with the spread of the virus.
As the situation develops, Pakistan’s main concern was to balance public health needs with the pressure COVID-19 places on its already weak economy. Despite criticism from medical professionals and opposition politicians, the Prime Minister of Pakistan Imran Khan has continued to ease lockdown restrictions saying the country’s ailing economy would collapse and the poorest among the country’s 220 million would die of hunger. Eventually, on May 9, Pakistan’s government eased a nationwide lockdown initially imposed as a preventive measure against the COVID-19 spread. The decision to lift lockdown in Pakistan was largely influenced by its socio-economic structure. The livelihood of majority of Pakistanis depend on the informal sector (Ahmad 2020). Already, as many as 30 percent Pakistanis are living at or below the World Bank’s poverty line of USD 1.90 a day. There are anxieties that people may die from other non-pandemic deaths (Mamun and Ullah 2020) if the national economy went into a crash due to prolonged lockdown restrictions.
Researchers have reported positive contributions of lockdown to various COVID-19 outcomes. For example, a study from China concluded that lockdown measures significantly reduce growth rate and increase doubling time of COVID-19 cases (Lau et al. 2020). Another study from China used province level data and found that social distancing measures are effective in reducing virus infection and deaths (Figueiredo et al. 2020). In developed countries, restriction policies were found to be efficient in reducing contact rate and the number of infectious cases (Roques et al. 2020). Some studies have also analyzed the impact of lockdown measures on environmental indicators (Berman and Ebisu 2020; Cadotte 2020; Cole, Elliott, and Liu 2020; Fan et al. 2020; Gupta, Tomar, and Kumar 2020; Ward, Xiao, and Zhang 2020; Xu et al. 2020). While, no study has yet reported the health implications of lifting lockdown. Given this, the aim of this study is to evaluate whether lockdown lifting has the potential to speed-up the virus’ spread and deaths. In this current environment, it is crucial to understand and assess the effect of these measures and policies, as their consequences remains unclear.