When the call came on 21 March 2020, it did not feel as if it was God-sent. I accepted the invitation more in bewilderment than in the quiet contentment that Professors enjoy on noticing the recognition of their abilities by others. My reaction surprised me. After all, I have known for ages that appreciation by others is what humans look for to reward themselves and to value their own existence. But I was definitely not basking in the sunshine now. Perhaps I was subdued having moved to Granada just a week back on the very day that Spain went into lockdown. Or, perhaps it was the enormity of the challenge that made me doubt if capability-wise I truly was up for it.
The very next day it was my privilege to be part of a multicountry video call from the comfort of my apartment. Looking over my laptop screen through the window I had a picturesque view of the Albyzin neighbourhood at the foot of the cliff on which stands the Alhambra Palace. As I listened to the great and the good of Pakistani science speak one after another, my focus on the landscape waxed and waned. Their tone of voice and expressions said it all. An unprecedented tsunami was heading our way. In Pakistan, the country where I was born, grew up and lived the best part of my first two and a half decades, there has been a continuous flux. Its people constantly juggle between the frying pan and the fire. They were now faced with no ordinary problem.
"This is no ordinary problem" is exactly what I had been thinking during the fortnight before my move to Granada as I listened to the radio and watched the news in London. Herd immunity was the UK's promoted policy response then to the coronavirus threat. I had had the pleasure of attending Wuhan's Evidence-based Medicine Centre as an invited speaker a year earlier, before it all started. Having recently exchanged comments with my Chinese colleagues, I felt that, in the UK, this island nation's indulgence with independence from Europe was being conflated with the notion of impermeability to a foreign virus. The transition from that country of free-born islanders exercising their right to meet up in cafes and bars, freely transmitting the invisible virus, was in sharp contrast to the state I entered into in locked-down Spain. No wonder I was bewildered.
At some point during this call the penny dropped. I could begin to see clearly. While the so-called civilised world was reverting to the plagues of the dark ages, Pakistani scientists were planning their next steps well ahead of the arrival of the proverbial tsunami, the peak of the coronavirus pandemic. At that moment I realised that the last three decades of dabbling in science had gone to prepare me for this very time. It made no sense to treat people with paracetamol like the rest of the world did on testing corona positive. What we needed was an intervention to nip it in the bud. Ah, but no known effective treatment exists for a previously unknown ailment. Scientists have a tendency to observe from the sidelines what passes in front of them, analysing and trying to understand what is happening. There was not the luxury of time to study, to evaluate, to examine the nature of the virus in order to determine what could work. There was no time to waste on pontification. Now was the time to intervene!
With this conclusion came the thought of throwing everything at it in a carefully planned scientific study using readily available treatments for malaria, bacteria and viruses. On that very first day and the days that followed, colleagues in the Pakistan Government's Scientific Task Force on COVID-19 set out to employ their collective wisdom to be ahead of the tsunami, ready to protect Pakistan with a Randomised and Observational Trial of the Effectiveness of Coronavirus Treatments or PROTECT for short. Through the truly tireless efforts of many, a unique project is today underway in more than a dozen hospitals across Pakistan, in record time, previously unheard of. I'm amazed! This is not my first rodeo. I've taken part in around 50 projects involving 979,242 participants.
The virus knows no borders and it does not discriminate. Droplets in the air take the virus across, and as the study logo shows, the hand of PROTECTion can stop it spreading. Science, like the virus, is not restricted by its passport, and its benefits are universal. The basic approach is to reduce the time test-positive individuals take for their condition to improve, and with it to reduce the opportunity available for the virus to move on to infect others. PROTECT aims to do exactly that – cure and prevent. The pandemic should galvanise humanity into solidarity. Already PROTECT is be being considered for adoption in sister countries. This coming together of nations will have a profound effect.
From my window, one can trace the footsteps of a 19th-century author, Washington Irving, as he walked up Cuesta Gomeres to the gates of the Alhambra Palace. As a child I had dreamt of visiting the great places covered in the history lessons. Coming to Granada directly into house confinement was not something I could have imagined possible even just a few weeks before I landed, taking the last plane to arrive here from London. Everything is shut down but my own senses have opened up, responding to the call of 21 March 2020. It was definitely God-sent.
In Spanish, Dios guarde a usted, or May God PROTECT you! Khuda Hafiz!
Professor Khalid Saeed Khan
Distinguished Investigator, University of Granada, Spain
Member of Pakistan Government's Scientific Task Force on COVID-19