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Abstract:Background:The 2019 novel coronavirus disease (COVID-19) has spread to more than 213 countries and as of 17th April 2020, 1995,983 confirmed cases and 131,037 deaths have been reported globally. Pakistan being sharing border with China and Iran, having high frequency of travel and trade has been at risk of viral transmission.Methods:We examined current state of COVID-19 epidemic and preparedness in Pakistan using publicly available data and documents on COVID-19 government dashboard.Results:Pakistan reported its first 2 confirmed cases, on 26th February 2020 linked to travel history of Iran. The number of confirmed cases nationwide rose to 7,025 on 17th April 2020 with 135 deaths and 3276 confirmed cases in Punjab,2008 cases in Sindh,993 in Khyber Pathunkhawa,303 in Baluchistan,237 in Gilgit Baltistan,154 in ICT and 46 in Azad Jammu Kashmir. To-date 7000 Pakistani pilgrims have returned from Iran and placed in quarantine in Taftan. Directing of pilgrims back to their cities without testing at the border resulted in introduction of virus in country. Pakistan's weak healthcare system with 0.6 bed for 1000 people and less than 0.75% of GDP as health spending is doubtful to bear the COVID-19 shock in case of exponential increase in cases.Conclusion:Low literacy rate and general lack of awareness leading to non-seriousness of people towards the adoption of social distancing and hand hygiene. The high population density in major cities of Pakistan can facilitate in the spread of virus. Three-pronged approach of trace, test and treat needs to be aggressively implemented to halt the community transmission leading to exponential increase in cases. Keywords:COVID-19,Preparedness,Three-pronged approach, community transmission.

Background: The 2019 novel coronavirus (SARS-CoV-2) originated in the central Chinese city, Wuhan, at the end of December 2019. Pakistan reported its first 2 confirmed cases on 26February 2020, linked to a travel history of Iran. This study was conducted to see the trends of COVID-19 infection growth and doubling time in Pakistan, from an early containment state to a much belated exponential rise pattern.Method: This study is based on the analysis of the publicly available data on COVID-19 from the Ministry of National Health Services Regulations and Coordination's COVID-19 dashboard and the publicly available National command and operation centre daily situation reports from 26February - 27July 2020 to show the trends and patterns of COVID-19 among the Pakistani population.Results: A total of 275,225 COVID-19 patients have been reported, with 5,865 deaths, 1,229 critically ill, and 242,436 recovered. Sindh has the highest number of confirmed cases (92,279). The majority of affected patients are male (72%). Local transmission cases stand at 97%. The percentage positivity has now declined to 4.8%, reaching a peak value of 25.7% in May. An average of 6.4 daily tests were conducted for each confirmed case, which makes 0.11 daily tests per thousand people. Daily cases surge had a 5.8% increase per day, with a 5-fold increase in infection until mid-June, which has now decreased to 80%. On 13 June 2020, the highest number of cases were reported (6,825 new highest daily deaths were reported on 19 June 2020). The case doubling time was 3 days initially and now stands at 28 days. The current CFR is 2.1%, with 5,865 deaths.Conclusion: The lack of effective quarantine facilities and limited testing capacities at the Taftan border crossing resulted in the importation of the virus in the country. Risk mitigation measures that were implemented, such as lockdown by provinces and the Federal government, were eased in mid-May due to the economic impact but was followed by a spike in cases. The cumulative confirmed case count, after showing an exponential growth pattern within two months of the start of the outbreak, is now on the decline. Careful and responsible behaviors from people, preparedness, and planning, including sentinel surveillance at the district level, are required for the sustainability of COVID-19 control.