{"doi":"10.1371/journal.pone.0281326","title":"COVID-19 in Pakistan: A national analysis of five pandemic waves","abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives</jats:title>\n<jats:p>The COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each country had slight, nuanced differences, lessons from each wave with country-specific details provides important lessons for prevention, understanding medical outcomes and the role of vaccines. This paper compares key characteristics from the five different COVID-19 waves in Pakistan.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods</jats:title>\n<jats:p>Data was sourced from daily national situation reports (Sitreps) prepared by the National Emergency Operations Centre (NEOC) in Islamabad. We use specific criteria to define COVID-19 waves. The start of each COVID-19 wave is marked by the day of the lowest number of daily cases preceding a sustained increase, while the end is the day with the lowest number of cases following a 7-days decline, which should be lower than the 7 days following it. Key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough are used to draw descriptive comparisons. Additionally, a linear regression model estimates daily new COVID-19 deaths in Pakistan.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results</jats:title>\n<jats:p>Pakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except for wave 4, which lasted longer than wave 3. A one percent increase in vaccinations decreased deaths by 0.38% (95% CI: -0.67, -0.08) in wave 5 and the association is statistically significant.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion</jats:title>\n<jats:p>Each wave displayed distinct characteristics that must be interpreted in the context of the level of response and the variant driving the epidemic. Key indicators suggest that COVID-19 preventive measures kept pace with the disease. Waves 1 and 2 were mainly about prevention and learning how to clinically manage patients. Vaccination started late during wave 3 and its impact on hospitalizations and deaths became visible in wave 5. The impact of highly virulent strains Alpha/B.1.1.7 and Delta/B.1.617.2 variants during wave 3 and milder but more infectious Omicron/B.1.1.529 during wave 5 are apparent.</jats:p>\n</jats:sec>","journal":"PLOS ONE","year":2023,"id":643244,"datarank":0.5101796072493234,"base_score":3.4011973816621555,"endowment":3.4011973816621555,"self_citation_contribution":0.5101796072493234,"citation_network_contribution":0.0,"self_endowment_contribution":0.5101796072493234,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":29,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1673548,"name":"Mujahid Abdullah","orcid":"0000-0002-2923-0526","position":1,"is_corresponding":false},{"id":1673550,"name":"Abdul Mueed","orcid":null,"position":2,"is_corresponding":false},{"id":1673552,"name":"Faisal Sultan","orcid":null,"position":3,"is_corresponding":false},{"id":1342152,"name":"Ayesha Khan","orcid":"0009-0008-0631-1228","position":4,"is_corresponding":false},{"id":1673553,"name":"Adnan Ahmad Khan","orcid":"0000-0002-3816-3943","position":5,"is_corresponding":false},{"id":1673547,"name":"Taimoor Ahmad","orcid":"0000-0002-1648-2353","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"COVID-19 in Pakistan: A national analysis of five pandemic waves","abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives</jats:title>\n<jats:p>The COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each country had slight, nuanced differences, lessons from each wave with country-specific details provides important lessons for prevention, understanding medical outcomes and the role of vaccines. This paper compares key characteristics from the five different COVID-19 waves in Pakistan.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods</jats:title>\n<jats:p>Data was sourced from daily national situation reports (Sitreps) prepared by the National Emergency Operations Centre (NEOC) in Islamabad. We use specific criteria to define COVID-19 waves. The start of each COVID-19 wave is marked by the day of the lowest number of daily cases preceding a sustained increase, while the end is the day with the lowest number of cases following a 7-days decline, which should be lower than the 7 days following it. Key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough are used to draw descriptive comparisons. Additionally, a linear regression model estimates daily new COVID-19 deaths in Pakistan.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results</jats:title>\n<jats:p>Pakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except for wave 4, which lasted longer than wave 3. A one percent increase in vaccinations decreased deaths by 0.38% (95% CI: -0.67, -0.08) in wave 5 and the association is statistically significant.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion</jats:title>\n<jats:p>Each wave displayed distinct characteristics that must be interpreted in the context of the level of response and the variant driving the epidemic. Key indicators suggest that COVID-19 preventive measures kept pace with the disease. Waves 1 and 2 were mainly about prevention and learning how to clinically manage patients. Vaccination started late during wave 3 and its impact on hospitalizations and deaths became visible in wave 5. The impact of highly virulent strains Alpha/B.1.1.7 and Delta/B.1.617.2 variants during wave 3 and milder but more infectious Omicron/B.1.1.529 during wave 5 are apparent.</jats:p>\n</jats:sec>","is_dataset_classified":null,"base_score":3.4011973816621555,"endowment":3.4011973816621555,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"38157382","pmcid":"PMC10756537","openalex_id":"https://openalex.org/W4390401740","authors":[],"funders":[{"funder_name":"Bill and Melinda Gates Foundation","grant_id":"INV-025171","title":null}],"total_grants":1,"fwci":5.157,"citation_percentile":0.96764911,"influential_citations":0,"citation_trend":[{"year":2023,"count":1},{"year":2024,"count":10},{"year":2025,"count":14},{"year":2026,"count":4}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0281326&type=printable","host_type":"journal"},{"url":"https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0281326&type=printable","host_type":"publisher"},{"url":"https://dx.plos.org/10.1371/journal.pone.0281326","host_type":"publisher"},{"url":"https://doi.org/10.1371/journal.pone.0281326","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/38157382","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10756537","host_type":"repository"},{"url":"https://doaj.org/article/2ff6d42d9e4e41d1b6aa31e003a52983","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10756537/pdf/pone.0281326.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC10756537","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC10756537?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["COVID-19 epidemiological studies","COVID-19 and Mental Health","SARS-CoV-2 and COVID-19 Research","Humans","Pandemics","SARS-CoV-2","Pakistan","COVID-19","SARS-CoV-2 variants"],"mesh_terms":["COVID-19","SARS-CoV-2","Humans","Pakistan","Pandemics"],"keywords":["Pandemic","Coronavirus disease 2019 (COVID-19)","Demography","Medicine","Trough (economics)","Geography","Disease","Infectious disease (medical specialty)","Internal medicine","Sociology","Economics"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-08T14:28:02.533229Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}