Lockdown lifting was required, but Covid-19 threat is still high, public health experts warnDoctors say the government should have taken the country’s healthcare capacity and experts’ advice into consideration.
The government on Tuesday said it had decided to lift the coronavirus lockdown starting Tuesday midnight, with some restrictions in place, signalling that Nepal is by and large open, but public health experts say the move was taken in haste without proper consultations, as the Covid-19 threat level is still high.
Doctors say if precautions are not taken, Nepal could see a massive surge in Covid-19 cases, burdening the country’s already fragile and exhausted health care system.
"The decision has been taken without taking possible risk factors into account," a senior official at the Covid-19 Crisis Management Center, told the Post on the condition of anonymity because he was not authorised to speak with the media.
"We should have considered at least the capacity of our hospitals to deal with Covid-19 cases if they spike, and our testing capacity as well as preparations."
The government imposed the nationwide lockdown on March 24 when the country had seen two Covid-19 cases.
As of Wednesday, over 18,000 positive cases and 42 deaths have been reported.
The government said on Tuesday that the decision to lift the lockdown was taken in view of the decreasing number of cases and the impact the pandemic was having on the economy.
Educational institutions, cinemas, stadiums and party venues where large numbers of people gather remain closed.
The country is reporting around 100 cases a day, and public health experts say it will be dangerous to go by the government figures, as the number of positive cases is low because testing is limited.
"The lockdown was imposed without proper planning and it has been lifted without conducting a risk assessment," Dr Kedar Nursing KC, former chairman of Nepal Medical Association, told the Post. "The government has now left everything on the people by suddenly lifting the lockdown. It’s tantamount to dereliction of duty.”
Government officials too agree.
"Since the risk has increased, risk communication becomes important and such communication has to be effective," said an official of the MInistry of Health and Population on condition of anonymity since the ministry has directed officials not to speak to the media.
But the position of risk communication expert at the ministry remains vacant as the expert has been given some other responsibility within the ministry.
Public health experts for long have said that lockdown is not a solution and that it was just a tool to contain the spread of the virus. According to them, the government failed to utilise the lockdown period to expand testing, improve quarantine facilities and make people aware.
Three months into the lockdown, the government was under immense pressure, as cases were rising while the economy was taking a beating. The government on June 11 announced that it was easing the restrictions, but it failed to provide a strict protocol. Public vehicles stayed off the roads, but the odd-even rule for other vehicles was hardly implemented. Restaurants and cafes operated with customers, even though the protocol called for take-away facilities only.
Dr Sameer Kumar Adhikari, joint-spokesperson at the Health Ministry, said that it was not possible to restrict people to homes for an indefinite period.
“The lockdown had to be lifted to make life normal,” said Adhikari. “People were suffering a lot.”
There, however, is no clarity as to how the government is going to deal with the coronavirus if the number of cases spikes.
At least two ministers the Post spoke with said that the government was under pressure as it was struggling when it came to revenue. The Supreme Court order to not ask anyone to file tax for 30 days from the date of complete lifting of lockdown had put the government in a fix, as the state coffers were running dry.
Foreign Minister Pradeep Gyawali admitted that the government was under financial pressure.
“We had no option than to relax the lockdown. If cases spike, we can impose restrictive measures again,” Gyawali told the Post. “The decision to lift the lockdown was taken as per the recommendation of the Health Ministry, as it said there has been a sharp decline in Covid-19 cases.”
According to Gyawali, the continued lockdown was also creating psychological fear among the public. “Then again, the general public, business community, entrepreneurs and others were suffering,” said Gyawali. “We also needed to give an impetus to economic activities.”
How the decision to lift the lockdown came about, however, is not clear.
An official at the Covid-19 Crisis Management Centre said on condition of anonymity that the Centre’s last meeting on Sunday had just updated the Covid-19 status in the country and some future predictions but it did not recommend lifting the lockdown at once.
“We were for lifting the restrictions gradually and waiting for at least two weeks,” said the official. “Other protocols related to testing, tracing and treatment should continue but the decision to suddenly allow even long-distance vehicles poses the risk of transmission.”
The government has decided to allow long-distance vehicles to operate starting August 17, the same day domestic and international flights resume.
“If Covid-19 cases rise, we will take further measures,” said Mahendra Guragain, secretary at the Prime Minister’s Office, who is the spokesperson for the Centre.
Doctors say they are not convinced about the sudden decision to lift the lockdown, given the threat level.
“Whether we agree or not, there is a certain degree of community transmission and if the general public fails to maintain healthy practice, our health care system will not be able handle the burden if cases rise,” said Dr Bhagwan Koirala, chairman of the Nepal Medical Council. “This is a pandemic. Even a small mistake can have huge consequences. Easing the lockdown gradually and step by step would have made more sense.”
A doctor who takes part in the Health Ministry's planning meetings said that government officials barely listen to experts’ advice and decide on their whim.
“I am considering skipping those meetings as nobody listens to experts’ advice,” said the doctor requesting anonymity. “We have made it clear on multiple occasions that cases are yet to reach a half of what we had anticipated in about a month and August is yet to come.”
Officials are expecting the number of cases to rise to 40,000 by August.
The Health Ministry data shows that around six percent of the total positive cases are from the community, which means, concerned authorities have failed to trace their contact history.
"We have to test more, trace more and increase surveillance measures," said Dr Anup Bastola, spokesperson for Sukraraj Tropical and Infectious Disease Hospital. “Since the government has lifted the lockdown, it’s now incumbent on the people to be cautious, take precautions like wearing masks and avoiding crowds.”