Nepal’s hospitals have no ICUs to treat coronavirus patients, doctors say
The government plans to place any coronavirus patients in public hospitals, but these hospitals have few ICU beds that are almost always occupied. The Sukraraj Tropical and Infectious Disease Hospital in Teku, which is the primary hospital in the treatment of the coronavirus, has three ICU beds, which also remain occupied most of the time. Post Photo
Dr Prem Krishna Khadga, director of the Tribhuvan University Teaching Hospital, receives dozens of calls every day asking for beds in the hospital’s intensive care unit. The general ICU’s 11 beds are almost always full, with a long line of people waiting to take any vacant spots. As the country’s largest public hospital, the teaching hospital treats patients for a fraction of the cost at private institutions, which is why there is such a long queue.
But the teaching hospital is among the few hospitals where the government is planning to treat Nepalis evacuated from China who might be infected with the new strain of coronavirus, dubbed 2019-nCoV.
Khadga says that is next to impossible.
“Patients admitted to ICU either need to be fully cured or they need to die for the beds to become vacant,” he said.
Plans are currently being formulated to airlift 180 Nepalis from China’s Hubei province, the epicentre of the current outbreak of the coronavirus. At least 1,017 people have died and the virus has infected 42,694 people in the last four weeks.
The Ministry of Health and Population estimates that up to 10 Nepalis out of the 180 could be infected with the virus, and when they are brought back to Nepal, they will need to be placed in quarantine for two weeks. But new research has shown that the incubation period for the virus could be as long as 24 days rather. Anyone found infected with the virus needs to be swiftly moved to isolation and if their condition deteriorates, they will need intensive care.
According to director Khadga, the teaching hospital’s 11 beds remain occupied most of the time. It’s other 12 dedicated ICU beds—surgery ICU, neonatal ICU, and pediatric ICU—cannot be used for general patients.
“Even patients in critical conditions wait several days to get ICU beds,” said Khadga. “How can we remove patients from their beds in order to accommodate patients with the coronavirus?”
In any case, even if one patient with the coronavirus is placed in the ICU, the entire ward of 11 beds will have to be evacuated as the coronavirus is highly pathogenic, said Khadga, who was invited to a planning meeting held by the Ministry of Health and Population.
As far as Khadga is concerned, he believes that no government hospital will be able to accommodate patients infected with the coronavirus.
As per the government’s plan, it will be sending a plane on Saturday to evacuate Nepalis from Hubei.
Authorities at Bir Hospital, another public hospital and the national referral centre, said they too do not have an adequate number of beds for patients infected with the coronavirus. Bir’s 11 ICU beds too remain occupied most of the time. Even ministers and lawmakers call the hospital director to manage beds for their ailing relatives or party workers, said officials.
“We have committed two ICU beds for patients with the coronavirus, and for that, we have had to deny beds to patients in critical stages,” Kedar Prasad Ceintury, director of Bir Hospital, told the Post. “Our hospital is not an ideal place to treat such patients, but we will have to manage if such a situation arises.”
Bir Hospital does not even have sufficient personal protective equipment, as at least four sets of protective gear are required for one-time use, and at least a dozen throughout the course of a day, said Ceintury.
Patan Hospital, another public hospital, has just seven general ICU beds, which remain occupied most of the time, according to director Bishnu Sharma.
“We have to send several patients to ICU wards in other hospitals every day,” Sharma said.
Officials at Civil Service Hospital, which has just five ICU beds, echoed Sharma.
“How can we risk the lives of other patients by admitting patients infected with the coronavirus," said Dr Dirgha Raj RC, director of Civil Hospital. “A separate isolated hospital is needed to treat such cases, and we don’t have separate buildings or separate wards.”
The Sukraraj Tropical and Infectious Disease Hospital in Teku, which is the primary hospital in the treatment of the coronavirus, has three ICU beds, which also remain occupied most of the time.
“We have to deny ICU beds to other patients, who could not afford beds in private hospitals," a doctor told the Post on condition of anonymity. "How can a government hospital do such discrimination to patients? All are equal to the government and only serious patients needs ICU beds."
As per the recommendation of technical experts from the World Health Organization, separate isolation rooms are needed in the ICU, out-patient department and emergency room to deal with the coronavirus.
“Even a month after the outbreak of the coronavirus in China, and the UN health agency’s alerts, no hospital has started work as per the WHO recommendation,” a doctor at the Teku hospital told the Post on condition of anonymity. “No hospital in the country has an isolation room.”
Health officials are not just concerned with the 180 Nepalis who will be brought home from Hubei, but also the hundreds of Nepalis and Chinese who have entered Nepal since the outbreak. Nepal is just not equipped to deal with an outbreak, said Dr Dirgha Singh Bom, a former health secretary.
But not much can be expected from a government that even failed to repair thermal scanners placed at the Tribhuvan International Airport health desk, said Bom.
Of the two thermal scanners placed at the airport health desk, one had broken down at the time of the 2015 earthquakes. Officials at the Epidemiology and Disease Control Division eventually replaced the broken scanner after allegations of negligence in the face of a global pandemic.
So far, a 31-year-old Nepali student who had returned from Wuhan, China on January 5, had tested positive for the new strain of coronavirus. Specimens—throat swab and blood samples of the suspect—were sent to the World Health Organization's reference laboratory in Hong Kong, which confirmed that the man was infected with the virus.
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19? Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19? Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from? The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territoriesaround the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe? The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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