Tackling the coronavirus outbreak needs a holistic approachThe need of the hour is to activate national preparedness along with international collaboration.
Recently, the Global Health Security Index 2019 demonstrated that no country in the world, including the United States, is fully prepared to tackle an epidemic or pandemic. However, Nepal’s preparedness—or more accurately lack thereof—reaches a new depth altogether. With an Index Score of 35.1, Nepal ranked 111 out of 195 countries, which means we fall under the category of ‘least prepared’.
As the world prepares to counter the threat of a new strain of the coronavirus that has killed 56 people and infected at least 1,975 more, Nepal’s inability to prevent and manage an outbreak or epidemic is pathetic. Due to the geographical closeness and direct air connection between China and Nepal, we are at high risk of this infectious virus. At the same time, not much is known about the ability of this mutated strain to pass from human to human.
Although it has been more than two weeks since Chinese researchers identified the new strain, Nepal’s government has not published any plan of preparedness and mitigation. Nor have key stakeholders initiated a quarantine of the suspected individuals coming from China. The Epidemiology and Disease Control Division has not even given a detailed press conference on the disease yet. This is a sign of severe irresponsibility. The analysis of the genetic code of the new virus revealed that it is more likely similar to the virus causing Severe Acute Respiratory Syndrome (SARS), a disease that initiated from China in 2002 and which resulted in 774 deaths and more than 8,000 infections.
Nepal always sends delegations to attend international conferences, but the implementation aspect has been historically very poor. The country’s response to public health issues has usually been confined to journal papers and training visits. Nepal doesn’t have functional biosafety and biosecurity standards which can help to store or process dangerous pathogens and toxins, although we are party to the UN Biological Weapons Conventions (BWC).
Although we do have a functional laboratory system, real-time surveillance and reporting of infectious diseases is non-existent. Further, the country lacks epidemiologists, veterinarians, and a team of experts who can tackle the possible infectious disease epidemic systematically and scientifically. In such a way, our prevention and detection capacity is very weak. We have a national public health emergency response plan and the Emergency Operation Center (which can address multiple communicable diseases) but their proper functioning, particularly when needed, is questionable.
At the same time, there is no evidence of effective coordination between national security authorities and public health officials. In the sub-category of availability of health capacity in clinics, hospitals and community care centres, Nepal ranks 168 out of 195 countries. More seriously, Nepal does not have biocontainment patient care units that are used to isolate the patients having highly communicable diseases. If an infected person having symptoms visits hospital for treatment, then there will be a higher chance that the infection will transmit to other patients as well. Patients and health workers at hospitals are already at higher risk than the general populace, and the lack of proper isolation facilities and personal protective equipment further increases the risk.
Due to Nepal’s open border with India and closeness to China, we should have cross-border agreements on public health emergency response with these two giants, but no such agreements have been signed. From the perspective of political and security risk, we rank 103, meaning we are vulnerable to external threats and risks. At the same time, our socioeconomic resilience and infrastructure adequacy is too feeble to tackle any foreseeable epidemic. In this manner, from various dimensions, our preparedness to tackle the possible epidemic of newly detected coronavirus is embarrassingly low.
Despite such inadequacies, we need to act immediately. The first action should be the screening of travellers at the airport with a well-equipped and trained health desk. Suspicious patients should be isolated and managed properly at a designated hospital which has proper isolation units. At the same time, the agencies concerned should inform citizens about the virus, sign or symptoms of the disease and the preventive measures which will prevent possible havoc in people.
However, these steps are not sufficient to deal with a major outbreak. In the long run, we need a well-established disease surveillance system having adequately trained human resources along with equipment. If we don’t tackle this agenda collaboratively and holistically, we will be waiting for the catastrophic incident similar to Africa, where the Ebola epidemic killed more than 11,000 during 2014-16. The need of the hour is to activate national preparedness along with international collaboration.