On ending this lockdownThe end of Covid-19 is not imminent. Meanwhile, life cannot be put on hold without plans for a way out.
Today is the 30th day of the lockdown. So far, Nepal has 42 cases of the coronavirus, but no patient is in intensive care. What's more, there are no deaths yet, and since getting infected, 5 of them have recovered. Our total tally is nothing compared to what other countries have been experiencing. The number of cases per million in Nepal is one of the lowest in the world, lower even than Bhutan's, which has just five cases.
Despite a sense of fear among the general population, if the official figures are anything to go by, its spread has been relatively contained. Of the 77 districts, the virus has been seen in nine districts. Twelve cases, or 40 percent of the total, were in one district, or to be more precise, one building. There have been just two known cases of local transmission. In the absence of evidence otherwise, one has to accept the government's claim that contact tracing of the known cases (except the last detected 14 cases) has been done as far as it has been possible and no positive cases were not detected among those traced.
One can argue that more tests could (or even would) detect more cases. But that can be argued for every country in the world bar maybe a very few like South Korea and Germany which had its own testing kit manufacturing in place along with exemplary health services. One can also argue that the government has not been efficient in efforts to contact trace, and there has been a lack of transparency in government activities. There is weight behind this argument, but this government is what we have, and its modus operandi cannot be expected to change overnight.
Looking at the endgame
Without a proven treatment or a Covid-19 vaccine, the end of the pandemic is not imminent. Even if the spread of the coronavirus can be checked for the moment, there are fears that there could be second or third waves. There also seems to be a consensus that a vaccine is the only solution. But that is 12 to 18 months away. And, by the time it becomes available in Nepal, it could be two years as the whole world would be lining up.
Two years is a long, long time to put life on hold. Therefore, ways of moving forward must be envisioned. Countries will have to keep a strict check on people entering and quarantine them before being allowed to mix with the general population. The weaker the public health infrastructure in a country, the more vigilant it has to be. With a dismal tradition of service delivery, poor sense of service and professionalism among some health care workers if one is to go by incidents of hospitals turning away the sick and ambulance drivers refusing to carry those with the coronavirus, 0.3 hospital beds per 1,000 population (one of the lowest in the world, according to WHO), Nepal's ability to face the long march of the pandemic is indeed daunting. And as if that was not enough, it shares an open border with India where cases are growing at an alarming rate despite the lockdown. Whether the border can remain sealed, if need be, until there is universal vaccination is another question altogether.
Following India's lead
Nepal's lockdown began a day before India's, but Nepal's last announcement of a 12-day extension came after India extended its lockdown for an additional three-week period. Days before Nepal announced the last of its two extensions, on April 14, Prime Minister KP Oli held a video conference with chief ministers of the seven provinces during which he said Nepal had to extend the lockdown since the cases in India were rising.
The situation of the two countries as well as the progression of the spread of the virus, however, is clearly different. Compared to Nepal's 42, India has more than 19,000 cases; Nepal has had no deaths, India more than 600. When Nepal announced its lockdown, it had two positive cases (with one complete recovery). On the day India announced the lockdown on March 17, with only four hours notice, it had 548 recorded cases. More than half of India's 720 districts have cases of Covid-19, while about an eighth of Nepal's districts do. The growth in numbers and geographical spread has been starkly different.
So Nepal needs to come up with its own strategy, including ending the lockdown based on the situation here. From any point of view—social, psychological, economic, political, and even health—the lockdown cannot continue for too long.
Ending the lockdown
Obviously, with new cases continuing to be detected in different parts of the country and testing (albeit the unreliable rapid diagnostic test) being increased, the whole of the country cannot be opened immediately. With about a week left for the present lockdown period to end, planning for the next phase needs to begin immediately.
Which parts need to remain in lockdown needs to be decided first. Province 2, Sudurpaschim and maybe Karnali would fall in this category. It may not be wise to open Chitwan district or at least parts of it since cases were seen there only a few days ago. The government then has to decide which regions can be opened up. It then has to spell out what opening up entails. Large gatherings cannot yet be allowed. Businesses that attract a large number of people like cinemas, gyms, restaurants cannot open immediately. Schools may be permitted to open up in some least risky areas gradually, and the lessons learned can be implemented elsewhere. Public transport cannot be allowed immediately. It would be too dangerous, both within and between cities.
A much more rigorous play out of scenarios is needed before making any decisions on ending this lockdown. Decisions have to be flexible depending on the trajectory of the spread of the virus, but the more scenarios are thought through, the less the risk. Meanwhile, people must maintain social distancing and be vigilant, and the government continue testing and tracing and, more importantly, be caring and transparent. People will be sincere if the government is, too.
What do you think?
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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 territories around 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.