Nepali man returned from Wuhan lays bare government preparedness to contain deadly virusesEpidemiology and Disease Control Division sought security agencies help to set up isolation facilities.
When a 21-year-old man from Kavre died of flu-like disease in a Capital hospital last March, it took health authorities two and a half months to confirm that the patient had died of bird flu.
It was the first case of H5N1 infection since February 2017, and the incident had exposed the country’s lack of preparedness to monitor and combat infectious diseases.
The Epidemiology and Disease Control Division (EDCD) had formed a rapid response team only after the World Health Organization's Collaborating Center for Influenza in Japan, confirmed the presence of Influenza H5N1 virus.
"A lot of people would have contracted bird flu or died of it if the virus could transmit from one human to another,” Dr Baburam Marasini, a health expert told the Post. "In that case, we must say we were lucky.”
But even after that alarming incident, the country is still not adequately prepared to stave off infectious diseases.
Last week, when a Nepali man who had returned from Wuhan city of China earlier this month visited Sukraraj Tropical and Infectious Disease Hospital in Teku with complaints of fever, sore throat and pneumonia-like symptoms, doctors were worried that he might have contracted the new strain of coronavirus.
Dr Basudev Pandey, director at the hospital, told the Post on Friday that the man was discharged after being put under observation for five days.
But the term “under observation” did not mean that he was kept in an isolation ward. The doctors and nurses constantly came into close contact with the man, who was suspected to be carrying the mystery virus that has already killed at least two people and affected four dozen others.
"The number of visitors at the hospital increased by several folds after the rumour spread that the man had returned from Wuhan, China, where the deadly virus originated," Dr Anup Bastola, the chief consultant on tropical medicine at the hospital, told the Post.
The hospital eventually discharged the man without confirming if he had indeed contracted the mystery virus, as it lacked the equipment to conduct tests.
“We wonder if the man had Wuhan coronavirus and we cannot say if it has been transmitted to others,” said Bastola.
The World Health Organization has already alerted all the member countries, including Nepal, about the possible risk of transmission of the deadly virus.
The hospital has collected specimens—throat swab and blood samples—of the patient and preparing to send them for a test to the WHO’s Collaborating Center in Delhi or Hong Kong.
"We were neither prepared in the past nor at present to handle any untoward situation," said Marasini. "The Nepali man returning from Wuhan has once again exposed our preparedness to deal with emergencies."
The EDCD, which is responsible for containing the spread of the deadly diseases in the country, conceded that it lacked isolation transport ambulance for patients suspected of carrying infectious viruses, treatment facilities, trained human resources and laboratory for conducting preliminary tests.
Meanwhile, most of the health desks, set up at the time of the Ebola outbreak in 2014 in Africa, are out of commision due to staff crunch.
"We lack even the basic facilities when it comes to dealing with emergencies,” said Dr Bibek Kumar Lal, director at the EDCD. "We cannot handle if we face a situation like in China."
According to Lal, none of the hospitals in Nepal has an isolation facility to treat patients suffering from highly contagious diseases.
An isolation ward set up at Sukraraj Tropical and Infectious Disease Hospital at the time of avian flu outbreak in 2010 in financial assistance of the World Bank lacks infrastructure including high-efficiency particulate air (HEPA) filter.
The EDCD had requested the WHO to determine if the ward met the required standards as per the UN health agency’s guidelines in June last year. The WHO had sent its team of experts to conduct a study, but it is yet to submit a report.
Meanwhile, the EDCD has sought help from the security agencies—Nepal Army, Armed Police Force and Nepal Police—to set up isolation wards in the hospitals they run.
"In other countries too, security agencies set up such facilities and offer help to the government for the same," said Lal. "We are ready to provide expertise as well as other assistance if they show readiness to help."
Brigadier General Bigyan Dev Pandey, spokesperson for the Nepal Army, said the Health Ministry had not made any formal proposal to set up isolation facilities.
"We are ready to set up such facilities," Pandey told the Post. "We have been constructing a facility in the airport barracks to quarantine our personnel returning from peace missions."
Frequently asked questions about the coronavirus outbreak
UPDATED as of March 29, 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. As of Wednesday, Covid-19 had spread to 199 countries and infected more than 650,812 people with 30,341 deaths. In South Asia, Pakistan has reported the highest number of infections at 1,495 with 12 deaths. While India has reported 918 confirmed cases with 19 deaths. Nepal has so far reported five cases, in which one patient recovered.
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.