Nepali authorities being too slow to recognise disease outbreak threats is not new, experts sayEven as the new coronavirus spreads rapidly, with one case confirmed in the country and globally the death toll and cases rising, Nepal’s response has been lackadaisical.
Samit Thapa, a Nepali doing a PhD in civil engineering at the Harbin Institute of Technology in Heilongjiang, China, returned to Kathmandu on January 24 when the coronavirus outbreak had already become a global concern. The death toll and the number of new cases were rising. Nepal too had already reported a confirmed case in a Nepali student who had returned from Wuhan, where the virus originated.
Thapa said he was screened three times at the Beijing airport before boarding the plane.
“But I walked out just as other passengers did at our airport in Kathmandu. There was no one at the health desk,” Thapa told the Post.
A concerned Thapa then decided to go to Sukraraj Tropical and Infectious Disease Hospital at Teku to get checked.
“I was shocked at seeing how a hospital designated as the primary facility for testing and treating infectious disease was ill-equipped and mismanaged,” said Thapa. "The deadly disease might pass from the hospital itself if it keeps on dealing with the patients the way it is doing.”
According to Thapa, no one was even wearing masks, something people use as the first line of protection during a disease outbreak. “Not even health workers. And no one was being asked if anyone had influenza-like symptoms,” said Thapa. “I did not only consult the doctors but also inquired about the preparedness of the hospital. But I hardly got an answer.”
Thapa’s assessment reflects poor preparedness on the part of the authorities as well as the government’s failure to raise awareness about the new strain of coronavirus which is wreaking havoc, killing at least 132 people and sickening nearly 5,900.
Though no new cases have been detected in Nepal since the first case was confirmed last Friday, health experts say there is no reason for the authorities to be complacent.
Chinese health officials have already confirmed transmission between people, even through touch.
Countries around the world have stepped up measures to curb the spread of the virus, dubbed “novel coronavirus” and even the World Health Organization has admitted that it made an error in its risk assessment of the dealy China virus.
The Nepali student in whom the case was later confirmed had also earlier this month had visited the Teku hospital just the way Thapa visited earlier this week. But he was discharged even before the virus was confirmed.
Health experts say it’s a matter of grave concern as authorities have no idea about this student’s movements or as to how many people he has met, talked and shook hands with.
"Can't the hospital set up a separate desk and a few chairs to examine patients having influenza-like symptoms?" said Dr Sushilnath Pyakurel, a former health secretary. "What has prevented the hospital from enforcing compulsory masks and other measures?"
The risk of transmission of the deadly virus can be minimised by simply implementing some measures—such as maintaining hygiene, washing hands frequently, avoiding crowds and using face masks, according to Pyakurel. “But such behavioural change has not been seen even among health workers. Our authorities, as usual, have been too slow to recognise the threat.”
Weeks after the new strain of coronavirus started making its way out of China, the government scrambled to set up thermal scanners. But experts say a thermal scanner works well only when it is set up in air-conditioned rooms. The airport exit corridor where the machine has been set up in Tribhuvan airport is not air-conditioned.
Health experts say Nepal has failed to learn from its past mistakes. Given its lack of infrastructure and trained medical personnel, Nepal is ill-equipped to deal with a massive outbreak of disease, they say.
According to Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, the country did nothing when there was an outbreak of Severe Acute Respiratory Syndrome in 2003 except set up a temporary health desk at an international airport for three months.
“There was some visible work in 2007 when there was an avian flu outbreak in 2007. A few training programmes for health workers and veterinarians were conducted, biosafety level-3 laboratory was set up, the Teku hospital was designated the primary health facility for treatment of infectious disease with an isolation facility,” Marasini told the Post.
Putting up permanent health desks at the airport at the time of the Ebola outbreak in 2014 and eight land-crossings was a good move, according to Marasini.
“Isolation facilities were intact, but as the risk receded, the health desks were shut down,” said Marasini. “All the trained staff were transferred. No one thought about continuing the health desks and retaining trained human resources.”
Even though no new coronavirus cases have been confirmed, with specimens of three suspects testing negative, the authorities must continue to think about measures to battle the spread of the virus, according to experts.
The virus could enter via the thousands of Nepali students who study in China, Nepalis who work in China or Chinese tourists who visit Nepal.
Dr Bhim Acharya, a former director at the Epidemiology and Disease Control Division, said that the Health Ministry should enforce strict measures not only at the Teku hospital but all the hospitals across the country.
"Influenza season has already started and symptoms of a new strain of coronavirus are similar to those of seasonal influenza," said Acharya. "All hospitals must examine the patients having influenza-like symptoms separately and use safety measures."
The Teku hospital has now placed a large banner on the hospital premises to inform patients about the precautionary measures against the new strain of coronavirus. But there is no separate health desk to screen patients. Nor is there any facility for hand washing, which health experts say should be done frequently to protect one from infection
Dr Basudev Pandey, director at the Teku Hospital, said that his hospital cannot set up a separate desk to examine patients suspected to have been infected with the new coronavirus which has been given “nCoV-2019” name.
“There is a risk of the hospital getting designated as a coronavirus hospital and patients of other infectious diseases are likely to stop visiting the hospital,” Pandey told the Post. “We are taking suspected cases directly to cabins that we have allocated here. We cannot have a separate desk for the coronavirus suspects and those visiting the out-patient department.”
According to a doctor at the hospital, it admitted a 20-year-old male Nepali student after he complained of respiratory problems. “He also returned from Wuhan recently,” said the official.
As discussions on lack of preparedness and measures to be taken to curb the spread continue, health experts also pointed at one major area where they say the government is lacking.
“Awareness is key,” said Dr Geeta Pandey, a former director at the National Public Health Laboratory under the Department of Health Services. “All concerned government authorities should at least start disseminating information to the public about the threat of the new virus and ways to protect themselves from the virus.”
Frequently asked questions about the coronavirus outbreak
UPDATED as of July 2, 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 had spread to 213 countries and infected more than 10,805,108 people with 518,968 deaths. In South Asia, India has reported the highest number of infections at 605,220 with 17,848 deaths. While Pakistan has reported 213,470 confirmed cases with 4,395 deaths. Nepal has so far reported 14,046 cases with 30 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.
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