Central laboratory is equipped to test 500 Covid-19 cases a week, but that is far too low, say public health expertsAn outbreak in densely populated Kathmandu could overwhelm the laboratory, which is the only public health facility where the test is conducted.
With the World Health Organization’s declaration of the Covid-19 outbreak as a pandemic, countries across the world are springing into action, bolstering their public health systems and preparing for the eventual arrival of the virus.
Nepal’s authorities, after dithering for long on proper preventive and control measures, are slowly swinging into action, releasing public statements and holding press meets to educate the public.
On Thursday, the National Public Health Laboratory, the only health facility that is equipped to test for the coronavirus, held a press meet where officials provided a situation report.
As of Wednesday, the laboratory had tested 447 people for the coronavirus. Only one person, on January 23, tested positive while all others were negative for the virus, said laboratory officials.
According to Dr Runa Jha, the laboratory director, the facility is currently equipped to test 500 coronavirus cases per week.
“If provided with adequate human resource, proper infrastructure and chemical reagents, we can boost our capacity to test up to 3,000 cases for the disease per week,” Jha told the Post.
According to Jha, the central laboratory is also prepared to hire additional lab technicians from other government labs and the private sector if there is an outbreak of the disease.
But given how dense Kathmandu Valley is—population density is estimated to be 20,288 people per sq km—there are concerns whether 3,000 tests per week will be adequate if there is an outbreak, and if there are enough testing kits.
Dr Shrawan Kumar Mishra, joint chief medical technologist at the National Public Health Laboratory, said they have been using the 1,000 testing kits provided by the WHO to test samples from suspected individuals.
“We have requested the WHO to provide us with 5,000 more testing kits,” said Mishra. “The WHO has assured us that it will provide us with any number of testing kits, including primers and probes, in case there are Covid-19 cases.”
But, according to public health experts, 5,000 kits are by no means adequate for a country of Nepal’s size, especially since there is only one laboratory in Kathmandu conducting tests and it could easily get overwhelmed.
“We have a centralised system when it comes to laboratory tests in Nepal, and if Covid-19 spreads across the country, these test kits won’t be enough to conduct the much-needed tests,” said Dr Sharad Onta, assistant dean at the Institute of Medicine. “The concerned authorities must be prepared for such a scenario as people cannot be waiting for test kits to arrive once the disease spreads.”
Mishra, however, said there is no immediate need for additional testing equipment as there have been no cases of local transmission in Nepal.
“The one case of confirmed Covid-19 was an imported case as the patient had come from Wuhan, the epicentre of the outbreak,” said Mishra.
But now that the virus has spread to India, with the bordering state of Uttar Pradesh reporting 10 cases, there are fears that it is only a matter of time before the virus makes the jump across the open border. Samples from any suspected patients in the Tarai will need to be sent to the central laboratory in Kathmandu to be tested.
As of Thursday, India had reported 74 cases of the coronavirus.
The Health Ministry, in a bid to screen people entering Nepal from neighbouring India and China, is working to set up at least 41 health desks at various land crossing points. There are, however, 129 land crossings with India alone.
According to Onta, just setting up health desks at border points will not be enough to control the disease in the event of an outbreak.
“Even if we have active surveillance of people who have come in contact with those infected by Covid-19, there are no laboratories to test for the disease at the provincial level,” said Onta. “The concerned authorities must prepare the local level in case an outbreak occurs outside Kathmandu.”
As of Thursday, there had been 126,182 confirmed cases of Covid-19 across the world, with 4,632 reported deaths.
Frequently asked questions about the coronavirus outbreak
UPDATED as of March 28, 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 596,349 people with 27,343 deaths. In South Asia, Pakistan has reported the highest number of infections at 1,373, with 11 deaths. While India has reported 667 confirmed cases with 20 deaths. Nepal has so far reported four 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.