Doctors advise contact tracing of all suspected of harbouring Covid-19
Contact tracing has been effective in preventing the virus’ spread in many East Asian countries but Nepal lacks the means to trace and adequate means to test. Passengers walk past a thermal scanner installed at the Tribhuvan International Airport following the global coronavirus outbreak. Kiran Panday/TKP
On Tuesday evening, a 58-year-old woman from Shantinagar in Kathmandu arrived at the Tribhuvan University Teaching Hospital with fever, cough and chest pain. The woman, who had returned to Nepal 13 days ago from the United States, had gone to the hospital’s emergency wing, as the outpatient department was closed for the evening.
The woman’s presence prompted a near-panic in the doctors and nurses at the emergency ward, as none of them was wearing personal protective gear. They asked her to either visit the Patan Hospital, Sukraraj Tropical and Infectious Disease Hospital in Teku, or the Armed Police Force Hospital in Satungal, as the Teaching Hospital did not have proper measures for treatment.
The woman left and sought treatment at Manmohan Cardiothoracic Vascular and Transplant Centre, but doctors transferred her to Patan Hospital at 2 am on Wednesday.
During this journey, the woman got in contact with countless people, all of whom she might have infected if she carries the virus.
Ideally, the woman would have been immediately isolated and all the people who came into contact with her tracked down and tested, including all doctors and health workers.
This is called contact tracing, and it is one of the ways in which Asian countries and territories like Taiwan, Hong Kong and Singapore have prevented the rapid spread of the virus. But it is something that the Nepal government has so far been unable to do.
“Active surveillance and contact tracing is key to controlling the possible outbreak of Covid-19 in the country,” Dr Subhash Prasad Acharya, chief of the critical care department at TU Teaching Hospital, told the Post. “But unfortunately, we are placing more emphasis on purchasing ventilators and setting up intensive care units."
According to Acharya, proper screening should be performed first, after which all suspected infections should be placed in quarantine for the 14-day incubation period.
But as of Wednesday evening, health officials were unaware of who all the woman had got into contact with. Earlier in January, no attempts were made to trace and test all the people who came into contact with one man who was diagnosed with Covid-19 in Nepal.
In countries like Singapore, health authorities have employed CCTV cameras and vast troves of data to monitor movement and trace contact. Authorities even released the personal details of Covid-19 patients, including where they lived and worked, so that others in the community could protect themselves.
In Hong Kong, authorities have handed out electronic wristbands that connect with a smartphone app to suspected patients who should remain in isolation. If anyone breaks quarantine, the app alerts the authorities.
All the while, these Asian countries, especially South Korea, have conducted thousands of tests—on suspected patients, their friends, families and anyone they could’ve got in contact with. This has greatly limited the spread of the virus and has reduced deaths.
According to Dr Basudev Pandey, director of the Epidemiology and Disease Control Division, his office has been attempting to trace the contacts of patients who could carry the virus.
“We have hired 18 health workers with the help of the World Health Organization to conduct contact tracing,” he said. “They have been collecting information about patients admitted to hospitals."
But Nepal has neither the wherewithal to trace patients and their contacts nor the ability to conduct tests on a mass scale.
Last week, Dr Shrawan Kumar Mishra, joint chief medical technologist at the National Public Health Laboratory, told the Post that they had been using 1,000 testing kits provided by the WHO to examine samples. So far, the laboratory says it has conducted over 450 tests, meaning only half of those test kits remain. Mishra said they’ve asked WHO for 5,000 more kits but these have yet to arrive.
Laboratories should be strengthened to carry out more tests, said Acharya.
"Patients only need intensive care if they become critical,” he said. “The government first needs to make sure that all doctors and health workers have N95 masks and other protective gear to deal with patients potentially infected with the coronavirus while also ensuring that laboratories have adequate testing kits.”
Without proper protection, health workers themselves panic at the sight of a patient suspected to be carrying the virus.
On Wednesday, doctors, nurses and other health workers at TU Teaching Hospital threatened to stop coming to work if they were not properly protected against Covid-19 as they had small children and elderly parents at home.
“I myself have been serving patients today to assure my staff that nothing will happen," said Dr Yogendra Shakya, head of the emergency department at the hospital. “Reading something in theory and dealing with the real situation are two different things. I am tired of consoling my fellow doctors and nurses today.”
The hospital received nine sets of personal protective gear on Wednesday, but they’ve been instructed not to wear it without confirmation that the patient is infected with Covid-19. The same equipment cannot be used twice and stocks are limited.
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 territoriesaround 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.
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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