Change approach to testing and plan for possible outbreak before lifting lockdown, experts suggestHealth Ministry working on plans to create into ‘red’, ‘yellow’ and ‘green’ zones based on risk of spread of the coronavirus.
Public health experts have warned that the decision to lift restrictions imposed to contain the spread of Covid-19 should be supported by data and more tests, as the government prepares to change the guidelines of the ongoing lockdown after May 7.
With the health ministry announcing that 16 more people have tested positive for the contagious disease, the number of cases of Covid-19 in the country has climbed to 75. While authorities are concerned about the growing number of cases, experts say they are worried about the way tests (both rapid diagnostic and lab) are being conducted, and lack of planning on the part of the government during “bought” time to fight a possible outbreak.
"The ongoing lockdown, quarantine and isolation measures have helped us prevent a massive outbreak of Covid-19," Dr Arjun Karki, consultant, internal, pulmonary and critical care medicine, told the Post. "It will be disastrous if we underestimate the risk of infection on the basis of positive cases and lift all restrictions at once."
Karki’s comments come as officials from the Ministry of Health and Population on Sunday consulted public health experts on lifting the lockdown after May 7. Officials at the ministry told the experts that the government can’t continue with the lockdown for an indefinite period as people have already suffered a lot.
Several doctors, including those who took part in the consultation, say that authorities are sending people found positive in rapid diagnostic tests, but negative in laboratory tests are being sent home without tracing their close contacts. Those found positive in the rapid test were infected with the disease in the past and could have passed the virus on to others. However, authorities haven’t bothered to trace the contacts of such people, they say.
"I don’t understand why we are performing rapid tests, if we are not tracing contacts of those found positive," Dr Anup Subedee, infectious disease consultant, told the Post. "We have not yet started testing those who might have come into contact with people found positive in rapid tests,” he said.
The government is also ill-prepared to handle a possible massive outbreak which could take place if all restrictions are lifted at one go, said Subeddee. "The government should first ascertain if it is prepared to test thousands of samples in a day if a massive outbreak occurs," said Subedee. "Similarly, surveillance systems need to be in place to trace the contacts of those infected and sufficient protective gears should also be made available before restrictions are lifted."
Other doctors say that Nepal should learn lessons from countries that have witnessed a second wave of infections after lifting restrictions. “Countries such as Singapore and Japan had effectively controlled the epidemic in the initial stages, but are struggling now due to premature lifting of restrictive measures,” said Karki.
"We cannot repeat those mistakes. Our healthcare system does not allow us to do so," he said. "Any decision to lift the restrictive measures should be supported by test results."
Dr Bhagwan Koirala, chairman of Nepal Medical Council who participated in the health ministry’s discussion, said that most experts also stressed that the decision to relax restrictions should be supported by test data and plans to contain a possible outbreak.
“We also stressed the need to prepare plans to handle a possible epidemic,” said Koirala. “We have told officials that a lockdown cannot prevent an epidemic. It only helps us buy time and we should step up preparations for possible worst case scenarios.”
Despite warnings from experts to change its approach to testing and plan for a possible outbreak before relaxing restrictions, the ministry has been working on measures to gradually lift movement restrictions by demarcating the country into “red”, “yellow” and “green” zones depending on the risk of a Covid-19 outbreak an area faces.
Hotspots where outbreaks have already occurred, such as Bhulke in Udayapur, are to be designated “red zones”. Similarly districts in the Tarai, especially in provinces 1, 2, 5 and Sudurpaschim, are to be designated yellow zones, considering the high risk for a possible outbreak.
But experts warn that an area should not be designated a green zone just because it has reported few positive cases. “Data on positive cases is needed to seal some areas, but we also need data on negative cases to declare an area a green zone,” Koirala told the Post. “We said that green zones cannot be declared only on the basis of zero reported positive cases.”
It’s not just the government that has to change the way it looks at the epidemic, the people also need to take it seriously if lockdown rules are to be relaxed, experts say.
Subedee said that change in behaviour should be the new normal in the post-lockdown period. Hand washing, using masks, avoiding crowds, and maintaining social distance should be enforced strictly even after the government lifts some restrictions or relaxes the ongoing lockdown.
Dr Senandra Upreti, former secretary at the ministry of health, said that it will be disastrous if people don’t change their behaviour. "People might think that they are immune to the deadly disease and behave like in the past." Upreti told the Post. "We do not have vaccines and treatment to make our people immune to the disease. "We should either be ready to die or change our behaviour. "
Likewise, experts have suggested that the government notify businesses to start preparing to re-open if it plans to lift some restrictions. Such a notice would allow them to prepare their infrastructure to maintain sanitary conditions and physical distance between co-workers.
The health ministry said discussions held on Sunday on the fate of the lockdown could not reach a conclusion. "Some experts suggested that the lockdown be continued until it is lifted in India," Dr Roshan Pokhrel, chief specialist at the ministry, told the Post.
The discussions are to continue on Monday and Tuesday.