Seventeen people, including two infants, tested positive for Covid-19 in Birgunj, Parsa, on Wednesday, 14 days after the district confirmed its first case. In Nepalgunj, Banke, the number of positive cases soared from one to 23 in a matter of one week.

Health officials suspect that in both districts a single infected person might have spread the infection.

Officials at the Ministry of Health and Population, however, say they are still working to find the index cases (first identified case in a group) in Banke and Parsa outbreaks.

"If the source is a single person, and had passed the virus to 17 others, how many more people would have been infected from the 17 people who recently tested positive for Covid-19," a ministry official deployed told the Post over the phone from Birgunj. "Had we worked seriously after the first case was detected, it would not take 14 days for others to get diagnosed."

The official has been deployed to Province 2 for coordination among the agencies under all three tiers of government—federal, provincial and local— in contact tracing. Failure to identify the index case even after two weeks is a serious cause for concern because there is a high chance that the disease might have spread in the community, which is the third phase of a pandemic.

"What we are seeing is a lack of coordination among the agencies under the federal, provincial and local levels," the official said. "Separate agencies come and collect the data and do not share them with one another. Coordination is lacking even among the security agencies—Nepal Army, Nepal Police and Armed Police Force."

The Health Ministry and Epidemiology and Disease Control Division have deployed separate teams to Province-1,2 and 5 for coordination. Provincial governments have also deployed their own teams while local governments and security agencies too have been working independently.

Moreover, the World Health Organization's country office has also deployed its teams in the disease-hit areas.

However, these agencies do not seem to be coordinating in their efforts to contain the virus from spreading, the official told the Post.

Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, says the two infants in Parsa— two and six months old— might not have been infected had the authorities concerned initiated contact tracing in time.

"All agencies are working. But if they are not coordinating among one another, it will only amount to loss of time and resources," Marasini, told the Post. "Chances of major outbreaks will increase if we do not learn lessons from our mistakes. It will be impossible to contain the disease in case of multiple outbreaks."

Dr Sameer Adhikari, deputy spokesperson for the Health Ministry, admitted to the lack of coordination among the government agencies working in the Covid-19 affected areas, particularly in their contact tracing efforts.

"Yes, we could work more efficiently in contact tracing. But we should not forget that it takes time to test the people who have been located through contact tracing," he told the Post.

The Health Ministry has decided to collect specimens—nasal and throat swabs— of 1,000 suspects from Nepalgunj and Birgunj and 500 from Udayapur. 

Lab technicians from the Nepal Army and the Epidemiology and Disease Control have been deployed for the task.

Dr Sarad Onta, a public health expert said that agencies concerned should work more efficiently and in a coordinated way to mitigate the risk before the disease is spread in larger communities.

"Until now the problems have been manageable," said Onta. "It will be difficult for us to control and trace contacts if the disease is spread in several communities at once."