If Covid-19 cases continue to increase at current rate, Nepal’s health infrastructure could easily be overwhelmed, doctors warnMost of Nepal’s isolation, ICU beds and ventilators are centralised in the Kathmandu Valley and urban centres, leaving many parts of the country without adequate infrastructure.
Eighteen patients who were diagnosed with Covid-19 on Tuesday afternoon in Parsa were still in makeshift quarantine at schools and public buildings around the district until Wednesday evening, as the authorities were unable to arrange an adequate number of beds in the hospital’s isolation ward. While none of them needs immediate medical treatment, doctors say that it would be ideal to move them into the isolation wards to make sure they do not spread the disease to others and also that they have easy access to treatment in case they require it.
In Province 2, where Parsa is located, the Narayani Hospital in Birgunj is overwhelmed with patients. The hospital, which is a designated hospital for treatment of Covid patients, has just 70 beds and all of them are occupied.
“We have already crossed our limit,” Dr Madan Upadhyay, medical superintendent at the hospital, told the Post over the phone. “From five Covid-19 patients, we managed to accommodate 25, then 50, and now 70. Now we have no more space to admit additional patients.”
Though the health conditions of most patients diagnosed with Covid-19 are reported to be normal, doctors anticipate a deterioration in at least some individuals in the coming days. Out of the over 200 cases diagnosed in the country, more than a dozen are expected to require oxygen supply, intensive care and ventilators—all of which are in short supply in hospitals across the country, especially those outside of Kathmandu Valley.
According to Dr Upadhyay, the Narayani Hospital has just six intensive care beds and two ventilators.
As Covid-19 cases continue to rise at alarming rates—Tuesday alone saw 83 new infections—there are worries that Nepal’s poor health infrastructure could easily get overwhelmed, especially when patients start developing more serious symptoms. On Wednesday, 26 more cases were reported, taking Nepal's Covid-19 tally to 243. So far, all of Nepal’s Covid-19 patients are reported to be in stable condition with no health risks, according to the Health Ministry.
Even hospitals designated by the federal government as special institutions to fight the coronavirus are under-equipped. The Corona Special Hospital in Butwal, built specifically to deal with the pandemic, is currently accommodating 36 Covid-19 patients and is not in a position to take in any more patients, according to Dr Sudarshan Thapa, the point person at the hospital.
“We sent four Covid-19 patients to Bhim Hospital in Bhairahawa yesterday as we did not have beds to admit them," Thapa told the Post over the phone from Butwal.
The Corona Special hospital has eight intensive care beds and four ventilators.
Most hospitals in the Covid-19 hotspots—Parsa, Udayapur, Kapilvastu and Banke—are overwhelmed, and hospital administrations have already begun to write to the Health Ministry about their limitations.
Officials at the Health Ministry said they are well aware of the lack of beds for Covid-19 patients and have directed officials to coordinate with other health facilities to accommodate patients. But they admitted that things are getting more difficult.
“It will be very difficult to manage cases in the coming days if infections rise at the current pace,” Dr Roshan Pokhrel, chief specialist at the Health Ministry told the Post. “We will have a shortage of everything—isolation beds, beds in intensive care units and ventilators.”
According to the Health Ministry, there are a total of 974 isolation beds, 345 ICU beds and 146 ventilators available throughout the country. But a large number are concentrated in Kathmandu Valley and in other urban centres, with Provinces 1, 2, 5 and Karnali and Sudurpaschim provinces all underequipped.
Data provided by the ministry shows that there are 170 isolation beds, 88 ICU beds and 31 ventilators in Province 1; 89 isolation beds, 26 ICU beds and 10 ventilators in Province 2; 188 isolation beds, 69 ICU beds and 26 ventilators in Province 5; 210 isolation beds, 14 ICU beds and 9 ventilators in Karnali Province; and 41 isolation beds, 10 ICU beds and six ventilators in Sudurpaschim Province.
As the state of Nepal’s infrastructure is not going to change anytime soon, the best way to deal with the pandemic would be for the Health Ministry to follow its own guidelines and only admit patients in serious need of care, according to Dr Bhagwan Koirala, chair of the Nepal Medical Council. Those infected but without severe symptoms can be asked to stay home or in quarantine facilities.
“All infected people are not patients,” said Koirala. “They only need treatment when their condition deteriorates. Neither the World Health Organization nor the Health Ministry’s guidelines recommend placing all infected people in isolation at hospital.”
According to Koirala, all ICU beds and ventilators in the country cannot be reserved for Covid-19 patients, as patients with other serious conditions will also need to make use of these facilities, even if cases continue to rise.
Pokhrel at the Health Ministry anticipates an exponential rise in Covid-19 cases in the days to come, as infections in India continue to rise and people are continuously sneaking into the country through the porous border with India. The ministry has increased the range of testing, targeting 3,000 to 5,000 people over the next few days, said Pokhrel.
More cases are certain to emerge and the ministry has already directed all medical colleges across the country to allocate at least 200 beds and human resources for the treatment of Covid-19 patients, according to Pokhrel.
According to public health experts, it does not look like the pandemic will overwhelm the country. Nepal is still in the second stage of the pandemic and, contrary to speculations in the media, has not entered the third stage—community spread, according to Dr Basudev Pandey, director of the Epidemiology and Disease Control Division.
“We have identified the source of all infected patients until today and we can call it cluster transmission,” said Pandey. “We do not have community transmission yet.”
Frequently asked questions about the coronavirus outbreak
UPDATED as of May 26, 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 210 countries and infected more than 5,589,712 people with 347,903 deaths. In South Asia, India has reported the highest number of infections at 144,950 with 4,172 deaths. While Pakistan has reported 57,705 confirmed cases with 1,197 deaths. Nepal has so far reported 685 cases with four 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.