Rising Covid-19 cases and limited isolation beds once again expose government’s lack of preparedness to fight the virusAmid plans to send infected persons home and to poorly managed quarantine, experts warn of community spread.
Nepal on Saturday reported 189 new Covid-19 cases, the highest for a single day, as the total number of coronavirus cases in the country rose to 1,401. Saturday’s increase marks the fourth consecutive day of more than 100 cases. With the sudden spike in the number of Covid-19 cases, there are now concerns that it’s just a matter of a couple of days that the hospitals designated for Covid-19 treatment will run out of isolation beds.
The government has designated 97 hospitals as Covid-19 treatment facilities and allocated 1,624 isolation beds.
Most of the hospitals in Covid-19 hotspots—Biratnagar, Birgunj, Butwal and Nepalgunj—are already overwhelmed. With 219 patients discharged as of now, there are now just 442 isolation beds available for new patients across the country.
Health Ministry officials conceded that there won’t be any isolation beds in the next few days, given the rate of rise in Covid cases.
According to an official, by arranging a few hundred more beds, the maximum number of Covid-19 patients the hospitals can adjust will be somewhere between 1,500 and 2,000.
Dr Bikash Devkota, spokesperson for the Health Ministry, said Covid-19 patients will be sent to quarantine facilities set up at schools and public buildings, like in Birgunj and Nepalgunj.
“They will be monitored there by trained health workers,” said Devkota. “We will then ask asymptomatic patients to go home.”
But given the already overwhelmed quarantine facilities and poor management, experts have warned against taking such a move, as it could lead to a catastrophe.
Currently, over 110,000 people are being quarantined in facilities across the country, with some housing around 1,000 while their capacity to accommodate is just around 100.
And even if the asymptomatic patients are sent home, there are chances of the virus spreading in the family and the community.
"In a country like ours, where a majority of people use a single toilet, share beds and live in small congested rooms, chances of transmission of the disease in the family and then the community are high,” Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, told the Post. “Only those who can ensure self-quarantine can be sent home.”
Marasini said that this situation, however, was imminent.
“The Health Ministry briefings have become a ritual where they have been simply counting the number of patients and tests. The government completely failed to utilise the lockdown period to prepare for the situation we are in today,” said Marasini. “All the available isolation beds were allocated before the lockdown started. The government has not increased the number of isolation beds in the last two months.”
The government’s poor handling of the disease was evident since the early days when the country had reported only a couple of positive cases. Even as countries across the world confirmed a rise in the number of cases and deaths, government ministers were claiming that Nepal was a Covid-19-free country.
When the cases started to gradually rise, the government was embroiled in a controversy over the purchase of medical equipment. The government was so unprepared that even those working on the frontlines lacked basic amenities like masks and personal protective equipment. The rapid diagnostic kits that were imported from China could not be used for days as there were concerns over efficacy.
It was only in late March, when two cases were reported, that the government announced a lockdown, which on Saturday entered its 68th day.
“The Health Ministry wasted precious time given by the lockdown to upgrade and increase facilities,” said Marasini.
Bagmati Province, which has reported fewer cases (45) until now, has 473 isolation beds, the largest number in the country. Meanwhile, Province 2, which is severely affected with 547 cases—over one third of the total cases, has only 140 isolation beds. There are 210 isolation beds in Province 5 with 547 cases, with Kapilvastu reporting 269 cases, second highest for a district.
"Yes, we have encountered a big problem,” conceded Devkota, the Health Ministry spokesperson. "Now we don’t have any other option than to send infected people home if they cannot be adjusted at quarantine facilities.”
Authorities, however, are yet to ascertain which quarantine facilities are to be used for keeping the infected persons. Devkota admitted delay in preparations. “A decision on the next move is yet to be taken,” said Devkota.
Dr Roshan Pokhrel, chief specialist at the Health Ministry, said that the authorities are aware of the fact that sending infected people home raises the risk of virus transmission.
“The risk level has gone up with the rise in the number of cases,” Pokhrel told the Post. “But we have limited options. Most of the countries have asked asymptomatic patients to stay home, and we too will follow the same protocol."
Marasini, however, said Nepal cannot afford to simply follow what other countries are doing, as the situation is completely different here.
“There is no other way than expanding isolation facilities. Hotels, schools and college buildings can be used, and the government should immediately start converting them into isolation facilities," said Marasini. "Otherwise, the disease can spread in the wider community. If that happens, it will be very difficult to contain the disease."
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 18, 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 territories around the world and infected more than 30,349,591 people with 950,555 deaths and 22,038,587 recoveries. In South Asia, India has reported the highest number of infections at 5,212,686 with 84,404 deaths. While Pakistan has reported 304,386 confirmed cases with 6,408 deaths. Nepal has so far reported 61,593 cases with 390 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.