At a time when most of the Covid-19 tests are being performed on suspects placed in quarantine facilities across the country, public health experts have stressed tests in communities too, especially those which are highly vulnerable.
They said that the Covid-19 epidemic has not yet started in Nepal and performing tests only on people placed in quarantine does not help prevent the looming public health threat.
Those who have tested positive for Covid-19 so far do not represent the real situation of the pandemic in Nepal, Dr Anup Bastola, spokesperson for the Sukraraj Tropical and Infectious Disease Hospital, told the Post.
"Almost all the people who have tested positive had returned from abroad and were placed in quarantine. Tests in communities are necessary to know if the disease has spread there."
The government has been performing polymerase chain reaction tests only on those who developed Covid-19 symptoms, have a travel history to disease-hit countries or came in close contact of the infected people.
Thousands of people who returned from abroad, especially India, have already been released or are being released, after rapid diagnostic tests, which have been giving misleading results.
Hundreds of people released from quarantine after rapid diagnostic test results have later tested positive for the disease in polymerase chain reaction tests. Some who tested negative in the rapid diagnostic tests have also died on the way home or after reaching home.
"We all know that some people have sneaked into Nepal through the porous border [with India], and the authorities have released thousands of people after rapid diagnosis tests," said Bastola. "Tests should be performed in communities, as disease might have spread from such people."
Authorities across the country have been releasing hundreds of people from quarantine facilities with or without rapid diagnosis tests every day. Officials at the Health Ministry hope that once the pressure in quarantine centres lessens and people return to their villages, the risk of coronavirus spread will subside.
"Thinking that the risk will be minimised by releasing people from quarantine without conducting proper tests will be a blunder," Dr Mingmar Gyelgen Sherpa, former director of the Department of Health Services, told the Post.
"It will be almost impossible to contain the disease if it spreads to community. Concerned officials should not take this issue lightly."
Due to the absence of Covid-19 testing in most health facilities across the country, tests are not being performed even on the people having symptoms of Covid-19—respiratory issues, chest pain and fever, among others.
According to Sherpa, polymerase chain reaction tests should be performed for all having Covid-like symptoms and in highly vulnerable communities, where a lot of people have returned from abroad and tested positive for the coronavirus.
"We don't know if the people who returned from abroad and were released from quarantine have mixed up with the residents of a community," said Sherpa. "We need to take precaution."
Due to the failure to manage quarantine facilities properly, a lot of people are being infected there. Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, said that the risk would be lower if the quarantine centres were managed properly and people released only after confirming that they will not spread the disease in their families and communities.
"Tests for Covid-19 should have been performed in communities long ago to know the risk level," said Marasini. "We should start testing all the people visiting health facilities with symptoms and start testing vulnerable communities in the Tarai region."
Meanwhile, the Epidemiology and Disease Control Division said that sporadic cases have been reported in some communities but community transmission has not yet been seen.
"We are testing more people placed in quarantines, as they are suspects, returned from disease-hit countries and have symptoms," Lila Bikram Thapa, senior public health administrator at the division, said. "We will also test the people of the community if they have symptoms that match with Covid-19."
Thapa concedes the risk of community transmission and need of community testing.
So far 11,755 people have been infected with Covid-19 as of Thursday including 2 deaths. Of them, 2,698 people have been recovered.
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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