Maiya Sainju is the in-charge of urban health clinic at the office of Ward No. 32 of Kathmandu Metropolitan City. Amid the coronavirus pandemic, she has been assigned the duty of contact tracing, which entails informing the infected people about their infection, enquiring about the family members and others who came in their close contacts, checking the facilities for the infected people to stay in home isolation, and taking updates on their health.

But with cases rising, Sainju has not been going out these days for the fear of getting exposed to the virus.

Like Sainju, most of the health workers deputed for contact tracing are doing their job over the phone.

“Due to the infection risk, we have stopped meeting the infected people and others,” Sainju told the Post. “Our office [urban health division under the metropolitan city] has asked us to try to contact people by phone.”

Public health experts say the health workers’ concerns are understandable but since contact tracing involves so many things, it is not possible just by phone.

Contact tracing is the key to breaking the virus transmission chain and doctors have for long argued that the prohibitory period should have been used to ramp up efforts to ensure effective contact tracing.

Even after two weeks of prohibitory orders, the virus spread has shown no signs of slowing.

On Thursday, 445 people tested positive in the Kathmandu Valley–357 in Kathmandu, 46 in Lalitpur and 42 in Bhaktapur. The number of new cases stood at 200 on August 20, when the prohibitory orders first came into force in the Valley.

As of Thursday, the number of cases in the Valley reached 7,038 with 4,540 of them detected after the prohibitory orders were announced on August 19 midnight.

Across the country the tally stands at 42,877 with 1,228 reported in the last 24 hours.

“With prohibitory orders, authorities may have been able to prevent an explosion of infections, but there has been no decline in the number of new cases,” Dr Prabhat Adhikari, an infectious disease and critical care expert, told the Post. “There could be several loopholes, which need to be fixed at the earliest.”

Doctors say new cases should have declined by now as two weeks is the upper limit for the incubation period of the coronavirus. The continuing rise in new cases shows that restrictions alone do not help contain the coronavirus spread.

According to Dr Sher Bahadur Pun, chief of the clinical research unit at the Sukraraj Tropical and Infectious Disease Hospital, the ongoing restrictions may have prevented community transmissions, but they have not stopped cluster transmissions.

“People have not stopped meeting relatives, acquaintances, and visiting one another's homes,” Pun told the Post. “I like to call the ongoing transmission family transmission, as entire family members and their relatives are testing positive.”

According to experts, if a person from a family has visited the disease-hit areas and s/he transmits the infection to other family members or to the extended family, it is cluster infections.

Inability to find the source of virus and apathy of the authorities to establish the source and break the chain of infection could be another reason why new cases are not declining.

According to an official at the Epidemiology and Disease Control Division, over 95 percent of the new cases being detected these days are local cases, whose source of infection could not be established.

“When sources cannot be established, contact tracing, testing and isolation becomes almost impossible,” said an official of the division requesting anonymity.

At a meeting of officials from the World health Organisation country office in Nepal, the European Union and the Health Ministry, the UN health agency stressed for coordination and unity among the government bodies fighting against the pandemic.

Despite the rising number of cases, Kathmandu Metropolitan City has a limited number of people for contact tracing, according to Hari Kunwar, chief of the Urban Health Division of KMC.

Health workers deployed for contact tracing only contact people, whose number is provided by the infected. Sainju said that some infected people do not give information about the people whom they had close contacts with.

But the number of people who want to be tested are high.

“Dozens of people from the area [where the infected lives] come to us and tell us that they too have met the infected and demand tests,” one health worker said, asking not to be named. “But we cannot recommend tests for all those who demand tests.”

The government has even failed to make people aware about the risk of the infection.

“People have either taken the risk too seriously or ignored the risks,” Dr Radhika Thapaliya, a risk communication expert, told the Post. “We should change the communication strategy and give tailored messages.”

According to Thapaliya, in risk communication tailored messages mean giving a message as per the belief and circumstances of the people, which can help improve behavioral outcomes.

On Thursday, hundreds of youths defied prohibitory orders and pulled the Machhindranath chariot in Lalitpur without heed to the risk of infection.

“We too are surprised over the rise in new cases even after two weeks of restrictions,” Dr Roshan Pokhrel, chief specialist at the Health Ministry, told the Post.

“This shows that restriction only does not help to contain the spread of infection. We are working to figure out the loopholes.”