Step up measures or brace for the worst, experts say amid new Covid-19 projectionsHealth Ministry estimates 320,000 additional new cases in the worst case scenario, and 148,000 new cases in moderate conditions in the next four months.
In the next four months, an additional 320,000 people will be infected with Covid-19, if the daily average infection rate is 2,665.
This internal projection of the Ministry of Health and Population is for the worst case scenario.
But the Health Ministry’s own figures of the past two weeks show that there have been an average of 3,195 new infections every day. In the period, numbers have not gone down either. The lowest number of recorded cases was 1,551 on October 6 and the highest on October 10 with 5,008 infections.
As of Saturday, 129,304 people throughout the country have tested positive for coronavirus with 727 deaths. In the last 24 hours, 3,167 people contracted the disease, including 1,746 in Kathmandu Valley.
The Health Ministry also has another estimate in a moderate case scenario. If the daily average infection rate limits at 1,230, an additional 148,000 people will get infected in the next four months.
Experts however, are sceptical over the new projections, and say the decline in new cases from a high of 5,008 on October 10 is not due to the measures taken by the authorities to curb the contagion, but because of the decline in the number of tests.
On October 6 there were 11,047 tests and on 10 October there were 19,320 tests, according to Health Ministry data. On Saturday, 15,438 tests were conducted.
“If the projection is scientific and the new cases match it, authorities should start preparations to deal with that situation,” Dr Prabhat Adhikari, an infectious disease and critical care expert, told the Post. “The existing preparations will not help to deal with the projected scenario.”
Health facilities treating patients infected with the coronavirus in major cities, including in Kathmandu Valley, are already overwhelmed and serious patients have been struggling to get intensive care and ventilator.
This despite the government declaring all public hospitals in Kathmandu Valley as Covid-19 hospitals and only emergency surgeries being performed in them.
“You will know the real situation if you see the plights of patients, waiting for beds in our emergency department,” Dr Dinesh Kafle, executive director at Tribhuvan University Teaching Hospital, told the Post.
“They can neither afford treatment in private hospitals nor go home without treatment.”
Doctors treating the infected patients complain that they get calls from relatives of serious patients from early morning every day for beds.
Despite the projections, if the past preparations are anything to go by, the government has failed to prepare adequately. When the country went under lockdown on March 24 there were two cases. When the lockdown was lifted on July 21 there were 17,994 positive cases.
As cases continued to grow, district administration offices were given the authority to impose restrictions. In Kathmandu Valley when restrictions were imposed from August 19 midnight, there were 2,498 infected people and when they were relaxed on September 9 after three weeks there were 9,440 cases. Since then until Saturday, the number of cases has increased to 53,684.
“Every projection, study or estimation is made for preparation,” said Dr Bhagwan Koirala, chairman of Nepal Medical Council, the national regulator of medical doctors. “Authorities should start preparing accordingly, if they have made new projections.”
The World Health Organization has said that 80 percent of Covid-19 infections are mild or asymptomatic,15 percent are severe infections requiring oxygen and five percent are critical infections requiring ventilators.
Over 52,000 more infected patients would become serious if only 15 percent of the projected 320,000 cases require serious treatment. Likewise, 17,500 people will be critical, needing ventilator support.
“We should prepare to increase tests, make contact tracing effective, arrange for isolation beds, intensive care unit beds and ventilators,” Koirala added. “Apart from this, saving health workers from getting infected is another equally important task for which we should invest.”
According to the Health Ministry, there are 2,600 intensive care unit beds and 900 ventilators across the country. Of them 241 ICU beds and 107 ventilators are available for the patients infected with coronavirus in Kathmandu Valley in the government’s dedicated Covid-19 hospitals.
As of Saturday, 290 patients were receiving intensive care and 66 were placed on ventilator support. This figure includes patients in private hospitals too.
Dr Gunanidhi Sharma, an official at the Health Ministry, said that the new projections are meant for the government to make adequate preparations.
“We had made this type of projection earlier too, but then numbers did not get as high as projected,” said Sharma. “Containment measures—lockdown and prohibitory orders—helped to slow down the infection rate.”
But now there are hardly any restrictions and even those that have been announced by the government like the odd-even rule for vehicles and restrictions on the number of passengers on buses, they are hardly followed. As a result, cases are growing.
In the past two weeks, for example, the number of cases increased by 44,734, with 25,766 in Kathmandu Valley alone.
Officials at the Health Ministry expect that the existing health facilities will be able to deal with the infected patients, if the new cases raise moderately, meaning an increase of only 148,000 cases in the next four months.
But the number of intensive care beds and ventilators will need to be increased if cases rise by more than 3,000 a day, they say.
The Health Ministry had recommended lockdown once active cases crossed 25,000. As of Saturday, active cases exceed 38,700.
According to Health Ministry officials, no decision was taken by the Cabinet on the recommendation.
The festive season—Dashain, Tihar and Chhath—poses a serious risk of the virus spreading in remote places that lack hospitals and other infrastructures needed for treatment of infected patients as people will be travelling to their homes from cities, according to doctors.
Ventilators may be expensive and setting up more intensive care units would require the supporting infrastructure but not all preparations are expensive, they say.
“Loss of lives will be more, if we cannot arrange for minimum services like oxygen supply and others,” Dr Sher Bahadur Pun, chief of Clinical research Unit at Sukraraj Tropical and Infectious Disease Hospital, told the Post. “Several international studies have shown that lives can be saved even if we can provide better supply of oxygen to patients and this does not require a lot of human resource and budget.”