Angry with decision not to treat them, Covid-19 infected refuse to cooperate, health workers sayWithout help from those who’ve contracted the disease, contact tracing becomes ineffective, further risking the spread of the virus and more significantly many more deaths, experts and officials warn.
A health worker at the Epidemiology and Disease Control Division had a bad hair day on Tuesday. The health worker, tasked with informing people about their infection status and coordinating in contact tracing, said he faced a hard time.
“Today was really a bad day for me,” the health worker told the Post requesting anonymity. “I got scolding from many people whenever I rang them up to ask about their contact history and health condition.”
According to him, people complained why they were being asked about their health status when the government has already said that it is not going to pay for Covid-19 tests and treatment for them.
The health worker summed up what the majority of people told him thus: “Why does the government need all the details when it is not going to do anything for us.”
The government decision that it is not going to bear the cost of Covid-19 tests and treatment has enraged people no end.
“I have been working here for quite some time calling up people and asking them about their health status and contact history,” said the health worker. “But no one had responded like this before.”
As per an October 5 Cabinet decision, the Health Ministry on Sunday said that the government would not pay for Covid-19 tests and treatment for the general public, except for those who are poor, single women, disabled, elderly people above 70, frontline health workers, security personnel and cleaning staff.
The decision has already met with massive criticism, including from members of the ruling Nepal Communist Party, for not abiding by a Supreme Court ruling and running away from its constitutional obligations.
Public health experts and Health Ministry officials say that the government decision is counterproductive and disastrous and that it in no way helps control the pandemic.
“Public outrage is genuine,” Dr Prabhat Adhikari, an infectious disease and critical care expert, told the Post. “Why would anyone cooperate when the authorities concerned have declared that the public’s concern is not their responsibility?”
According to Adhikari, the government decision to let people fend for themselves raises risks because people won’t seek tests and treatment until they are seriously ill.
“This could mean even those who have contracted the virus would stay away from seeking tests and treatment, resulting in the spread of the virus,” said Adhikari. “By coming up with the decision, the government has actually shot itself in the foot.”
Even within the government, there is criticism of the Cabinet decision.
“Refusal of infected people to cooperate in contact tracing and case management is a genuine consequence of the government decision,” said a Health Ministry official on condition of anonymity. “Infection and death rate will exacerbate due to this new decision.”
The Health Ministry did not recommend the latest government decision, he said.
“We had instead recommended restrictions, increasing tests, hospital beds, ventilators and arranging for oxygen supply,” the official told the Post. “We implemented the Cabinet decision after the Office of the Prime Minister and Council of Ministers directed us for the same.”
While the main opposition, Nepali Congress, has come down heavily on the Oli administration for the decision, some members of the ruling Nepal Communist Party (NCP) too have censured it, calling the move a highly irresponsible act.
Nepalis on Monday even took to social media to ask why the people should pay the government taxes if it has shirked its constitutional duty of ensuring public health care services.
In a damage-control bid, a scrambling Oli government on Tuesday put Health Minister Bhanubhakta Dhakal at the front to make some clarifications.
“The ministry is committed to protecting the lives of the people,” Dhakal said in a video message. “The decision to provide free tests and treatment for the poor, people with disabilities, single women, people above 70 years, frontline health workers, security personnel and cleaning staff was taken to make Covid-19 treatment more effective.”
According to Dhakal, there are 2,600 intensive care beds and ventilators ready and that additional 400 beds are being prepared.
“Work to increase 3,500 high dependency units with oxygen and monitors has been expedited, which will ease the treatment of serious Covid-19 patients,” said Dhakal.
Dhakal also said that the ministry has allocated the budget to build five-bed hospitals at 649 local units, which will increase the number of hospital beds by 3,245.
“There will be 922 beds after the upgrade of 58 district hospitals to 25- and 50-bed facilities. There will be additional 1,035 beds by upgrading 11 zonal and sub-regional hospitals into 200-bed hospitals,” he said. “Work has started to upgrade seven provincial hospitals into 500-bed hospitals.”
Public health experts and doctors, however, look askance at the government claim, saying that it is not possible to create such facilities overnight.
“If that was so easy, why was it not done earlier when there was a lockdown and plenty of opportunity?” said an official at the Department of Health Services asking not to be named. “What the authorities are saying now seems to be aimed at shutting up critics.”
With the number of Covid-19 cases rising at an alarming rate by the day, there are now concerns if Nepal will face a new humanitarian crisis.
As of Tuesday, 139,129 people have tested positive for Covid-19 throughout the country with 765 deaths. In the last 24 hours, 3,093 people have tested positive for the virus. Among them, 1,702 are from Kathmandu Valley. The number of active cases stands at 41,755 as of Tuesday, according to the Health Ministry.
An internal projection of the Health Ministry suggests that additional 320,000 people will get infected in the next four months in the worst case scenario. In a moderate case scenario, additional 148,000 people will get infected in the same period.
Dr Lochan Karki, chairman of the Nepal Medical Association, an umbrella organisation of medical doctors, said that by leaving people to fend for themselves in the time of pandemic, the government has just proved once again how irresponsible it is towards its citizens.
“The government has not worked seriously since the pandemic began,” Karki told the Post. “Now it is escaping its constitutional obligations towards the citizens.”
Public health experts say that it is now a race against time and that if the authorities fail to act now, the situation will be even more disastrous. According to them, the authorities must work on immediate measures rather than talking big and promising what they cannot achieve, like building hospitals overnight.
“The authorities should focus on arranging oxygen therapy, which is less costly, doable and proven to be highly effective,” said Dr Kiran Pandey, a consultant physician. “What we should not forget is even one case of infection poses the risk of virus spread.”
According to Pandey, there are ways to address the challenges posed by the pandemic only if the government is serious.
“The government decided to impose the lockdown when there were just two cases. Now when the cases have risen, it is dodging its responsibility,” said Pandey. “Instead of exploring ways to reduce the expenditure, the government has chosen to give up the fight, which is very unfortunate–for the country and people.”