Contact tracing was never effective. Government decision on tests and treatment has made it even more difficultAfter authorities said people have to pay for tests and treatment, labs are refusing to conduct tests and no one is coming forward to share information, making it difficult for contact tracing which could exacerbate the virus situation.
On Wednesday, Janardan Adhikari, a health coordinator at Tarakeshwor Municipality, did not receive any call from people infected with the coronavirus or those who had come in close contact with the Covid-19 infected.
With the government deciding not to pay for Covid-19 tests and treatment for the general public, except for those who are poor, single women, disabled, elderly people above 70 years, frontline health workers and security personnel and cleaning staff, people infected with the virus or those who came in close contact with them have stopped contacting health workers for tests or other related information.
“I used to wake up to various calls. At times the number of calls would surpass 400, many of them asking about tests,” Adhikari told the Post. “But there was no call from anyone–neither those with symptoms of Covid-19 nor those who had come in close contact with the people who had been infected with the virus.”
What the health worker came across, according to public health experts and doctors, is a cause for a serious concern, as such a lack of communication will affect contact tracing, which is a key when it comes to containing the virus spread.
Health workers say the government’s decision that it won’t pay for tests and treatment of Covid-19 for the citizens could lead to massive spread of the virus in the community. Since the new decision by the government, people have to pay for tests on their own—and also for treatment if their result is positive for the virus—not many are keen to share information.
Health workers at Tarakeshwor Municipality, who used to collect swab samples of the people who came in close contact with infected people every day and send them to the National Public Health Laboratory for tests, have now stopped collecting samples for the last one week.
“We have stopped collecting specimens—nasal and throat swabs—for polymerase chain reaction tests for the last one week after the laboratory sought Rs 2,000 to test for each swab sample,” said Adhikari.
According to Adhikari, health workers deployed for contact tracing had collected swab samples of 389 people a week ago, which were sent to the National Public Health Laboratory.
Health workers at the laboratory, however, refused to accept the swab samples, demanding Rs 2,000 to test each sample.
Adhikari then contacted Health Ministry’s joint spokesperson Dr Sameir Adhikari, and Dr Runa Jha, director at the National Public Health Laboratory, and pleaded that tests be conducted on the collected samples.
The laboratory performed tests on the samples but told municipality officials not to send additional samples, as the government had directed them to charge a fee for the tests.
“If the government asks us not to conduct polymerase chain reaction tests for free, there is no point collecting samples and conducting contact tracing,” said Adhikari. “Dashain is just here, and we have the pretext to stop collecting samples and conduct contact tracing. The government must make things clear. Or else contact tracing will be very difficult.”
The government’s new decision on Covid-19 tests and tracing, according to public health experts, will have serious consequences, as it has already discouraged people from sharing information with health workers. If there is a lack of information about people infected with the virus or those who came in close contact with the infected, contact tracing will be impossible, they say.
Contact tracing is one of the major components in the fight against the virus. The Oli government, which seems to have already given up on its fight against the pandemic, has made it even more difficult by deciding not to test and treat all, according to public health experts.
Rameswor Bohara, mayor of Tarakeshwor Municipality, said he is at his wit’s end.
“The government decision has not only created confusion about tests and contact tracing but also raised the risk of infection,” Bohara told the Post. “I can say more about the issue only after the Dashain holidays. We have to hold a meeting with the provincial and federal governments before taking a decision.”
He, however, is concerned that by the end of Dashain holidays, the virus could take stronger hold.
Public health experts say that the time is running out, as virus cases are rising at an alarming rate.
According to the Health Ministry, in the last 24 hours, 5,743 people tested positive. The number of deaths stood at 26, the highest single day toll since the first Covid-19 case was reported in Nepal in January.
Of the total new infections, 3,107 are from Kathmandu Valley, according to the Health Ministry.
As of Wednesday, 144,872 people have tested positive nationwide including 791 deaths. The number of active cases stands at 44,476 as of Wednesday.
The Health Ministry has said there will be an additional 320,000 cases in the next four months in the worst case scenario. The internal projection of the ministry estimated 148,000 more new cases even in the moderate case scenario.
“The government refused to listen to experts. Now, there is no other way than the general public rising up and holding the government to account. Unless the people stand up, it does not look like this government will learn a lesson,” Dr GD Thakur, former director at the Epidemiology and Disease Control Division, told the Post. “The decision not to perform free tests and treatment is an irresponsible act by the government. It looks like the decision was taken by a handful of people in power who are drunk with power.”
Doctors say that increasing polymerase chain reaction tests and making contact tracing more effective are the only tools at this time to contain the virus. Contact tracing is not only about finding the whereabouts of those who have tested positive but also about tracing all those who came in close contact with the infected people within the last few days, according to them.
“If the government does not perform tests, there will be no meaning of doing contact tracing,” said Thakur. “Contact tracing comes along with testing, which is done to know the infection status.”
According to Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital, the current rise in infection rate and deaths was very much expected, as the authorities gave up on the fight against the pandemic long ago.
“What is happening is what doctors and experts, including me, had warned of and feared from the very beginning,” Pun told the Post.