Nepal at risk from new virus variants, experts warnThe government’s focus on vaccination while ignoring importance of testing, contact tracing and genome sequencing could prove costly, they say.
After three cases of the United Kingdom variant of coronavirus were first confirmed in the country on January 18, at least 13 suspected infections from the same virus have been identified in Kathmandu and Pokhara.
The World Health Organization’s collaborating centre in Hong Kong had confirmed through a whole-genome sequencing test that the three returnees had indeed been infected with the virus dubbed B.1.1.7 lineage.
However, authorities concerned have not shown any concern to conduct the whole-genome sequencing test of swab samples of those 13 people of Kathmandu and Pokhara, who did not travel outside the country but had come in close contact with abroad returnees.
Public health experts say the country is at high risk from the new variants of coronavirus, be it from those first detected in the United Kingdom, South Africa or Brazil, and warn that negligence from the authorities to contain their possible spread could prove to be costly for the country.
“We should not forget that the first case of Covid-19 was detected in January [last year] and the second in March in Nepal and after that the virus spread throughout the country,” Dr Sher Bahadur Pun, chief of Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital, told the Post. “In the case of the new UK variant, we have already three confirmed cases and over a dozen suspicious cases.”
With the government deciding to provide free tests and treatment to only symptomatic patients, contact tracing has completely halted, which has also raised the risk of spread of the new virus variants.
Authorities are not bothered to work on active case findings either.
“We didn’t learn anything from the experiences of other countries, nor from our own failures,” an official at the Department of Health Services said asking not to be named. “Infections from the new virus variants could strike at any time, as we all are focussed on immunisation.”
Doctors say that even if the authorities are busy with the immunisation drive, that began on January 27, preventive measures should not be given up. They warn that a new variant of the virus could spread like the fire in the chaff, as authorities have not been performing contact tracing and testing of asymptomatic patients.
The World Health Organization has said that the UK variant of the coronavirus has spread to 82 countries and the South Africa variant to 39 countries throughout the world.
However, the Health Ministry has been only placing people returning from the UK in the hotel quarantine. Over 2,000 people enter the country every day from abroad.
Mahendra Prasad Shrestha, chief specialist at the Health Ministry, concedes that Nepal is at high risk from new variants of the virus.
“Yes, active case findings, contact tracing and testing is always important to lessen the risk of outbreaks,” said Shrestha. “But I don’t know much about what is being done, as the Epidemiology and Disease Control Division is working on it.”
Officials at the division, however, maintain that there is no need to worry.
“Yes, these people are positive for Covid-19 but negative for the s-gene target,” Dr Krishna Prasad Paudel, director at the Epidemiology and Disease Control Division, told the Post. “We need not be worried, as the infection has come under control.”
S-gene target or spike protein is one of the key biological characteristics of SARS-CoV-2, which enables the virus to penetrate host cells and cause infections.
Without spike protein, the coronavirus cannot infect people but doctors say that if the polymerase chain reaction tests are failing to detect the spike proteins in the swab samples of the infected people or negative s-gene target, there is a possibility that the virus may have undergone mutations or the virus could be of a different variant than the one common in the country.
The swab samples of all the suspects have been preserved at the National Public Health Laboratory.
According to The New York Times, British government scientists are increasingly finding the United Kingdom coronavirus variant to be linked to higher risk of death than other variants of the virus— highlighting the serious risks and considerable uncertainties of this new phase of the pandemic.
The scientists said last month that there was a “realistic possibility” that the variant was not only more contagious than others, but also more lethal. Now, they say in a new document that it is “likely” that the variant is linked to an increased risk of hospitalisation and death.
“Testing, contact tracing and whole-genome sequencing are basic, which should be done on a regular basis,” Dr Sameer Mani Dixit, director of research at the Center for Molecular Dynamics Nepal, told the Post. “Whole-genome sequencing test is needed not only to study if the virus seen in foreign countries has come to Nepal but also to know if the new variants have developed within the country.”
Ever since the coronavirus was first detected in humans in Wuhan of China in December 2019, it is believed to have undergone hundreds of changes.
“Keeping suspicious swab samples with the excuse of not having the capacity to perform gene sequencing does not help in containing the spread of infections,” Dixit added.
The National Public Health Laboratory is setting up its own facility to carry out whole genome sequencing with the financial and technical support of the World Health Organization.
Doctors say conducting the whole genome sequencing does not make any difference in the containment of the infection but it gives information about the virus, which is a basic thing to take preventive measures.
According to Dixit, active case findings are necessary, to find the hidden cases and testing is prerequisite for it.
Authorities, however, are at present more focused on the Covid-19 vaccination drive.
Nepal has launched its vaccination drive against Covid-19 with the Oxford-AstraZeneca’s Covishield vaccine, which is manufactured by the Serum Institute of India.
Despite, there being concerns about the effectiveness of the vaccines developed so far in people who are infected with the new variants, the UN health agency’s Strategic Advisory Group of Experts on Immunization, known as SAGE, said on Wednesday that it recommends using the vaccine developed by the University of Oxford and AstraZeneca even in countries tackling new variants of coronavirus. In their interim recommendations, the experts’ panel said the vaccine is 63 percent effective overall.
However, early data from trials in South Africa showed the vaccine was offering "minimal protection" against mild and moderate disease with the South Africa variant in young people, according to the BBC.
Experts say that while it is a good thing that recent reports suggest the Oxford-AstraZeneca vaccine has been recommended by the World Health Organisation for its wide use, the immunisation drive so far does not give room for complacency.
“Even if the vaccine works against the new variant of virus and we have sufficient doses, existing pace of the immunisation will not help contain the spread,” Dr Sarad Onta, public Health Expert, told the Post.
Authorities had announced that the government would inoculate 430,000 health frontline health workers with the one million doses of Covishield provided by India under grant assistance, but only 184,847 were inoculated by February 6. Then in the second round journalists and staff at diplomatic missions were included. Inoculation of the third group of local government representatives and staffers began on Sunday but with inadequate planning experts are doubtful if the target will be met again.