Two weeks ago, there were two Covid-19 patients at the Sukraraj Tropical and Infectious Disease Hospital.

On Thursday there were 12. And all these cases are serious, doctors at the hospital said.

They predict that the number of patients at the hospital will continue to rise.

“We expect that cases will increase after the Nepali new year and all [60] beds will be occupied within a month,” Dr Sagar Rajbhandari, director at the Infectious Disease Hospital, told the Post. “We may have to convert the entire hospital into Covid hospital after a month, if immediate measures are not taken to contain the spread of infections.”

Of the 70 to 150 tests performed at the hospital every day now, the case positivity rate stands at 14 to 20 percent.

What is more alarming is that the case positivity is high despite the fact that most of those seeking tests are not because they have some symptoms or are known to have been in contact with someone testing positive.

“Most of the people seeking tests are those planning to go abroad,” Rajbhandari said. “They are healthy people and seeking tests voluntarily. We don’t know the exact situation of infection rate in the community.”

Active cases of Covid-19 across the country reached 1,579 on Thursday. According to the Ministry of Health and Population, 152 people tested positive in the last 24 hours and one died, taking the total number of infections to 277,461 and the death toll to 3,031.

Doctors say that the exact number of active cases could be 10 times more as only one in 10 infected people might have been seeking tests. Contact tracing has not resumed since October when the government decided to halt free testing amid a rising number of cases, a decision later overturned by the Supreme Court. The number of tests has also not increased since then.

Public health experts say that the country is already facing a new wave of infections.

“A new wave of infections has already started in our country,” Dr Keshav Deuba, a public health epidemiologist, told the Post.

Authorities concerned are making assumptions that the infection rate is low on the basis of tests of healthy people seeking tests voluntarily to go abroad.

Indicators such as the rise in the number of new cases and increase in the number of infected patients being admitted to hospitals mean that a new wave of the infections has started in the country, experts say.

“We are not taking the issue seriously, which may lead us to another catastrophe,” said Deuba.

Intervention measures are still not in place and vaccination coverage is not at the level required to slow down the infection rate.

So far, only around 1.8 million people have taken their first dose of the vaccine and the government has halted the immunisation drive for an indefinite period due to its failure to secure sufficient doses.

Officials say that they are not in a position to say anything about the resumption of the vaccination, due to the uncertainties of vaccine supply.

“The general population and some officials in authority believe that we might have developed immunity against the virus,” said Deuba. “An exponential spike in new cases in India shows that the tale of natural immunity is just a myth.”

On Wednesday, India recorded 72,182 new cases from a low of 12,000 cases a day in mid-February. Doctors there are worried that new variants are partly responsible for the spike in cases and with Nepal sharing a 1,800-kilometre open border with India, it will be a matter of time before they spread in Nepal.

Some doctors in Nepal already suspect that new variants of the coronavirus might be responsible for the rise in new cases, as one of the key spike proteins in SARS-CoV-2 virus has been found missing in swab samples of the people infected with Covid-19 lately.

“In our laboratory, we have been finding S-gene targets missing in the swab samples of infected people on a regular basis,” Rajbhandari, director at the Sukraraj Hospital, told the Post.

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.

Experts warn that apathy and negligence on part of the authorities could be too costly.

“There is no doubt that new cases have been rising and a new wave has started,” Dr Sameer Mani Dixit, director of Research at Center for Molecular Dynamic, told the Post. “But I think our own behaviour is more responsible for the rise in the new cases.”

Of late people have stopped wearing face masks, maintaining social distancing and following other safety measures.

Authorities concerned have also not shown concern to know the risk level and make strategies accordingly.

According to Dixit, by ignoring risks we cannot contain the infections.

“Tests should be increased, contact tracing resumed and virus variants identified and safety measures should be enforced strictly to lessen the risks,'' he said. Without knowing the virus variant, one cannot know how infectious the new virus is and whether the vaccine works against it.

The new variant of the coronavirus, the one that was identified in the United Kingdom in December last year, was confirmed in Nepal in January.

The World Health Organisation’s collaborating centre in Hong Kong, where swab samples of three people, who had returned from the UK, had been sent for whole-genome sequencing, confirmed that all three people were infected with the new more contagious variant, identified as being part of the B.1.1.7 lineage.

Even in the United States of America, health experts believe that the UK variant is responsible for an uptick of new cases and may already be dominant across the US.

Experts said that taking the issue of missing spike protein lightly and not performing gene sequencing is a sheer negligence on the government’s part.

Government laboratory facilities are not even equipped to perform tests to identify new variants although some private laboratories are.

“We have recorded UK variants, and are finding missing S-gene targets. This means a new virus variant is responsible for the rise in new cases,” Dr Prabhat Adhikari, an infectious disease and critical care expert, told the Post.

“New restriction measures may have to be introduced if the virus variant is found to be more infectious and deadly. But before that we have to know the virus variant prevalent in the country now.”