As virus cases surge in Nepal, experts warn against lapses and complacencyWith the country reporting 13 new deaths and the daily count of 496, concerns have grown over a repeat of last year’s cycle if authorities fail to ramp up measures to contain the spread.
On April 8, when Prime Minister KP Sharma Oli was saying gargling with guava leaves could help people easily get rid of the coronavirus, the country reported 332 new cases. After peddling the “benefits” of drinking turmeric water against the coronavirus, which has scared the whole world once again, with neighbouring India scrambling to find a way to contain the spread, Oli came up with yet another unverified treatment for the disease, just as hospitals’ intensive care units saw a steady flow of seriously ill patients.
According to the Ministry of Health, as of Monday 92 people were in intensive care units of various hospitals and 15 on ventilator support. Of the 92 people admitted to the intensive care units, 54 were in Bagmati Province and 46 of them in the hospitals of Kathmandu Valley.
Sukraraj Tropical and Infectious Disease Hospital’s 20-bed intensive care unit has already taken in 16 Covid-19 patients.
“We can admit only four additional patients to our intensive care unit now,” Dr Sagar Raj Bhandari, director at the hospital, told the Post. “We can do nothing except saying no to other serious patients after four more patients.”
With the sudden surge in coronavirus cases, the hospital administration is planning to convert the entire hospital into a “Covid-19 designated hospital” like in the last year.
After a dramatic decline in Covid-19 cases, Nepal has been seeing a steady rise in the number of infections lately.
The Ministry of Health said on Monday 496 new cases were reported in the last 24 hours. According to the ministry, there were 63 positive cases through antigen tests.
Thirteen deaths have been reported in the last 24 hours. The number of active cases stands at 280,524. So far, the country has reported 3,053 deaths across the country due to Covid-19.
Doctors warn that health facilities will be overwhelmed within a few days, if containment measures are not taken to slow down the virus spread.
There are 1,158 intensive care unit beds and 476 ventilators at government hospitals throughout the country. Not all can afford treatment at private hospitals for the exorbitant fees, doctors say.
“What is alarming is that even young people have developed serious conditions unlike in the past, needing intensive care,” said Rajbhandari. “If we do not enforce preventive measures strictly, we are headed for a worse situation than last year.”
When Nepal reported zero deaths on January 28 in six months and just 213 new infections, complacency had already taken hold, and authorities believed the worst was over. When the virus was circulating last year, the country’s young population was considered less susceptible to severity and death.
Now even children are showing symptoms.
According to Dr Samir Kumar Adhikari, joint spokesperson for the Ministry of Health, of the total cases reported in recent days, 14 percent are children. Last year, only four percent of the total infections were children.
Officials say the United Kingdom variant, known as B.1.1.7, is responsible for the recent spike in Covid-19 cases in Nepal.
According to scientists, the UK variant is 40 to 70 percent more transmissible than the one that caused the first wave of coronavirus infection. They have also said that the virus is 64 percent more deadly than the previous strains.
Epidemiologists and public health experts say what the country needs to do immediately is work on preventive measures so as to contain the spread and ramp up efforts to arrange intensive care beds and get vaccines.
“Increasing tests is the first step toward containing the spread of the virus,” Dr Keshav Deuba, a public health epidemiologist, told the Post. “Unless we expand tests, we won’t know how and where there are more infections.”
Data provided by the Health Ministry show that 5,105 swab samples were tested throughout the country in the last 24 hours. Doctors at the laboratories said that most of the tests were performed on swab samples of the healthy people seeking foreign visit.
Of the 84 laboratories having polymerase chain reaction tests facilities operating throughout the country 13 laboratories did not perform any tests on Monday.
Swab sample of only one person was performed in Karnali Province in the last 24 hours. Seventy-four swab samples were tested in Sudurpaschim Province and 15 of them showed positive results.
Swab samples of 81 people were tested in Province 2 and 28 of them were found positive. In Gandaki Province, swab samples of 202 people were tested and 22 of them came back positive. A total of 271 swab samples were tested in Province 1, of which 26 came back positive.
In Lumbini Province, 448 swab samples were tested, which showed 119 positive and in the Bagmati Province 3,301 tests were done and 286 came positive.
“The number of cases and tests shows infections are being widespread again,” Dr Prabhat Adhikari, an infectious disease and critical care expert, told the Post. “Authorities must increase tests and resume contact tracing immediately. The number of tests we are performing at present won’t help us.”
Nepal’s vaccination drive is currently on a halt with no new supplies. The China-gifted 800,000 doses are going to be over in a day or two, officials say. Nepal launched its vaccination drive against Covid-19 on January 27 with the 1 million doses of the AstraZeneca vaccine, manufactured by the Serum Institute of India under the brand name Covishield, that India had provided under grant assistance.
Nepal then signed a deal with the Serum Institute to procure 2 million doses and made the 80 percent advance payment as sought by the company. But Nepal has received only half of the order it placed for, with no clarity on when the remaining doses will arrive, as India has put a temporary ban on the export of AstraZeneca vaccine in light of growing demand amid a surge in cases.
India on Monday reported 169,914 new cases and over 904 deaths.
Nepal needs to inoculate 72 percent of the 30 million population–or a little over 21 million people, for which it will need 43 million doses of vaccine. The World Health Organisation-backed COVAX facility has committed to providing 13 million doses of vaccine for free to inoculate 20 percent of the total population–or 6 million people.
With the Indian ban on exports, the WHO-backed COVAX is also struggling to acquire vaccines. Nepal has received 348,000 doses of vaccine under COVAX so far.
The Oli administration, which faced criticism for imposing the four-month lockdown last year, this time has not said anything about complete restrictions. But government agencies have proposed measures like closing schools in densely populated cities like Kathmandu, Pokhara and Birgunj, among others.
The Health Ministry has also recommended that public vehicles carry passengers only 50 percent of their capacity and enforce safety measures strictly.
Doctors have suggested that authorities concerned enforce restrictions in public movement in hotspots to prevent the virus spread.
But no decision has been taken yet. School operators are vehemently opposed to the idea of closing schools.
That the percent positive rate too has jumped to around 10 percent compared to 3 percent last year is also a cause for concern, experts say. According to them, Nepali authorities made a massive bungling last year, as they initially made light of the virus and downplayed it before taking haphazard steps.
A government-formed committee, the Covid-19 Crisis Management Centre, that was supposed to work continuously had remained dormant for months after the number of cases started to decline. But public health experts had continuously warned that there was no room for complacency.
When the country had its first zero death in six months in January, public health experts had told the Post that the authorities and the people must not let their guard down, as cases could go up anytime soon and that a second wave was not very far.
Now with the cases rising, the Covid-19 Crisis Management Centre has suddenly woken up but over the past few months, there has been an utter lack of coordination among agencies, experts say.
“A lack of coordination among agencies concerned could be too costly for the people and country,” Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, told the Post. “People have to pay the price of the indecisions and missteps of the government and the agencies dealing with the Covid-19 pandemic.”
As the second wave is looming large, authorities are at their wit’s end.
Experts say the fundamental mistake the authorities, including the prime minister, have made is they have refused to recognise Covid-19 as a serious health crisis issue. Some statements by Oli including the one that Nepalis have high immunity to fight the coronavirus are irresponsible.
“Even if such statements are made as jokes, the country’s executive must understand that it’s not a good time to crack a joke,” said Dr Sarad Onta, a public health expert. “Offering scientifically unfounded advices, which are not supported by any evidence, could make people careless, thereby fuelling infection risks.”
According to Onta, public health experts including him have for long been pressing for more tests, increased contact tracing and managing the cases.
“If we don’t do it now, when will we do it?” said Onta.