Adult population increasingly driving virus spread, experts sayDoctors stress restrictions on mobility to flatten the curve, which has been going up in an unpredictable way, as the country reports over 3,000 new cases and 28 deaths.
That a mobile population can spread the coronavirus widely has been well established and the rapid surge in the number of positive cases during the second wave in Nepal is testament to this.
Since the Nepali New Year, the daily number of cases have grown more than fivefold with widespread movement of people for different celebrations, data suggest.
Doctors say the mobile population, which makes up people aged 20-40, is responsible for the current spike in new cases.
“Mobile population is the medium to carry the infection everywhere,” Dr GD Thakur, former director at the Epidemiology and Disease Control Division, told the Post. “Not only this time, if we look at the history of the first case, the second case, third cases and many other cases, we can find that the infection was spread by a mobile population.”
The first case of the coronavirus was detected on a Nepali student who had returned from Wuhan, China last January. The second case was detected in another student who had returned from France. Then the sources of other cases were the Middle East and India, and slowly the infection circulated within the population.
In India, the number of daily cases was hovering around less than 20,000 until early March, but suddenly the cases spiked amid election rallies, weddings and festivals. By April 1, the number of daily cases had shot up to more than 81,000 and on Sunday it hit an all-time high of 349,691 new cases.
With the porous 1,800-km border with India, it was only a matter of time that cases in Nepal too would skyrocket.
Authorities here, however, were not paying heed. The government was busy trying to come to terms with the Supreme Court’s reinstatement of the House on February 23 and invalidation of the Nepal Communist Party (NCP) on March 7 and the subsequent political fallout of these decisions.
Political meetings and rallies were being held across the country.
On April 13, the Nepali New Year eve, the number of news cases in the country was 460 with 201 in Kathmandu Valley alone. The slow rise in the number of new cases was already evident then as there were only 60 new cases, 44 of them in the Kathmandu Valley, on March 13.
Of the total infected, 340 are under 20 years.
The Health Ministry said that 28 deaths have been recorded in the last 24 hours, pushing the toll to 3,164. Active cases stand at 19,382 and the total number of cases has reached 300,119.
On Sunday, 252 seriously ailing patients were receiving treatment at intensive care units and 65 were on ventilator support.
In the 12 days since April 13, there have been the Nepali New Year and a number of jatras in the Kathmandu Valley–occasions that mostly young people move about in celebrations.
The link is between mobility and rise in the number of cases is obvious.
With the degree of contagiousness of the new variants of the virus like the UK variant B.1.1.7 and the Indian variant B.1.617 higher, the young have also become the medium to transmit the infection to family members and in society.
“Even if the people of the said age group generally do not get serious, they could pass the infection to the elderly and children, whose immunity is low and might have multiple comorbidities,” Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital, told the Post.
Moreover, there is another reason for worry during the current second wave as younger people too are requiring hospitalisation.
“But of late even people of this age group are also getting serious and require oxygen support,” said Pun.
People in their 20s and 30s not only participate in political rallies, jatras, festivals but also go out of their homes to work.
Infection in people between 20 and 30 has seen a steady rise in the past fortnight while new cases in the age group 30 and 39 continue to escalate.
“Restricting the mobility of the people is the only way to contain any further spread of infections,” said Thakur.
That the second wave was looming was very much evident from what was seen in India, but authorities failed to act.
“The writing was on the wall,” said Thakur. “But the authorities failed to monitor movements, expand tests and prepare for the possible worst-case scenario.”
Doctors say the coronavirus has already penetrated deep into society.
Case positivity rate was around 33 percent on Sunday.
According to a report in Johns Hopkins Bloomberg School of Public Health, the percentage positive is a critical measure as it gives an indication of how widespread the infection is in areas where testing is occurring and whether levels of testing are keeping up with the levels of disease transmission.
The report said that percentage positive will be high if the number of positive tests is too high, or if the number of total tests is too low. In Nepal’s case, test numbers suggest both numbers of tests are too low and the positive percentage is too high, doctors say.
“Case positive rate shows that the actual infection rate is very much higher in society than the daily case count,” said Dr Biraj Karmacharya, an epidemiologist, who was invited to the Health Ministry’s press briefing on Sunday.
According to doctors at various hospitals, only those in serious condition are coming to hospitals. But the pressure is being felt already not only on hospital beds but also on testing capacity.
On Sunday, the Ministry of Health and Population issued instructions asking health facilities and laboratories not to perform polymerase chain reaction tests on the people visiting Nepal only for tests or only for transit.
Only foreigners staying in Nepal and those working in diplomatic missions should be provided this service, according to the ministry.
Officials at the ministry said the instruction was issued after reports that the number of foreigners seeking tests increased several folds.
“If it were a normal situation, it would not be a problem to provide the services. But we ourselves are in a very difficult situation. People visiting from the disease-hit countries for tests and those making Nepal a transit simply increases the risk,” Dr Samir Kumar Adhikari, joint spokesperson at the Health Ministry, told the Post. “We hope that if we stop providing tests on such a mobile population they will not come here for tests only.”
But the open border with India is yet to be regulated, another source of mobility.
Another official at the Health Ministry said on the condition of anonymity that free movements from borders should have been restricted long ago and that people entering from India must have been–and should be–mandatorily quarantined for a certain number of days.
“A lockdown or restriction in movement is the only way to break the transmission chain and flatten the curve,'' said Pun of Sukraraj Hospital, who is also a virologist.
Doctors say the severity and death rate could exacerbate in the coming days, as more elderly people and those having comorbidities are likely to get infected.
Projections show that per day deaths could reach 149 in the coming days, according to Karmacharya, the epidemiologist.
Experts say even if the government does not enforce restrictions, people should abide by safety measures strictly to save themselves and their family members.
“I cannot express my feelings in words about the possible scenario in the coming days,” said Pun. “I would like to request all to think of themselves and their family members. If we do not follow safety protocol, we may lose our dear ones.”