Get back to basics, increase tests, experts say, as rising cases overwhelm hospitalsPositivity rate continues to be high which means either there is not enough testing or infection is very widespread in society. On Thursday, it was 38 percent.
Dhulikhel Hospital in Kavrepalanchok started performing polymerase chain reaction tests for Rs500 from Wednesday. That is half of what it costs at state-run hospitals and laboratories.
The Ministry of Health and Population has allowed private hospitals and laboratories to charge Rs 2,000 for the service.
“We have reduced the price of the test not because we have a lot of money or testing costs less in our laboratory,” Dr Biraj Karmacharya, an epidemiologist, who is also the chief of the Department of Community Programme at Dhulikhel Hospital, told the Post. “We have done so to lessen the burden on our hospital in the coming days.”
Reducing the cost of testing would encourage more people to get tested early on if they show symptoms or have been in contact with those infected and this would tell people of their infection status. This would in turn help them decide to remain in isolation and take precautionary measures.
“Chances of spreading the infection from the infected person will lessen if people know about their disease status early on,” said Karmacharya. “When the spread of infection declines, few people will reach the hospital and few will require oxygen, isolation and ventilator support.”
With Nepal reporting more new infections every day, health facilities are running out of beds and oxygen supplies.
On Thursday, the positivity rate stood at 38 percent.
According to a report by Johns Hopkins Bloomberg School of Public Health, the percentage positive is a critical measure as it gives an indication on 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, doctors say test numbers suggest both numbers of tests are too low and the positive percentage is too high.
Without widespread testing, which should not be considered an expenditure but an investment, ongoing infection rate cannot be controlled, doctors say.
“We have been urging the government to increase testing and provide free testing at least for now,” Dr Binjawala Shrestha, a public health expert, told the Post. “Without testing, we do not know where the virus is spreading more.”
Dhulikhel Hospital is also working to start a telephone hotline service to help the infected patients, who are placed in home isolations and have not been getting much support.
“We had planned to launch the hotline service from Wednesday, but due to some technical reason, we could not do so,” said Karmacharya. “We will start the service within the next couple of days.”
Experts say that if Dhulikhel Hospital, a non-profit community-based hospital, can reduce the cost of polymerase chain reaction tests by half and start a direct hotline service targeting infected patients, why can’t the state-run hospitals do the same.
“A lot of people, who have already been infected by the virus, still do not know about their disease status,” Dr Keshav Deuba, a public health epidemiologist, told the Post. “A lot of people who know their disease conditions might be forced to conceal from others. Amid such difficult conditions, authorities should also bring programmes to address such problems.”
If the health of the infected people who are in home isolation is not monitored, a lot of people may die without reaching hospitals, experts say.
However, the government, at the moment, seems to be focusing on preparedness for the worst case scenario by equipping hospitals.
The Ministry of Health and Population on Thursday informed agencies concerned about waiver of customs duties and VAT for medical grade oxygen (liquid and gaseous oxygen), helmets for non-invasive ventilation, oxygen cylinders, liquid oxygen containers, liquid oxygen tanks, oxygen containers, containers for shipping oxygen, and cryogenic road transport tanks for oxygen, as per the decision of the Cabinet on Monday.
Likewise, all kinds of taxes have been exempted on the import of vacuum pressure oxygen flow meter, oxygen regulator, blood gas analyser, oxygen concentrator, venturi masks, monitors in intensive care units among other devices used in treatment of the patients infected with coronavirus.
Meanwhile, experts have said that the prohibitory orders imposed in the disease-hit districts, including in three districts of the Kathmandu Valley, that began on Thursday, is not a long-term solution and restrictions cannot be enforced for an indefinite period.
“Lockdown only stops the infection from becoming widespread but doesn't make it disappear from society,” said Shrestha, who is also an assistant professor at the Institute of Medicine under Tribhuvan University. “Our past experience also showed that when we eased restrictions, the new cases surge again.”
Last year, a lockdown was imposed in March when there were just two cases, one of them active. Infections continued to rise and prohibitory orders were imposed in August. But the number of daily cases peaked in October.
Nepal on Thursday recorded 4,831 new cases out of 12,579 polymerase chain reaction tests conducted, and additional 97 positive cases from 963 antigen tests.
The Health Ministry said that 35 deaths were recorded in the last 24 hours, the highest number of casualties from the coronavirus infection on a single day since the start of the pandemic.
The total deaths from the infection reached 3,246 while the active cases of infection stood at 34,117.
On Thursday, 337 people were in intensive care units and another 107 on ventilator support. Of those admitted in the intensive care units, 114 are in the Kathmandu Valley. The Health Ministry said that 58 people have been placed on ventilator support in various hospitals of the Valley.
Dozens of health workers, serving in several hospitals of the big cities, including those of Nepalgunj, have tested positive but even infected health workers are compelled to serve the patients.
Doctors have warned that if health workers keep getting infected, health facilities may not be able to provide treatment to critical patients.
Several doctors the Post talked to said that prohibitory orders were the only way to lessen the damage and prevent catastrophic conditions for the present and stressed that the time should be utilised for preparations for the worst-case scenario.
Apart from testing and isolating the infected, setting up quarantine and isolation centres and ensuring hospital beds with high flow oxygen supply are equally essential in the ongoing lockdown period, according to experts.
The number of new cases will not decrease immediately, as those already infected before Thursday will be tested in the coming days. But if restrictions in mobility are enforced effectively, doctors say new cases could start declining after a week or so.
“However, a restriction alone is not the solution,” said Deuba. “We must work to lessen the loss of lives, and for that we have to keep health facilities prepared. We must start with more tests.”