Earlier this week, Dr Binjawala Shrestha, an assistant professor at the Tribhuvan University’s Institute of Medicine, met with Khageshwor Gelal, chief of the Health Office, Lalitpur. Shrestha suggested that Gelal’s office take some measures to break the coronavirus transmission chain.

Gelal told Shrestha he would consult officials at the local level in the district and invite her to impart training to health workers on what measures they can enforce.

“I had also made a Powerpoint presentation on measures that can help break the chain,” said Shrestha. “But I have not been asked to visit. I have no idea what measures they have taken.”

According to Shrestha, she suggested that the local federal units should be activated to locate the source of infection, find the total number of cases and divide them into red, yellow and green zones, which will help identify which area needs to be completely locked down with all kinds of assistance.

“Those in the yellow zone need contact tracing and testing,” she said, stressing the need for effective awareness campaigns for the green zone.

Early detection, isolation, contact tracing and setting up timely response mechanisms are the most fundamental steps that can protect the vulnerable populations from the virus.

Kathmandu Valley has been in a lockdown-like situation for the past one week. The measure was imposed by the chief district officers of Kathmandu, Lalitpur and Bhaktapur after the three districts started reporting more than half of the country’s total cases daily after the arrival of the second wave in early March. The authorities have decided to make the current prohibitory orders stricter starting Thursday.

As of now, 56 districts have been under prohibitory orders.

But new cases have been rising and close to half of the total tests conducted are returning Covid-19 positive results.

On Wednesday, Nepal once again hit a new record of daily cases of 8,605 ever since the pandemic began last year. The country also reported the single-day highest death toll at 58.

The numbers from the past week suggest the virus is surging despite the prohibitory orders in place.

“To break the chain, the source of the infection should be identified first. And for this, testing should be expanded and contact tracing made effective,” said Shrestha, who is also a public health expert. “The number of tests cannot be increased unless we make the testing free and contact tracing effective.”

Over the last few days, the test numbers have certainly gone up, but so have the positive results.

According to the Health Ministry, the total positive cases of 8,605 were obtained from a total of 20,756 polymerase chain reaction tests.

On April 29, a total of 12,597 PCR tests were performed, which increased to 15,391 on April 30.

Test numbers were down to 14,403 on May 1. But then again, the number increased to 16,147 on May 2 and 16,658 on May 3. On May 4, a total of 16,131 tests were performed.

The trend suggests: the more the tests, the more the positive results—a clear indication that the virus is circulating at a very fast pace and has penetrated communities.

Studies also suggest that Nepal’s R, or reproductive number of the virus, is a little over 2. The R number indicates how many people one infected person can potentially transmit the virus on to.

Experts say a lockdown is just one of the measures—and it is considered the harshest way—to break the transmission chain. Without other steps taken simultaneously, the situation could easily go out of hands.

Government officials, however, appear to be at a loss. They are not sure what other measures, apart from prohibitory orders, they are going to take to control the spread and break the transmission chain.

Nepal’s authorities were initially too slow to recognise the virus threat. After reaching the peak in October last year, when the cases started to decline, it made authorities even more complacent. Governments at all levels did not even consider raising public awareness. As ministers and public post holders openly met in gatherings and addressed huge masses, people shed their masks. Physical distancing became an alien term. At political parties’ calls, people participated in rallies and demonstrations. The public celebrated festivals and other functions, like New Year parties, with full fervour.

Some basic things that people were at least practising to some extent—hand washing, physical distancing, wearing masks—had already gone for a toss.

Experts say public behaviour is crucial to stopping the virus from spreading. Every time each individual somehow delays the spread, it’s a step towards victory, according to them.

“In every meeting, we draw the attention of officials concerned to the importance of contact tracing and increased testing,” Dr Biraj Karmacharya, an epidemiologist, who is also the chief of the Department of Community Programme at Dhulikhel Hospital, told the Post. “But either we have not been able to convince them or they are simply not paying attention to the threat the virus poses. Without contact tracing, it’s impossible to break the transmission chain.”

When the second wave hit in early April, the country had almost returned to the pre-pandemic stage–or at least it appeared so.

The three tiers of government which should have made concerted and coordinated efforts to prepare for the surge acted as if they were caught by surprise when infection numbers started to rise.

Local levels had even stopped collecting swabs after the Cabinet on October 5 decided to stop performing free tests.

Now the local levels have an enormous responsibility to contain the spread, so that the chain of infections could be stopped at a larger scale

Gelal, chief of Health Office Lalitpur, said that he has been holding meetings with local levels to make contact tracing effective.

“We have held discussions with experts and have been working to implement their suggestions,” said Gelal. “We have taken the issue seriously.”

A study carried out by the Ministry of Health and Population last year had shown that 13 people on an average come in close contact with infected people.

Doctors say fighting the pandemic is like fighting a war, which cannot be won without coordination and cooperation of all agencies concerned. Moreover, active participation of the public is equally necessary to defeat the virus.

“Without the help of the local levels, the ongoing fight against the pandemic cannot be won,” Karmacharya told the Post. “I am still unable to figure out why the local levels are not being activated in this war.”

When India started reporting a rise in the number of cases, concerns had grown that Nepal could immediately see a surge in infections. Despite calls to manage and regulate border points, authorities paid little heed. The roles of the local and provincial governments would have been instrumental in controlling the spread, say doctors.

When it comes to daily cases per million people, Nepal is not far behind India.

As of Wednesday, Nepal’s total infection tally stands at 359,610. The number of people admitted in the intensive care unit has reached 600, and 156 patients, whose conditions are critical, are on ventilator support.

On Wednesday, India reported 382,691 new cases and 3,786 deaths. Its total infection tally has surged past 20 million to 20,658,234.

“We should regulate the border points, keep the people returning from disease-hit areas in quarantines for certain days and allow them to go home only after tests,” said Sarad Onta, a public health expert. “Without contact tracing and testing, we cannot identify the source of infection.”

The government, however, does not seem to have any other plan, except issuing prohibitory orders. The way cases are rising, sooner or later, all 77 districts of the country could be under prohibitory orders.

But doctors are not sure if that will stop the diseases from spreading.

“Yes, prohibitory orders will not alone help contain the spread. Such measures help in slowing down the spread,” Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post. “It’s a fact that without coordination and collaboration among all agencies concerned, it is not possible to bring the infection rate down.”

Adhikari admitted that other concerned agencies were not taking the issue as seriously as it should be taken.

Thursday onwards, as per new orders from the authorities, shops won’t be allowed to open in the evening like in the past week when they were allowed between 5pm and 7pm. People will have until nine in the morning to buy their daily essentials.

There are already concerns if this measure could create more crowds in pocket areas thereby defeating the whole purpose of imposing the prohibitory orders.

With cases rising by the day, hospitals are running out of beds and oxygen. Concerns are growing about shortages of medical goods. There is no certainty when the vaccines will arrive.

Public health experts say while focusing on taking measures to break the chain of infection, the government should immediately seek support from the international community.

“We lack almost everything. We need support from the international community also to save lives,” said Onta, the public health expert. “From beds to critical care medicines to oxygen and vaccines, we are in dire need of everything. The government must not hesitate to request the international community for help.”

Meanwhile, doctors have been constantly warning of a catastrophic situation amid the rising number of coronavirus cases in the country.

“Covid prevention has been out of control. As hospitals and medical team have been overwhelmed, patients and public hopelessness is the highest [sic],” Dr Chakra Raj Pandye, director of Grande International Hospital, wrote on Twitter on Wednesday night. “As we cannot keep on crying, we need to stay inside our house until things get better. Family interaction helps psychological boost.”