Test, trace, isolate and treat.

That was the World Health Organization’s mantra for countries to check the spread of infections when the Covid-19 pandemic first hit the world early last year.

In Nepal, with the number of new cases within manageable limits, contact tracing was conducted up to an extent when the country was in lockdown between March and July last year. There was free testing and treatment too.

But when restrictions were lifted, the number of cases gradually grew. Unable to cope with the surge in infections, the Ministry of Health decided to stop free testing and along with that contact tracing. Although the Supreme Court overturned the decision and the government was forced to resume free testing, contact tracing was never resumed.

That remains the case now even as the country sees a record number of new cases every day.

On Thursday, Nepal recorded 8,970 new cases–a new record and the second consecutive day when cases surged past 8,000. The positivity rate was 44 percent.

The Health Ministry said that 54 people succumbed to Covid-19 in the last 24 hours taking the death toll to 3,529.

Of the total new cases Thursday, 3,972 are from the Kathmandu Valley—3163 in Kathmandu, 567 Lalitpur and 242 in Bhaktapur. The number of active cases stands at 72,561.

And hospitals continue to feel the pressure.

From a total capacity of 60 beds, Sukraraj Tropical and Infectious Disease Hospital in Kathmandu has extended it to 90. All rooms, corridors and emergency departments of the hospital have been occupied by beds of the infected.

“We are not in position to extend further,” Dr Sagar Rajbhandari, director at the hospital told the Post. “Neither do we have the human resources, nor the space to extend the number of beds.”

Reports from across the country suggest similar situations. In Banke, one of the worst-hit districts, Covid-19 patients are being turned away for a lack of beds and oxygen.

Doctors have been seeing the crisis could soon become unmanageable if the authorities fail to take immediate measures to flatten the curve. The country is seeing 1,200 percent rise in Covid-19 cases, with many health care workers infected with Covid-19.

On Wednesday, Dr Chakra Raj Pandey, director of Grande International Hospital, said the fight against the coronavirus has become difficult.

“Covid prevention has been out of control. As hospitals and medical team have been overwhelmed, patients and public hopelessness is the highest [sic],” Pandey 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.”

Authorities, however, have failed to figure out what steps they can take to control the spread. The prohibitory orders that were put in place in the Valley's Kathmandu, Lalitpur and Bhaktapur from April 29 have been made stricter from Thursday. The current lockdown has been enforced for another seven days. No one knows what after that.

“As we are not working with any other options, extending prohibitory orders is the only choice we have at present,” said an official at the Health Ministry who spoke on condition of anonymity.

A Cabinet meeting presided over by Prime Minister KP Sharma Oli on April 19 had decided to resume contact tracing, increase testing, and set up quarantine, isolation and holding centers. But even after 17 days neither contact tracing has resumed nor quarantine, isolation centers and holding centers have been set up.

The Ministry of Health has issued a statement requesting local levels to resume contact tracing but they haven’t done so. Local level representatives say they lack resources.

“When a decision made by the Cabinet itself is not implemented, what else can be implemented?” said the official who spoke anonymously.

After hospitals started to get overwhelmed, the Health Ministry last week threw its hands up, saying the situation had become unmanageable. After much criticism, the ministry, in a damage control bid, said it was adding beds and isolation centres.

Experts, however, say without fulfilling the basic requirements like contact tracing and testing, the chain of infection cannot be broken.

Government officials have another excuse for not resuming contact tracing.

“We do not have sufficient antigen test kits to conduct tests after contact tracing,” said Mahendra Shrestha, chief specialist at the ministry.

When the Post spoke with Shrestha, there was a meeting going on at the ministry on how to fly in antigen test kits now that international flights have been halted.

Antigen tests are helpful in identifying cases quickly so as to curb the virus spread. But such tests need to be done in huge numbers. As the second wave hit India in early April and cases started to rise in Nepal, authorities ordered antigen tests at border points. But they were done in limited numbers.

Public health experts say allowing people to go home without testing will spell catastrophe.

“Didn’t they know tests are necessary and for that testing kits are required? Sufficient testing kits in stock should have been ensured before enforcing a ban on international flights,” Dr GD Thakur, former director at the Epidemiology and Disease Control Division told the Post. “No agency is taking the issue seriously and coordination is lacking not only between the inter-government agencies but also within the different agencies of a particular ministry.”

With no testing, there is no contact tracing. Authorities are therefore focused on increasing the number of hospital beds, whether it is Prime Minister KP Sharma Oli or Kathmandu Metropolitan City Mayor Bidya Sundar Shakya.

Officials as of now see lockdowns as the only way to check the spread.

But despite the prohibitory orders enforced in most of the districts, the number of new cases has not been declining. Almost half of the people tested have positive results.

“Situation has become very grave,” admitted Shrestha, the chief specialist at the Health Ministry.

Some Health Ministry officials say even the prohibitory orders came a bit late.

According to them, had the agencies concerned implemented their recommendations and enforced lockdown some three weeks earlier, infections would not have been widespread in communities and health facilities would not have been overwhelmed.

The Ministry had issued a statement about a month ago to shut down schools but the Education Ministry issued another statement asking schools to continue in-person classes.

Experts had warned against large crowds, but political leadership encouraged rallies. Besides, festivals were held and an international cricket tournament was organised in the Capital.

But unless there is widespread testing and contact tracing, for now, lockdown seems to be the only answer. Officials say prohibitory orders could be in place for as long as three months.

“Lockdown has to be extended to lessen the pressure on hospitals.” Dr Sher Bahadur Pun, chief of the Clinical Research Unit at the Sukraraj Hospital told the Post.