The number of daily new infections in the country crossed the 8,000 mark for the first time on May 5. Two days later it crossed the 9,000 mark. The highest one-day tally was 9,317 on May 11. On Thursday it was 8,842.

With almost the whole country under restrictions, the number of daily infections may be plateauing but the death toll could continue to rise, according to experts.

“It generally takes one week for people to get severely ill and a few more days to die,” Dr Keshav Deuba, a public health epidemiologist, told the Post. “Even if the number of new cases do not continue to rise after a certain point, those already infected will continue to die.”

The highest toll that the Ministry of Health and Population reported on a single day was 225 on Tuesday. But that was not the toll of 24 hours as the ministry said that the number included “bodies managed by Nepal Army on different dates”.

On Thursday the ministry reported 214 more deaths from Covid-19, the figure again includes deaths of other days. The total death toll now stands at 4,466.

Since, according to Nepal Army sources, it has been managing more than 100 bodies a day in the Kathmandu Valley alone for the past few days, the daily death toll continues to be high even if the number of positive cases has not been rising significantly in the past one week.

More alarming is that health facilities throughout the country have reached a tipping point mainly because they have no oxygen.

At one point on Wednesday night the National Trauma Centre of Bir Hospital, Kathmandu, a premier government hospital, had only seven oxygen cylinders.

Each cylinder holds 7 cubic metres of the gas and that is sufficient only for three to four minutes for 100 Covid-19 patients requiring high flow oxygen.

“There would have been a disaster last night,” Dr Santosh Paudel, director at the Centre, told the Post. “Most of the patients admitted in intensive care units and placed on ventilator support could have died, had we not been able to manage more oxygen cylinders.”

The Centre, which had started providing care to the infected patients only from Sunday had admitted 137 patients in the beginning but has now reduced the number to 105 due to a shortage of oxygen.

The Centre needs over 350 cylinders a day but the Health Ministry set it a quota of 20 cylinders only.

The hospital has its own liquid oxygen plant but in lack of supply from India it has been dependent on cylinders.

The lack of sufficient oxygen is a situation recounted again and again across the country.

And like the National Trauma Centre, hospitals have already started reducing the services due to lack of oxygen supply despite having beds and human resources to provide services.

“Despite having human resources and beds, we are not in a position to provide care to infected patients due to lack of oxygen,” Dr Biraj Karmacharya, an epidemiologist, who is also the chief of the Department of Community Programme at Dhulikhel Hospital, told the Post.

The potential of a nightmare scenario, keeps doctors and nurses awake at night.

“We have not been able to sleep properly for the last three days due to the problems in oxygen management,” said Karmacharya.

The National Trauma Centre’s Paudel said that staff at his hospital have not slept for two days.

Oxygen manufacturers have already said that demand far outstrips supply although they have been running their plants 24 hours a day.

The government has decided to fix quotas for hospitals so as to better manage the supply of oxygen but this has only led to hospitals turning away patients.

Given the oxygen crisis, the Health Ministry on Thursday issued a statement directing all hospitals with 100 beds capacity to install their own oxygen plants within 15 days.

That is impossible, private hospitals say.

Prohibition orders are in place and equipment to install oxygen plants are not available in the country, according to them.

“If the government is serious about saving lives, it should have brought oxygen plants and asked the hospitals to install them,” Rajendra Bahadur Singh, executive director of Norvic Hospital, told the Post. “They could have asked hospitals to pay on an installment basis.”

The hospital, which can provide care to around 150 infected patients, has been providing treatment to only 133 and is planning to reduce the numbers further due to lack of oxygen supply.

Meanwhile, the Health Ministry is exploring the possibility of purchasing oxygen plants from wherever possible.

“We have decided to explore the possibility of purchasing oxygen plants from France and Turkey,” Dr Roshan Pokhrel, chief specialist at the Health Ministry told the Post. “But no decision has been reached yet.”

The number of active cases throughout the country surpassed 100,000 on Wednesday. According to the Health Ministry, active cases stood at 105,207 on Thursday. The majority of them are in home isolation and if their conditions worsen the pressure on hospitals will continue to grow.

“All infected people placed in home isolations are not seeking care at hospitals not because they do not need it but because hospitals are not in the position to provide care,” said Deuba, a public health epidemiologist.

Generally, doctors say of the total infected patients, 20 percent need hospital care, and of them 15 percent need oxygen support and around five percent need intensive care and ventilator support.

But with the Indian variant B.1.167.2 of the coronavirus already spreading in Nepal these figures could be higher as it has been found to be more transmissible and deadlier, according to the World Health Organization.

Dr Bhagwan Koirala, chairman of Nepal Medical Council, said that the only way to save lives at present is to increase the production of oxygen, use available oxygen and other resources rationally and make the distribution system effective.

“Even if it has already been late, we should work to set up oxygen plants, buy more oxygen concentrators, make arrangements for liquid oxygen, bring dysfunctional oxygen plants into operation at the earliest,” Koirala told the Post. “Authorities should work on all fronts to save lives.”

However, with most of the hospitals running in their full capacity, chances of new patients getting care immediately are slim.

Moreover, infected people in home isolation in remote villages who do not have access to tests and treatment are at high risk and they could die due to lack of care even if the recorded infection rate slows down in coming days with restrictions in place, doctors say.

“Authorities should monitor the infected people placed in home isolation,” said Karmacharya, the epidemiologist. “Local levels should also shoulder the responsibility.”