Covid-19 recovery numbers could veil actual threat if other data are ignoredExperts say infections, severity and deaths should be viewed simultaneously and tests expanded to measure how the country is placed in the fight against the coronavirus.
After hitting the peak of 9,317 cases a day on May 11, Nepal’s daily new infection count has gradually come down over the past few weeks. Amid this, the focus of late has been shifted to how many people are recovering from Covid-19 on a daily basis.
Over the past week, the number of daily new coronavirus infections is hovering around 5,000 and the number of recoveries around 7,000.
On most days, the number of daily recovery cases is exceeding that of new daily infections, and this is being touted as a successful fight against the pandemic.
Experts, however, say the numbers can be confusing—and misleading—if they are viewed in isolation, as data need to be analysed from a wider perspective. While the decline in the number of daily new cases and increase in that of recovery could be a good sign, the real reasons behind that must be found for an actual assessment of the impact of the coronavirus, according to them.
“If we look at the number of the people discharged from hospitals, things might look reassuring,” said Dr Achyut Raj Karki, the Covid-19 focal person at Bir Hospital. “But if we delve deep and look at things in the communities, the recovery data could be misleading. There is a possibility that discharged people might have been readmitted and they could be at risk.”
Karki’s assessment stems from the fact that the Health Ministry counts the number of active cases and assumes that they are discharged (recovered) after 10 days, without knowing the actual health conditions of the patients.
Data disparity has been an issue ever since the pandemic began. When the second wave of the pandemic hit the country, infecting and killing more people, there were concerns if a lack of data could spell a bigger disaster.
Experts say there still is a huge difference between the actual numbers of infections and deaths and the numbers made public by the government because tests are not happening in adequate numbers and the government's list contains the Covid-19-related deaths and infections at hospitals and institutional isolation centres only. Those who have lost their lives to the virus in home isolation are not included by the government in its official tally.
Amid this, projecting the recovery numbers to say a feat in the fight against the virus could veil the actual threat, say experts.
According to doctors, time has not come yet to say Nepal is out of the woods just by looking at the decline in daily new cases and increase in the number of people recovered or discharged, as the actual scenario of the infection in rural areas is not known.
“It is but natural for cases to decline in big cities after seeing a surge. But it does not mean the risk is over and it will be wrong to say people are not getting infected,” Dr Anup Subedee, an infectious disease expert, told the Post. “The virus has penetrated the communities… the rural areas and remote villages in hill regions in recent days. The situation could turn worse because of a lack of tests as well as scarcity of health facilities and health workers.”
The steady decline in new daily cases has been largely attributed to the lockdown that has been in place for over the past month. Most of the country has been under prohibitory orders for over a month now. With the fall in daily new infections, talks are being held either to lift or loosen the lockdown. Officials, however, are yet to come up with any specific modality. While a complete lifting of the lockdown could once again lead to a virus surge, continuing the prohibitory orders for long can have a devastating impact on the economy and livelihoods.
Experts say there is a need for taking studied measures and that a prudent decision can be made only after analysing the numbers.
Even when the new daily cases have declined and the number of recoveries is increasing, the daily deaths have remained somewhat constant.
For the past seven days the daily new deaths have stood, on average, at 89.
“The curbs imposed throughout the country could be the reason for the fall in the new infections,” Dr Prabhat Adhikari, an infectious disease and critical care expert, told the Post. “But authorities need to look at test numbers, hospital admission rate, the rate at which people are becoming seriously ill and the number of deaths before reaching a conclusion.”
According to data provided by the Health Ministry, over 70,000 infected people have been placed in home isolations. Their chances of needing hospitalization cannot be ruled out.
“The number of seriously ailing coronavirus patients at Bir Hospital had reached 198 to 200 at one time and declined to 116 about four days ago,” said Karki of Bir Hospital. “But for the last four days, the number of serious cases has been rising steadily. We have 139 serious patients at the hospital.”
All 21 intensive care unit beds and ventilators of the hospitals have been occupied.
Other hospitals designated for Covid-19 treatment said that the number of seriously ailing patients from remote villages has been rising of late.
“The number of serious Covid-19 patients has risen these days at our hospital,” Dr Sagar Rajbhandari, director at Sukraraj Tropical and Infectious Disease Hospital, told the Post. “All intensive care unit beds and ventilators of our hospital are occupied.”
The good thing is Nepal’s R, or reproductive, number of the virus, has come down to 0.74 from 2 after the second wave hit the country in April. The R number indicates how many people one infected person can potentially transmit the virus to.
What, however, is concerning, say experts, is the reduction in testing, as the lower the number of tests, the lower the daily infections.
According to Subedee, a massive testing campaign should be launched, which has not happened yet. Symptomatic people should be considered positive even if antigen tests show negative. Oxygen saturation of the infected people should be monitored and health workers should be provided training and other resources, he said. “A lot of people get cured by oxygen supply and that should be ensured,” said Subedee.
Laboratories to perform polymerase chain reaction tests are available only in big cities and only those who can afford to pay are getting timely tests. The Ministry of Health has committed to performing 25,000 antigen based tests a day but only around 3,000 such tests are being performed.
Experts say by reducing test numbers, infection rate cannot be generalised. According to them, highlighting the recovery numbers while decreasing the test numbers, as a result the number of positive cases comes out low, could be a pretext for authorities to portray that they have been able to overcome the virus threat.
After the first wave receded, Nepali authorities were in a chest-thumping mode, claiming that it was because of their efforts that the virus could not make a devastating impact. But the second wave exposed how unprepared the authorities were. The health system started to crack under the strain of the rising Covid-19 cases, with hospitals turning away patients for lack of beds, ventilators and oxygen, Nepal’s Covid-19 rise mirrored India’s surge.
A scrambling government then imposed the lockdown.
Experts say lockdown is just one measure to contain the spread and that as soon as it is lifted, the cases could rise again.
“We must not forget that the case detection rate is still high compared to the peak of the first wave of infection,” said Dr Biraj Karmacharya, an epidemiologist. “We may see a surge once if the lockdown is lifted without taking proper measures.”
So far, 8,179 people have died in Nepal due to the coronavirus since it was first confirmed in the country in January last year. Of the total, over 5,000 have died since the second wave hit the country in April.
The number of active cases stands at 80,336.
Case positivity rate continues to hover around 30 percent. According to Health Ministry data, in the last one week, 90,800 polymerase chain reaction tests returned 27,702 positive results.
Now that the virus is spreading fast in rural areas, there is a need for expanding testing on a massive scale, say experts.
“Population-based screening is a must to understand the actual burden of infections,” said Dr Keshab Deuba, a public health epidemiologist.