Scientists in the United Kingdom say that the country is in an early stage of the third coronavirus wave. Health experts in India have predicted a third Covid-19 wave by October. Such warnings come as a major cause for concern in Nepal, which is still struggling to contain a deadly second wave.

Public health experts and doctors say the spread of the virus and the damage it can inflict depend on the level of preparations, enforcement of the safety measures, behavioural changes and vaccination.

As experts in India warn that the country has limited time before it faces the looming third wave, authorities in the Kathmandu Valley have decided to continue the ongoing lockdown with some relaxations in three districts—Kathmandu, Lalitpur and Bhaktapur. Nepal shares a long open border with India.

Experts say the third wave could be deadlier for Nepal given the low vaccination coverage and complacency on the part of the government agencies as well as the general public.

“The tendency to be complacent just when there is more risk is the main problem,” Dr Bhagwan Koirala, chairman of Nepal Medical Council, the national regulatory body of medical doctors, told the Post. “Authorities should learn from their own experience and follow the science and start preparations accordingly.”

After reaching a peak of 9,317 infections on May 11 during the second wave that hit the country in April, the number of new infections has gradually declined. The decline in cases is attributed to the lockdown in the Kathmandu Valley since April 29. Almost all districts once were under prohibitory orders as the second wave swept across the country.

While continuing with the lockdown is not a viable option, the third wave threat is just round the corner and authorities do not seem to be prepared, experts say.

Epidemiologists and public health experts the Post talked to on Sunday said that the third wave is inevitable and it could be more deadly due to a very low vaccine coverage and lack of seriousness on the preparation front.

“It may take a few months for the third wave to start, but before it there will be a new surge in infections,'' said Dr Biraj Karmacharya, an epidemiologist. “Loosening the restrictions is necessary, but at the same time we should be more vigilant.”

The magnitude of the second wave this year was more severe than

the first wave last year, largely because of the lack of preparations. That the country has a fragile health system was just validated when people were turned away by hospitals for a lack of beds, ventilators and oxygen. Over 5,600 people have died in the ongoing second wave of infections.

As Nepal’s coronavirus crisis mirrored India, with cases soaring in the second wave, the world turned its attention to Nepal. Over the last two months, medical supplies, including ventilators and oxygen concentrators, have been flown into Nepal by various countries. But vaccines are what Nepal needs the most and there are no signs they will arrive anytime soon.

“Authorities must continue to follow the basics—tracing, testing and treating. Mass testing is a must,” said Karmacharya, who is also the head of the Community Programme at Dhulikhel Hospital. “Public health measures should be enforced strictly.”

That the number of tests has come down of late itself is a cause for concern. The decline in daily cases could also be because of low testing, but the positive rate still continues to be high. About 22 percent of the total polymerase chain reaction tests are still giving out positive results.

Recently, the Health Ministry said that it was sending hundreds of thousands of antigen test kits to various parts of the country. Officials claimed that over 25,000 antigen tests would be performed each day, but only a few thousand such tests are being performed.

On Sunday, 1,021 people tested positive in 4,249 antigen tests performed throughout the country. Among the 6,677 polymerase chain reaction tests, 1,421 came out positive.

Mahendra Prasad Shrestha, chief specialist at the Health Ministry, said that antigen tests are being performed “in thousands” but there are issues regarding updating the test data.

“We are working to fix the problem,” Shrestha told the Post.

Ever since the authorities turned their focus to lockdown and prohibitory orders, they seem to put other preparations like building quarantine and holding centres on the backburner.

“A third wave is inevitable and even if it is driven by the existing virus variant, we cannot rule out a new and possibly more lethal variant, which could wreak havoc,” Dr Keshab Deuba, a public health epidemiologist, told the Post. “The only way to save lives is to vaccinate as many people as possible.”

Despite being one of the first countries in the world to launch its vaccination drive, Nepal’s vaccine crisis has deepened now, as it has not been able to acquire additional jabs.

So far, 2,500,196 have taken their first shots, and 731,653 of them have taken both doses.

Nepal needs to vaccinate 72 percent of its 30 million population, or 22 million people for which it needs around 44 million doses. As of now, only around 2.4 percent of the population has been fully vaccinated.

Nepal so far has received 4,248,000 doses of Covid-19 vaccines (2,448,000 Covishield jabs and 1.8 million BBIBP-CorV jabs).

Of the total, the government bought 1 million doses and the rest came under grant assistance from India, China and COVAX, the international vaccine sharing scheme backed by the United Nations.

With India facing its own crisis, it is unlikely to sell vaccines to Nepal. The plan to buy vaccines, around 4 million doses, from China, the other neighbour which too is a vaccine powerhouse, has run into controversy after concerns from the Chinese over the disclosure of the price.

“Vaccine is the only solution, but until we get enough shots to vaccinate people, following safety protocols is a must,” said Deuba. “Easing the lockdown could make people careless. A lack of Covid-19-appropriate behaviour could fuel infections.”

Nepali authorities’ response to the Covid-19 crisis has always been poor, with decisions most of the time taken on ad-hoc basis, at times only after the crisis deepened. This year too, many say, restrictive measures should have been enforced much earlier. However, the period of prohibitory orders does not seem to have been utilised well on planning and preparing, as well as making people aware.

Doctors say government agencies must also work on running awareness campaigns on a massive scale, which is crucial to fighting a pandemic.

“Washing hands, wearing masks and maintaining social distance may appear to be minor, but practising these makes a huge difference and helps in checking the virus spread,” said Dr Sher Bahadur Pun, chief of Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital.

“Everyone must follow safety measures and remain safe until the majority of people get two doses of vaccine.”