For someone needing an intensive care unit bed at Bir Hospital, a Covid-19 patient either has to recover and get discharged, or die. And sadly, doctors say, recovery is not the trend of late.

“It’s quite alarming that the recovery rate of those infected patients, especially those requiring intubation, is almost zero,” said Dr Achyut Raj Karki, a Covid-19 focal person at Bir Hospital.

Karki said he gets around 15 t0 20 calls seeking intensive care unit beds, but the hospital can hardly accommodate one or two patients.

It is not only the case of Bir Hospital. The situation is almost the same at all major state-run hospitals treating Covid-19 patients in Kathmandu Valley, according to doctors.

The new trend of patients failing to recover has set off alarm bells, as cases have started rising again after a steady decline since the second wave. And the third wave is looming large.

The Ministry of Health on Thursday directed health facilities to remain vigilant.

“In view of a possible challenging third wave as the number of new infections has been rising over the last one week, the ministry would like to request all to remain prepared,” the ministry said in a statement.

According to the ministry, 10 districts including all three districts of Kathmandu Valley—Kathmandu, Bhaktapur and Lalitpur—have over 500 active cases and 26 districts have over 200 active cases.

The number of districts having over 500 and over 200 active cases have increased compared to last one week, the ministry said.

The rise in cases of late has also been attributed to the lifting of the prohibitory orders.

“When authorities lifted the prohibitory orders, 10 to 15 patients needed to be admitted every day, but now the number has shot up to 30,” Dr Ravi Shakya, director at Patan Hospital, told the Post. “Intensive care unit beds rarely get vacant, as there are already patients lined up to get admitted.”

Patan Hospital has a total of 32 intensive care unit beds.

After the second wave slid into a devastating crisis with the number of hospitalisations sharply going up and more people dying of Covid-19, authorities decided to impose restrictions in Kathmandu Valley, the most densely populated area in the country, starting April 29. The lockdown was lifted two months later, with only a few avenues like restaurants, cinema halls, gyms, party banquets, clubs and discos remaining closed.

And now public mobility has increased. Not many are following basic safety protocols like wearing masks and maintaining physical distancing. Public buses have been allowed to operate. Though they have been asked to operate with only half the passenger capacity, implementation and monitoring have been weak.

What is also alarming is the ‘R’ factor, or the reproductive number, which tells how many people one infected person can pass the virus onto, has crossed 1.1. The 'R' factor above 1 is dangerous, according to epidemiologists.

Doctors say the trend of infections has also changed and health facilities could be overwhelmed again.

Earlier, infected patients used to reach hospitals seeking medical help only after becoming serious. These days patients are reaching hospitals immediately after knowing that they have been infected. But still, doctors say, patients are getting severe during hospital stay, needing intensive care and even intubation.

“Change in the virus variant could be the reason for the patients getting serious even after getting to the hospital on time,” said Shakya of Patan Hospital.

Patients need to be intubated when their conditions become critical and they cannot breathe on their own. During intubation, oxygen is supplied with the help of a machine.

The rate of patients not recovering after intubation has suddenly risen compared to the first wave of the pandemic, according to Karki, of Bir Hospital.

“The recovery issue is the same among adults and the elderly,” said Karki. “Chances of returning after intubation are very slim in patients of all age groups.”

Doctors, however, failed to provide the exact cause.

“We have not checked if the infection is caused by the new variants, Delta and Delta Plus, or the one that was seen during the first wave,” said Karki.

The rise in the number of cases is also attributed to people’s behaviour.

Dr Santa Kumar Das, deputy director at the Tribhuvan University Teaching Hospital, said that the risk of infection has increased due to the negligence in following safety measures and apathy of the agencies concerned to enforce the safety rules.

Now amid the third wave threat, the rising number of cases is a cause for concern, especially also because the vaccination rate is dismal. Only 4 percent of the population have been fully immunised against Covid-19 so far.

According to the data provided by the Health Ministry, 3,308730 people have taken their first doses of vaccine, and 12,81,240 people have been fully immunised.

At Sukraraj Tropical and Infectious Disease Hospital, only two beds were vacant on Wednesday and Thursday.

“All beds were occupied until Tuesday, but on Wednesday and Thursday, there were two vacant beds,” said Dr Anup Bastola, director at the hospital. “The number of infected patients has started to increase again.”

The hospital has 24 intensive care beds.

The hospital also has an additional 65 general beds for coronavirus infected patients and only around 20 percent general beds are vacant.

Bastola said intensive care unit beds do not get vacant frequently, as it takes several days for serious patients to recover.

“The number of districts turning into hotspots has increased and the risk of rapid surge has also shot up,” said Bastola. “If we do not follow public health measures and take precautions, the coming days won’t be easy for us.”

On Thursday, 1,855 people tested positive in 9,122 polymerase chain reaction tests. An additional 859 people tested positive from 3,707 antigen tests.

Nearly a quarter of total tests are still giving out positive results every day.

Of the total number of daily polymerase chain reaction tests, doctors suspect the majority of people undergoing tests are healthy people, who are undergoing tests to go abroad. Tests of those who have already been infected but are undergoing tests are also counted in the total test numbers, thereby the actual number of new patients is hard to determine.

The Health Ministry has already made it clear that the Delta and Delta Plus variants of the virus have been circulating in the country, whose infection rate is much higher than other variants of SARS-CoV-2.

The World Health Organisation chief Tedros Adhanom Ghebreyesus on July 15 warned that the world is in the ‘early stage’ of Covid-19 third wave as cases of the Delta variant are soaring.

“The virus continues to evolve, resulting in more transmissible variants,” said Tedros. “Last week marked the fourth consecutive week of increasing cases of Covid-19 and after 10 weeks of declines, deaths are increasing again.”

The Delta variant has now spread to more than 111 countries, and the UN health agency expects it to be the dominant coronavirus strain circulating worldwide, if it has not already, very soon.

“Nothing has changed when it comes to risk factors–infections, severity and deaths. The public’s perception has rather changed, and quite dangerously. It looks like no one is afraid of the virus,” Dr Hemanta Chandra Ojha, an official at the Epidemiology and Disease Control Division, told the Post. “Despite risks, people are not following safety measures. Public gatherings have increased, people are holding meetings and eating out.”

The UN health agency says Delta variant is one of the main drivers of the current increase in transmission fuelled by increased social mixing and mobility and inconsistent use of proven public health and social measures.

Experts said that complacency on the part of the authorities is to blame for the increase in new cases. Despite warnings from public health experts, epidemiologists and virologists, almost all restrictive measures enforced to check the virus spread have been lifted.

“No agency is monitoring if public health measures are being followed,” Dr Keshab Deuba, a public health epidemiologist, told the Post. “The actual number of infected people is not known, as the number of tests is very few.”

Nepal was among the first countries to start immunisation drive against Covid-19 but the vaccination pace has been dismal.

“Infection is on an upward trend and the virus is circulating in communities,” Dr Biraj Karmacharya, an epidemiologist, told the Post. “Authorities should continue preparations for the third wave and speed up the vaccination drive.”