On July 4, the Ministry of Health and Population reported 1,042 new coronavirus infections, the lowest number of daily cases since the second wave of the pandemic began in the second half of April.

Prohibitory orders that local administrations across the country, including those in Kathmandu Valley, imposed from the end of April were gradually loosened from mid-June when the number of cases started to come down.

At the end of June shops were allowed to open and public vehicles to operate in Kathmandu Valley. Officially, prohibitory orders are still in place but much of everyday life has returned to normal. Public gatherings are still prohibited, banquet venues, sporting venues, clubs and cinemas are still closed. Educational institutions are closed although university examinations are going on. Restaurants are only allowed to provide takeaway services.

The number of daily infections has been rising with relaxations in prohibitory orders.

“The lull in the number of cases until about two weeks ago could be the calm before a devastating storm,” said a Health Ministry official on condition of anonymity.

Public health experts, epidemiologists, virologists as well as officials at the Ministry of Health and Population have warned that a third wave of the pandemic is inevitable.

Going by the number of daily infections in the last few days, it may not be long before the third wave.

In the last two weeks, 25,808 people have tested positive in polymerase chain reaction tests. Of them 14,196—or 55 percent—tested positive between July 20 and 26. During the same period, 11,411 people tested positive in the antigen based tests performed throughout the country and of them 6,110—or 54 percent—tested positive from July 20 to 26.

“The Health Ministry’s data of the infected persons of the last two weeks indicates that the coronavirus is spreading rapidly once again,” Dr Krishna Man Shakya, a public health expert, told the Post. “It seems that the chain of infections, which had been broken when widespread prohibitory orders were in place, has been joined again.”

On Tuesday, 2,726 were reported to have tested positive in PCR tests, up from 1,539 on Sunday and 2,391 on Monday. Tuesday’s figure was the highest since June 22 when 3,702 cases were reported. Also on Tuesday, 1,173 tested positive in antigen tests. The combined figure of 3,899 is the highest since June 11.

“For the last two weeks, I have been receiving more than half a dozen calls from the infected people every day asking for advice on what they should do,” Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital, told the Post. “Such calls had reduced to zero until some two weeks ago.”

The Health Ministry is worried too.

On Monday, the ministry asked the provincial logistic management centres to keep at least 1,000 filled oxygen cylinders as back-up, fix defunct oxygen plants and oxygen concentrators and keep the oxygen tanks in working conditions.

In its latest such update on Thursday, the Ministry said that 10 districts have more than 500 active cases and 26 districts have over 200 cases.

On Monday, a Health Ministry official told the Education and Health Committee of Parliament that a third wave of infections will hit the country in seven weeks.

But if other Health Ministry officials are to be believed, it will be sooner than that. Officials the Post talked with said that the present situation regarding case numbers is similar to the one in the third week of April.

“We were then criticised for creating unnecessary panic, when we warned that we are facing a second wave and asked agencies concerned to start preparations,” an official at the Health Ministry, told the Post, asking not to be named.

“Before last week the number of daily new cases was in the range of 2,000; now it has reached 3,000. We can expect it to be in the 4,000 range in the coming week and cases could rise exponentially after that.”

Before the second wave hit the country, the Health Ministry had asked the authorities to shut down schools and academic institutions, prohibit political rallies, regulate crowds at public places including in public transportation, regulate movement across the border with India, among other precautions. But other government agencies ignored warnings.

The second wave of the pandemic hit the country in the last week of April after the southern neighbour witnessed a massive explosion of new infections.

“Due to frequent movements of the people between the two countries and inability of the authorities concerned to regulate the border points, infections spread in Nepal during the second wave,” the Health Ministry official said. “But for the third wave to start, we do not need the virus to come from elsewhere, as highly infectious virus variants have already been present in the country.”

The highly infectious Delta and Delta plus variants of SARS-CoV-2 have been circulating in the country.

According to a statement issued by the Health Ministry on Tuesday, of the 47 swab samples of the infected persons collected between early June and mid-July, on which whole-genome sequencing were performed in the World Health Organisation-identified Center for Excellence in Genomics, the Institute of Genomics and Integrative Biology in Delhi, Delta variant (B.1.617.2) was found in all swab samples and new sub-lineage of it—K417N also known as AY.1, also known as Delta Plus—was found in three of them.

“Studies show that this variant of virus is more infectious and affects people of all ages,'' reads the statement. “The ministry urges all to follow safety measures and start preparations for a possibly challenging third wave of infections.”

In June too the Health Ministry had announced findings of whole-genome sequencing on 48 swab samples of infected people. The Delta variant of the virus was detected in swab samples of 47 people. Of the 47, the sub-lineage Delta Plus was identified in nine swab samples. The swabs had been collected between May 9 and June 3.

How soon the third wave hits the country will depend on the behaviour of the public and measures authorities take, according to Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry.

The Health Ministry has said that strict prohibitory orders should be immediately enforced in more than 10 districts, including the three districts of Kathmandu Valley—Kathmandu, Bhaktapur and Lalitpur—which have more than 500 active cases. Another 26 districts, which have over 200 active cases, should be considered hotspots and should restrict the mobility of the public.

“Whatever the official told the Parliamentary Committee or the ministry has said in its statements about the third wave is not to scare the public but to alert the general population and agencies concerned about the risks,” Adhikari told the Post. “The warnings and statements are in line with international experiences, projection and estimations of experts from relevant fields.”

Public health experts, however, said that the Health Ministry, which is supposed to be taking the lead in the fight against the pandemic, is only focussing on issuing warnings and statements. Besides, instead of focusing on the preventive measures, priority has been given only on the curative measures.

“Focussing only on the curative measures—increasing the intensive care units, arranging oxygen—means doing nothing to prevent the spread of infections and waiting for the patients to come to health facilities,” said Shakya, who is also the vice president of Nepal Public Health Association.

“It is like saying when patients die, then we will start preparations to manage the bodies accordingly. They have to do something to prevent the spread of infections.”

The ministry, on the other hand, says that the timeline of the third wave of infections and its impacts have not yet been estimated but work is being done to project the impact of the third wave.

But doctors say that the country could already be in the initial stage of the third wave of the pandemic.

“Second wave had started before the first wave stopped completely and cases had declined to zero,” said Dr Binjwala Shrestha, a public health expert. “I am unaware of the science behind the Health Ministry’s warnings of a third wave.”

According to her, the current daily infections could just be the tip of the iceberg, as active surveillance is not being done.

“The rapid rise in new cases indicates that the coming days will be difficult. Already, intensive care unit beds and ventilators are packed, and what is more alarming is that health workers are exhausted from working continuously for months,” Shrestha said. “Preparations should be made keeping in mind the possible consequences.”