With hospitalisations on the rise, lockdown is inevitable, experts sayRestrictions are not being enforced and those vaccinated are growing complacent even though the risk of Delta variant, predominant in Nepal, is higher.
At 8am on Saturday a relative of a patient infected with Covid-19 contacted doctors at Bir Hospital asking if they could find an intensive care unit bed with a ventilator. The caller was desperate to get a bed for the 57-year-old male relative as his condition was deteriorating fast.
“Doctors at Dhulikhel Hospital said that the patient needed ventilator support immediately,” Dr Achyut Raj Karki, the Covid-19 focal person at Bir Hospital, told the Post. “Other relatives of the patient too called several times pleading for a bed as they could not find a bed in other hospitals. Since we could arrange for a bed only at 2pm, we asked them to bring the patient then.”
As new coronavirus infections have started surging in recent days, intensive care units of most of the hospitals treating Covid-19 patients have been running in full capacity.
According to Dr Anup Bastola, director at Sukraraj Tropical and Infectious Disease Hospital, the number of infected people admitted at the hospital has been increasing gradually.
“On an average every day 20 people are admitted to the hospital with Covid-19,” Bastola told the Post.
With cases surging experts have warned of another lockdown.
“As authorities seem indifferent to monitoring the public’s movement, it seems that another prohibitory order or lockdown is inevitable again in the Kathmandu Valley,” Dr Binjwala Shrestha, a public health expert, told the Post.
On Saturday, the Ministry of Health and Population reported 2,280 new cases of coronavirus infections in 9,263 polymerase chain reaction tests—a positivity rate of 25 percent. It also reported another 826 infections detected in 4,256 antigen tests—a positivity rate of 19 percent.
More than one in five tests continue to return positive.
Experts are worried about insufficient tests and the Delta and Delta Plus variants of the SARS-CoV-2 responsible for the continuing surge in infections.
“We do not know the actual infection rate of the virus in communities,” Shrestha said.
The United Nations has said the Delta variant is “dangerous and most transmissible SARS-CoV-2 virus to date.”
Among the infected in Nepal, the variant has been dominant.
According to the Health Ministry results of whole-genome sequencing on 47 swab samples of the infected persons collected between early June and mid-July, the Delta variant (B.1.617.2) was found in all swab samples and a new sub-lineage of it—K417N also known as AY.1 and as Delta Plus—was found in three of them.
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.
According to the data provided by the Ministry of Health and Population, active cases in Kathmandu Valley have crossed the 9,000 mark. Of the 31,355 active cases throughout the country, around 29 percent are in the Valley.
Everyday life has returned to normal in the Valley and most parts of the country with prohibitory orders in place only in name. Educational institutions, banquet venues and cinemas, however, are still closed.
Restrictions are not followed.
At 4pm on Friday, a public bus travelling from Balkot to Kalanki was found crowded at Thapathali despite the authorities saying buses should carry passengers only in half their seats. The conductor had his mask on his chin while calling in passengers.
Inside the bus, a woman passenger sitting next to the driver was wearing her mask around the chin. The driver was without a mask too.
“It’s too hot, and wearing a mask makes breathing uncomfortable,” said Hira Kaji Shrestha, the 55-year-old driver.
And as the vaccination drive picks up speed, people are becoming complacent.
“I have already got my Chinese vaccine, twice from Civil Hospital, and I am sure the coronavirus is not going to touch me anymore,” said Shrestha. “Besides, I do not believe in the virus. There is no virus anymore as everything has opened.”
But with the Delta variant being widespread, there is worry the world over.
A story published in the New York Times on Friday said that according to the Center for Disease Control and Prevention of the United States, the Delta variant is as contagious as chickenpox and is more transmissible than viruses that cause MERS, SARS, Ebola, common cold and seasonal flu.
The Center also found that the Delta variant is more likely to break through protections afforded by the vaccines and may cause more severe disease.
Studies show that the Delta variant is 40 to 60 percent more transmissible than Alpha and almost twice as transmissible as the original Wuhan strain of SARS-CoV-2.
A Chinese study found that viral loads in Delta infections were 1,000 times higher than those in infections caused by other variants.
In terms of severity caused by the Delta variant, Dr Van Kerkhove, World Health Organization epidemiologist and Covid-19 technical lead, has highlighted that there has been an increase in hospitalisations in certain countries affected by the variant. However, the UN body hasn’t “yet seen an increase in mortality”.
Authorities in Nepal are worried too.
Officials at the Health Ministry said that it has been doing its best to alert all agencies concerned and the general public about the growing risk of infections.
“We have been pleading with the public not to take risks saying that the risk of infection is increasing,” said Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry. “We have also alerted the agencies concerned for preparations.”
According to him, several other agencies, which are responsible for enforcing rules, should also take the responsibility.
On Friday, a meeting of the Covid-19 Crisis Management Centre, the key government body to make decisions to check the spread of infections, discussed enforcing a ‘smart lockdown’.
“We have discussed imposing a smart lockdown categorising the districts on four categories— red, amber, yellow and green. At present, we are trying to implement lockdowns in the same way, but there is no similarity in understanding it,” said Nurhari Khatiwada, spokesperson of the Covid-19 Crisis Management Centre. “Henceforth, we will issue a guideline so that there won’t be confusion in understanding it. The individual District Covid-19 Crisis Management Centre will be allowed to impose lockdown as per the situation of the coronavirus infections in the district.”
But experts warn against lockdown.
“Lockdown or any other kind of restrictions should be the last resort, but it seems that authorities have only one weapon, which is lockdown,” Dr Bhagwan Koirala, chairman of Nepal Medical Council, the national regulatory body of medical doctors, told the Post.
According to Koirala, authorities should increase testing, make contact tracing effective, isolate the infected people, and regulate public movement and crowds to lessen the spread of infections. If needed, they could enforce some kind of restrictions in certain areas.
“With cases increasing, authorities should also revive quarantine and community isolation centres and take other measures since time is running out again,” said Biraj Karmacharya, an epidemiologist who heads the Department of Community Programme at Dhulikhel Hospital.
But ever since the pandemic began more than a year and a half ago, none of these measures has been effectively taken.
“Restriction for an indefinite period is not possible and what I want to say is before authorities enforce restrictions on our movement, we should follow safety measures, stay inside if we do not have important work,” added Koirala. “If health facilities are overwhelmed again, authorities have to enforce strict lockdowns. The people too will be responsible for inviting restrictions again.”