Covid-19: Learn from the past, prepare for the worstExperts say while prohibitions help curb virus spread, they stress science-based approaches to keep everyone safe.
Seventeen months into the pandemic, Covid-19 has already killed over 10,900 people in Nepal, but authorities concerned continue to fail to apply science-guided measures or take the public into confidence.
As new infections have taken a dip, so has testing, but the Health Ministry continues to report 1,319 new infections on average each day and asserts that any complacency could quickly deteriorate the Covid-19 situation and all hard-won vaccination gains.
But around a week since the government lifted all restrictions following the controversial preliminary findings of a second nationwide serological survey, authorities say they will reimpose strict restrictions if there’s a surge in new infections.
“We will enforce lockdown again, if the new cases start to surge uncontrollably,” Nurhari Khatiwada, spokesperson for the Covid-19 Crisis Management Centre, told the Post. “We will take a decision accordingly if the situation goes out of control but for now, we have to open up everything.”
With the understanding of the nature of coronavirus and its mutations evolving on a daily basis, public health experts say restrictions or lockdowns cannot be the weapon to contain the spread of infections every time. A potential transmission at the community level, they say, may not come under control even with restrictions.
“Next two to three weeks will be crucial to us, as we have lifted all restrictions enforced to contain the spread of the virus,” Dr Anup Subedee, an infectious disease expert, told the Post. “We have to see how the number of infections will change in the next two to three weeks.”
According to Subedee, imposing restrictions alone would not work to break the chain of virus transmission.
While the number of new infections in the country has decreased of late, what worries experts like Subedee is that the test positivity rate continues to be around 14 percent. According to the World Health Organization, if the positivity rate, or the number of tests that return positive for every 100 tests, is more than 5 percent, the pandemic is supposed to be beyond control.
Science is clear that without adequate testing, contact tracing and a parallel effort to boost vaccination figures, there is no way out of the pandemic. Scientists have also envisioned a near future where Covid-19, like influenza, will become endemic.
As governments across the world secure vaccines and take decisions guided by epidemiological data, Nepal still has a long way to go before the Covid-19 situation turns safer but until then standard operating protocols together with testing and tracing remain the major defence against the coronavirus.
However, key measures to manage the pandemic, doctors say, have been halted and no contact tracing has been done since the authorities stopped free testing in October last year, the time when the first wave cases reached their peak.
Nepal recorded 5,743 cases on October 21 just ahead of Dashain, and then cases dramatically declined, even surprising the experts and doctors.
When the second wave hit the country in April, cases surged exponentially again, with the number reaching 9,317 on May 11. There, however, has been a decline in the number of cases of late, which has been attributed to fewer tests.
With daily tests, both polymerase chain reaction and antigen, remaining too low, it becomes difficult to take a scientific decision-making approach. Worse, doctors say, the ongoing tests are largely made up of people seeking hospital care or those who have to mandatorily produce negative test results before travelling abroad.
“Tests should be made accessible to all and made free to symptomatic people, which help people to self-isolate,” said Subedee. “We are still not free of risks of the infection and the restrictions should be the last resort.”
That the risks remain—despite the fewer new infections—driven by more contagious Delta variants of the coronavirus, is evident in the daily situation report by the Health Ministry. Several districts including the districts of Province 1 have a high test positivity rate.
In the 816 polymerase chain reaction tests performed in the last 24 hours in Province 1, 206 people tested positive. It is over 25 percent of the total tests of the province. And what is concerning is, of eight swab samples tested at Dhankuta Hospital, five tested positive. It is 63 percent percent positive of the total tests.
“People are still getting infected and dying,” Dr Bhagwan Koirala, chairman of Nepal Medical Council, the national regulatory body of Medical doctors, told the Post. “Although the infection and death rates have been declining, we should not forget that around 80 percent of the population of the country have yet to be fully immunised.”
According to Koirala, authorities must understand the fact that the country is not out of the woods yet.
“While the positivity rate and daily reported deaths continue to remain on the higher side, breakthrough cases among the vaccinated population are being reported,” said Koirala. “This is alarming because although such cases are rarely severe or need hospitalisation, they can easily transmit the virus to others.”
Although the government aims to raise vaccination coverage to 33 percent by next month, complacency, doctors warn, could be more dangerous than the virus itself.
From schools to the malls, cinemas, gymnasiums, temples, zoo, public transportation and other public places have reopened and people are behaving as if there is no virus. As the festival season is round the corner, which means celebrations and crowding, doctors say preparatory measures should be stepped up, just as people should be made aware of the fact that the coronavirus risk is not over yet.
So far, 5,729,789 people (over 19 percent) have taken the first dose of the vaccine and 5,102,244 people (over 17 percent) have been fully vaccinated.
“Ongoing tests cannot show the actual infection rate of the community,” Dr Bikesh Tamrakar, an assistant professor at Kathmandu University, told the Post. “Without active surveillance and increased testing, we cannot know the actual infection rate.”
Of the swab samples of 8,898 people tested on Thursday, 1,058 tested positive. Additional 213 people also tested positive in the antigen tests performed throughout the country.
Experts say the ongoing festive season could invite a new hump in the infection rate. They said that authorities should start preparations for the possible new surge.
“Street festivals have already started and the major festive season has just begun. People have been behaving as if there is no virus,” said Tamrakar. “New cases and death rate could rise again if the elderly people get infected during the festive season.”