As the festive season is just round the corner, with Ghatasthapana, the first day of Dashain, five days away, Kathmandu and other cities are seeing an increased mobility of people. Almost everything has reopened since September 1 and people are in a festive mood. With a steady decline in Covid-19 cases of late, complacency seems to have taken hold. Authorities have cautioned people to strictly follow health protocols, but there is a lack of implementation. Public health experts say increased mobility and festive gatherings could lead to a sudden spike in coronavirus cases. And the major culprit can be the Delta variant.

The Health Ministry has already warned people of the presence of the Delta variant circulating in society. Though there has not been any genome sequencing on new samples of late, of the 42 swab samples of the infected people, collected between mid-August and September, the Delta variant was detected in 41.

Reuters reported on Friday that unvaccinated people were particularly exposed to the Delta variant. Worldwide deaths related to Covid-19 have surpassed 5 million, according to Reuters. “More than half of all global deaths reported on a seven-day average were in the United States, Russia, Brazil, Mexico and India,” it said.

That India is still reporting a high number of cases and that the Delta variant continues to sweep the world should be a major cause for concern in Nepal, say experts. Nepal shares a long porous border with India and thousands of people cross into each other’s territories every day. It is estimated that around 100,000 people enter the country during Dashain from India through various border points and officials say it is impossible to keep records of those entering from hundreds of illegal land crossings. The influx of people into the country during the festival means an increased risk of outbreaks of various diseases, not just Covid-19. In the past, outbreaks of diseases including malaria, kala-azar, and dengue have been reported immediately after Dashain in many districts.

India has so far reported 448,605 deaths. It reported 23,910 new cases on Friday.

“The Delta variant that caused the second wave in our country is still dominant,” said Dr Runa Jha, director at the National Public Health Laboratory. “The virus spreads rapidly and can infect a lot of people in a short period of time.”

The number of deaths due to Covid-19 too has drastically come down in Nepal in recent days, which doctors call a sign of improvement but they warn against complacency. According to the Health Ministry, nine people died from complications related to coronavirus infections in the last 24 hours. The number of Covid-19 fatalities over a 24-hour period has remained somewhat the same over the last two weeks.

So far, 11,157 people have died of Covid-19 in Nepal.

Reports suggest the global death rate has been slowing in recent weeks but an average of 8,000 people are dying daily across the world over the last week—or around five deaths every minute.

The Delta variant’s penetration and a huge chunk of unvaccinated people around the world, including in Nepal, hence put a spotlight on the need to scale up the vaccination drive. Despite facing a hitch after launching the campaign to inoculate people early this year, Nepal has managed to secure vaccine doses in recent months. But the number of people fully vaccinated in the country leaves a lot to be desired.

As of Saturday, 6,348,279 people were fully vaccinated, which makes up over 21 percent of the total 30 million population. Nepal is likely to receive around 2 million doses of Covishield from India this week. China has promised some 1.6 million doses under grant assistance, but delivery date is yet to be fixed.

If the doses fail to arrive on time, the vaccination campaign could hit a snag again.

There is no exact data on the number of doses in stock but officials say vaccines are available in storage facilities across the country. There also has been some data discrepancy, as the Health Ministry has been providing confusing numbers on vaccination. So far, Nepal has received 17,858,710 doses from various countries and sources.

Experts say Nepal’s total vaccine coverage is yet to reach a level to prevent new outbreaks. According to them, there could be a new surge in infections after Dashain and Tihar festivals, as the number of unvaccinated population is much higher than that of vaccinated.

“Around 80 percent of the total population is yet to be fully vaccinated and it has been evident that the Delta variant of the virus infects vaccinated population as well, which in turn can pass the virus on to others,” Dr Prabhat Adhikari, an infectious disease and critical care expert, told the Post. “As the risk of infection has been growing, more tests and more precaution are needed.”

Doctors say an increase in people’s mobility heightens the risk not only of a Covid-19 outbreak but that of other diseases as well.

“Since the virus continues to mutate, there is always a chance of an outbreak of a new strain. And our complacency could increase risk multifold,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital. “The festive season could be an excuse for people to throw caution to the wind. This could spell disaster. Meanwhile, authorities must continue to stick to the basics—test, trace and treat.”

Officials at the Health Ministry concede the risk of a new outbreak of not only the Delta variant but also of other diseases.

To lessen the risk of an outbreak, the Epidemiology and Disease Control Division (EDCD) said it has directed agencies concerned to set up booths in villages to collect swab samples of those suspected to have been infected.

“Chances of an outbreak of a new variant of the virus are always there, and there is an increased mobility of people of late,” said Dr Krishna Prasad Paudel, spokesperson for the Health Ministry who is also the director general at EDCD. “We have directed all agencies concerned to set up sample collection booths in villages and make the surveillance system more effective.”

Last week, the division directed all agencies concerned to increase antigen tests at border points and carry out tests on the maximum number of people possible.

The directive was issued targeting Nepalis based in foreign countries who have started returning home to celebrate the upcoming festivals.

“As we have no effective mechanism to quarantine people after entering the country, risks of infections have increased in villages also,” said Paudel. “And it will also not be practical to prevent people from going home in the Dashain.”

The division has also increased the supply of antigen kits to the districts bordering with India. In May, the Health Ministry said that it would carry out 25,000 antigen tests every day, but the number of tests never crossed the 7,000 mark. Officials say local level authorities did not carry out the testing despite having sufficient testing kits.

Now there are concerns if the antigen test kits that were supplied months ago have expired.

“We have not received any report from the local authorities about the expiry of antigen kits,” said Paudel. “We don’t have any report on whether they have enough test kits in stock. However, we have asked them to carry out a maximum number of tests on people in view of the festive season.”