Until a week ago, the Armed Police Force Hospital, on the outskirts of Kathmandu, had eight people infected with Covid-19. On Tuesday, the number rose to 35, with five of them receiving intensive care.

“The hospitalisation rate among the infected patients has been rising significantly for the last one week,” Dr Pravin Nepal, spokesperson for the hospital, told the Post.

The Tribhuvan University Teaching Hospital in Maharajgunj said that 22 patients infected with Covid-19 were receiving treatment at the hospital on Tuesday. The number was less than a dozen until a week ago. The daily test positivity rate has also spiked at the hospital—to 26 percent on Monday. Of the 218 people who underwent polymerase chain reaction tests, 71 tested positive.

“When we performed 100 to 150 PCR tests until a week ago, only four to five people would test positive,” said Dr Dinesh Kafle, director at the hospital. “The rise in the daily test positivity rate shows the virus is spreading fast.”

Doctors suspect the spike in cases could have been driven by Omicron, the new iteration of the coronavirus which is super-contagious.

The Health Ministry confirmed 24 new Omicron cases in the country on Friday, after tests on 250 of the 1,146 samples of the infected collected randomly from across the country showed S-gene dropout. According to the Health Ministry, all 24 samples from among those sent for genome-sequencing showed they had Omicron. The samples were collected in the month of Poush (until January 7).

The Health Ministry has not provided any updates on Omicron since Friday. But citing the way cases have been rising, doctors suspect Omicron has taken hold in society and that the country is facing threats from the new variant and Delta, which has been the dominant strain in Nepal.

On Tuesday, Nepal reported 2,444 new cases—1,981 people tested positive from 10,648 polymerase chain reaction tests and 463 from 4,385 antigen tests.

Of the total new cases, more than half (1,286) are from Kathmandu Valley—980 from Kathmandu, 221 from Lalitpur and 85 from Bhaktapur.

Overall daily test positivity rate has increased to 18.6 percent on Tuesday from 3 percent on January 3, according to the Ministry of Health and Population.

District administration offices of Kathmandu Valley responded with a slew of orders. A meeting of the chief district officers of Kathmandu, Lalitpur and Bhaktapur have imposed a ban on gatherings of more than 25 people with effect from Tuesday. Proof of vaccination has been made compulsory to access public amenities like hotels, restaurants, cinemas, stadiums, airports and parks and to access services from government offices from January 21.

As per the new order, all public vehicles should not carry more passengers than the seat capacity and they must wear masks properly, with drivers and helpers using face masks or visor, gloves. The order says that sanitisers must be made available for passengers. “Passengers without masks should not be allowed in the vehicles and the vehicles must be sanitised everyday,” states the order.

“New orders will be issued if cases continue to rise,” said Rudra Devi Sharma, chief district officer of Bhaktapur. “The order issued today will be in place until further notice.”

The orders are similar to what the chief district officers had issued last time when cases started to peak before the second wave struck.

Doctors say authorities’ reactive approach has always been as dangerous as the virus. There were no plans in place to fight the third wave, and as cases surged, officials have come up with the same measures again, according to them.

With the spike in cases, Sukraraj Tropical and Infectious Disease Hospital has started a separate fever clinic from Sunday. Of the total patients visiting the clinic, who were recommended for polymerase chain reaction tests, 45 percent are found to be positive for Covid-19 according to the hospital.

“There could be more cases in communities,” said Dr Manisha Rawal, director at the hospital.

The Bir Hospital administration informed that 36 people infected with Covid-19 were receiving treatment at the hospital on Tuesday.

“The number was seven until two weeks ago,” Dr Umesh Bogati, Covid-19 focal person at the hospital, told the Post. “We are witnessing a rapid surge in new cases in recent days.”

Doctors at Patan Hospital said there were 35 Covid-19 patients at the hospital on Tuesday. “Daily positivity rate from polymerase chain reaction tests at our hospital is hovering at around 40 percent,” Dr Ravi Shakya, director at the hospital, told the Post.

Experts say the overall high positivity rate and positivity rates at individual hospitals suggest the virus has spread faster than anyone thought. There could be so many people with the coronavirus who have not gone for tests, according to them.

Since the coronavirus symptoms are similar to those of a seasonal flu, many tend not to go for tests, which doctors say could prove costly, because they can be carriers and could spread the virus to those coming in contact.

Amid the rise in cases, more hospitalisations are being seen, which is a major cause for concern for doctors serving at major hospitals designated for treatment of Covid-19 in the Valley. And there are breakthrough infections.

“Most of the patients admitted in our hospitals have been fully vaccinated against Covid-19,” said Nepal, the spokesperson of the Armed Police Force Hospital.

The risk is, according to doctors, the fully vaccinated may recover from breakthrough infections, but they could spread the virus.

Despite calls for launching booster shots, the government has delayed the plan until 40 percent of the total population is jabbed. As of Tuesday, 11,336,538 people, or 37.3 percent of the population, have been fully vaccinated. The vaccination rate is so woefully slow that there was just a 0.3 percentage point increase from Monday. Despite the Health Ministry’s plan to inoculate 500,000 people a day, on Tuesday, only 180,457 people were vaccinated.

Experts say booster shots should have been administered to at least frontline workers, including health care professionals, as they are the first ones to respond in case of an explosion of infections.

The Tribhuvan University Teaching Hospital said it has downsized its intensive care service after doctors and nursing staff were infected. Of the eight medical intensive care unit beds, the hospital has been operating only four.

“We do not have enough staff to run the intensive care unit fully,” said Kafle, director at the Hospital. “Not only the intensive care unit service, some scheduled surgeries also have been postponed, and we cannot say anything about planned surgery in the coming days.”

The way cases have surged and hospitalisations have increased, experts wonder, it won’t take long for health facilities to get overwhelmed.

“The virus has spread into communities,” Dr Biraj Karmacharya, an epidemiologist, told the Post. “Time has come to start hospital preparations.”

If the positivity rate continues to rise at the current rate, it will soon hit 40 percent in a matter of a few days. During the second wave in April last year, the daily test positivity rate had crossed 40 percent.

Doctors say infection rate at some hospitals crossing 40 percent at the start of the third wave means the virus has penetrated communities.

Most of the hospital directors and officials the Post spoke to said that the number of severe cases are low compared to the second wave of the pandemic but they were of the view that the situation could change anytime, as the third wave has just started. Infection is yet to reach the vulnerable population—elderly people, those with compromised immunity and the unvaccinated population.

“The situation could turn worse in two weeks,” Kafle, director at the Tribhuvan University Teaching Hospital, said.

Doctors are worried other regular health care services could be hugely affected if Covid-19 cases continue to rise at the current rate.

“We cannot increase the number of beds and improve other infrastructure overnight,” said Shakya, director at the Patan Hospital. “If the number of Covid-19 cases rises, we have to reduce other services.”