Case management is key as virus has taken root in the country, experts sayAs coronavirus has penetrated communities because authorities failed in timely action, doctors stress focus on measures other than testing.
The National Public Health Laboratory has the capacity to carry out over 3,500 polymerase chain reaction tests a day. But on Tuesday, only 258 tests were performed there.
Of them, 252 people’s tests returned positive results. A staggering 98 percent.
The laboratory had carried out 196 tests on Monday and 140 people tested positive. The test positivity rate on Monday was around 72 percent.
Three state-run laboratories in Madhes Province (previously Province 2) did not carry out any tests on Tuesday. On Monday, five laboratories in the province, including the Provincial Public Health Laboratory, did not conduct a single test.
As many as 17 laboratories of Bagmati Province did not perform any tests on Tuesday. The number was 19 on Monday.
Only one laboratory in Karnali Province carried out testing on Tuesday and of the 22 samples, 16 were found to be positive. Positivity rate is 73 percent.
Polymerase chain reaction tests at the Public health Laboratory of Lumbini Province returned 100 percent positive results.
What do these numbers tell?
“The answer is simple,” said Dr Kishor Pandey, a tropical and infectious disease expert. “The virus has taken hold in communities. Not only in cities, which are densely populated, the coronavirus has reached rural areas as well.”
Pandey also shared his experience.
“Right now [Tuesday afternoon], I am in Phalewas Municipality of Parbat and I have noticed almost all households have symptoms similar to those of Covid-19,” Pandey told the Post during an interview over the phone.
The Health Ministry on Tuesday reported 10,258 new cases in the last 24 hours—8,730 in 17,872 polymerase chain reaction tests and 1,528 in 4,956 antigen tests.
This is the highest number of cases recorded in a single day since the start of the pandemic.
The daily positivity rate has jumped to 44.9 percent, which was 40 percent on Monday and a meagre 3 percent on January 3.
Public health experts say questions now are: “What next? What measures to take? How to save lives?”
According to them, as almost everyone being tested seems to be getting a positive result, questions have arisen over the relevance of expanding testing.
Anyway, the numbers of tests at government laboratories show people are not going for tests, as it’s expensive.
Experts say the best move now should be to consider all cases having Covid-19 like symptoms as Covid-19 infections and prepare measures accordingly to fight the disease.
“Had authorities expanded tests on time, say about two months ago, and taken measures to control movements through open border points, we would not have reached this situation,” said Dr Biraj Karmacharya, an epidemiologist. “Based on tests, contact tracing could have been made more effective. Now with almost everyone testing positive, contact tracing seems to have lost its meaning.”
Timely testing is key in the fight against the coronavirus as it provides a window to the authorities, if they are working as per the protocol, to carry out contact tracing and monitor the infected.
Doctors say routine data of testing is necessary to make decisions on resource allocation or estimate epidemiological parameters in populations.
Given the rate at which the cases are rising, doctors say, making a projection now will be futile. Focus now should be on the management of the infected—how to treat the infected, how to provide the required care, how to ensure beds, oxygen and ventilators to serious patients, according to them.
Dr Sher Bahadur Pun, chief of Clinical Research Unit at the Sukraraj Tropical and Infectious Disease Hospital, said there is no point in harping on testing now.
“There is a need to drive home one simple point—that people should self-isolate themselves as soon as they develop symptoms that are similar to those of Covid-19—at least for five days,” Pun told the Post.
“Even if people think they have caught flu, they should treat it as Covid-19 and must pay attention to monitor health conditions. Authorities should focus on the management of cases, increasing hospital beds and ensuring that there is no human resource crunch.”
It has by now become apparent that the current wave is driven by Delta and Omicron, the new iteration of the coronavirus which is considered super contagious.
Officials have already made it clear that there is no point in carrying out genome-sequencing as every 25 in 100 positive cases in Nepal are caused by Omicron.
The World Health Organisation says the case doubling time for Omicron is 1.5 to 3 days in areas with community transmission.
More tests will be a waste of resources now, say doctors, as the new variant too has spread in communities and it’s impossible to stamp it out immediately.
“We neither have the capacity nor resources to carry out testing of all people. And it’s not possible,” said Dr Prabhat Adhikari, an infectious disease and critical care expert. “Those who become serious should go to the hospital and others should stay in home isolation.”
According to Adhikari, authorities should rather set up hotline numbers so that people can talk to doctors and get counselling services on their health conditions.
Scientists across the world as of now are relying on the vaccine and experts in Nepal also say measures must be taken to ramp up the vaccination drive. Mismanagement at vaccination centres is so rife across the country that people reaching for the jabs are returning without one.
As of Tuesday, 12,347,304 people, or 40.6 percent of a little over 30 million population, have been fully vaccinated. The government has also launched booster shots, but many have failed to get the jabs due to poor management, a lack of communication and shortage of human resources. So far,7 324 people have received booster shots.
Officials at the Health Ministry say that the infection has already reached every household and data of the daily testing does not represent the actual number of infections across the country.
“I can only say that more people will be infected in the third wave compared to the second wave,” Dr Krishna Prasad Paudel, director at the Epidemiology and Disease Control Division, told the Post. “We have the projection of the infected people in the third wave to prepare a rapid action plan and have submitted it to the Health Ministry.”
According to officials, a projection at this time won’t make any sense for various reasons, as the number depends on testing and the government has limited capacity. A total of around 20,000 polymerase chain reaction tests can be carried out across the country in a single day.
Officials said they have made their own projections for the purpose of responding to the Covid-19 situation. They refused to divulge what their estimates suggest.
“What is the projection is not important right now. The fact is the actual number of people infected with the virus is far more than what is shown by the daily testing,” said Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry. “I just want to urge all to take maximum precaution and follow safety measures properly.”