Dr Baburam Marasini: We lost an opportunity to strengthen our health care systemFormer director of the Epidemiology and Disease Control Division, Department of Health Services on the coronavirus, Nepal and its ability to tackle it.
Covid-19 is now officially a pandemic. The World Health Organization declared the disease caused by a new strain of coronavirus, dubbed SARS-CoV-2, a pandemic on 11th March. It has spread to more than 125 countries, with 1,73,197 confirmed cases as the Post went to press. Similarly, the death toll had reached 5,937. New infections plateau in China but they are soaring in Europe. Cancellation of public gatherings and quarantines have deepened anxiety as well as fuelled fear among the public. A supply shock and general panic is already hitting economies of the world, including Nepal. As for Nepal, it has recorded just once case so far, that too recovered, but concerns over the virus spread remain. In a country where the healthcare system is dysfunctional by nature and inadequate in resources, the government’s response to containing the diseases so far has been ad hoc at best. Government’s efforts to communicate the risks of the outbreak to its public has been unsatisfactory, too. Against this backdrop, the Post’s Arjun Poudel spoke to Dr Baburam Marasini, former director of the Epidemiology and Disease Control Division, Department of Health Services, and one among the health experts drawing the attention of concerned agencies about their inaction and lack of seriousness towards the risks.
How confident are you regarding the government's plan to deal with a possible outbreak of the coronavirus?
No one can be assured regarding the government’s preparation. I think even the concerned officials of the Ministry of Health and Population are not convinced with their own preparation to handle possible outbreaks.
The World Health Organisation had alerted all countries, including Nepal, about the possible risks. Public health experts, including myself, have been drawing attention about inactions and lack of seriousness towards the possible catastrophic situations. But the government still seems complacent. I lacked the resolve and missed the huge opportunity to strengthen and reform the existing healthcare system. The government could have upgraded health posts to primary health care centres, primary health care centres to hospitals and set up new facilities to use in the time of possible disasters. But we lost a great opportunity to reform.
Government officials are claiming that beds are allocated in hospitals to treat patients infected with Covid-19, and measures are taken for precautions. Are they lying to us?
No one believes that a public hospital can be used for the treatment of patients infected with a highly infectious disease like the coronavirus. I am clear that keeping patients in a general hospital means spreading the deadly disease in other patients, hospital staffers and to the larger community. The entire hospital must be vacated if we are to admit patients suffering from the lethal virus.
The media is replete with news that hospitals, throughout the country, lack surgical masks, gloves, headcover and essential medical gears. The National Public Health Laboratory—the only place where specimens for suspected Covid-19 can be tested—has limited test kits. Hospitals have started sewing their own masks. The public is panicking. The anxiety that has fuelled fear regarding the possible outbreak has resulted in panic buying already. People are hoarding essential commodities like cooking gas and food supplies. This has caused already artificial shortages. But government agencies have failed to contain this and communicate effectively with the people.
What should the concerned government agencies do to prevent the possible outbreak in the country?
Providing the right information to the public about the risks and precautionary measures to be applied is critical. People are in a fask-mask buying frenzy. The government should have urged the general public to not hoard surgical or N-95 masks and instead leave the important resources for healthcare professionals.
Had the government communicated so, people would not have been panicked and rushed to buy them.
Second, the government should clearly have told what needs to be done in the aftermath of a possible outbreak. A nationwide public awareness campaign should be launched to make people aware of the risk and tell them how they could stay safe at home and take other precautionary measures.
Third, the government should have proper planning to contain the settlements, community and larger areas in case of an outbreak. Places and hospitals should be designated to be used as a treatment facility and isolation centres. Health workers should be given proper training and essentials such as masks, gloves, personal protective equipment should be arranged in sufficient numbers.
We have not yet told the public what they should do in case they are infected with the deadly virus. We lagged far behind in active screening and monitoring of people. We should collect more samples from the suspects, test them if found positive, treat them and trace all people who come in their close contact.
Are we in a position to track all the suspects should there be cases in several parts of the country at once?
Italy failed to track all suspects and now the entire country is under lockdown to prevent the spread of the virus. It was also the first nation to cancel direct flights from the affected places, quarantine people who were returning to Italy from countries that had cases of coronavirus. But despite all measures, the spread of coronavirus within the country could not be contained.
An outbreak of the virus is not a matter of if but of when. It is certain that an outbreak will happen, but we do not know the scale of the outbreak. We have to be prepared for the worst-case scenario. From what the government seems to be doing right now, we cannot track all suspects. We have to be serious and start preparations swiftly.
Some agencies under the health ministry complain about a lack of financial resources and legal hurdles. How can the government ease such hurdles?
I have heard that Prime Minister KP Sharma Oli had summoned a cabinet meeting and directed the concerned ministries to do everything that is required to prevent a possible outbreak. He had also assured a sufficient budget for measures needed to take as precautionary measures.
What can an executive head do more than this? We have a lot of aid agencies, which are also offering help but we are not taking their help.
The health ministry and its agencies are not fulfilling their duties and taking the issue seriously. They could do a lot of things—identify quarantine facilities and treatment sites, launch an awareness campaign, upgrade laboratories and so on. The existing National Public Health Laboratory under the Department of Health Services in Teku has its limitations. We should have set up a high tech laboratory at least in three to four places—Chitwan, Pokhara, Dharan and in Nepalgunj outside the valley.
If a tourist goes to visit Mustang, falls sick and develops coronavirus-like symptoms, the person has to be brought back to Kathmandu owing to lack of lab facility in the province. Our health system is yet to be decentralised.
It could be difficult to transport deadly samples from long places and will be impossible if we have to test samples of hundreds of people at once. We have to test 1,000, to 1,500 samples in a single day if any large scale outbreak happens.
How can we minimise risk and loss in case of outbreaks?
Active monitoring and better planning for the worst-case scenario is the only way to deal with a possible outbreak. At the time of the Ebola outbreak in African countries, over 200 armed police personnels, around 100 army personnels and around 30 Nepal police personnels had returned to Nepal from their respective peace missions. Concerned security agencies had requested the health ministry for safety measures. We had kept them in Shivapuri barracks and in Kakani for 35 days and monitored their health.
We were able to limit the cases of cholera to just 200 following the Gorkha earthquake. All of this was possible with effective water quality surveillance. Chances of the outbreak were high at the time, but no one died. We monitored water samples from the beginning, tested for E coli, coliform and improved water quality. We even requested people to boil water before drinking. There was also a risk of an outbreak of dengue virus at the time. Huge numbers of people were in tents, but we prevented an outbreak.
We can learn from our own experience, take international help and start planning effectively for possible risks. Government has been monitoring only those who have been admitted in the hospital with symptoms of the disease. Rather it must energetically track down all contacts of anyone identified to have the disease, for only detecting and isolating can stop the chain of transmission.
Frequently asked questions about the coronavirus outbreak
UPDATED as of May 30, 2020
What is Covid-19?
Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19?
Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from?
The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 had spread to 213 countries and infected more than 6,029,950 people with 366,802 deaths. In South Asia, India has reported the highest number of infections at 173,491 with 4,980 deaths. While Pakistan has reported 64,028 confirmed cases with 1,317 deaths. Nepal has so far reported 1401 cases with six deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe?
The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.