‘We need to think about our elderly parents and young siblings.’Infectious disease and critical care expert, Dr Prabhat Adhikari, on containing the spread of Covid-19 and increasing tests at the community level.
Following the government decision to lift the lockdown on July 21, the number of new Covid-19 cases has been rising at an exponential rate in several districts including in the Kathmandu Valley. In the past two weeks, the hospitals designated for Covid-19 treatment in the Valley have been overwhelmed by the number of patients. As authorities scramble to arrange more beds and enforce measures to contain the spread of infection, dozens of infected people have been told to self isolate at home. The Post’s Arjun Poudel talked to Dr Prabhat Adhikari, infectious disease and critical care expert about the ways to contain the spread of Covid-19.
How do you evaluate the ongoing situation of the Covid-19 pandemic in Nepal?
New cases are rising at an alarming rate in densely populated areas like Birgunj and Kathmandu. Even people who do not have a history of travelling to coronavirus hotspots or those who have not come in close contact with the infected people have tested positive. All these indicate community transmission. It could be cluster transmission but we need community tests to know what exactly is happening. Without testing in the community, we cannot say for sure.
How can we contain the spread of the infection rate if it has already reached the community level?
The only way to contain further spread of the virus is to break the chain of transmission and it is possible only if we have an effective contact tracing methodology. Those suspected of infection should be isolated and we should figure out how people are getting infected in the first place. To know the scale of the spread of Covid-19 in the community, testing must be expanded. But we don’t necessarily need to conduct polymerase chain reaction tests, which are being conducted right now. Serology tests can also give us a perspective about the scale of transmission and officials shouldn’t wait any longer.
Authorities have asked infected people to self isolate at home, as hospitals are overwhelmed in Kathmandu Valley. What does this tell about our preparation?
First of all, we failed to recognise the threat level of this virus. Many people, including those in power kept on saying we Nepalis have [strong] immunity against the virus and that turmeric can treat the disease. We squandered the precious time and opportunity provided by the lockdown to prepare for the situation like today.
There was also a lack of political will and commitment to deal with the pandemic. I am not blaming any particular party; I mean the parties across the spectrum. The job of containing the spread of the virus was considered the responsibility of health workers, the Health Ministry, security agencies and journalists. But we should not forget that this is a war. All state machinery including the political parties and others should unite to overcome this war.
We miserably failed in testing too. We could not perform sufficient numbers of polymerase chain reaction tests. We then made another mistake by starting rapid diagnostic tests, which gave misleading reports. These actions show there was a lack of strategy to deal with the pandemic. We must have proper planning to tackle the outbreak. If there is a shortage of beds at government hospitals, the government should take private hospitals and medical colleges into confidence. Authorities must invest in building makeshift hospitals, just like various countries across the world.
Also, contact tracing is very important but we are not doing it effectively. While making arrangements for isolation beds, authorities must also focus on expanding contact tracing.
Do you think the public is also responsible for the spread of the infection?
Janai Purnima is just over. Major festivals like Teej, Dashain, Tihar and Chhath are just round the corner. It won’t make much of a difference if we do not celebrate the festivals in a grand way this year. If we neglect safety measures, it could be the last festival for some of us. We should not believe in rumors that we have immunity against the virus, which is not proven. A lot of people are dying in India. We have similar genetic nature like Indians.
It is important to note that until now, only youth returnees who are comparatively healthy, tested positive for Covid-19 but fatality rates could rise if the infection reaches the community level and spreads among chronic patients, elderly people and children. The number of deaths is already rising. We cannot afford to be negligent. We need to think about our elderly parents and young siblings.
The number of new cases has spiked after the government ended the lockdown. Has the abrupt decisions contributed to the rise in new cases?
The government enforced the lockdown without any preparation and it seems that it did not think much before ending it. The disease has spread rapidly since the lockdown was lifted as we can see from the number of new cases in the Kathmandu Valley. The lockdown should have been lifted in a controlled way. Had we increased testing at the community level before lifting lockdown, we would have a better knowledge about the infection status.
I think borders of densely populated areas like Kathmandu, Pokhara, Chitwan should be sealed strictly to contain the spread. We cannot do more once the virus enters such dense communities. We are not following simple rules, which has created big problems. Had the decision-makers listened to experts or epidemiologists, we would not have arrived at this situation.
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 20, 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 has spread to 213 countries and territories around the world and infected more than 30,683,828 people with 955,841 deaths and 22,038,587 recoveries. In South Asia, India has reported the highest number of infections at 5,308,041 with 85,619 deaths. While Pakistan has reported 305,031 confirmed cases with 6,415 deaths. Nepal has so far reported 62,797 cases with 401 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.