Now that Nepal has reported fifth Covid-19 positive case—four live cases in all those recently travelled from countries like France, Belgium and the United Arab Emirates—authorities are staring at a hard time when it comes to contact tracing. The first Nepali who had tested positive for Covid-19 in January has already recovered.
Two women who travelled from France and Belgium used the same flight from Qatar on March 17. The plane carried 158 passengers. Then a 34-year-old man who tested positive for Covid-19 on Friday had flown from Dubai to Delhi and then to Kathmandu.
The man told the Post on Saturday that he took an Emirates flight to Delhi and then an Air Vistara flight to Kathmandu on March 20. The next day, he flew Buddha Air to reach Nepalgunj, from where he travelled on a public transport—a Toyota Hiace vehicle—to Attariya before reaching his home in Dhangadhi. It is not clear how many passengers were there in the Emirates flight. According to the authorities, there were 130 passengers in the Air Vistara flight to Kathmandu.
Doctors say contact tracing of people who came in contact with the so far Covid-19 cases is simply impossible with the existing human resources.
For instance, said Dr Gunaraj Awasthi, provincial health director at Sudurpaschim Province, the person from Dhangadhi who has tested positive may have come in contact with dozens of people while he travelled in Nepal—from Kathmandu to Nepalgunj and then from Nepalgunj to his hometown.
“We have just three people working at the Provincial Health Office and four in the Provincial Health Directorate,” Awasthi told the Post over the phone
Of the two students who came from France and Belgium via Qatar, one is in isolation at Sukraraj Tropical and Infectious Disease Hospital while the other one is in Baglung. The one from France is said to have exercised self-quarantine after reaching Kathmandu, while the one from Belgium had taken a flight to Pokhara from where she travelled on a jeep to reach Baglung.
Public health experts say the government approach has been too lackadaisical.
It’s not about the returnees just imposing self-quarantine when they reach home, it’s about who all they met and who all they came in contact with before reaching home, they say.
“The situation could be catastrophic if we fail to take immediate steps to trace the people and conduct tests on them,” said Dr Shyam Raj Upreti, public health expert.
Of those 458 passengers who travelled in different flights, according to authorities, only 156 have so far come in contact. The other 302 are still out of contact.
According to Senior Superintendent Umesh Raj Joshi, spokesperson for the Nepali Police, of the 158 passengers who came to Kathmandu on the March 17 Qatar Airways flight along with the second and fifth patients, only 134 have come in contact as of Sunday evening.
Those who have come in police contact are in isolation under the observation of local police or local level officials, said Joshi.
“The others are yet to come in police contact,” he added. “There are many whose passport address does not match with their actual address.”
The Air Arabia flight in which the third Covid-19 patient had travelled carried 170 passengers. Of them, only 22 have come in police contact, according to police.
And of the 155 passengers who were in the Air Vistara flight in which the fourth patient had travelled, police are yet to trace even a single one.
Police say now they also need to find out the number of passengers the domestic carriers carried, in which the fourth and fifth patients had travelled. That aside, they had used public vehicles also.
While all those who have tested positive so far are returnees from Europe and Gulf countries, thousands of Nepalis living and working in India have entered via land routes. There were no proper screenings. Nor were they quarantined.
Even if the government were to conduct tests, it neither knows how to do it nor has it the capacity to do it, according to health experts.
“Contact tracing of people in such a huge number is difficult but there is no other way,” said Upreti.
Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, said that the concerned agencies must work in a unified way, just like security agencies do in the time of emergency.
“This is one of the biggest emergencies faced by the world,” said Marasini. “We should not wait for separate directives. The government should activate all its health networks and take help from all other agencies.”
Police said their priority now is to trace down all those who took the international flights with the patients.
Joshi, the police spokesperson, said all those who travelled with the infected persons should display responsibility and get in touch with police. “They can also dial 100 and inform us about their health condition and address,” said Joshi. “We need assistance from the citizens’ level. If everyone relies solely on the police, it might take long to trace all these people.”
Correction: This story has been updated with a correction in the 7th para. An earlier version said she travelled in a microbus to Pokhara. She took a flight to Pokhara.
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 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 territoriesaround the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 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.
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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