With first case of local transmission, window to prevent a mass outbreak is fast closing, public health experts say
As Nepal enters stage 2 of the pandemic, Saturday’s three new cases have brought the total number of cases reported in the country to nine.Three-dimensional drawing of Coronavirus. Shutterstock
The Health Ministry on Saturday confirmed three more cases of Covid-19, taking the total number of coronavirus cases identified in the country to nine.
According to the ministry, the three patients are a 21-year-old man from Kailali who had recently returned from Mumbai; a 41-year-old man from Kanchanpur who returned from Uttarakhand of India; and a 34-year-old woman from Kailali, a relative of a person who had earlier tested positive for the disease.
According to an official at the Sudurpaschim Provincial Health Directorate, the 34-year-old woman is the sister-in-law of the 34-year-old man who had returned from the United Arab Emirates and tested positive for Covid-19. This marks the first instance of the local transmission of the disease, said the Health Ministry.
With local transmission, Nepal has now officially entered stage 2 of the pandemic, which public health experts call “a very disturbing and dangerous” phase that they hoped Nepal would not enter.
“The one case of local transmission could be the tiniest piece of the tip of the iceberg,” Dr Baburam Marasini, former director of the Epidemiology and Disease Control Division, told the Post. “The window is rapidly closing. It will be impossible to control simultaneous outbreaks in many places. Thousands of people from countries with outbreaks have returned to Nepal and some infected people might definitely have already passed the coronavirus to others.”
Before Nepal went into a lockdown, cancelling all international flights and closing the border, thousands of Nepalis, and even some foreigners, had continued to enter Nepal from countries with active Covid-19 cases. Most of them were not placed in quarantine and doctors do not believe that a majority are quarantining themselves.
“If we fail to contain this stage, we will enter the third stage—community transmission— which will be devastating,” said Marasini. “Then the situation enters an epidemic stage, in which transmission gets out of control and the disease has no clear end.”
The World Health Organization has been urging countries around the globe to isolate, treat and trace, while testing all suspects, especially those who’ve returned from abroad.
The government, however, has not been carrying out enough tests, say doctors. Many who have visited the Sukraraj Tropical and Infectious Disease Hospital in Teku looking for tests have been turned away for not presenting enough symptoms. So far, according to the Health Ministry, 1,521 tests have been carried out, a miniscule number in a country of 30 million people. Doctors at the hospital themselves believe that more tests need to be carried but they are tied down by the government’s instructions.
“We should forget symptoms, as asymptomatic patients can pass the virus to many,” a doctor at the Sukraraj Hospital told the Post on condition of anonymity. “Local transmission means the level of risk has increased. Time is running out very fast and we need to act immediately to mitigate the risk.”
Doctors and public health experts believe that the government has not realised the gravity of the situation and is still treating the pandemic flippantly. In the past few days, controversy after controversy has dogged the government, with the Health Ministry pulled into a corruption scandal over procurement of medical equipment from China.
On Thursday, in an interview with Naya Patrika, Defence Minister Ishwar Pokhrel, who leads the high-level coordination committee to control Covid-19, appeared largely unaware of the magnitude of the outbreak and was cavalier in his answers to pressing questions.
“We are still not taking the issue seriously and diverting public attention to other things,” said Dr Mingmar Gyelzen Sherpa, a former director-general of the Department of Health Services. “We will not be able to control things if we let the disease spread in the community.”
According to Sherpa, there are numerous examples from across the world to study and learn from, including the mistakes that the governments of the European Union and the United States have made.
“The ongoing lockdown needs to be prolonged and all areas where local transmission was reported need to be sealed,” said Sherpa. “And we need to test all suspected cases to lessen the risk of an outbreak in the community.”
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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