While dealing with Covid-19, government should not lose sight of other infectious diseases, say doctorsWith the onset of summer, infectious diseases like malaria, typhoid, dengue, and cholera could lead to epidemics of their own if focus stays on the coronavirus, they say.
Last week, Lalu Kumari Rokaya, of Thuli Bheri Municipality in Dolpa, died of excessive bleeding after giving birth. The health post closest to her was empty, as staff were unable to come to work due to the ongoing nationwide lockdown. Rokaya, a 22-year-old third-time mother, delivered at home, and didn’t stop bleeding for six hours, resulting in death, according to health care officials.
In the past few weeks, numerous instances of women forced to give birth at home, sometimes resulting in the deaths of infants, mothers, or both, have been reported from across the country, according to the Department of Health Services’ Family Welfare Division. With public movement prohibited across the country, women and health care officials have both been unable to get to hospitals and health posts.
“Some pregnant women have died on the way to hospital while others have died at home waiting ambulances or choosing unsafe delivery methods,” Dr Punya Poudel, chief of the safe motherhood unit at the division, told the Post. “We too are dependent on news media, as our official channel of reporting has broken due to the ongoing lockdown.”
Institutional delivery, antenatal and postnatal care, immunisation and other services have all been halted, which is certain to have long-term consequences.
Poudel said that her office has been preparing a guideline to run the safe motherhood programme during the Covid-19 pandemic.
With the entire country so focused on preventing and preparing for a Covid-19 outbreak, other ailments, sometimes life threatening, are not receiving the attention they require, say doctors. Many hospitals, even in the Capital, are only looking into emergency cases, and that too, if there are doctors available. Important services that require timely administration, like immunisation for infants, have all but stopped, as nurses and doctors stay home.
With the ongoing measles-rubella drive halted indefinitely, two children have already died and more than 150 others have been infected with measles-rubella in Dhading’s Chepang settlements.
“If children do not get regular immunisation, it will affect their immune system in the long run,” Dr Jhalak Sharma, chief of the immunisation section at the Family Welfare Division, told the Post. “Although the government has not halted the immunisation programme, we have to admit that services are not being provided.”
The nationwide lockdown, enforced by the government to prevent the spread of Covid-19 since March 24, has only complicated matters.
Although the government has declared free movement for health emergencies, there is often no public transportation available and it can be impossible to walk far while suffering from an ailment that requires emergency treatment. Police deployed to enforce the lockdown often do not allow citizens to pass, even if they are headed to the hospital. On Thursday, there was even a report from the Capital of police assaulting doctors for violating the lockdown.
Public health officials say that while the government needs to combat the coronavirus pandemic, other pressing health issues cannot be neglected.
“More people will die of other ailments if we neglect them and focus only on the coronavirus,” Dr Basudev Pandey, director of the Epidemiology and Disease Control Division, told the Post.
The division is responsible for coordinating the public health response to the Covid-19 pandemic, but is also mandated to deal with other infectious diseases. With the onset of summer and the monsoon, cases of diseases like dengue, typhoid, malaria and cholera tend to rise, especially in rural areas where health care is already poor and health professionals are few and far between.
Three cases of malaria have already been detected in people residing in the quarantine zone in Banke, where dozens of people who returned from abroad are housed, and dozens of dengue cases have been reported from several districts, said Pandey.
Last year, a dengue epidemic that started in April in Dharan later spread to 68 districts, killing at least six and infecting over 16,000.
“Cases of scrub typhus and severe acute respiratory problems are also on the rise,” Pandey said. “We are worried that other diseases will kill more people than the coronavirus.”
So far, 16 people, including three Indian nationals, have tested positive for Covid-19 in Nepal, with no fatalities.
The division has alerted health facilities across the country about the risk of other diseases, but the lockdown and the entire country’s focus on the coronavirus are proving to be obstacles.
“We are facing difficulties getting reports from the districts, as health workers are unable to reach health facilities due to the lockdown,” Uttam Raj Pyakurel, vector control inspector at the division, told the Post.
Given the poor state of Nepal’s health care system and the country’s vulnerability to infectious disease, it is vitally important that the government not underestimate the risk of another possible epidemic while dealing with the coronavirus, say public health experts.
“Common ailments like dengue, malaria, seasonal influenza and diarrheal diseases could kill a lot of people,” said Dr Sher Bahadur Pun, a virologist at the Sukraraj Tropical and Infectious Disease Hospital. “We need to take precautionary measures to prevent such epidemics and also work to lessen the plight of patients with chronic conditions who have been deprived of treatment for about a month.”
Frequently asked questions about the coronavirus outbreak
UPDATED as of June 2, 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 6,321,836 people with 375,657 deaths. In South Asia, India has reported the highest number of infections at 198,140 with 5,608 deaths. While Pakistan has reported 72,460 confirmed cases with 1,543 deaths. Nepal has so far reported 1,811 cases with eight 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.