Without proper contact tracing, the lockdown will have little effect, doctors say
Public health experts warn that failure to expand contact tracing, especially in Covid-19 hotspots, and not testing all suspects could be costly. A health worker draws blood for testing. Post file photo
On Sunday, 15 new cases of Covid-19 were detected in Nepalgunj, the highest number of coronavirus infections reported in the country in a single day so far.
All of Nepalgunj’s 15 cases were related to those previously identified in the city, according to Dr Basudev Pandey, director of the Epidemiology and Disease Control Division.
According to public health experts, the identification of the new cases points to a glaring failure on the part of the government to adequately trace the contact of all those who were previously infected with Covid-19. Even in cases where contacts have been traced, health officials have not conducted testing, despite the fact that most positive cases in the country have been asymptomatic.
“It would be a blunder to think that the virus can be contained simply by extending the lockdown,” said Dr Bhagwan Koirala, chair of the Nepal Medical Council. "The lockdown only gives us time to prepare.”
According to doctors, the government needs to take active measures to trace and test everyone who has come in contact with those infected with the coronavirus.
However, adequate contact tracing is not taking place, public health officials say.
It was only a week after the outbreak of Covid-19 in Triyuga Municipality in Udayapur district that officials from the Epidemiology and Disease Control Division reached the area. Up until then, local health workers had neither training nor the proper forms to conduct contact tracing.
"We only received training and got the forms after officials from the division came here," Krishna Prasad Khatiwada, a health worker in Udayapur, told the Post over the phone.
By the time contact tracing began, 28 people had already been infected with Covid-19.
Health workers had collected nasal and throat swabs of around 300 people for tests and declared contract tracing complete.
“But we searched again for people who had come in close contact with the infected, we found an additional 30 people,” said Khatiwada.
The Health Ministry has given the responsibility of contact tracing to the local level, which lacks human resource, training and supplies. Officials deployed in Udayapur conceded that health workers serving at the local level lacked basic knowledge of contact tracing.
"We found that they have not been able to explore deeply to trace the contacts of all those who came in close contact with infected people,” an official at the Health Ministry who was deployed in Udayapur told the Post.
Public health experts say that chances of Covid-19 continuing to spread are very high, if even a single person is missed.
The Health Ministry has been using a mobile application, ‘Hamro Swasthya’, and the webpage covid19.mohp.gov.np, where people can enter their personal details voluntarily.
As of Monday, over 30,468 people had entered their details, and among them, 328 people were from the ‘red zone’ meaning they could be infected with Covid-19.
The Epidemiology and Disease Control Division and provincial health offices have been monitoring their health, according to Dr Bikash Devkota, spokesperson for the Health Ministry.
But it is not just a failure to trace contacts; the practices adopted after tracing individuals are not adequate either, say doctors.
During the process of contact tracing, doctors involved in the treatment of Covid-19 patients collect the details of all those who came in contact with them. This information is passed on to the health workers at the local level, who in turn meet with the individuals identified and ask them to stay at home and take precautionary measures. If they display any symptoms, they are placed in isolation.
According to doctors and going by international practice, all those who came in contact with infected patients need to be tested. But in Nepal, contacts are not tested unless they develop symptoms, despite the knowledge that many cases in the country have been asymptomatic.
Dr Anup Subedee, a consultant infectious disease physician, said that even a minor mistake could be costly.
"The government should train health workers serving at the local level, activate all channels, including female community health volunteers, for contact tracing, ensure smooth supply of reagents, and increase testing of all suspects,” Subedee told the Post. "We do not know if any of that has been done."
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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