On Tuesday, Nepal reported an exponential increase in the number of Covid-19 cases detected every day. With 83 new cases in a single day, the country’s Covid-19 tally has now reached 217, and with more and more infections being reported from across the country every day, government officials and public health experts warn that unless Nepalis are allowed to enter the country legally, the number of cases could rise.

According to public health experts, the significant rise in cases can definitely be attributed to an increase in testing and the government’s faith in the results of the rapid diagnostic test kits.

“The increased use of rapid diagnostic test kits is responsible for the spike in the number of cases," Dr Mingmar Gyelgen Sherpa, former director general of the Department of Health Services, told the Post. “We performed a rapid test and let people go home and meet others without thinking that the test is not foolproof.”

Research has shown that rapid tests, which test for the presence of antibodies in the blood, are not very reliable when it comes to testing individuals. The polymerase chain reaction (PCR) tests, which test for the presence of the virus itself, are much more reliable.

According to Sherpa, rapid diagnostic tests should only be used to study the percentage of people infected with the virus and not to assess whether someone is infected with the coronavirus or not.

So far, 78,591 tests—18,964 polymerase chain reaction tests and 59,627 rapid diagnostic tests—have been performed, according to the Health Ministry.

But the increase in testing is not the only reason for the rise in cases, say doctors.

“The government’s policy of preventing its own citizens from entering the country is also to blame,” said Dr Baburam Marasini, former director of the Epidemiology and Disease Control Division. “Had the government allowed its citizens to enter the country through formal channels, documented them, placed them in quarantine for 14 days and tested, the number of cases wouldn’t have increased so much."

Ever since the lockdown was instituted on March 24, tens of thousands of Nepalis have been marooned in foreign lands, unable to return home. While many migrant workers languish without jobs or pay in the Middle East and Malaysia, thousands more are at the border with India. Desperate citizens have even taken to swimming across dangerously large rivers to enter Nepal.

And now that India has relaxed its total lockdown, many are using the opportunity to sneak across the open border into Nepal, sometimes carrying the coronavirus with them, say doctors.

"People have been forced to use illegal channels to enter the country,” said Marasini. “Those who enter the country illegally do not seek testing or treatment as they are afraid of being punished and thus spread the disease to their families and others in the community.”

While numerous countries like the United States, the United Kingdom, France, Australia, South Korea, Sri Lanka and Bangladesh have taken their citizens home on chartered flights, the Nepal government has refused to budge from its decision to refuse entry to everyone, including Nepalis. Countries in the Persian Gulf, like the United Arab Emirates, have already asked Nepal to take their citizens home or face penalties.

As long as the government does not come up with proper measures to allow Nepalis to enter the country legally, the number of Covid-19 cases is bound to increase, say doctors. The rate of increase could shoot up in the months to come, as India continues to report more cases of Covid-19. Both Nepal and India have relaxed the lockdown, leading to much more public movement, which only increases the risk of transmission.

"The only option is to allow citizens to come in through formal channels and place them in quarantine,” said Sherpa. “More polymerase chain reaction tests should be performed and the government needs to prepare for the worst."

Government officials too admit that the policy of restricting Nepalis from entering the country might have been misguided and has contributed to the spread of Covid-19 in Nepal.

“Yes, we have to rethink our decision to prevent people from entering the country,” said Dr Bikas Devkota, spokesperson for the Health Ministry. “This decision has only increased the risk of transmission in the country.”

In order to deal with the increased number of cases and the potential for more in the days to come, government officials say that they will now be pursuing new models of isolation in order to make sure that the health infrastructure is not overwhelmed.

Semi-isolation and home isolation models will now be instituted, as hospital beds will not be able to hold all patients if cases rise at the current pace, say officials.

"First, we will adopt a semi-isolation model," Dr Roshan Pokhrel, chief specialist at the Health Ministry, told the Post. “We will adopt a home isolation model if more people get infected at once and the semi-isolation model does not work."

In the semi-isolation model, Covid-19 patients who do not display severe symptoms or are asymptomatic will be placed in under-construction and unused buildings, government godowns or schools buildings, according to Pokhrel.

“For home isolation, we will ask asymptomatic patients to stay home and contact health facilities only if they have complications,” said Pokhrel. “America and countries in Europe have adopted this model and we too are preparing for such a scenario.”

Though the health condition of all patients tested positive to coronavirus is said to be normal, officials at the Health Ministry expect a deterioration in some patients who may need oxygen and ventilator support in the coming days.

The Health Ministry has also been collecting more nasal and throat swabs for polymerase chain reaction tests from Covid-19 hotspots, including Udayapur, Birgunj in Parsa, Nepalgunj in Banke, Rupandehi, Kapilvastu and Bardiya.

But as the government has expanded testing and more people continue to enter the country, Devkota warned that more cases are likely to be detected in the days to come.