The government has sought assistance from India for the supply of oxygen, antiviral drugs and intensive care unit beds, as the country’s healthcare system is cracking under the pressure of the rising coronavirus caseload.

According to officials, a request to that effect was made to New Delhi by the Ministry of Health through the Ministry of Foreign Affairs. The Nepali embassy in New Delhi has already started taking up the matter with concerned Indian government agencies, officials said.

“We have received a list of requirements from the government and have forwarded them to relevant [Indian] government agencies,” a senior Nepali diplomat at the Nepali embassy in Delhi told the Post over the phone.

The list of requirements includes oxygen, Remdesivir and intensive care unit beds.

The request, however, has come at a time when India itself is struggling to contain the lethal second wave of the coronavirus, with the daily count of infections soaring over 300,000 and the number of daily deaths hitting a record 2,263.

Public health experts say the request to India at this time exposes the government’s lack of preparedness against the looming second wave about which they had consistently warned.

That the second wave of the coronavirus was going to strike was evident when India, after a decline in the number of infections, which many termed “miraculous”, started reporting a sudden resurgence of the virus. The daily count started to shoot up at an exponential rate. Concerns had grown in Nepal, but authorities by and large made no moves, while governance took a backseat as politicians, including Prime Minister KP Sharma Oli, engaged in a bitter political fight.

Nepal too had seen a sudden decline in the number of cases after the daily count hit the highest ever on October 21 last year at 3,439. But from less than 100 new infections on March 12, the country on Thursday reported 2,365 new cases.

The Ministry of Health said on Friday the number of new cases in the past 24 hours hit 2,449, with five deaths.

Officials say the country’s health facilities are already overwhelmed, with hospitals running out of intensive care beds, oxygen and Remdesivir.

About a few weeks ago, when India decided to impose a ban on exports of Remdesivir, Nepali officials said Nepal won’t be impacted much by the decision, and it was importing the antiviral drug from Bangladesh as well.

Public health experts, doctors and analysts say India is no doubt a friendly country but extending a begging bowl at a time when the neighbour itself is struggling to deal with one of the biggest humanitarian crises of its own just does not make sense.

“Why not procure some items like Remdesivir from Bangladesh, as it is manufactured there as well,” said Dr Baburam Marasini, former director of the Epidemiology and Disease Control Division. “The government can purchase small oxygen concentrations also from East Asian countries like Thailand and Malaysia.”

As the coronavirus cases are swelling, there are concerns about hospitals running out of oxygen. Out of 185 hospitals across the country, only 26 have oxygen plants and not all of them are in operation.

As far as intensive care unit beds are concerned, their number currently stands at 1,486 throughout the country. The number of general beds which can be allocated for coronavirus patients stands at 18,917.

“Until now, as far as I understand, we have a fairly good stock of oxygen, but we might need more. However, there is a need to preserve what we have, as there are chances oxygen, which is in high demand in India, could be smuggled out.”

According to Marasini, the government must be careful about any possible hoarding and blackmarketing of medicines and oxygen.

“The government must explore multiple options to meet the demand for necessary items instead of looking to just India,” said Marasini.

Media reports suggest that amid the sharp rise in the number of cases, India is badly gasping for oxygen. On Wednesday, Delhi High Court told the Indian government to “beg, borrow or steal” and arrange oxygen.

“It’s your job to get oxygen,” the court ordered the Indian government, according to media reports in India.

Some reports suggest that India’s oxygen crisis is graver than it is thought.

An investigation by scroll.in, an Indian news portal, on Thursday suggested that India's oxygen reserves are fast depleting.

“Based on current demand, it may run out of stocks in a few weeks even if all oxygen is diverted to medical use,” the portal said.

In such a scenario, whether India will be able to fulfil Nepal’s oxygen request is not certain. The Serum Institute of India, the world’s largest vaccine manufacturer by volume, has yet to supply 1 million doses of vaccine for which Nepal paid for in February. Though the Nepal government had signed a direct deal with the Serum Institute to procure 2 million doses, the private manufacturer has expressed its inability to supply the remaining 1 million doses after the Indian government put a ban on exports of the vaccine.

There are concerns if the Indian government will address Nepal’s request for the supply of oxygen and other items like intensive care unit beds for which it itself is struggling at a time when it has not delivered the vaccine doses.

The government’s move to seek assistance from India is reactive, say foreign policy watchers. The pandemic has brought the world down to its knees and it’s not good to seek support from the neighbours all the time when they themselves are under immense pressure, according to them.

“India itself is struggling to cope with the pandemic and we do not know what is happening inside China, as mobility with China has been restricted,” said Bhekh Bahadur Thapa, a former foreign minister and ambassador. “Our government should have been proactive in dealing with the pandemic.”

According to Thapa, Nepali system has been historically lethargic and slow.

“Everyone knows that this pandemic is a global crisis and every country has been hit hard. There was denial that the second wave was coming,” said Thapa. “Seeking support at the last moment when the crisis is just about to overwhelm us does not help.”

Nepal has received the support of both of its giant neighbours—India and China— recently in its fight against the virus.

Earlier in May and August last year, China had donated medical supplies to Nepal besides 800,000 doses of Covid vaccines to Nepal as a grant. India too has provided different materials and equipment to support Nepal in its fight against the pandemic.

In January, Nepal became one of the first countries in the world to launch its vaccination drive with the 1 million doses of Oxford-AstraZeneca vaccine, which is manufactured by the Serum Institute of India under the brand name of Covishield, the Indian government had provided under grant assistance.

Nepal so far has inoculated around 1.9 million people against Covid-19. It currently has a little less than 300,000 doses of Chinese Sinopharm vaccine, of the 800,000 doses that China provided under grants.

Nepal needs to inoculate 72 percent of the 30 million population, but there is no certainty when the government could acquire new consignments of vaccine.

The Health Ministry says it has approached most of the countries manufacturing the coronavirus vaccine, but no countries and companies have responded in an affirmative manner.

Nepal so far has granted emergency use authorisation to four vaccines—Oxford-AstraZeneca, China’s Sinopharm, Bharat Biotech’s COVAXIN and the Russian Sputnik V.

Dr Roshan Pokhrel, chief specialist at the Health Ministry, said private firms have been allowed to import the Russian vaccine but so far no one has applied.

According to him, the supplier of the Russian vaccine has quoted Rs2,600 for two doses and Bharat Biotec’s COVAXIN has proposed Rs1,800 for one dose of vaccine.

Besides, the Health Ministry has also approached a South Korean company, via diplomatic channels, which produces the Oxford-AstraZeneca vaccine, to sell the jabs to Nepal.

“We need vaccines and we have a budget as well,” said Pokhrel. “The problem is there is no availability of vaccines.”

The Health Ministry expects around 1.6 million doses of AstraZeneca vaccine under the World Health Organisation-backed COVAX facility within May.

Authorities plan to use the 1 million doses that the Serum Institute is yet to supply to administer the booster shots to those who took the first dose in March in the second phase of the campaign.

“If we get 1.6 million doses under the COVAX facility, we can also administer the first dose to people between 60 and 65 years of age,” Dr Shyam Raj Upreti, coordinator of the Covid-19 Vaccine Advisory Committee, told the Post.

Arjun Poudel contributed reporting.