Unmasking the second wave

As Nepal plunges headlong into the second wave of Covid-19, the new surge is infecting more young people and children than before and making them sicker. This has raised fears that the highly contagious and sometimes deadlier UK variant B.1.1.7 is now spreading in the community.

Despite this, Nepalis celebrated New Year parties this week and thronged town squares in the Valley for various festivals, like the Biska and Sindur Jatra (pictured above).

Prativa Pandey of the CIWEC Clinic says, “We are allowing political demonstration and festival celebrations as if there is no second wave, leaders must set an example of what is acceptable and what is not.”

Of the 603 new cases confirmed on Wednesday, 70 were children under the age of 20. Twenty-six of them were identified with the new UK strain. In the last 48 hours, 118 people below the age of 19 tested positive for Covid-19 (see graph).

As feared, the B.1.1.7 variant is rapidly overtaking other strains in South Asia and in Nepal, and the latest surge in positive cases across the country has been blamed on the spread of this strain among a younger population.

Supporting this claim are recent studies that have found higher prevalence of S- negative in representative samples. Absence of detection of the S-gene target, failure (SGTF) can be a sensitive surrogate of B.1.1.7.

Of the 76 samples collected in Kathmandu last week, 48 were found to be S-negative, 20% of which were of people under 20. Of 176 samples collected in Pokhara, 105 were S-negative, and 51 of them were in the age group 10-14.

"Looking at the figures of the last two weeks, we can see that up to 18% of those infected are children," says director of Kanti Children’s Hospital R P Bicha. "In the age group 10-18, who represent some 60% of positive tests, detection of lethal variant is riskier.”

It is clear that the younger groups are at most risk of infection as was the case during the first wave. The difference between then and now is that they are getting infected with the more virulent and lethal variants of the coronavirus, adding to the risk of higher mortality rates.

“It is time we prioritise younger populations and school-going children for vaccinations as they are out and about and taking home the virus,” says epidemiologist Lhamo Yangchen Sherpa, adding that it is advisable to shut down schools, unless they can assure safety measures.

Prime Minister K P Oli in his New Year message on Wednesday said if the public took precautions, a new lockdown could be avoided. However, it does not look like the public is taking that caution seriously.

Active cases nationwide now stand at 4,056, up sharply from 562 in late February. Positivity rates are also increasing, from 4% two months ago to nearly 13% of those tested. Kathmandu Valley accounts for nearly half of the daily new cases.

The government has released dates for the second dose for those who were inoculated against Covid-19 in the first phase of the vaccination drive. With 500,000 Covishield in stock, a total of 438,000 health workers, security personnel, civil servants, journalists and dignitaries will be administered the booster shots from 20-24 April.

But the government has run out of vaccines for the next phase. Altogether about 2 million people have received the Indian Covishield and Chinese VeroCell shots so far. But 1 million Covishield vaccines that Nepal has already paid the Serum Institute of India is stuck, as is the promised consignment  of nearly 2 million doses under the COVAX initiative.

The Health Ministry is also planning to provide second shots for some 1.3million people above 65 who were inoculated in the second phase from May 16. But this will require India to lift the export ban on Covishield.

Public health experts also warn that much of the government’s focus has been on the UK variant even as neighbouring India is being hit by other strains, including the double mutant and South African variants.

The Health Ministry has confirmed the detection of a double mutation pattern in Lalitpur. "This is proof that variants are spreading rapidly in Nepal as well." says director of the Epidemiology and Disease Control Division Krishna Paudel.

“The government should work immediately on analysing and identifying variants other than the UK strain, as we have found that vaccines are ineffective against some,” says Lhamo Yangchen Sherpa. “Our vaccine drive will fail unless we continue to test, follow safety measures and develop infrastructure to study new variants.”