Open and shut case


Nearing the 15th week of the lockdown is a decisive milestone to take stock of how Nepal is positioned vis-a-vis the coronavirus pandemic. 

The epicentres have been shifting across the world, with some  countries like the United States “knee-deep in the first wave”, as the country’s top infectious diseases expert Anthony Fauci described it this week.

Brazil’s President Jair Bolsanaro, who refused to let his country deal seriously with the pandemic even as it became the country with the second highest death toll, himself tested positive this week. In India, the virus has spiked in the country’s metros with record daily cases just after Prime Minister Narendra Modi started relaxing the lockdown last month. 

However bad it may seem at the moment, Nepal is not doing too badly. Its PCR test rate in one of the highest in South Asia, the fatality rate is low, hospitalisation and ICU admissions are not above normal.

Public health experts say the positivity rate is going down and the total case load is plateauing.

Physicians, however, are not as optimistic. They have always pooh-poohed the idea that Nepalis have greater immunity because of our diet, or exposure to germs. The reason the case load is low, they say, is because there still have not been enough tests. And they warn that Nepalis are predisposed to diabetes and cardio-vascular diseases, and the prevalence of tuberculosis puts the whole population at high risk. The virus could just be waiting to strike. 

But one thing both agree on is that full re-opening is not advisable even after the ‘eased’ lockdown is over on 22 July, and a full scale public awareness campaign should be launched about wearing masks in public and physical separation. The government seems to be listening — on Tuesday it announced fines and punishment for those caught without masks in public.

The dilemma for governments everywhere has been to balance lives and livelihoods. Countries that have lifted lockdowns too early have paid for it with a resurgence, those which maintained strict lockdowns without widespread testing have squandered the sacrifice made by their citizens. As fear of hunger overcomes the fear of the virus, some leaders opened up dreading public anarchy and loss of political control. 

The countries that have done well to quell the virus are the ones where politicians and technocrats have taken the advice of scientists, weighed the pros and cons, communicated clearly with their citizens, and eased restrictions in a carefully calibrated manner. 

In Nepal, the government of Prime Minister K P Oil has been so busy with political fire-fighting that his administration has bungled the response. In a quintessentially Nepali way, the government has muddled along with no real plan. Worse, it has allowed greedy politicians, bureaucrats and crony businessmen to profit from the pandemic.

From the very start, it got the wrong testing kits. It was not prepared for the influx of returnees from India, it delayed overseas repatriation flights causing misery to tens of thousands of Nepalis stuck abroad. Even when it got the right PCR kits, they were not compatible with the machines already here. Valuable time was lost, and at one point there were 35,000 swab samples piled up at testing centres. 

Even then, it refused to allow private labs to conduct tests. It did not want to listen to specialists who offered a cheap solution — get cartridges for the 100 GeneXpert PCR machines that are already there for TB surveillance.

And the latest scandal this week is that the Ministry of Health has been trying to cover-up its incompetence in the counting process which resulted in some government labs in Patan and Dhangadi showing 100% positivity rate on 1 July and 3 July. It did not even notice the error in its own daily tabulation, and when it did, tried to sweep it under the carpet.

As we go to press on Thursday evening, the total number of confirmed cases have risen to 16,531, with about 8,700 in isolation and 24,000 in quarantine centres. There have been 35 fatalities so far, mostly dying of co-morbidity. Most cases are asymptomatic, and there has been no marked increase in hospitalisation. 

The good news is that quarantine centres are emptying as the number of returnees from India goes down. 

The bad news is that the number of positive cases in Kathmandu is going up. Surveillance testing of focus groups and in crowded parts of the Valley may show community transmission.

If that is the case, there is only one way out: test-isolate-trace-treat. 

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