1. Mask Up. 2. Avoid Crowds. 3. Get Boosters

A new surge in Covid cases in Nepal has served as a reminder that the pandemic is not over yet, and on the need to keep masks one, avoid crowds, and get booster shots.

Hospitals have not reported an increase in admissions, and no fatalities from Covid have been reported since March. But highly transmissible new sub-strains like BA.4 and BA.5 have also been detected in Nepal, as they have elsewhere in the world.

“For the most part, people who have been fully vaccinated are unlikely to get very sick from the new strains, there has been no real increase in hospitalisation,” confirms Sher Bahadur Pun, virologist at Teku Hospital in Kathmandu.

The fact that the new sub-strains are all Omicron variants means that, unlike the deadly Delta variant, they mostly infect the upper respiratory tract and not the lungs. Delta was responsible for millions of deaths in India in 2021, and killed at least 8,000 people in Nepal as hospitals ran out of oxygen and vaccines were delayed.

But with 82% of the eligible population now fully vaccinated, Nepalis are now more protected from severe illness. But the virus is still mutating, and scientists are engaged in a cat-and-mouse to stay one step ahead of new strains.

“Covid-19 has proven itself to be even more cunning than we thought. It is clearly still prevalent, and can be life-threatening for some,” warns Buddha Basnyat, physician at the Patan Academy of Health Sciences. “This is not the end of the Covid story.”

That is not to say that the present surge is a new wave. While each new sub-lineage of Omicron is more contagious, they are also milder. That is good news, but asymptomatic infected people are also spreading the virus wider.

While active cases are on the rise in Nepal, hospitalisations are not, and infected individuals could be putting the elderly and those with co-morbidities at risk at home, or at work.

Studies overseas have shown that up to half of those infected with the new sub-strains are asymptomatic. As people travel more this summer and shed masks, the BA.5 and other variants are infecting and re-infecting even those who are vaccinated.

“We must continue to vaccinate and take a booster, especially those who haven’t even had their first shot. It might also be the time to start thinking about a fourth dose for vulnerable populations,” says Buddha Basnyat.

Because ‘immune escape’ is putting more people who have had Covid-19 still at risk of reinfection, scientists are trying to improve the efficacy of vaccines as they try to keep up with mutations of the coronavirus.

“Eventually, Covid-19 will be like seasonal flu, and perhaps we will have vaccines for different strains,” says Sher Bahadur Pun at Teku.

BA.4 and BA.5 were first seen in South Africa, and are currently the dominant strains in Nepal. This is surprising because it is BA.2.75 that was spreading in India last month, and the surge is now peaking there. Whatever happens in India comes to Nepal with a two-week lag,  experts say, and predict the same scenario could play out again here with the present surge.

“Newer strains, and mutations are nothing abnormal but we have to continue to mask up and vaccinate. As for the new surge, it is peaking at the moment and it will have subsided by end-July,” predicts Sameer Dixit at the Centre for Molecular Dynamics.

The Centre is leading Covid-19 gene sequencing in Nepal, and it worked with the Nepal Health Research Council, Birat Nepal Medical Trust, Liverpool School of Tropical Medicine and Oxford to study 1,800 Covid-19 samples collected from all over Nepal in the past year. The findings will be released soon, and could reinforce the importance of genetic sequencing in Nepal so scientists can predict the behaviour of the next variant.

Nepal is also a part of the largest Covid-19 recovery study, currently being undertaken in the UK which has come up with significant findings, including the use of some steroids in the treatment of coronavirus diseases.

But the fact that the new strains are milder does not discount the inherent correlation between health and the economy. Even the best health care systems can collapse as seen in Sri Lanka. Moreover, we now have record inflation brought on by the Russian invasion of Ukraine, which has made healthcare even more unaffordable for most Nepalis.

“Nepal with its limited resources and government indifference needs to be even more prepared for a health crisis, which often spells disaster for those unable to afford treatment,” cautions epidemiologist Lhamo Yangchen Sherpa.

She adds: “The new surge may look mild, but it is always better to be over-prepared than under-prepared.”