3rd wave in 2 years

It was on 23 January 2020 that the first Covid-19 case was detected in Nepal. Two years later, the country is on the cusp of a third wave.

The time to sound an alarm about a new surge is long over. Action should have been taken months ago. All the government can do now is to launch a massive campaign to inoculate the unvaccinated, offer boosters to frontline workers, the elderly, and people in densely populated areas.

Evidence elsewhere, including in neighbouring India, show that while the Omicron strain is 12 times more transmissible than previous variants, most of those infected do not need critical care in hospitals – unless unvaccinated or immuno-compromised.    

Cases are rising fast in Nepal, doubling every 2 days to 3,075 new recorded infections on Wednesday. The positivity rate has soared 10 times in a week to 23.5%. At this rate, there will be 12,000 new confirmed cases by 16 January, which will be higher than the peak of the second wave in May 2021.

“With Omicron now spreading in the community, we don’t need to gene sequence anymore,” says Epidemiology and Disease Control Division director Krishna Prasad Paudel.

He is hoping Omicron will show a similar trajectory to elsewhere, and those infected will have milder symptoms compared to Delta. The new variant mostly impacts the upper respiratory tract, with lungs largely unaffected, hence lessening the need for oxygen and ventilators.

However, Nepal’s low vaccination rate (50% partially, 40% fully) means that individuals need to continue taking precautions with masks and distancing.

Read also: “Nepal has all the conditions for an Omicron surge”, Nepali Times

A double dose of the vaccine is not as effective against Omicron, and most Nepalis have passed six months since they were inoculated, meaning that their antibody levels have fallen considerably by now. Boosters would provide more protection, but the government is only offering those to high risk groups from next week.

Although Omicron is now the dominant strain, Delta is still circulating, and causing deaths. We know from the past two years that it takes a few weeks for mortality to pick up after cases start rising. This has been seen in India, and Nepal closely follows health trends there.

“We need to keep a close watch on our mortality figures, find out which variant is causing most deaths, and we will have to prepare hospitals and healthcare workers once again,” warns epidemiologist Lhamo Yangchen Sherpa of IPAS.

Across Nepal, many rural hospitals are still understaffed and do not have trained personnel to operate ventilators and run ICU wards. Not all new oxygen plants are functional yet.

But Sangeeta Kaushal Mishra of the Health Coordination Division assures that the government is in a better position this time: “We are prepared for hospitalisations if cases are milder, but we don’t know how the virus will behave."

The sheer transmissibility of Omicron could mean severe symptoms and even deaths among the elderly and those with pre-existing conditions like diabetes.  Elsewhere in the world, even vaccinated health workers have been infected, overwhelming hospitals.

Read also: “All vaccines prevent severe Covid”, Nepali Times

The first line of defence against Covid is still masks and distancing. The second is mass vaccination. Nepal still has a stockpile of over 10 million doses in refrigerated stores, and 6 million more doses in the pipeline. A syringe shortage reduced the vaccination rate, but Mishra expects the drive to pick up next week. More than 200,000 people were vaccinated on Wednesday.

“We were lucky Omicron is mild, but we should use this  opportunity to inoculate both the unvaccinated and boost the  vulnerable on war footing,” says physician Buddha Basnyat of Patan Academy of Health Sciences.

The government is starting mass inoculation of children from 12-17 years, and has shut down schools for three weeks until 29 January due to the new surge. Gatherings of more than 25 people have been banned, masks are mandatory outdoors, and people will need vaccine cards to enter public spaces from next week.

“The fact that Omicron is much milder has made people even more careless, so we must once again reinforce the importance of masks, ventilation and distancing,” warns virologist Sher Bahadur Pun at Teku Hospital.

Equally important is the institutional isolation of active cases and contact tracing. Experts believe official figures are under-reported and total cases and fatality figures are much higher. 

The Economist tracks ‘excess deaths’ across countries and estimates that 2.3 million people had died from Covid-19 by May 2021 in India, compared to only 200,000 official fatalities.

Its calculations show that when Nepal recorded its highest daily Covid deaths of 246 on 19 May 2021, the actual number was 425. The real infection rate was also much higher than official data.

Read also: Living with Covid in 2022, Sonia Awale