Covid-19 will get worse before it gets better

Nepal’s capital has run out of affordable ICU care for Covid-19 patients, but public health experts warn that the worst is yet to come with the onset of the winter season that will see rise in other respiratory illnesses too.

With 4,329 new positives on Friday, total Covid-19 cases in Nepal have reached 126,137, of which 37,832 are active infections. Kathmandu Valley alone accounts for 19,827 of them.

At present, 315 people are being treated in various hospitals across the country in ICU with 77 on ventilator support. Bagmati province has 170 patients in ICU and 58 on ventilators.

Kathmandu has now reached a saturation point for coronavirus patients with exponential growth of positive cases, but the infection rate continue to rise, now at 26.5%.

If that sounds bad, the worst is yet to come. Experts are warning of another surge in Covid-19 cases as well as other respiratory illnesses during the winter season, and as such have suggested that the government to take proactive steps to address it.

At 40°C, SARS-CoV-2 can survive on cotton for less than 16 hours, and on surfaces of glass, stainless steel, paper and plastic notes for up to 24 hours, a recent Australian study has found. At 20°C, the virus survives less than 14 hours on cotton and up to 7 days on the glass, stainless steel, paper and plastic notes.

The findings seem to prove that coronavirus thrives in cold weather, survives longer, thus increasing the risk of infection. But during winter, viruses other than SARS-CoV-2 also become active in the environment for longer period, which then can cause long-term infections.

“People tend to stay in less well-ventilated rooms in the winter and do not wash their hands as frequently because of the cold. This helps the virus enter the body, not only Covid-19 but also other influenza,” says Arpana Neupane of Kathmandu Medical College.

When people get viral infection in the winter, it affects the body’s immune system and also increases the risk of pneumonia. In addition to added risk of Covid-19, people infected with coronavirus are also more likely to develop severe health complications in the winter.

Moreover, infected people might experience symptoms such as coughing for a longer period and even those who have recovered could experience shortness of breath and muscle ache while walking. In some countries including India, lung problems have been detected among recovered populations.

“The virus develops in the body within seven to eight days of the onset of symptoms. The antibodies will then start to kill the virus,” explains Neupane. “While trying to remove the virus from the body, it affects other organs and can lead to complications.”

For asymptomatic and mildly symptomatic Covid-19 patients, Neupane suggests administering the antiviral drug Favipiravir in order to prevent possible complications.

"This antiviral drug plays a role in preventing the growth of coronavirus in the body and resulting complications. It would be better if the government allowed drugs like these produced by Nepali pharmaceuticals to be studied and used,” she says.

Patients with other respiratory illnesses, such as chronic obstructive pulmonary disease (COPD) and other respiratory illnesses, also have a higher risk of getting infected with Covid-19 in the winter. They are also more likely to develop fatal complications.

The prevalence of COPD has been increasing every year in Nepal due to worsening air pollution. According to the Department of Health Services, 211,229 COPD patients were admitted to hospitals for treatment three years ago. This figure has now climbed to 245,768 with Bagmati province having 78,350 of them. Similarly, 948,830 patients were admitted to the outpatient department for the treatment of Acute Respiratory Infection in 2019-20.

Chief Consultant of Teku Hospital, Anup Bastola says even before the onset of the winter season, COPD patients with coronavirus infection already have pneumonia and are being treated in hospitals with oxygen.

In winter, the human body is also drier, and cells in the body's respiratory system are less active, which in turn helps coronavirus survive longer. "The body's immune system is weaker in winter than at other times. Also, it’s not as sunny, which can cause vitamin D deficiency. These factors increase the risk of Covid-19 and the complications it can cause," he says.

This winter, as in other years, cases of influenza (H1N1 and H3N2) and other respiratory infections are certain to increase. Elderly are especially at risk. But because of the explosive rise in Covid-19, patients with other chronic conditions are unlikely to get hospital beds and other essential health services, increasing the risk of fatalities.

Says Bastola: "We have difficult days ahead. We need not only additional hospital beds, but also human resources to provide proper care and treatment. Management of oxygen supply will be crucial and we must do everything to prevent and control infection in the hospitals.”