Microcosms of a pandemic

Every day, many Nepalis across the country religiously tune in to the Health Ministry’s website, Facebook or Twitter at 4PM. It is the same grim statistics every day: another day, another record that should not be broken.

On Wednesday, Nepal registered 8,659 new cases and 58 fatalities. The number of active cases is now 66,352 – a hundred-fold increase from mid-March. Half of everyone who gets a PCR test is Covid-19 positive.

These numbers may seem low compared to neighbouring countries like India, but in proportion to the population, it is one of the highest in the world: 211 per 1 million population. In India the figure is 278, but in both countries the tally is said to be a gross underestimate. The virus is also replicating faster in Nepal than in India, and most other parts of the world.  

“Nepal saw 127% increase in infections this week, the pace of the spread of Covid-19 here is much higher than most of the countries in the world,” said Archana Shrestha of Kathmandu University during the Ministry of Health’s daily briefing on 5 May.

All seven provinces had more than a 100% rise in infections with Gandaki reporting a whopping 384% increase. Similarly, test positivity was highest in Karnali at 67.9%, much higher than in Bagmati where it was 25.9% on Wednesday.

The second wave with new and deadly variants breaking across Nepal has devastated the country. Oxygen cylinders are in short supply, doctors are overwhelmed with patients and families are running from hospital hospital to find beds for the sick. The death toll has soared to 3,475.

Kathmandu’s only electric crematorium at Pashupati in Kathmandu, designated for Covid-19 patients could not handle the increasing number of fatalities even while running round the clock. Officials had to arrange pyres for coronavirus dead on the banks of the Bagmati.

Nationwide, 4,764 Covid-19 patients are in hospitals, 600 of them are seriously ill, requiring ICU treatment and 156 more are on ventilator support. Unlike last year, most of them are in the 25-39 age group. 

The Health Ministry has procured 128,000 vials of remdesivir, and 4,000 more are on the way. However, the antiviral medication that many desperate families try to get for sick relatives, has not been proven to save lives even though it reduces hospital stay of patients.

With over half of new cases concentrated in Kathmandu Valley (Kathmandu, Lalitpur and Bhaktapur recorded a combined total of 3,835 cases in the past 24 hours), hospital beds and oxygen cylinders in such short supply in the capital. But the situation in provincial and district hospitals is even more dire. 

The Tarai districts bordering India have been ravaged by the virus, as Nepalis returning from India brought the disease back. But by now it has moved up to the mountains as well, and is spreading in rural communities with rudimentary medical services. 

In Banke district, the positivity rate is as high as 70% and one-third of them require hospital admission, doctors and nurses with Covid-19 are forced to care for patients undergoing treatment for the same disease in Banke district.

Physician Prakash Bahadur Thapa at Bheri Hospital told Nepali Times on Tuesday: “In the coming days, it will be the availability of oxygen that will determine how many live and how many die.” 

With no help coming from Kathmandu, the Covid-19 hotspot of Nepalganj has converted its district training centre into an isolation ward and treatment hub with 50 oxygen-equipped beds. The idea is to take the pressure off the district’s two designated Covid hospitals: Bheri and Nepal Medical College in Kohalpur which are treating patients from all over Karnali and Far-western Province. 

Nepalganj spent Rs2 million of the city’s own budget to set it up and staff it with doctors and nurses who work in three shifts. Patients are provided free food and ambulance service.

In Biratnagar, the head of Kosi Hospital Chumanlal Das and his staff are working day and night. “Test positivity rate is extremely high,” he said during the Ministry of Health’s briefing in Kathmandu on Wednesday.

Over 50 districts in Nepal are now under some form of lockdown. With hospitals at full capacity, the government has advised citizens that they have to protect themselves.

With the federal government waving a white flag, local municipalities and wards are setting up their own isolation wards. Nepal Engineering College and the local government in Changu Narayan of Kathmandu Valley has set up a 100-bed isolation centre, neighbourhoods in Patan have added small wards with oxygen for patients who cannot find a hospital. Butwal has established an oxygen bank and independent activists have set up free services for those in need.

Collectively, local initiatives are stepping in to fill the gap left by the government. But public health experts say the only way out of the pandemic is mass vaccination and personal precautions. 

They say the lockdown period should not be allowed to go waste again, and the government must step up tracing and testing, expedite vaccine procurement and launch a massive public awareness drive. 

Subcontinent under seige

It is not just Nepal, the Subcontinent itself is reeling under the new surge that threatens to reverse global gains in health, education and nutrition and has a disproportionate impact on children.

Disruption of essential health, immunisation and nutrition services during the first surge in South Asia cost the lives of an estimated 228,000 children and 11,000 mothers, according to UNICEF. 

“We may be exhausted, but the virus is not yet exhausted,” warns George Laryea-Adjei, UNICEF Regional Director for South Asia. “Now more than ever, we must commit ourselves to wearing masks, handwashing with soap as often as possible, keeping physical distance and getting ourselves vaccinated if we have the opportunity to do so.”

Effective contact tracing has also been noted as a much faster and cost-effective way than lockdowns and prohibitory orders in reducing transmission and controlling the pandemic.

Says Archana Shrestha of Kathmandu University: “We have over 8,000 new infections a day but we have only reached the first of the third phase of the new wave, we have to survive through the rest. But stringent contact tracing can reduce 85% of infections.”

Covid Helpers

To donate to the group setting up isolation centres in Kathmandu

America Nepal Medical Foundation: http://anmf.org/

For any information regarding Covid symptoms, how to take care at home etc

Covid Alliance for Nepal: 9880035000 (8am to 8pm)

For Ambulance

24-hour free Covid ambulance service: 9851277342, 985123942, 9851312417

Free ambulance service from KMC: 1180

For oxygen

Hamro Team Nepal: 9851102652 9851102653: 9851102654, 9841669170, 9851054280, 9741710493

For bed with oxygen:

Youth for Nation: 9861116456 ,9857030887 ,9841309599,9863322793

For Bed:

Siyana Karki  9841730903

Dr Utsav Timilsina  9847023345

For Oxygen :

Anil Rijal  9847297745

Shisir GC 9857025765

For ICU :

Arjun Chand 9851206644

Dr Amrit Bhusal 9841375180

For food:

Juju Kaji: https://www.facebook.com/kajijuju 

Covid-19 hotline service: 113 (8am to 8pm), 1115 (6am to 10pm), 9851255839, 9851255837

The list has been compiled based on the information available on social media.

Updated covid directory: https://www.facebook.com/groups/453859702218765/permalink/573621080242626/