Nepal needs to prepare for new Covid wave

After a dozen or so people were admitted to a hospital in Delhi with suspected omicron strain of Covid, neighbouring Nepal is on a high alert fearing a similar outbreak that ravaged the two countries earlier this year.

Although the new variant is said to be more transmissible and resistant to existing vaccines, the good news is that those infected have only reported mild symptoms.

Studies the European Centre for Disease Prevention and Control (ECDC) have found out that the omicron strain was already circulating in Nigeria from October, and it was already in Europe before flights arrived from South Africa last week.

Until more is known about the new virus strain, public health experts in Nepal have recommended that people get vaccinated if they have not done so already, wear masks and avoid crowds for now. The WHO on Thursday advised those above 60 and with co-morbidities to avoid air travel for now.

Epidemiologists have recommended strengthening safety measures over travel restrictions, which is often too late to entirely stop the surge as seen during the devastating second wave in the subcontinent. Nepal has issued travel ban on eight African countries and Hong Kong.

“General people are now letting their guards down, public places are most crowded than during normal times, people have all but forgotten about social distancing, and masking has become minimal,” says virologist Sher Bahadur Pun at Teku Hospital.

Mutations are natural but the higher the spread of the existing virus, the higher the threat of more virulent variants to arise. Public health experts have blamed the rise of new strains on inequitable vaccine distribution globally.

Roughly 30% of Nepalis are now fully vaccinated and with 30 million more doses of various vaccines in the pipeline, the Health Ministry has set a goal to vaccinate the entire targeted population by mid-April. The government has also expanded vaccinations to everyone above 12.

Nepal’s vaccine infrastructure and network of community health workers have played a significant role in reaching the far corners of the country with Covid-19 jabs. But now the challenge is to increase vaccine acceptance among those who have so far refused to take it.

This means better communicating pandemic risks and training more healthcare workers to administer the vaccine. The information that is regularly shared through the Viber group, composed of hundreds of health officials and open to the public, is not necessarily accessible to everyone due to language barriers.

“Covid related information is either in English or Nepali, people who don’t speak either have a hard time accessing them. Language equity has been a major issue,” says Bijay Acharya of the Nepal-Johns Hopkins University Advocacy Group, adding that this has also exacerbated misinformation spreading through Whatsapp and Facebook as people attempt to informally translate and interpret information about the virus.

Lack of translation can also affect the ability of community health workers, who act as the front line of information about the pandemic, to counsel their communities on the vaccine and how to best protect themselves.

In what is now termed as ‘vaccine discrimination’, the US, Australia and the majority of the European countries do not recognise all the Covid vaccines equally. Such discrepancies have been most notable in the case of labour migrants and foreign students who have been barred from their station because they didn’t receive mRNA vaccines such as Pfizer or Moderna.

“Even those who are fully vaccinated with a viral vector booster will only be considered partially vaccinated and there will be lot more issues like this in the future,” adds Acharya.

China’s VeroCell is still largely unaccepted while Indian-made Covishield is not recognised even in countries that accept AstraZeneca. This is unfortunate at a time when Omicron with multiple mutations in the spike protein is on the rise. mRNA vaccines primarily target this protein, rending it ineffective against the new strain.

Experts say that only VeroCell, Covaxin which is manufactured by Bharat Biotech, are made from inactivated viruses and are better placed to ward off new spike proteins in mutants.

The pandemic has also affected routine childhood immunisation in countries like Nepal. Lockdowns and fear of contracting the virus have stopped many parents from travelling to health clinics for measles, polio, whooping cough or tetanus shots. Nepal has also seen a rise in  maternal and infant death rates during the pandemic due to reduced institutional deliveries.

Officials say it will be important for the Nepal government to be prepared with oxygen, ICU beds, medicines and medical staff to prepare for a new Coid-19 surge in spring. A measurement widely used by epidemiologists, called excess mortality, is applied to contextualise the differences in deaths during a pandemic compared to a normal year.

Excess mortality data, however, may not be applied in the case of stateless people, have no documentation or property and where families have no interest in reporting deaths. There might also be deaths that cannot be recorded or accounted for. Nonetheless, this will help governments prepare for economic slumps and with informed decision-making.

Adds Acharya: “Excess mortality data can be used to predict the future and inform future preparation. Just looking at excess deaths in Nepal in the past five years will give us a good idea about how to respond to pandemics.”