Too early for Nepal to let its guard down

UPDATE: The Kathmandu District administration on Thursday decided to put off the reopening of in-person classes, citing that new Covid-19 cases have not dropped as expected. 

On 5 September, for the first time in nearly five months, there were less than a thousand daily new Covid-19 cases. Since then, new infections per day have mostly stayed below 1,500. 

The rate of infection is also dropping below 9%, and schools in Kathmandu which have remained closed for nearly two years are scheduled to reopen  rom next week. Cinema halls, bars and clubs are already up and running as if it is all over. 

In fact, most Nepalis seem to think the pandemic is over. But it is not. The infection rate is still several times higher than most parts of the world, and with the festival season around the corner there is a danger of a repeat of last year.

Face-to-face classes online, Dinesh Paudel 

About this time in 2020, the government also loosened the lockdown and there was an increase in social and economic activities. Millions travelled from Kathmandu to hometowns, or returned from India ahead of Dasain-Tihar, spreading the virus and eventually leading to the first wave. The only difference this time is that we have vaccines. 

“Given the vaccination drive and natural immunity in the population, there might not be another big spike in near future, which also means fewer hospitalisations,” says virologist at Kathmandu’s Teku hospital Sher Bahadur Pun. “But transmission and breakthrough cases will continue.”

Indeed, Pun narrates a case of his colleague who was fully vaccinated but was infected by Covid-19. His symptoms were not serious, but both his parents were infected next and succumbed to the virus.

The much more contagious Delta variant, which was responsible for the devastating second wave in the Subcontinent, is still circulating in the community, and is the dominant strain of the novel coronavirus in Nepal.

Studies have shown that even vaccinated people can be infected with the Delta variant and spread it. Jabs do not prevent transmission, they just reduce the seriousness of symptoms. And with the vaccinated population still low in many countries, the virus can replicate and mutate further into even more virulent strains.

The Health Ministry’s recent sero-prevalence study has revealed that nearly 69% of people have SARS-CoV-2 antibodies, and therefore have natural immunity against the virus. This means quite a large section of the population has been infected in the past, and have developed resistance to the virus. 

To boost or not to boost, Buddha Basnyat

But experts say that this is a misinterpretation and can cause people to disregard proven preventive measures, including masking and vaccination.

Sero-prevalence surveys like the recent study were designed to detect antibodies to measure the spread of the virus in the community. It does not mean people are immune to the virus, and even with vaccinations, ‘breakthrough infections’ of the Delta variant are possible. 

Also, the survey does not show how long after the participants were infected that antibodies were detected in them. This is important because natural immunity lasts up to eight months.

“The key is to vaccinate as many people as possible,” adds Pun, and Nepal is catching up with its inoculation drive. Close to 20% of Nepal’s 30 million people have now been fully vaccinated, and this figure will likely reach 30% by Dasain and 40% by December. 

More vaccines are arriving, including 100,000 doses of BioNTech’s Pfizer through the COVAX initiative for which ultra-cold refrigeration storage is being installed. There are also two new vaccines under trial in Nepal: a Chinese messenger RNA (mRNA) jab, and another developed by Sonafi, a partnership between a French company and UK’s GlaxoSmithKline.

Despite this, experts warn that it is not a time to let our guards down. “It is always better to be overprepared than underprepared,” says Buddha Basnyat, a physician at Patan Academy of Medical Sciences. “We must continue wearing masks and practise safety measures. Only when 80-90% of people have vaccinated will we be out of the woods.”

In fact, recent studies have shown just how effective masks can be in saving lives. In the largest study of mask-wearing yet, researchers conducted a trial in 600 villages and more than 340,000 people in Bangladesh earlier this year and found that mask-wearing tripled in the community and increased physical distancing by 5 percentage points. 

‘When surgical masks were employed, 1 in 3 symptomatic infections were avoided for individuals 60+ years old, the age group that faces the highest risk of death following infection,’ noted Innovation for Poverty Action, one of the partners of the study.

With Dasain around the corner, experts say the government should step up its public awareness campaign so that people limit unnecessary travel and mingling, and ensure mask-wearing even indoors for family gatherings if they cannot be avoided. 

It is the elderly and unvaccinated children who will be most at risk, especially with schools reopening just weeks before the holidays and teachers only getting their first doses recently.  

Says epidemiologist Lhamu Yangchen Sherpa: “Now that we know that the Covid-19 is airborne, we should be especially mindful about enclosed spaces during Dasain, something as simple as moving to the terrace rather than crowding a living room can spare the grandparents and children."