1st signs of the 2nd wave in Nepal

Nepalis had started to heave a sigh of relief with the start of the vaccine drive in January, but the latest surge in infection rates show there is much to be vigilant about. On 7 April 2021, Kathmandu Valley reported 163 new Covid-19 cases, against the 298 cases across the country.

At a first glance, the numbers look insignificant but this is 300% increase compared to the figures from a month ago. Many of those who have tested are school children, teachers and students going abroad, and most of them have shown positive for the UK strain B.1.1.7., which was first detected in Nepal back in January.

“The UK variant among students point to the community spread of the new strain in Nepal and given that it’s more infectious as it is deadlier, we must look into this immediately,” says virologist at Teku Hospital Sher Bahadur Pun.

Despite surpassing the US to become the fastest vaccinating country in the world, India is reporting an excess of 100,000 new cases per day now. On Wednesday, the country recorded over 126,000 cases with 630 deaths. India has been registering higher cases of the B.1.1.7 variant, which is 64% more lethal than SARS-CoV-2.

The increasing infection rates in India has put Nepal on high alert and experts warn of a repeat of the trajectory last year, when imported cases from the southern neighbour led to rapid community spread. Nepal usually tracks India in health trends, and there are already signs of the second wave.

“There are three things working in favour of a possible second surge: our own cases, those being imported from India and the rise of the more contagious UK strain,” says Pun.

Nepali migrant workers are already arriving in large numbers at the 1,770km long porous border between Nepal and India, as the most affected states including Maharastra, Karnataka and New Delhi announce lockdowns and curfews.

Officials have deployed tests at the Indian border, and those testing positive are recommended to self-isolate. However, returnees could easily bypass the official border checkpoints as they did last year.  

Sameer Mani Dixit of the Centre for Molecular Dynamics agrees: “It is not possible to test everyone at the border so we should deploy local government to test and observe the returnees.”

Health Minister Hridayesh Tripathi told the Parliament this week that Nepal was likely to see a surge in new cases by May, while he has also turned down the possibility of another lockdown.

The Covid-19 Crisis Management Center (CCMC) has decided on antigen tests for everyone with symptoms entering the Kathmandu Valley. The government has meanwhile, instructed all local levels to set up isolation and quarantine centres. The Health ministry has also urged businesses to close after 9PM and for schools to increase safety measures.

While the government has drawn flak in the past for not doing enough to control the spread of the virus, it is the public that seems to have flung all caution to the wind this time. People have continued to crowd malls and restaurants and participate in celebrations and even attend political rallies-- often unmasked and with no regard for physical distancing.

“Nepalis have all but forgotten how a year ago, pregnant women couldn’t go to hospitals and how there was food insecurity and the crushing burden of economic fallout. Now, they are back to ignoring safety measures,” says epidemiologist Lhamo Yangchen Sherpa. Hazardous levels of air quality in the past two weeks following wildfires across the country has added to the challenge.

For most of this week, Kathmandu has been recording an average of 200-300 in Air Quality Index (AQI) measurements, aggravating the condition of people with chronic obstructive pulmonary disease (COPD), other respiratory illness and Covid-19.

The government has started to inoculate frontline workers, teachers, hotel staff, Himalayan traders, among others in the age group 40-59, with ‘Vero Cell’ vaccines donated by the Chinese government. Nepali students leaving for China are also eligible for the jab.

Nepal got an early start in the vaccination drive with 1.6 million inoculated in the first and second stages of the campaign, with India’s support. But with only 500,000 doses of Covidshield in the stock and 100,000 more with the Nepal Army, uncertainty persists over when the second doses will happen for all those who have taken the first.

With the European Medicines Agency concluding that there is indeed a link between AstraZeneca vaccine and a rare but lethal blood clot case detected in the EU, countries including the UK and Germany have either restricted or have found alternatives to the Oxford University developed jab for younger age groups. This could mean that countries like Nepal suffering from a shortage could be supplied with more doses of the Covidshield shots sooner than later.

After inoculation began in Nepal, many districts stopped testing. There are only about 3,000-4,000 tests happening in a day, mostly for people going abroad, and there is virtually no contact tracing.

“Vaccination is important but so is testing and contact tracing. And we must continue to communicate about safety measures, there is no other way around wearing masks, hand washing and maintaining physical distance,” says Sherpa.