Is Nepal on the verge of a fourth wave?

With a new increase in the number of Covid cases in Nepal, there is now a looming threat of a fourth wave in Nepal, even as public health experts are divided about the extent and severity of the new surge.

But they agree on one thing: we must continue to follow preventive measures despite our vaccination and infection status since the elderly and people with comorbidities are still at high risk.

Six new Omicron variants have been detected in Nepal including BA.2, BA.5, BA.2.38, BA.2.73, BA.2.75 and BF.1, according to Rajeev Shrestha, infectious disease specialist at Dhulikhel Hospital which conducted whole-genome sequencing on 22 swab samples last week.

On Sunday, Nepal reported 347 new cases while 95 patients recovered. Two fatalities were recorded in the past 24 hours. Active cases have surpassed 3,000 again, with the test positivity also climbing to 8.9%.

The newer variants of Omicron are many times more contagious than the original strain leading to a spurt in new Covid cases daily. The World Health Organisation (WHO) has also termed all the new sub-strains as variants of concern because of their higher  transmissibility.

So far, BA.5 is the most dominant sub-variant and has spread over 110 countries with France, the US, Italy, Germany and Brazil.

Japan, Australia and China are also reporting spikes in new Covid cases while Iraq and Tunisia have emerged as new 'hotspots'. In South Asia and Southeast Asia, BA.5 is widespread in India and Indonesia.

“Some 5.7 million people worldwide have been infected with this variant. Scientists say that 50% of the existing Covid-19 infection is from this variant,” says Sameer Kumar Adhikari of the Health Ministry. “And because it is spreading widely in India, we are also very much at risk, especially if we are lax about it like we were with previous variants.”

Another Omicron variant BA.2.75 which was first detected in India seems to be equally infectious and has spread to 14 countries including Japan, Germany, UK, Canada, America, Australia, New Zealand and Nepal.

According to WHO chief scientist Saumya Swaminathan, BA.2.75 has mutated in such a way that it defeats the immune system's ability to fight the disease and can cause severe infections. Most recently, BA.1 has been found to be the most contagious of the bunch, more so than BA.2.75.

The good news is that the new variants will largely spare previously vaccinated populations. But while the variants are yet to register complications like those caused by the Delta variant during the second wave, vulnerable populations are still at the highest risk, especially given that Nepal has a very low uptake for boosters.

“What all these new variants are doing is reducing the effectiveness of Covid vaccines. How much is a matter of further investigation but they are indeed decreasing vaccine efficacy,” says Shrestha.

The Nepal government last week reinforced its vaccination campaign with a special focus on the booster shots. Even as over 80% of Nepal’s eligible population have been fully vaccinated against Covid-19, less than 25% of Nepalis have taken booster shots.

Meanwhile, a new study from Qatar has found that while the rate of reinfection of new variants is comparatively high, people who have been previously infected with earlier versions of SARS-CoV-2, particularly Omicron are less susceptible to the two fast-spreading lineages BA.4 and BA.5 sub-strains.

Nonetheless, experts recommend keeping a close watch on symptoms to break the cycle of infection and save those at risk of contracting the disease. People who have already been previously infected should also follow preventive measures, mask up, avoid crowds and sanitise regularly.

Says Rajeev Shrestha: “As soon as you have fever, cold and loss of smell, think of yourself as Covid infected and manage accordingly. Prevention and vaccination are the only ways to stop another deadly  wave.”

Read more: 1. Mask Up. 2. Avoid Crowds. 3. Get Boosters, Sonia Awale