Kathmandu locks down again

There is a feeling of déjà vu in Nepal as the country goes into a Covid-19 lockdown all over again one year later. The only difference this time is that the disease threatens to be much worse. 

On Monday, the three district administrations of Kathmandu Valley announced a week-long lockdown 29 April-5 May as the country suffers a rising trajectory of infections and deaths similar to neighbouring India. 

In fact, data shows that the rate of increase in the number of cases may be even higher in Nepal than India’s national average, and public health experts warn that the implications are even more dire because of a comparatively less developed health infrastructure.

“Both the government and the public ignored all the warning signs, the government did not respond in time and the people got complacent and gathered in crowds without masks,” explains Sher Bahadur Pun, virologist at Teku Hospital. “We are already experiencing what we did during the peak last year. It is anyone’s guess what will happen in the next few weeks, but one thing is for sure: it will get much worse.”

Under the lockdown rules, all public and private cars will be off the roads for a week starting Thursday. Everyone entering Kathmandu by air or road will have to go into mandatory quarantine. Restaurants, bars, pubs and public functions are suspended. Marriage ceremonies cannot have more than 15 guests. 

Exceptions will be vehicles for food, water supply, ambulances and other essential services, medical personnel, journalists with press passes. Food shops will be allowed to open till 10AM and 5-7pm only. 

Passengers on international flights can go directly to the airport by showing tickets and visas, but there is no mention of domestic flights in the order by the district administrations.

The country’s second wave is now clearly visible in a graph of active cases, which rose from a low of 550 on 21 February to nearly 20,000 by Monday.

Nepal recorded 3,556 new Covid-19 cases on Monday of 13,293 PCR and RDT tests, and the total number of cases has now exceeded 300,000. The positivity rate has risen to more than 30%, compared to less than 4% in February. This figure was down to 28% even at the peak of the first wave. 

Of the total positive cases, 1,912 were in Kathmandu Valley, with 1,567 in Kathmandu, 223 in Lalitpur and 122 in Bhaktapur.

The rate of infection is much steeper in this second wave, and it is also more lethal and affects younger people. There were 12 additional deaths from the coronavirus in the past 24 hours, bringing the official total to 3,176.

A near vertical rise in active cases across Nepal in April. Photo: WORLDOMETERS

Last year this time, Nepalis were worried about being infected. This time, the main concern is finding ICU beds and oxygen cylinders. Another difference is that this time, working age people are patients requiring ICU and ventilator support. 

“Before it’s too late we need to be prepared with treatment and management guidelines for children with Covid, as they may require a new set of health professionals and infrastructure,” adds Pun.

Hospitals in major cities in the Tarai are full, and those in Kathmadu are turning away serious patients. The Ministry of Health on Monday issued a directive for all non-medical industrial uses of oxygen, to be stopped or reduced.

Nepal had two lockdowns in 2020  but the country got back to pre-Covid normalcy in the first three months of this year as the numbers of daily new infections went down to as low as 59 in March.

“We got hit by a triple whammy, the original coronavirus, and the doubly aggressive UK strain, and the Indian mutant,” says Sameer Dixit of the Centre for Molecular Dynamics. He says a whole genome sequencing study has yet to be done, but thinks Kathmandu got hit first by the UK variant, and then the Indian strain was carried across the open border from India.

Health experts say public complacency because of low infection rates and the arrival of vaccines contributed to the rapid spread. In addition, Nepal’s political leaders did not set the correct example to the public about precautions by holding mass rallies, indoor meetings and lavish inaugurations.

“The first time around people were scared of the new virus and everyone followed safety measures but over a year later, the public has abandoned it all taking the latest surge lightly at a time when we face the more contagious and lethal variants,” says epidemiologist Lhamo Langchen Sherpa.

She cautions that a lockdown is not the solution, and must be used to contact trace aggressively and identify the variants circulating in Nepal. “And despite all the new developments, the best defence against the pandemic remains the same: masks, hand washing and physical distance,” she adds.

Dixit agrees that a lockdown should have been the last resort, only when the pandemic could not be controlled by masking and ban on gatherings. He says, 

“A lockdown is the easy way out for the government, it should have strictly enforced masks and ban on crowds and political leaders should have set a good example.”

The Coronavirus Control and Management Committee (CCMC) recommended the indefinite lockdown and the three CDOs of Kathmandu, Lalitpur and Bhaktapur endorsed it before the Cabinet passed it on Monday. Districts including Banke, Surkhet and other Tarai cities have also announced lockdowns.

“The decision was necessary to break the chain of infection and protect citizens,” Kathmandu CDO Kali Prasad Parajuli said. “But we decided to give people two days to go home or finish urgent chores.”

The lockdown will stop all non-essential travel, businesses and services, but will allow people from 5-10AM to buy essentials. 

Nonetheless, the shutdown could buy the government time as it tries to come up with a bigger oxygen stockpile, more High Dependency Units and ICUs in hospitals, drugs including remdesivir, and vaccines. India is overwhelmed with its own cases, and is too busy with its own emergency to help.