Nepal designates more hospitals for Covid-19 treatment

Amidst a dramatic surge in Covid-19 infections in Nepal, Prime Minister K P Oli has announced that all big government and private hospitals and medical colleges will be turned into Covid-19 treatment centres.

Wearing a surgical mask in his televised address to the nation on Monday, Oli said hospitals like Bir and the Tri-Chandra Army Hospital in Kathmandu and other big private hospitals in the country would serve only people with Covid-19 infections, while smaller hospitals would be designated for non-Covid-19 patients.  

He added that the Nepal Army would be adding 1,000 beds for coronavirus patients in each province as well as in Kathmandu Valley, which has been recording half of all new daily infections nationwide in the past week. Bigger hospitals will be setting up their own oxygen plants, Oli said. 

The prime minister’s address appears to have been prompted after widespread criticism that his government had ‘surrendered’ to the second wave that has seen a dramatic increase in daily case load and fatalities in the past month.

The daily new Covid-19 cases on Saturday, Sunday and Monday were the highest so far in the pandemic with  5,763, 7,211 and 7,448 testing positive. On Monday, there were 37 fatalities in the past 24 hours, bringing the total tally for Covid-19 deaths to 3,362. Altogether 2,021 people recovered from the disease on Monday, with the number of active cases reaching over 50,000 nationwide.

Nepal’s Ministry of Health has said that the Covid-19 spread in the country is not just out of control, but that the proportion of those infected who are seriously ill has also gone up.

The Ministry’s statistics show that the number of patients needing ICU and ventilator care has increased rapidly in the past two weeks. Of those patients who needed hospital treatment, 17% were serious enough to need intensive care.

The number of active cases in Nepal as of Monday is 54,041, of which 50,171 have mild symptoms and are in home isolation. But there are 3,869 Covid-19 patients in private and government hospitals, of which 578 are in ICU, and of them 141 are on ventilator support.

Most of the seriously ill are in Bagmati Province, where Kathmandu Valley is located. Of those hospitalised, 22% in the province are seriously ill, and there are 320 patients in ICU and 88 on ventilators. In Province 2, 26% of those in hospital need intensive care, and the proportion is 33% in Karnali Province. However, only 5% of patients in hospitals in Gandaki Province and 6% in Far-West Province need to be in ICU.

The Ministry of Health warned over the weekend that hospitals were full, and that the pandemic had gone “out of control”, asking people to strictly observe precautions. The government is advising people not to come to hospital unless their oxygen levels drop below 92, but most Nepalis do not have oximeters at home and do not go to hospital until it is too late.

This has prompted local municipalities and wards to set up their own isolation centres, and even oxygen-equipped spaces for those needing treatment.

In Nepalganj, Bheri Hospital and other hospitals are full, and infected health personnel are forced to treat Covid-19 patients because there has been no backup support from the central government. Nepalganj has therefore converted its training centre into its own isolation and treatment centre with 50 oxygen equipped beds. 

“We are trying to do what we can, and already the centre has ten patients who need oxygen,” says Nepalganj mayor Dhawal Shumshere Rana, who has spent Rs2 million of the city’s own budget to set it up and staff it with doctors and nurses who work in three shifts. Patients are provided free food and ambulance service. 

“it was much cheaper to cover the training centre, and we could bring the isolation ward into operation within a week, and we hope this will provide some respite to the overwhelmed hospitals,” Rana says. “We now want to add another centre with 100 beds. We want to make sure no one has to die because they could not get oxygen, or a hospital bed.”

Banke district on the Indian border is finding 400 new Covid-19 cases every day, and about a third of them need hospital admission. The new isolation centres are designed to take the pressure off the district’s hospitals which are treating patients from all over Karnali and Far-western Province. Only those needing ICU and ventilators will be sent to hospitals, Rana says.

Health Minister Hridayesh Tripathi told Nepali Times last week that his government would be adding 1,000 hospital beds in Kathmandu to deal with the rush at hospitals in the capital. “Our health system cannot sustain this level of infections,” he said.

In Kathmandu, the Social Welfare Council that regulates the activities of non-profit local and international voluntary organisations on Sunday issued a directive requiring them to set aside from 5-20% of their annual budget for Covid-19 related relief.

The Council’s Durga Bhattarai said non-profits with main annual budgets up to Rs50 million need to spend 20% of it on helping with the national coronavirus effort, while those with budgets above Rs500 Millie have to set aside 5%. It says the revenue will be used to buy oxygen cylinders, ICU equipment and ventilators, as well as relief for returnee workers from overseas.

With more than 25 of Nepal’s 77 districts under some form of lockdown, local governments have been told to enforce the restrictions more strictly, allowing only essential services, medical emergencies and funerals.

Government spokesperson Parvat Gurung said the Cabinet on Sunday decided tis suspend all domestic flights from Monday midnight, and all international flights from Wednesday midnight. However, international airlines serving Kathmandu had not been officially notified of the decision.

The Cabinet decision on Monday also said that as per the ‘air bubble’ agreement with India, there would be two weekly flights in both directions between Kathmandu and Delhi, but all passengers would have to spend ten days in hotel quarantine in Kathmandu and it would be strictly enforced.

Speaking in English at the end of his address, Oli said: "We are of the view that vaccines and critical care medicines are global goods and everyone should have access to it."