“Our health system can’t contain the pandemic”
Active cases of Covid-19 in Nepal have soared to over 30,000, from approximately 600 in February. 5% of those infected have been requiring hospital admissions.
Hospitals in major cities are already starting to feel the pressure. Nepal has a total of 18,917 general beds, 1,486 ICUs and 634 ventilators.
Health Minister Hridayesh Tripathi in an interview with Nepali Times on Wednesday warned that our health system cannot contain the pandemic at the rate people are getting infected.
Excerpts:
Nepali Times: Covid-19 patients are not getting hospital beds. How often do you get calls from people asking you for help?
Hridayesh Tripathi: The second wave is more contagious and lethal, often times symptoms appear towards the end when patients require ICU or ventilator support. As a result, there is higher demand. We have increased the number of beds but they are still not enough. This is the case also in the world’s most developed countries.
We are already working on our plan to build 5-15 beds capacity hospitals in each municipality. We are the first in South Asia to adopt such an ambitious program.
The decision to connect 2,000 HDUs (High Dependency Units with oxygen) across the country with 50 beds in each province have fallen by the wayside, however.
The ministry has already completed all the procedures and distributed 2,000 HDU connections. It has been installed successfully in few areas but for the most part, it has not happened due to negligence and delay.
You warned that cases will peak in July in Nepal. At the rate people are getting infected, will our infrastructure be enough?
We might be reporting 11,000 new cases a day by July. But our health system is already saturated.
When I made that point based on the projections by the ministry and WHO, I was ridiculed, some joked that I should become an astrologer, and others accused me of fear-mongering. At the time new variants had not even been identified in Nepal. This is to say that the total infections might be more than what we forecast previously.
You pointed to the need for vigilance before New Year. District administration offices have just started to enforce restrictions. Why it was not implemented on time?
Our effort has been on not to impose nationwide lockdown if possible taking into account its impact on our economy. We tried to find an alternative but the public didn’t take the latest surge seriously despite the government’s repeated appeal to follow safety measures.
Both political parties and communities are responsible for the second wave. I request everyone to adhere to health standards.
Why did the government then impose a lockdown for 15 days?
If the number of active cases in hill and mountain districts exceed 200 and 500 in urban centres, the Chief District Officer may issue a restraining order in those areas on the recommendation of the District Covid-19 Crisis Management Center (DCMC).
It takes at least 10 to 14 days to break the chain of the infection, which is why we have placed prohibitory order for two weeks.
Will we have lockdown for an extended period like last year?
Not if everyone follows the order. But if people neglect it, I can’t say how long it will last.
What has the government done to prevent rapid community spread as it happened last year when Nepali migrants from India returned home?
We have arranged to send returnee Nepalis home after antigen tests. Foreign nationals must have a negative PCR test to enter Nepal either via road or air. Everyone must quarantine.
We have received over 3 million doses of vaccines from India and China. One million doses of Covishield from Serum Institute of India that you paid for haven't arrived. What is holding things up?
Only a small number of vaccines have been approved for use and we lack storage infrastructure for some of those shots. So we have limited options and the Department of Drug Administration has approved some vaccines accordingly. After the initial donation from India, we even bought 2 million doses of Covishield from the Serum Institute.
We then offered to buy 5 million more. But the local agent here in Nepal of the manufacturing company asked for 10% in commission, forcing us to step back. The involvement of middlemen, who were also present when we bought the vaccine for $4 per dose complicated the procurement for 27 days. By then, infections began to soar in India and thre were restrictions on export.
If so, will everyone who received the first dose also get their second within the prescribed period?
People are getting a second dose. Everyone who got the first one will also receive the booster shot.
We have used all the options to bring the vaccine. We even asked the private sector but no one applied. The government has decided to approve no more than 10% profit for importers, which seems to have demotivated them.
We have also approved the Sputnik V vaccine and the Russian government is manufacturing vaccines in Nepal with selected private companies.
The British Ambassador has committed to providing additional 2 million doses to Nepal. The US ambassador gave us his word that he will also help with the vaccine.
Of the 14.8 million doses we pledged under the WHO’s COVAX initiative, we have received only 348,000 doses. Vaccines may seem like a health and commercial product, but, fundamentally, we are at the mercy of vaccine politics.
What about the availability of oxygen?
Patients of the new variant require three times more oxygen than those infected by the original strain. But we should be more concerned about cylinders than oxygen because they are occupied as long as patients are undergoing treatment. We are planning to buy 40,000 cylinders, and are talking with the UAE and the Korean ambassadors.
Who should people struggling with lack of hospital beds contact?
Kathmandu has the infrastructure, treatment won’t be a problem as of now. We can’t say the same for Nepalganj. I also see challenges in Birganj.
We are working tirelessly to develop the infrastructure required, which is why we are building hospitals with HDUs in all municipalities. We have already deployed skilled human resources and budget across the country. We are evaluating the situation as the second wave spreads.