The barber and the virus in Kathmandu

It was 11am on Monday morning in a quiet residential side street in Patan. Suddenly there was commotion as an ambulance and a police van arrived at the cul de sac, sirens blaring.

Families were at their windows looking down, curious neighbours crowded the street. Health official in a full protective equipment held a man, escorted him to the ambulance, and quickly drove off.

The man was the friendly neighbourhood barber. He had returned to Kathmandu from Saptari after the lockdown was eased last month, and had been in the Teku COVID-19 hospital after he tested positive. He had told neighbours that he had been discharged after recovering. But no one knew for sure, and rumours were flying.

Nepal's virus vortex, Sonia Awale

“He was lurking around yesterday, he bought some stuff from my shop,” said a worried shopkeeper. “I have kids to look after, what if he transmitted corona to me?” Another bystander, his mask down at chin-level, piped in: “I heard he ran away from Teku.” The police left to guard the street were even more clueless. They had every reason to be nervous, since 350 policemen are in quarantine after the Police Headquarters and the Traffic Police Office were both sealed after more than 35 officers tested positive.

Our own investigation into this incident makes it a case study in why there is so much confusion, misinformation and public stigma surrounding the coronavirus pandemic.

It turns out the 32-year-old was living by himself in a rented room in Patan near where he had a barber shop for the past two years. After testing positive in a swab sample taken in Thankot on return from the Tarai last month, he was admitted into the Sukraraj Tropical and Infectious Disease Hospital in Teku and stayed there for 17 days.

In that time, he had four PCR tests, all of which were positive. But after spending two weeks in isolation, he tested negative and was then asked to leave hospital to make way for another patient. However, Teku forgot to give him his negative report.  

On 10 August, the barber was summoned to the Ward office where he was asked for his negative certificate. Because he did not have it, and fearing that he might lose his shop, he fled. The Ward office immediately tracked him down, and informed police and an ambulance to take him back to Teku. There, he had to take another PCR test, and now is back in isolation in his room, awaiting the result.     

“What this example shows is that a little knowledge is dangerous,” said a Ward officer, explaining that fear of ostracisation, fear of the disease, public dread, misinformation, all came together to escalate the panic.  

At Teku, hospital director Sagar Rajbhandari explained that it was impossible for a patient to be released from the COVID-19 ward without testing negative. But he immediately contradicted himself by saying that since the hospital was so overwhelmed, there might have been lapses.

The Ward officer lamented that given the residents of the neighbourhood were all well-to-do and educated, they should have known not to crowd around when the ambulance arrived. On the one hand, they were worried about their health, but on the other they were not maintaining physical separation, he added.

“We want to help protect our residents, but it is time we start from scratch to work on COVID awareness,” the officer said. 

There has been a surge in COVID-19 infections since the lockdown was partially lifted on 21 July. People from India streamed into the Tarai, and many from there travelled unrestricted to Kathmandu Valley – leading to a spike in cases. This prompted the government to put off re-opening regular flights and long-distances buses, clamped down again on restaurants and closed district administration offices for two weeks in the capital.

On Wednesday, Kathmandu Valley saw 138 new cases – the sixth day in a row with more than 100 new cases of COVID-19. There were 8 more fatalities, and 85 patients in ICU. Nationwide, the total confirmed cases hit 24,432 with 484 more infections on Wednesday. Most of the patients have recovered and there are 11,058 people in isolation nationwide.

As the designated coronavirus treatment centres nationwide fill up with patients, especially in the Tarai cities, the government instructed private hospitals on Tuesday to set aside 20% of their capacity for COVID-19 cases. 

Public health experts like Sameer M Dixit at the Centre for Molecular Dynamics Nepal says the virus is here to stay, and the only way to deal with the pandemic before a vaccine is developed, is for every individual to uphold rules about distancing, masks and hand-washing.

“Nepalis lack enough knowledge on the pandemic. It is easily prevented, but once infected they can be in grave danger,” he says.  

For his part, Rajbhandari at Teku says the case of the Patan barber is emblematic of the many cases he sees at his hospital caused by the uncontrolled movement of people first from India to Nepal, and then from the Tarai to Kathmandu.

He says: “We doctors and health officials have to bear the brunt of all the policy mismanagement of the government.”  

Back at the Ward in Patan, the elected representatives say they are going to strictly enforce the guidelines on movement, physical distancing, and wearing masks so as to avoid the kind of panic that struck the neighbourhood this week.