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How Nepal must prepare for 3rd Covid wave

<figure><img width="720" height="540" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85729c7e80680e0677f3jpeg.jpg" alt=""/><figcaption>Jugal Rural Municipality in Sindhupalchok district setting up an isolation ward with oxygen. Photos: Srijana Tamang.</figcaption></figure>Setting the example for the rest of the country that is at <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">a breaking point</a> due to the lack of hospital beds, oxygen and ventilators for Covid-19 patients, local governments in parts of Nepal are going door-to-door to test and control community spread. Epidemiologists say that lockdowns alone are not the answer to the pandemic, they just buy time and the closure should be used to trace, test and isolate infected people.  Doing just that is Helambu in Sindhupalchok district 45km northeast of Kathmandu. So far, 31 people have tested positive in Helambu but only half of them are active. Once they were isolated, no new cases have been reported in the last six days, and not a single person has died of the disease. What this little village in the mountains is doing to control the spread of the disease could be <a href="https://www.nepalitimes.com/here-now/empowering-nepalis-during-covid-19-crisis/" target="_blank" rel="noopener noreferrer">an example for other parts of rural Nepal</a>, and also for the cities which have run out of hospital beds and oxygen. The idea is to test people before they become seriously sick and over-burden the health system. Helambu village chair Nima Galgen Sherpa is himself in isolation after contracting the virus. He explains the process: “First we identify people who are infectious, and manage them separately. This has helped stop the spread of the infection in the community, and most do not need hospitalisation.” Helambu has formed teams in each ward consisting of health workers who go house-to-house looking for people with symptoms, and then testing them on the spot. After their swab collection, they are told to isolate. If the PCR test result comes back negative, infected individuals are quarantined to be managed separately until they recover. Only if their symptoms get more serious are they taken to hospital. For Sherpa, the door-to-door campaign is just a continuation of what Helambu did when the contagion first spread last year. The second wave is more virulent, and the village learnt lessons from last year to make testing even more systematic.  “This strategy is effective because people don’t come forward for the test due to lack of awareness, or fear of being ostracised in the community,” he adds. Learning from Helambu, Indrawati Rural Municipality down the valley has also started conducting community-level house-to-house testing. "We have found that proactive testing and isolating those infected from others helps break the chain of transmission, so this has been our priority," says municipality chair Bansalal Tamang. Its house-to-house tests are being conducted in coordination with the local representatives, ward health post and community people. The village with a population of 28,000 has collected 183 pharyngeal-nasal swabs so far. Of the 51 people infected, 27 are still active, while three patients who had to be hospitalised died. A team in the ward is also monitoring the compliance of the lockdown and safety practices. “We can bring the pandemic under control faster with the help of people being more careful, and testing during the lockdown,” adds Tamang. Nearby Jugal Rural Municipality in Sindhupalchok has also been conducting RT PCR tests under the recommendation of the local health post. Of those 86 tested so far, 35 people are positive, and the rate is high because only those with Covid-19 symptoms were tested. Two have recovered. "We are working in coordination with other municipalities in the district to control the infection in our area," says vice-chair of Jugal municipality Sirjana Tamang, who is confident that a coordinated local effort can help defeat the virus. <figure><img width="720" height="540" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85749c7e80680e0677f4jpeg.jpg" alt=""><figcaption></figcaption></figure>Jugal has also collaborated with neighbouring Balephi Municipality started construction of a 70-bed isolation centre in addition to a 20-bed medical ward with the oxygen. Despite having inadequate influence and resources, these local governments appear to be more accountable and effective in tackling the pandemic than provincial or federal governments. And these villages in Sindhupalchok also seemed to know exactly what to do during the second wave, and they were prepared with tracing, testing, quarantine and isolation centres, and relief distribution. Not all local governments have been as effective. Many districts in western Nepal, for example, have been overwhelmed by the sheer ferocity of <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">the second wave</a>. The virus is spreading uncontrollably in the community and over-stretched hospitals in the cities are not taking any more patients.  Here in Sindhupalchok, local representatives say they have done what they can, but they need a helping hand from the provincial government in Hetauda or from the national capital in Kathmandu for <a href="https://www.nepalitimes.com/banner/nepals-life-or-death-o2-quest/" target="_blank" rel="noopener noreferrer">oxygen</a>, equipment at the quarantine centres and isolation wards.  “If we had more oxygen, medicines and testing kits we can save lives right here, but there is no one listening to us, so we are doing the best we can by ourselves,” adds Indrawati chair Bansalal Tamang. Jugal vice-chair Sirjana Tamang agrees: “We did not expect any help from Kathmandu, and we did not get any, so we decided to do what we could on our own.”

Rural Nepal fights back Covid-19

<figure><img width="720" height="540" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131124/636ced889c7e80680e09add0jpeg.jpg" alt=""/><figcaption>Jugal Rural Municipality in Sindhupalchok district setting up an isolation ward with oxygen. Photos: Srijana Tamang.</figcaption></figure>Setting the example for the rest of the country that is at <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">a breaking point</a> due to the lack of hospital beds, oxygen and ventilators for Covid-19 patients, local governments in parts of Nepal are going door-to-door to test and control community spread. Epidemiologists say that lockdowns alone are not the answer to the pandemic, they just buy time and the closure should be used to trace, test and isolate infected people.  Doing just that is Helambu in Sindhupalchok district 45km northeast of Kathmandu. So far, 31 people have tested positive in Helambu but only half of them are active. Once they were isolated, no new cases have been reported in the last six days, and not a single person has died of the disease. What this little village in the mountains is doing to control the spread of the disease could be <a href="https://www.nepalitimes.com/here-now/empowering-nepalis-during-covid-19-crisis/" target="_blank" rel="noopener noreferrer">an example for other parts of rural Nepal</a>, and also for the cities which have run out of hospital beds and oxygen. The idea is to test people before they become seriously sick and over-burden the health system. Helambu village chair Nima Galgen Sherpa is himself in isolation after contracting the virus. He explains the process: “First we identify people who are infectious, and manage them separately. This has helped stop the spread of the infection in the community, and most do not need hospitalisation.” Helambu has formed teams in each ward consisting of health workers who go house-to-house looking for people with symptoms, and then testing them on the spot. After their swab collection, they are told to isolate. If the PCR test result comes back negative, infected individuals are quarantined to be managed separately until they recover. Only if their symptoms get more serious are they taken to hospital. For Sherpa, the door-to-door campaign is just a continuation of what Helambu did when the contagion first spread last year. The second wave is more virulent, and the village learnt lessons from last year to make testing even more systematic.  “This strategy is effective because people don’t come forward for the test due to lack of awareness, or fear of being ostracised in the community,” he adds. Learning from Helambu, Indrawati Rural Municipality down the valley has also started conducting community-level house-to-house testing. "We have found that proactive testing and isolating those infected from others helps break the chain of transmission, so this has been our priority," says municipality chair Bansalal Tamang. Its house-to-house tests are being conducted in coordination with the local representatives, ward health post and community people. The village with a population of 28,000 has collected 183 pharyngeal-nasal swabs so far. Of the 51 people infected, 27 are still active, while three patients who had to be hospitalised died. A team in the ward is also monitoring the compliance of the lockdown and safety practices. “We can bring the pandemic under control faster with the help of people being more careful, and testing during the lockdown,” adds Tamang. Nearby Jugal Rural Municipality in Sindhupalchok has also been conducting RT PCR tests under the recommendation of the local health post. Of those 86 tested so far, 35 people are positive, and the rate is high because only those with Covid-19 symptoms were tested. Two have recovered. "We are working in coordination with other municipalities in the district to control the infection in our area," says vice-chair of Jugal municipality Sirjana Tamang, who is confident that a coordinated local effort can help defeat the virus. <figure><img width="720" height="540" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131124/636ced8a9c7e80680e09add1jpeg.jpg" alt=""><figcaption></figcaption></figure>Jugal has also collaborated with neighbouring Balephi Municipality started construction of a 70-bed isolation centre in addition to a 20-bed medical ward with the oxygen. Despite having inadequate influence and resources, these local governments appear to be more accountable and effective in tackling the pandemic than provincial or federal governments. And these villages in Sindhupalchok also seemed to know exactly what to do during the second wave, and they were prepared with tracing, testing, quarantine and isolation centres, and relief distribution. Not all local governments have been as effective. Many districts in western Nepal, for example, have been overwhelmed by the sheer ferocity of <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">the second wave</a>. The virus is spreading uncontrollably in the community and over-stretched hospitals in the cities are not taking any more patients.  Here in Sindhupalchok, local representatives say they have done what they can, but they need a helping hand from the provincial government in Hetauda or from the national capital in Kathmandu for <a href="https://www.nepalitimes.com/banner/nepals-life-or-death-o2-quest/" target="_blank" rel="noopener noreferrer">oxygen</a>, equipment at the quarantine centres and isolation wards.  “If we had more oxygen, medicines and testing kits we can save lives right here, but there is no one listening to us, so we are doing the best we can by ourselves,” adds Indrawati chair Bansalal Tamang. Jugal vice-chair Sirjana Tamang agrees: “We did not expect any help from Kathmandu, and we did not get any, so we decided to do what we could on our own.”

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9a79c7e80680e0878d1jpeg.jpg" alt="" width="995" height="659"/><figcaption>Photo: NEWS MEDICAL LIFE SCIENCES</figcaption></figure>As a physician, I am at the receiving end of a lot of questions from friends and relatives about the pandemic. While some want to know about their symptoms, most questions are about <a href="https://www.nepalitimes.com/here-now/why-nepals-covid-19-figures-are-deceptive/" target="_blank" rel="noopener noreferrer">whether the number of cases in Nepal is actually going down</a>.It is hard to tell. There a lack of tracing, testing is inadequate, and record keeping is unreliable. The media carries a daily tally that is based on government figures, and they show confirmed cases have now dipped to below 1,000 per day, almost half of them in Kathmandu Valley.The Ministry of Health statistics also show that there are about 250 patients in critical care, and some 50 of them require ventilator support. If these figures are to be believed, the death rate from Covid-19 does not seem to have decreased.More worrying are reports that <a href="https://www.nepalitimes.com/banner/bala-chaturdashi-and-covid/" target="_blank" rel="noopener noreferrer">Pashupatinath now sees 80 cremations daily</a> as opposed to 30 per day at this time last year. Are some of these unidentified Covid-19 ‘excess mortality’? It is all guess work, but this more than double increase in funerals needs to be accounted for.It is indeed possible that although some of the excess mortality is due to undiagnosed Covid-19, it could very well be that the <a href="https://www.nepalitimes.com/latest/covid-19-will-get-worse-before-it-gets-better/" target="_blank" rel="noopener noreferrer">winter death rate</a> has gone up this year because people with other pre-existing conditions like cancer, cardio-vascular diseases, diabetes or kidney patients needing dialysis are not visiting hospitals for treatment. These ‘indirect’ Covid-19 deaths could be a useful research project.Despite this, there are indications that young urban Nepalis are letting their guard down. The parties during the <a href="https://www.nepalitimes.com/here-now/tying-the-knot-during-covid-19/" target="_blank" rel="noopener noreferrer">wedding season</a>, unmasked crowds at Thamel’s indoor nightclubs and concerts and the throngs in Pokhara Lakeside and Sauraha show a <a href="https://www.nepalitimes.com/banner/concerts-rallies-and-crowded-malls/" target="_blank" rel="noopener noreferrer">‘what will be will be’ attitude</a>.An affordable and effective vaccine is still some way off. Wearing a mask, preferably a N95, which serves the dual purpose of protection from SARS-CoV-2 as well as Kathmandu’s air pollution, maintaining safe distance and frequent had washing with soap and water are our ‘vaccines’ for now.Japan has important lessons for us. So far, it has kept Covid-19 death rate at the lowest by far among G7 countries by strictly following guidelines including avoiding the ‘san-mitsu’ or the 3Cs: closed spaces, crowded spaces and close contact settings.<a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/">We in Nepal will be lucky</a> if a <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/">vaccination</a> arrives by mid-2021. Current vaccines like Pfizer and Moderna are out of the question because of their cost and the lack of capacity to maintain the very cold storage that they require.The <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">Oxford University Astra Zeneca vaccine</a> that the <a href="https://www.deccanherald.com/national/serum-institute-of-indias-covid-19-vaccine-not-to-get-nod-till-uk-authorises-astrazeneca-shot-931200.html">Serum Institute of India</a> is manufacturing appears to be our best bet because it is relatively inexpensive and only requires the regular 3-6o Celsius cold chain. The good news is that the Serum Institute of India is also studying other vaccines such as an <a href="https://www.livemint.com/companies/people/intra-nasal-covid-19-vaccines-will-be-far-easier-to-deliver-kiran-mazumdar-shaw-11603681291099.html">intra-nasal vaccine</a>, which can be stored at room temperature. If effective, this would be the answer for countries like Nepal.We are awaiting published results of trials of the <a href="https://www.nepalitimes.com/latest/nepal-to-test-covid-19-test-kits-from-china/">Chinese</a> vaccine, and that could also be the answer for developing countries like <a href="https://www.nepalitimes.com/latest/90-in-poor-countries-will-miss-covid-vaccinations/">like Nepal</a>. The Chinese have an impressive track record of making vaccines, and to combat infectious diseases. For example, the inexpensive <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">Japanese Encephalitis</a> vaccine made in Chengdu helped control the deadly disease in rural communities throughout Asia.This Chengdu vaccine cost less than $5, in contrast to the $100 per shot encephalitis vaccines made by Western pharmaceutical companies. The Chinese <a href="https://archive.nepalitimes.com/news.php?id=18079">Hepatitis E vaccine</a> could prevent infection and save lives of pregnant women in the Subcontinent where the virus is a scourge due to poor hygiene.TherapiesAside from vaccines, research into treatment of Covid-19 is also making progress. For example, the Recovery Trial in the UK has convincingly showed that dexamethasone, a readily available and inexpensive steroid saves lives in the treatment of moderate to severe Covid-19 patients.In all this confusion regarding treatment, however, it is equally important to note what does not work. Drugs like hydroxychloroquin do not work in the treatment of this disease, despite its false efficacy touted by Donald Trump. The <a href="https://www.who.int/nepal">World Health Organisation</a>’s Solidarity research also showed that the expensive remdesivir drug that our government was at one time handing out freely to Covid-19 patients is not very helpful, either.Reliable diagnosis of Covid-19 is important, especially in countries like Nepal as there are many other infectious diseases that may at first present with fever and cough, like tuberculosis. The PCR (polymerase chain reaction) test still remains the gold standard for Covid-19, but they are expensive and may take a day or two for the results.Antigen tests are being carried out in Nepal and can give a quick diagnosis in symptomatic individuals within 30 minutes. But they are not as accurate as the PCRs. There are other commercial brands, and some may not be as accurate as others.New variantNews of the new variant of Covid-19 reported in England and South Africa and now spreading across the globe, sound alarming. It is interesting that this new variant was discovered in the UK where a great emphasis is given to finding its chemical constituents.One of UK’s prime institutions for this is the Sanger Centre near Cambridge, with whom we at Patan Hospital also collaborated to delineate a variant of typhoid organism mutation, helping establish a new treatment strategy for typhoid in the Subcontinent in 2016.The best way to handle the new Covid-19 variant is <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/">continued vigilance</a> about preventive measures, especially since the mutation gives the virus the ability to spread faster. It is best to be over-prepared than under-prepared to fight this wily virus.Masking up, safe distance and hand washing are our best course of action for us to stop the pandemic in 2021 and beyond.<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">Buddha Basnyat</a> is a clinical researcher at Patan Academy of Health Sciences and writes Dhanvantari, a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">frequent health column</a> for Nepali Times.

Buddha Basnyat

Staying safe in 2021 and beyond

<figure><img width="2048" height="1364" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be6219c7e80680e08778bjpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Going by the Ministry of Health figures, Nepal’s Covid-19 pandemic has peaked, and the number of daily cases, the positivity rate and the number of active cases are all going down. The recovery rate now exceeds 90%. Is Nepal turning the corner on the pandemic? Experts say no. The number of fatalities is at an all-time high. There were 29 deaths reported each on Monday and Tuesday, taking the total to 1,538. And the reason the daily case rate is lower is because the government is conducting fewer tests, there is virtually no official contact tracing, and active cases are at home and going to hospital only when they are really serious. These are ideal conditions for community spread. “The fact that the fatalities are increasing, especially in Kathmandu, won’t allow us to say that fewer people are getting infected. This coronavirus isn’t going anywhere just yet,” explains Sher Bahadur Pun of the Ministry of Health. “Yes, the positivity rate has gone down, but the government has also more or less stopped contact tracing.” Since the government started charging for RT PCR tests and hospital admissions, patients and their families are reluctant to have tests despite symptoms, and do not want to go to hospital. The rates have remained high because <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">those infected during Dasain-Tihar</a> are developing symptoms. The current marriage season is another super-spreader event.   There are 77 hospitals and labs across the country conducting an average of  9,000 PCR tests a day, which went down from a daily total of 15,000 after the government directive to charge Rs2,000 for PCR tests in public facilities. The positivity rate went down, which is a good thing – but it happened for the wrong reason. In October a quarter of people tested came out positive, it is now down to 15% despite the onset of the winter season.   “The risk cannot be underestimated based on numbers of infected people by reducing tests itself at a time when increasingly more people are getting sick or dying of coronavirus,” says infectious diseases specialist Pravat Adhikari. “This argument would be valid only if the infection rate goes down despite an increase in total tests. However, very few tests are being conducted at the moment.” In fact, such hidden positives lead to more unidentified Covid-19 deaths, adding to the risk. It is reckless of the government to still not launch low-cost PCR tests with quick results, adds Adhikari. <figure><img width="2340" height="1216" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be6249c7e80680e08778cjpeg.jpg" alt=""><figcaption>Total Covid-19 cases from January 23 until 1 December in Province 2 and in Bagmati province. Source: MINISTRY OF HEALTH</figcaption></figure>The problem is further exacerbated by unmanaged home isolation, and quarantine cases. According to the Ministry of Health, 10,741 people across seven provinces are self-isolating at home, often without much resources or knowledge on how to manage their condition.Ideally, asymptomatic or mildly symptomatic <a href="https://www.nepalitimes.com/latest/kathmandu-homes-and-hotels-turn-into-hospitals/" target="_blank" rel="noopener noreferrer">people self-isolating at homes</a> should have a separate room and a bathroom. Patients should confine themselves in their rooms, wash their own utensils, wear masks while going to the toilet and sanitise it after use and wipe touch points with disinfectant.  Individuals need to keep track of their temperature and symptoms, measure oxygen saturation level if possible, take paracetamol for body ache and fever and make sure to eat nutritious food. One must be aware of danger signs: oxygen level below 93, chest pain, difficulty in breathing and blue tint to lips and limbs.But most families who have members in home isolation do not have this information, or live in such crowded quarters that it is impossible to fulfil all precautions. Conflicting directives from the government haven’t helped.At one point, overwhelmed with the surge of Covid-19 cases in Kathmandu, the Ministry of Health spokesperson Jageswar Gautam advised people live on television to go to hospital only if they feel faint. By then it is too late because it means the patient’s oxygen saturation is already dangerously low.The government has left the people to their own devices, and ignored expert advice on <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">increasing the number of beds in wards with basic oxygen supply</a> instead of spending money on ICUs and ventilators."When I tested positive for coronavirus and had slight difficulty breathing, I called a government health expert for advice, and he himself dissuaded me from going to a public hospital," says Rajendra Dahal, Editor of the magazine Shiskyak. “This is why the death rate is going up, while the positive totals are going down. People are at home, and their oxygen levels are falling, and they have no idea. The main point is that the people have lost their trust in the government health system.”The chief consultant at the Infectious Diseases Hospital in Teku Anup Bastola agrees that the risk has been heightened because health experts are unaware about the actual condition of people isolating at homes. “Nepalis have a tendency to not visit hospitals until it’s too late. We have found that this is even more true for coronavirus,” he says. With much of the 2020 overshadowed by the pandemic and its impact on all the sectors, young people wanting to get back to their lives are now ignoring the signs and symptoms, preferring not to voluntarily test in case they might have to isolate for two weeks.Even according to government figures, the number of people testing positive in Kathmandu Valley is not going down. With the marriage season, and people intermingling indoor in banquet halls, the surge is not expected to subside. At Pashupati Aryaghat, there are five times more <a href="https://www.nepalitimes.com/latest/with-3rd-covid-19-fatality-nepal-issues-funeral-guideline/" target="_blank" rel="noopener noreferrer">cremations</a> happening compared to the same period last year, according to reports. It is not clear how many of these extra deaths are due to Covid-19.The movement of the younger people has had a <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">direct impact on the elderly</a>, as they take home the virus and make parents and grandparents seriously sick. People in their sixties and above now make up over 60% of Covid-19 fatalities in Nepal.Even without the added risk of coronavirus, senior citizens are prone to <a href="https://www.nepalitimes.com/latest/covid-19-will-get-worse-before-it-gets-better/" target="_blank" rel="noopener noreferrer">pneumonia and other chronic respiratory illness in winter</a>. Public health experts advise being alert in regards to their condition even before they complain of symptoms and keeping communication channels open.Says Sher Bahadur Pun: “These are extraordinary times and we need to take extraordinary measures to protect the more vulnerable among us. <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Until we get a vaccine</a>, we must realise our responsibility in containing the virus and not become a medium for more deaths.”

1250x600

1084x550

Why Nepal’s Covid-19 figures are deceptive

<figure><img width="2048" height="1364" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110919118/636bed424b0ad905ca02eed4jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Going by the Ministry of Health figures, Nepal’s Covid-19 pandemic has peaked, and the number of daily cases, the positivity rate and the number of active cases are all going down. The recovery rate now exceeds 90%. Is Nepal turning the corner on the pandemic? Experts say no. The number of fatalities is at an all-time high. There were 29 deaths reported each on Monday and Tuesday, taking the total to 1,538. And the reason the daily case rate is lower is because the government is conducting fewer tests, there is virtually no official contact tracing, and active cases are at home and going to hospital only when they are really serious. These are ideal conditions for community spread. “The fact that the fatalities are increasing, especially in Kathmandu, won’t allow us to say that fewer people are getting infected. This coronavirus isn’t going anywhere just yet,” explains Sher Bahadur Pun of the Ministry of Health. “Yes, the positivity rate has gone down, but the government has also more or less stopped contact tracing.” Since the government started charging for RT PCR tests and hospital admissions, patients and their families are reluctant to have tests despite symptoms, and do not want to go to hospital. The rates have remained high because <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">those infected during Dasain-Tihar</a> are developing symptoms. The current marriage season is another super-spreader event.   There are 77 hospitals and labs across the country conducting an average of  9,000 PCR tests a day, which went down from a daily total of 15,000 after the government directive to charge Rs2,000 for PCR tests in public facilities. The positivity rate went down, which is a good thing – but it happened for the wrong reason. In October a quarter of people tested came out positive, it is now down to 15% despite the onset of the winter season.   “The risk cannot be underestimated based on numbers of infected people by reducing tests itself at a time when increasingly more people are getting sick or dying of coronavirus,” says infectious diseases specialist Pravat Adhikari. “This argument would be valid only if the infection rate goes down despite an increase in total tests. However, very few tests are being conducted at the moment.” In fact, such hidden positives lead to more unidentified Covid-19 deaths, adding to the risk. It is reckless of the government to still not launch low-cost PCR tests with quick results, adds Adhikari. <figure><img width="2340" height="1216" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110919118/636bed454b0ad905ca02eed5jpeg.jpg" alt=""><figcaption> </figcaption></figure>The problem is further exacerbated by unmanaged home isolation, and quarantine cases. According to the Ministry of Health, 10,741 people across seven provinces are self-isolating at home, often without much resources or knowledge on how to manage their condition.Ideally, asymptomatic or mildly symptomatic <a href="https://www.nepalitimes.com/latest/kathmandu-homes-and-hotels-turn-into-hospitals/" target="_blank" rel="noopener noreferrer">people self-isolating at homes</a> should have a separate room and a bathroom. Patients should confine themselves in their rooms, wash their own utensils, wear masks while going to the toilet and sanitise it after use and wipe touch points with disinfectant.  Individuals need to keep track of their temperature and symptoms, measure oxygen saturation level if possible, take paracetamol for body ache and fever and make sure to eat nutritious food. One must be aware of danger signs: oxygen level below 93, chest pain, difficulty in breathing and blue tint to lips and limbs.But most families who have members in home isolation do not have this information, or live in such crowded quarters that it is impossible to fulfil all precautions. Conflicting directives from the government haven’t helped.At one point, overwhelmed with the surge of Covid-19 cases in Kathmandu, the Ministry of Health spokesperson Jageswar Gautam advised people live on television to go to hospital only if they feel faint. By then it is too late because it means the patient’s oxygen saturation is already dangerously low.The government has left the people to their own devices, and ignored expert advice on <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">increasing the number of beds in wards with basic oxygen supply</a> instead of spending money on ICUs and ventilators."When I tested positive for coronavirus and had slight difficulty breathing, I called a government health expert for advice, and he himself dissuaded me from going to a public hospital," says Rajendra Dahal, Editor of the magazine Shiskyak. “This is why the death rate is going up, while the positive totals are going down. People are at home, and their oxygen levels are falling, and they have no idea. The main point is that the people have lost their trust in the government health system.”The chief consultant at the Infectious Diseases Hospital in Teku Anup Bastola agrees that the risk has been heightened because health experts are unaware about the actual condition of people isolating at homes. “Nepalis have a tendency to not visit hospitals until it’s too late. We have found that this is even more true for coronavirus,” he says. With much of the 2020 overshadowed by the pandemic and its impact on all the sectors, young people wanting to get back to their lives are now ignoring the signs and symptoms, preferring not to voluntarily test in case they might have to isolate for two weeks.Even according to government figures, the number of people testing positive in Kathmandu Valley is not going down. With the marriage season, and people intermingling indoor in banquet halls, the surge is not expected to subside. At Pashupati Aryaghat, there are five times more <a href="https://www.nepalitimes.com/latest/with-3rd-covid-19-fatality-nepal-issues-funeral-guideline/" target="_blank" rel="noopener noreferrer">cremations</a> happening compared to the same period last year, according to reports. It is not clear how many of these extra deaths are due to Covid-19.The movement of the younger people has had a <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">direct impact on the elderly</a>, as they take home the virus and make parents and grandparents seriously sick. People in their sixties and above now make up over 60% of Covid-19 fatalities in Nepal.Even without the added risk of coronavirus, senior citizens are prone to <a href="https://www.nepalitimes.com/latest/covid-19-will-get-worse-before-it-gets-better/" target="_blank" rel="noopener noreferrer">pneumonia and other chronic respiratory illness in winter</a>. Public health experts advise being alert in regards to their condition even before they complain of symptoms and keeping communication channels open.Says Sher Bahadur Pun: “These are extraordinary times and we need to take extraordinary measures to protect the more vulnerable among us. <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Until we get a vaccine</a>, we must realise our responsibility in containing the virus and not become a medium for more deaths.”

Sonia Awale

<figure><img width="760" height="428" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151112/636bb5d09c7e80680e07bc25jpeg.jpg" alt=""/><figcaption>Nepali workers entering the border from India through Behaliya checkpoint in Rupandehi. Photo: MANORANJAN SHARMA</figcaption></figure>In July, as the government eased the first lockdown, people streamed <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener noreferrer">across the border from India into Nepal</a>, spreading the <a href="https://www.nepalitimes.com/banner/as-india-peaks-covid-19-spreads-rapidly-in-nepal/" target="_blank" rel="noopener noreferrer">coronavirus infection along cities in the Tarai</a>. The districts from Jhapa to Parsa became hotspots. Hospitals ran out of ICU beds and ventilators, municipalities had no test kits left, and there were horror stories of patients dying while going from one hospital to another that refused admission. But it did not take too long for asymptomatic carriers to bring the virus into Kathmandu Valley, where population density and high mobility <a href="https://www.nepalitimes.com/latest/covid-19-spreads-closer-to-nepals-ruling-circle/" target="_blank" rel="noopener noreferrer">made the capital an ideal breeding ground for SARS-CoV-2</a>.   With 16 additional deaths on Monday and two on Tuesday, total Covid-19 fatality in Nepal has now reached 429. Kathmandu Valley alone accounts for over one-fourth of all deaths in Nepal from the virus. On Monday, Kathmandu, Lalitpur and Bhaktapur districts recorded 647 new cases (about half the nationwide total of 1,356). The tables are now turned. Even as the Tarai has the virus largely under control, the majority of the 223 patients in ICU and 37 on ventilator support nationwide are in Kathmandu Valley. The country’s only infectious diseases hospital in Teku, despite adding isolation wards, ventilators and ICU beds, has <a href="https://www.nepalitimes.com/banner/nepals-virus-vortex/" target="_blank" rel="noopener noreferrer">run out of space for Covid-19 patients</a>. “Even with the increased capacity, we cannot admit all the patients,” hospital director Sagar Rajbhandari told Nepali Times. Three months after the government announced it would build a 300-bed hospital just for coronavirus patients, there has been no action. It has not followed the advice of its own public health experts to expand testing and tracing. In fact, the Nepal government seems to have admitted defeat. Its unspoken strategy now is now letting the virus take its course, warning citizens to adopt their own precautions and learn to live with the disease <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">until a vaccine is available</a>. This explains why even as the number of new cases and fatalities in Kathmandu Valley <a href="https://www.nepalitimes.com/latest/nepal-beats-own-record-in-covid-19-cases-and-deaths/" target="_blank" rel="noopener noreferrer">break its own record every day</a>, the lockdown is being further eased with public transport, flights, shops and restaurants allowed to open. Adding to this is the utter lack of coordination between locally elected municipality officials and the District Administration Offices which issue new and contradictory guidelines every day, and blame each other for the situation getting worse. Locally elected representatives <a href="https://www.nepalitimes.com/editorial/nepals-leaders-are-in-isolation/" target="_blank" rel="noopener noreferrer">should have been allowed to handle the outbreak</a> like in the Tarai, with the central government only ensuring that they have adequate resources, equipment and medical personnel. “Kathmandu’s response to the pandemic shows that the central government doesn’t trust local units who are close to the people and can respond fastest to their needs,” says Chandra Kishore, a Tarai-based journalist in Birganj. “The focus should be on empowering local governments and health posts to contain the spread of the virus.”Even as Kathmandu struggles to contain the virus with all the resources and facilities at its disposal, Nepal’s capital could learn a few things from the way Tarai cities and municipalities handled the spike and brought the virus under control.One example is Narainapur in Banke district, which first made it to the news as a hotspot back in May <a href="https://www.nepalitimes.com/latest/with-3rd-covid-19-fatality-nepal-issues-funeral-guideline/" target="_blank" rel="noopener noreferrer">with over 100 cases and Nepal’s second Covid-19 fatality</a>.Most of the infected were migrant worker returnees from India. Since then, the municipality has brought active cases down to zero. <figure><img width="640" height="398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151112/636bb5d29c7e80680e07bc26jpeg.jpg" alt=""><figcaption> </figcaption></figure>“In our experience what worked the best was the collaboration between the local government, CDO office and the Nepal Army,” says Naresh Shrestha, the Covid-19 focal point for Banke district. “This has helped us conduct proactive contact tracing and raise awareness about safety measures. Narainapur is also relatively isolated which helped us seal the access points and better manage the outbreak.” <figure><img width="640" height="435" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151112/636bb5d49c7e80680e07bc27jpeg.jpg" alt=""><figcaption> </figcaption></figure>After Kathmandu Valley, Banke has conducted the most PCR tests and of the total 1,662 coronavirus cases in the district, 1,264 people have already recovered. The remaining cases are in densely populated areas of Nepalganj and Kohalpur.Nepalganj mayor Dhawal Shumshere Rana says his city was among the first to be hit with the coronavirus, and had to learn quickly through trial and error.“We didn’t know what was coming. Me and my staff took PCR tests ourselves to set an example for others,” Rana said on the phone. “We now have the virus more or less under control. We still have some cases, but life is back to normal and our people are following safety measures.”In the neighbouring district of Bardia which has a 83km border with India, there has been a gradual rise in cases. In Badhaiyatal municipality, the authorities shut the quarantine centre that had become an incubator for the virus.“After we realised what was happening, we focused on containing the virus in the quarantine centre and invested in contact tracing, which helped us bring the situation under control,” explained Gokarna Giri of the Bardia District Health Office. “But containing the virus in crowded cities and marketplaces has been challenging. We can’t reach everywhere, people have to be mindful about obeying safety measures.”Udaypur in the Inner Tarai of eastern Nepal <a href="https://www.nepalitimes.com/banner/nepals-muslims-face-stigma-after-covid-19-tests/" target="_blank" rel="noopener noreferrer">was a coronavirus hot spot in April</a> when 13 men in a mosque who had returned from Delhi all tested positive. There was stringent contact tracing of people who they had been in close proximity to, and the district was sealed off for months.In fact, Udaypur’s experience is now called the ‘Bhulke Model’ after a ward of Triyuga Municipality that used PCR tests for contact tracing after false negatives  from RDTs. Infected people were immediately sent to hospital isolation wards, and health officials did repeat contact tracing of the entire community until cases came down to zero.  <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Muslim-woman-activist-Udaypur%20,3997" target="_blank" rel="noopener noreferrer">Gaighat-based activist Najbul Khan</a> used to travel every day on her motorbike during the lockdown with supplies and essential medicines for communities ostracised due to infection. Her Muldhar Mahila Kendra offered counseling for youth who were mentally stressed, prepared iftaar for the Muslim community for 18 days during Ramadan.“All of us, the community, volunteers, and the local authorities worked together to overcome the coronavirus. It is because of this that Udaypur is a model for successfully bringing Covid-19 under control,” Khan says.In the beginning, Udaypur did not even have sufficient personnel to collect swab samples, and the district hospital’s Parmendra Yadav was working overtime to conduct tests <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">without proper personal protective gear</a>. His hard work was met with stigma: fearful colleagues stopped talking, and the eatery he frequented stopped serving him.  But Yadav persisted, he trained lab personnel to bring the district’s limited health services up to speed and received PPE from non-profits in the area.“It was a difficult two months, but it paid off knowing how far we have come in terms of controlling Covid-19,” says Yadav. “Kathmandu could learn from our strategy of widespread testing, contact tracing, and strict border controls.”With additional reporting from Ramu Sapkota.

Covid-19 lessons for Kathmandu from the Tarai

After a week of violent and destructive protests, Nepal’s President Ram Chandra Poudel on Friday appointed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">former Chief Justice Sushila Karki</a> as a caretaker Prime Minister to lead an interim citizens' government.&nbsp; Poudel had been in <a href="https://nepalitimes.com/news/what-next-nepal">closed-door discussions since Thursday</a> with youth members who spearheaded the protests, constitutional experts, the House Speaker, and the Army Chief. There was a consensus on the choice of Karki as candidate for interim prime minister, but her swearing-in was stalled due to a disagreement about Constitutional processes for her appointment.&nbsp; Youth delegates and Karki demanded that Parliament be dissolved before the appointment of the caretaker prime minister, while President Poudel had been arguing that Parliament would be automatically dissolved once the new council of ministers announced elections. Representing the GenZ movement, <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">Sudan Gurung</a> (pictured, below) is said to have insisted that dissolution of Parliament first was non-negotiable because he did not trust the political parties. He is said to have added that he would call his supporters out into the streets, and the President relented. The military’s warning earlier that an emergency would be declared if there was no agreement tonight clinched it.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3.jpg" data-media-id="editor_3" data-image-id="2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3" data-rendition-name="original" width="1080" height="600" loading="lazy" alt="Sudan Gurung"> <figcaption>Sudan Gurung of Hami Nepali during negotiations.</figcaption> </figure>  With this, Karki becomes Nepal’s first female prime minister, exactly a decade after she became the <a href="https://archive.nepalitimes.com/article/interview/a-woman-is-as-capable-sushila-karki,3375">country’s first female chief justice in 2016</a>.&nbsp; Nepalis, still shocked by the <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">death and destruction of the past week</a>, heaved a sigh of relief at the announcement, which was greeted as a victory of youth power for political reform led by the GenZ movement. Its initial anti-corruption protest on 8-9 September <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">spiralled out of control into violence and arson</a> nationwide that claimed at least 51 lives. Several other candidates were floated for the caretaker prime minister’s post. Kathmandu Mayor Balen Shah and former head of the electricity utility Kulman Ghising were being considered, but both declined possibly because they want to contest the next national elections. Given her experience in the judiciary and zero tolerance for corruption, Karki was the favourite of various groups within the GenZ campaign.&nbsp; The site of the negotiations moved to the official residence of the president in Shital Niwas from the Nepal Army Headquarters on Thursday. The Army had come under criticism on social media and from civil society for detaining the President and not letting him speak or be a part of the negotiation.&nbsp; This fuelled public perception that the military had a soft spot for a return of the monarchy. There were widespread rumours on Thursday that king Gyanendra, who was ousted after the abolition of the monarchy in 2008, was trying to stage a comeback by piggybacking on the agitation. Writing on X, senior journalist Kishore Nepal revealed that the Chief of Army Staff Ashokraj Sigdel had allegedly asked Poudel to step aside and pave the way for the military to negotiate, to which the President is said to have replied: “I will not resign. Kill me instead and blame it on the protesters. Then you can do whatever you like.” Live broadcast of swearing in of Sushila Karki:&nbsp; <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/53go4OxuOa0?si=Zd89QGIAX8-7Bm75" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d.jpg" data-media-id="editor_8" data-image-id="2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d" data-rendition-name="original" width="1280" height="851" loading="lazy" alt="Sushila Karki swearing in"> <figcaption>President ram Chandra Poudel swearing in Sushila Karki as the 42nd Prime Minister of Nepal.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba.png" data-media-id="editor_9" data-image-id="2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba" data-rendition-name="original" width="1480" height="924" loading="lazy" alt="Sushila Karki PM"> <figcaption>GenZ representatives with new Prime Minister Sushila Karki after her swearing in.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029.jpg" data-media-id="editor_10" data-image-id="2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Sushila Karki PM"> <figcaption>Sushila Karki with supporters including Genz representative Sudan Gurung of Hami Nepal and Sumana Shrestha of Rastriya Swatantra Party.</figcaption> </figure>  COURAGE AND INTEGRITY Sushila Karki served as the chief justice between 11 July 2016 to 6 June 2017, and has been known for her frugal ways. She was a firebrand judge unafraid to ruffle powerful feathers, and as chief justice was behind ruling to impeach for abuse of office a powerful head of Nepal’s anti-graft body in 2016. She wrote that he had ‘<a href="https://archive.nepalitimes.com/regular-columns/Legalese/the-end-of-karkistocracy,827">neither the moral character nor qualifications for the post</a>’. Even before she became Chief Justice, Karki was one of the two judges on the bench that convicted the sitting Minister for Information and Communication, Jaya Prakash Gupta, of corruption in 2012. Then in 2016, a bench including Karki ruled against granting amnesty to former Maoist lawmaker and convicted murderer Bal Krishna Dhungel. Karki was born on 7 June 1952 in Biratnagar. She completed her undergraduate studies at Mahendra Morang College in 1972 before obtaining a postgraduate degree in political science from Banaras Hindu University in India three years later. This was followed by a Bachelor's in Law in 1978 from Tribhuvan University, and she started her law career as an advocate a year later. In 1985, Karki worked as a teacher at Mahendra Multiple Campus in Dharan, and was jailed for participating in the 1990 People’s Movement to overthrow the Panchayat absolute monarchy. She became a senior Advocate at the Nepal Bar Association in 2008 and was appointed an Ad-Hoc Justice at the Supreme Court in January 2009.&nbsp; On Thursday, there were supporters for other candidates for the post sloganeering against Karki’s nomination outside the Army Headquarters. Some on social media were also skeptical of her connection to the Nepali Congress (NC) party. Growing up in Biratnagar Karki was close to the family of B P Koirala, Nepal’s first elected prime minister in 1960. Her husband Durga Subedi was part of a group of underground Congress activists who hijacked a Royal Nepal Airlines plane in 1973, flying it to India to snatch cash belonging to Nepal Rastra Bank in the cargo hold.&nbsp; The money was used for the party’s pro-democracy campaign. Karki has no love lost for the political establishment. In April 2017, the governing coalition under Maoist Prime Minister Pushpa Kamal Dahal <a href="https://archive.nepalitimes.com/article/editorial/lady-justice-sushila-karki,3693">submitted an impeachment motion against her</a> after the Supreme Court overturned his decision to install a favoured police chief, violating succession based on seniority. It was a political move backed by Dahal’s coalition partner Sher Bahadur Deuba of the NC who was waiting to become prime minister for the 4th time. CHALLENGES AHEAD With Karki now in charge of the interim government, she has the daunting task of forming a council of ministers made up of amorphous and disparate groups from the GenZ, technocrats, and current politicians. Karki has said she will not prevent members of her cabinet from contesting elections, which means those with electoral aspirations like Kulman Ghising, Balen Shah and Sumana Shrestha could be asked to join. Karki has her work cut out as she has to get her team members to pull in the same direction to hold free and fair elections. She also has to make sure she has the support of the military without giving the generals too much say, while also smartly maneuvering Nepal’s precarious geopolitical ties with its giant neighbours, China and India. But most of all, the new prime minister must lay the foundations to not just physically rebuild the judiciary, executive and legislature but also ensure that elections will produce a more accountable and efficient government. Read also: <a href="https://nepalitimes.com/editorial/trial-by-fire">Trial By Fire</a>, Editorial

Madam Prime Minister of Nepal

Many had never heard of <a href="https://www.haminepal.org/">Hami Nepal</a>, the organisation that is part of the GenZ movement that did not just topple the government this week, but <a href="https://nepalitimes.com/news/what-next-nepal">pushed Nepal’s political system into new, uncharted territory</a>. It was part of an organic coming together of various youth groups fed up with Nepal’s corruption, mismanagement and lack of accountability. Hami Nepal and its GenZ comrades are now part of the negotiations with the Army to form an interim government. Hami Nepal is a non-profit dedicated to supporting communities and individuals in need, guided by its motto ‘For the People, By the People’. Its core mission is to assist individuals and communities in need, particularly during emergencies and crises, with a focus on directly connecting donors with recipients, and delivering aid efficiently and transparently. It was set up after the 2015 earthquake, but was formally registered and gained recognition in 2020 during the Covid-19 pandemic. Hami Nepal is led by 36-year-old civic activist Sudan Gurung who started the organisation after he lost his own son in the 2015 earthquake.&nbsp; Leading up to the events this week, it played a central role in guiding the demonstrations, using its Instagram and Discord platforms to circulate protest information and share guidelines. Other GenZ groups used their own WhatsApp groups and other fora.&nbsp; Among the 20 or so volunteers is Ronesh Pradhan, who spoke to <a href="https://nepalitimes.com/news/nepal-s-gen-z-protest-turns-deadly">Nepali Times on 8 September </a>morning during the GenZ rally, before the violence escalated.&nbsp; “The voices of young people matter. We can’t keep being ruled by the same old men,” Pradhan said. “Our generation is the future and if there are older leaders in government, they need to be competent and accountable. We are ready to lead this country forward.” Hami Nepal’s earliest visible campaigns include donating more than 400 blankets to Bir Hospital’s Covid unit in 2022, creating a plasma and oxygen bank during the pandemic, and distributing school jackets to children in rural districts. More recently, it mounted a relief effort in response to the 2023 Jajarkot earthquake, reaching over 13,000 families with shelter, food, and medical support. The organisation was also associated with the two-month ‘Save Ghopa’ campaign, demanding effective and smooth administration of the BPKIHS (B P Koirala Institute of Health Sciences) in Dharan. The organisation was also actively engaged in providing rescue and relief during the Kagbeni and Sindhupalchok floods this year. It even sent aid to Turkey after its 2023 earthquake. After the Kavre floods last year, Hami Nepal donated solar lights. Funding for Hami Nepal comes directly from public donations, with a policy of channeling 100% of received funds for aid distribution. Volunteers self-finance administrative costs, and the group publishes detailed expenditure figures, regularly sharing updates and transparency reports through their social media and website which it launched at its Annual General Meeting in Bhaktapur last year.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88.jpg" data-media-id="editor_3" data-image-id="20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88" data-rendition-name="original" width="1080" height="719" loading="lazy" alt="Who, or what, is Hami Nepal?"> </figure>  Following the death of Nepali student Prakriti Lamsal at KIIT University in India earlier this year, Hami Nepal advocated for justice using its Instagram account, raising concern about the safety of Nepali students. Its advocacy platform started with rescue and relief, and Hami Nepal managed to develop a track record for efficient campaigns and transparency in Nepal’s humanitarian landscape. But its work pushed the group to realise that there was a deeper malaise in Nepali society. Its #youthsagainstcorruption campaign on social media platforms gained rapid momentum, and that led to the rally on 8 September. Read also: <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">Nepal’s 8 September massacre</a>, Shristi Karki The international #Nepobaby trend on TikTok propelled the rally even more, and young Nepalis used it to expose the scions of powerful politicians and politically-connected influencers who were exhibiting their flashy lifestyles on social media while citizens struggled with joblessness, corruption and poor service delivery. Public anger reached a tipping point when the UML-NC coalition led by Prime Minister K P Oli announced a sweeping ban on major social media platforms citing tax revenue, cyber security, and lack of content moderation. Netizens, civil society and media, however, saw it as the latest authoritarian attempt by the government to clamp down on free speech, increase surveillance of citizens and constrict Nepal’s open society. Susmita Khadka, 22, told us at the rally: “Politics is everywhere. Gen Z has the most platforms, and we want a revolution.” Leading up to 8 September, the GenZ movement disseminated information and reassured participants with volunteers readily available for help, medical support, and assistance. It put up a protest support helpline so that students needing assistance could get help. As the protests intensified, leaving at least 20 dead outside Parliament, and forcing Prime Minister K P Oli to resign, Hami Nepal shifted into a mediator role, engaging in talks with officials and seeking GenZ’s views on future leadership.&nbsp; Influencers like TikToker Nimesh Shrestha publicly backed the group, amplifying their voice in ongoing negotiations with the Nepal Army alongside other GenZ representatives. However, as the protests escalated on 9 September, <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">resulting in massive arson and vandalism of public and private property</a>, many GenZ activists disavowed association with the attackers, saying their movement had been infiltrated. The group backtracked, with Gurung saying he was not the leader of the protests.&nbsp; Meanwhile, others accused Hami Nepal for singlehandedly speaking with the Army chief, and said that they did not represent GenZ’s collective voice. Most GenZ supporters backed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">Former Chief Justice Sushila Karki</a> as their candidate for interim prime minister in an online group. Not everyone in the GenZ movement agrees with that choice, with support for Kathmandu Mayor Balen Shah, even though he has endorsed Karki’s appointment. Dharan Mayor Harka Sampang rushed to Kathmandu on Wednesday to push his own candidacy. Hami Nepal has supported Balen Shah to lead the country for the next five years, not just during the interim period, and have called on the public to share their posts supporting Shah to amplify the message. With the old guard gone, there is a power vacuum with multiple actors with competing interests to fill it. GenZ’s youth-led activism has brought new energy for political reform, but its real test begins now — whether it can unite Hami Nepal and other sections to negotiate with the Nepal Army.&nbsp;

Who, or what, is Hami Nepal?

As this story is being uploaded on Wednesday evening, sloganeering is going on outside the gates of the Nepal Army headquarters in Kathmandu between various GenZ groups about who should be the caretaker prime minister.&nbsp; The GenZ campaign includes Hami Nepal and several other groups that spearheaded the anti-government rally this week against corruption and neoptism. Thirty people died as the protests in Kathmandu turned violent on Monday and Tuesday. After Prime Minister K P Oli stepped down on Tuesday, Nepal has existed in a power vacuum, with no one really in charge. The Nepal Army took over security management from Monday night, and President Ram Chandra Poudel appealed to Nepali youth to come to the negotiating table.&nbsp; Thousands of GenZ youth held hours long discussions on Discord and other online fora on Wednesday, and voted to endorse former Chief Justice Sushila Karki to lead the transitional government. The group informed Chief of Army Staff Ashokraj Sigdel about their choice, but he has also been meeting leaders of at least 12 other groups claiming to be the genuine GenZs. Among them are royalist and other groups that many saw as having infiltrated the GenZ rally on Monday in which 20 people were killed while trying to storm Parliament.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d.jpg" data-media-id="editor_0" data-image-id="20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d" data-rendition-name="original" width="640" height="387" loading="lazy" alt="Sushila Karki"> <figcaption>Photo: SHAHIDUL ALAM</figcaption> </figure>  On Tuesday, disparate groups joined the arson and looting that ended up gutting Singha Darbar, the Parliament and Supreme Court buildings and attacks on party offices, media, schools and private residences across the country. The original GenZ disavowed involvement.&nbsp; 'Nepal's 2015 Constitution does not envision any transitional or emergency provisions to address a state of political and constitutional vacuum. For now, the President, per Article 273 of the Constitution, can exercise emergency powers in light of the current situation,’ wrote former National Human Rights Commissioner Mohna Ansari on social media on Wednesday evening. The President can declare a state of emergency per Article 273 of the Constitution, but that must be endorsed by a two-third majority of Parliament within a month, after which it will be in effect for three months. ‘Former Chief Justice Sushila Karki is the best option to address the adverse circumstances prevailing in the nation. The President must heed the Constitution and take the next steps in a manner that is transparent, keeps the public informed, and is in the national interest,’ Ansari added.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf.jpg" data-media-id="editor_1" data-image-id="20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf" data-rendition-name="original" width="8000" height="5760" loading="lazy" alt="Nepal in ashes"> <figcaption>Photos: KAMAL PRASAI</figcaption> </figure>  The Gen Z movement itself appears fragmented and without distinct leadership, both before the anti-corruption protests on 8 September and in the aftermath of the two-day protests.&nbsp; Various groups are said to have met or waited to meet the Gen Sigdel on Wednesday. The Army told others claiming to be GenZ and raising slogans against Karki’s candidacy to appear at the army headquarters on Thursday.&nbsp; Nepalis had floated the names of some of Nepal’s more acceptable public figures to lead a caretaker government, including Kathmandu mayor Balen Shah. But Shah told the Army chief he endorsed Sushila Karki’s nomination. <div class="embed-block"><iframe src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2FbalenOfficial%2Fposts%2Fpfbid02M9CBZiWETz4qocKaYUG6ZSZ4ARNcq231V8edJJVGQhPLmpSRMdv1mTWM2q7mJijjl&show_text=true&width=500" width="500" height="256" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowfullscreen="true" allow="autoplay; clipboard-write; encrypted-media; picture-in-picture; web-share"></iframe></div> The names of former NEA chief Kulman Ghising and ex-education minister Sumana Shrestha of the RSP had also been proposed.&nbsp; Polls conducted on social media to gauge public sentiment show a significant number are open to Sushila Karki taking charge of a transitional government. Both Shah and Shrestha are not so keen, and are probably waiting to contest elections.&nbsp; Meanwhile, Nepal’s young reform campaigners largely seem to reject the idea of handing leadership to RSP chair Rabi Lamichhane who was retrieved by supporters on Tuesday from Nakhhu jail after eight months of incarceration for embezzling depositers of cooperatives. But even as GenZ held discussions with the Army chief to decide on the interim government, other interest groups have continued to engage as well. Erstwhile royalist businessman Durga Prasai, posted a photo of himself with Sigdel on social media and professed that he has 'no interest' in leadership and would accept whomever GenZ youth chose. The job of the caretaker government, whoever leads it, will primarily be to hold free and fair elections for a new leadership which will then face the challenge of reestablishing Nepal’s democratic institutions.&nbsp; “The course of events showed that the movement has gone beyond Constitutional remedy,” political analyst Krishna Khanal told BBC Nepali following erstwhile Prime Minister Oli’s resignation on Tuesday. “There needs to be a middle-ground solution that will be acceptable to the people who took to the streets while upholding the existing constitutional process.” Various GenZ collectives have issued demands that include the dissolution of Parliament and the formation of a new civilian government, which analysts say are antithetical. Constitutional experts have suggested that the youth opt for a solution that allows for new leadership to move forward under the current Constitution.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29.jpg" data-media-id="editor_3" data-image-id="20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29" data-rendition-name="original" width="8064" height="6048" loading="lazy" alt="Nepal in ashes"> </figure>  One option, they say, is for the President to appoint any prime minister from the existing Parliament under Article 76(5) if all other measures fail, who would then have the authority to appoint up to 25 non-elected ministers for six months. This can be a way for that temporary leadership to hold elections within the mandated time frame. The existing Constitution can then be amended to accommodate the aspirations of the Nepali youth after the election.&nbsp; But any conditions put forward by GenZ youth that requires a new Constitution might set Nepal back years, warn some experts. The 2015 Constitution was the result of nearly 10 years of negotiations and strife, and the formation of another charter will mean that Nepal will head into decades more of rotating governments and political instability. For now, Nepali youth need to unite to decide by Thursday who leads the country into the next phase.&nbsp;

What next, Nepal?

Edited: The paragraph about K P Oli's whereabouts has been deleted. On Wednesday morning, orange flames are still leaping out of the windows of Singha Darbar. Fire trucks which could finally make their way in, were trying to douse the fires. Most of the ministries inside Singha Darbar, including the Prime Minister’s Office, are charred hulks. Singha Darbar’s imposing west facade built by Chandra Shumsher Rana 117 years ago and the hall where he met visiting foreign envoys was destroyed in the 2015 earthquake. It was restored last year to its original splendour with stained glass windows and an ornate ceiling. After demonstrators entered the central government secretariat on 9 September they set the entire complex on fire. Dozens of SUVs and cars that were smashed and burnt litter the parking lot.&nbsp; Across to the south at the Supreme Court, a fire truck belonging to Kathmandu Metropolitan City is trying to put out the flames. The building is still smoking, and hundreds of case files have gone up in flames. There is now also a threat from escaped prisoners from jails all over the country.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786.jpg" data-media-id="editor_0" data-image-id="20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786" data-rendition-name="original" width="1600" height="1066" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Supreme Court sustained heavy damages following Tuesday's arson.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628.jpg" data-media-id="editor_1" data-image-id="20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army cleaning up the debris outside the main gate of Singha Darbar.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529.jpg" data-media-id="editor_2" data-image-id="2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The grand staircase leading to the upper balcony of the Parliament building.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46.jpg" data-media-id="editor_3" data-image-id="20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46" data-rendition-name="original" width="6526" height="4350" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army armoured car guarding the Baneswor intersection outside Parliament.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4.jpg" data-media-id="editor_4" data-image-id="20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4" data-rendition-name="original" width="6677" height="4451" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The row of electric vehicle showrooms in Thapathali were all torched with the cars inside.</figcaption> </figure>  Interestingly, the under construction Supreme Court, and the newly-built Parliament Complex are untouched. The current Parliament is housed in the Birendra International Convention Centre (BICC) built by the Chinese in 1993, and was the first target of protesters on 8 September. Outside its gates was where 20 students were shot and killed as they tried to storm the gates. After Tuesday’s mayhem, Kathmandu’s streets are now under control of the Nepal Army which has imposed a nationwide curfew. K P Oli was whisked out of his official residence in Baluwatar on Tuesday.&nbsp; Tuesday and Wednesday saw additional 8 casualties, including policemen who were lynched in Tinkune and Budanilkantha.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf.jpg" data-media-id="editor_5" data-image-id="20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf" data-rendition-name="original" width="6539" height="4360" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The parking area of the Department of Roads with a row of charred cars (also below).</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30.jpg" data-media-id="editor_6" data-image-id="20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa.jpg" data-media-id="editor_7" data-image-id="20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa" data-rendition-name="original" width="6726" height="4484" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>A police vehicle set on fire by demonstrators at Patan Darbar Square on Tuesday.</figcaption> </figure>  The Army is negotiating with the president and representatives of the GenZ campaign that includes Hami Nepal group that organised the protests to form a new government. Kathmandu Mayor Balen Shah and former Supreme Court Chief Justice Sushila Karki have been named as potential candidates to lead the new government The Civil Aviation Authority of Nepal has decided to keep Kathmandu airport closed for all domestic and international flights ‘until further notice’. Update: The video of a flight attendant speakling on social media has now been found to be fake. The error is regretted.&nbsp;

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