It was only five years ago that neologisms like ‘self-quarantine’, ‘comorbidity’, ‘contact tracing’, ‘omicron’ entered the Nepali lexicon.
PCR, CCMC, PPE, WFH and other acronyms were thrown about, and we became intimate with vaccine names: AstraZeneca, Pfizer, Moderna, Sinovac. We ‘social distanced’ or ‘sheltered-in-place’ as we tried to ‘flatten the curve’.&nbsp;
After the second Covid-19 case was identified in a female Nepali student returning from Paris, the country went into <a href="https://nepalitimes.com/banner/nepal-goes-into-lockdown-for-a-week">lockdown on 24 March 2020</a>. A day later, India followed suit, halting the movement of over 1.3 billion people.&nbsp;
Tens of millions of <a href="https://nepalitimes.com/here-now/a-long-way-to-europe">migrant workers</a> walked hundreds of kilometers, including Nepalis. Many died along the way.
Social ostracisation and <a href="https://nepalitimes.com/banner/nepals-muslims-face-stigma-after-covid-19-tests">stigmatisation</a> based on rumours fanned by <a href="https://nepalitimes.com/news/the-social-media-contagion">social media</a> was rife. <a href="https://nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma">Nepali workers</a> who made it to the border were quarantined. Some jumped into the raging <a href="https://nepalitimes.com/news/lockdown-limbo-in-no-mans-land">Mahakali River</a> to get to their families and drowned.&nbsp;
Two million <a href="https://nepalitimes.com/here-now/in-the-minds-of-nepal-s-migrant-workers">Nepali migrant workers</a> in the Gulf and <a href="https://nepalitimes.com/opinion/labour-mobility/crossborder-virus-and-nepali-migrant-workers">Malaysia</a> were stranded, as there were not enough flights to repatriate them. Nepalis abroad sent money home as people lost their jobs, others collected money to ship <a href="https://nepalitimes.com/here-now/nepal-s-frontline-workers-brave-it-out">ventilators, masks and personal protective equipment (PPE)</a> to Nepal. &nbsp;&nbsp;
“Covid might be over but we are still unprepared for rescue and repatriation on that scale, considering that many Nepali workers are in conflict zones of the Middle East,” warns Upasana Khadka of the non-profit Migration Lab. “The pandemic also highlighted the need for <a href="https://nepalitimes.com/news/nepal-plans-to-reintegrate-returning-workers">migrant reintegration</a>, transnational mechanisms to claim wages of returnees, but most importantly it brought home the role of low-paying, unskilled migrant workers in propping up <a href="https://nepalitimes.com/news/nepal-prepares-for-economic-fallout-of-pandemic">Nepal’s economy.</a>”
Read also: <a href="https://nepalitimes.com/news/poor-cash-rich-nepal">Poor cash-rich Nepal</a>, Sonia Awale&nbsp;
The lockdown was initially announced for a week, but lasted four months till mid-July 2020. Within a month Nepal went back into lockdown again for four weeks before it was eased, and there was another two-month lockdown in April 2021. The time that should have been used for a mass vaccination was squandered in shutting people in their homes. This newspaper stopped its print edition for a year.&nbsp;
Without lockdowns many more <a href="https://nepalitimes.com/here-now/protecting-nepal-s-elderly-from-covid-19-c6e60vp6">elderly Nepalis</a> and those with pre-existing ailments would have died. During the deadly Delta second wave, even children became sick. But the <a href="https://nepalitimes.com/news/lockdown-likely-to-be-extended">prolonged lockdowns</a> hit the poorest and neediest Nepalis hardest.
Research scientist Sameer Dixit at the Center for Molecular Dynamics Nepal remembers getting into an argument with security personnel as he bicycled in the morning during lockdown.&nbsp;
“They would ask me to mask up but I would tell them it wasn’t required because the air was so clean for the first time,” he recalls.
Indeed, the air was so clean that people could see the snowy mountains from <a href="https://nepalitimes.com/here-now/the-tarai-s-shrinking-forests">the Tarai </a>and <a href="https://nepalitimes.com/news/mt-everest-pvt-ltd">Mt Everest</a> was visible from Chobhar. The lockdown offered proof that <a href="https://nepalitimes.com/news/double-whammy-air-pollution-and-covid-19-zevz0864">Kathmandu’s notorious air pollution</a> could indeed be cleaned up by <a href="https://nepalitimes.com/banner/blueprint-for-a-net-zero-nepal">reducing emissions</a>.
“In many ways, we had actually forgotten about the need for cleaner, better air, <a href="https://nepalitimes.com/here-now/coronavirus-shutdown-gives-nepal-s-nature-a-respite">Covid served as a reminder,</a>” says urban planner Bhushan Tuladhar. “In fact, air pollution made <a href="https://nepalitimes.com/news/nepal-has-no-health-minister-as-covid-19-cases-rise-again">Covid cases</a> worse. But as soon as the pandemic ended, we were back to breathing dirty air. Last week Kathmandu ranked among the most polluted cities in the world.”
A 2019 study put <a href="https://nepalitimes.com/here-now/bad-air-and-polluted-politics">air pollution</a> fatalities at 41,000 per year in Nepal, several times more than total reported Covid deaths, 11,959. Better air quality would increase the life span of Nepalis by nearly five years.
Unfortunately, there is no vaccine to combat <a href="https://nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking">air pollution</a>. And with the <a href="https://nepalitimes.com/opinion/life-time/to-vax-or-not-to-vax">anti-vaxxers</a> in the <a href="https://nepalitimes.com/editorial/trump-s-second-coming">Trump administration</a>, there are already cuts in critical vaccine research to fight the next pandemic. This coincides with a bird flu outbreak and measles deaths in the United States.&nbsp;
“The single biggest <a href="https://nepalitimes.com/news/life-lesson-from-the-pandemic">lesson of the pandemic</a> was the <a href="https://nepalitimes.com/latest/vaccines-are-the-only-solution">importance of vaccines</a>,” says Dixit, adding that the US withdrawal from WHO will lead to serious gaps in preparing for the next pandemic.
Read also: <a href="https://nepalitimes.com/here-now/still-learning-lessons-from-covid">Still learning lessons from COVID</a>, Sonia Awale&nbsp;
Buddha Basnyat of the Oxford University Clinical Research Unit (OUCRU) says US pullout from <a href="https://nepalitimes.com/opinion/global-solidarity-needs-intensive-care-in-pandemic-battle">global health</a> is a huge setback that could compromise disease surveillance and diagnosis: “The pace at which the Covid vaccines were developed was nothing short of a miracle, but we are vulnerable to both emerging and pre-existing diseases.” &nbsp;
<a href="https://nepalitimes.com/news/how-usaid-cut-affects-nepal">US withdrawal </a>has left the field wide open for China and India to now lead the way. According to AidData headquartered in Virginia, China provided over $4.6 billion in Covid-19 aid from 2020 to 2022, surpassing the United States and Germany which contributed $4.05 billion and $3.64 billion respectively.
China donated more than 239 million doses of Covid vaccines to its Asian neighbours. India supplied 301 million vaccine vials to 99 countries and two UN entities, 15 million doses as donation to more than 50 nations including Nepal. The US donated nearly three times more, but that may not happen next time.
Read also: <a href="https://nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal">Why is there vaccine hesitancy in Nepal?</a> Sonia Awale
“With <a href="https://nepalitimes.com/news/the-great-game-2nd-half">America backing out</a>, China and to a lesser degree India, will fill that role, and it is not necessarily a bad thing for us. As neighbours we are closer to them and it would be advantageous to us,” says Sher Bahadur Pun, virologist at the infectious diseases hospital in Teku. He adds: “But capacitating our health sector to manufacture <a href="https://nepalitimes.com/editorial/vacillating-on-vaccines">vaccines</a> at home would be the best way to prepare for future pandemics and health emergencies.”

Sonia Awale

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Lockdown+5

It was not long ago when families of hospitalised Covid-19 patients were frantically searching for a dose of remdesivir or hydroxychloroquine. These drugs were hard to come by, and their price surged. Convalescent Plasma Therapy which uses blood from those who have recovered from an infection to treat new cases was similarly thought to be another effective regime for Covid patients. Until that point during the Covid-19 pandemic, there were no working vaccines. Even when the first vaccines were produced, there were not enough doses for Nepal while the<a href="https://nepalitimes.com/here-now/delta-variant-s-wake-up-call-for-nepal"> delta variant </a>was sweeping India. Covid hospitalisation was at an all-time high, hospitals were running out of beds as even younger populations succumbed to the disease. Today, these drugs and treatment regimes have been found to be completely ineffective. A RECOVERY (Randomised Evaluation of Covid-19 Therapy) Trial started at Oxford University found that hydroxychloroquine was no good for hospitalised Covid patients. Surprisingly, the Recovery Trial also showed that it was a <a href="https://nepalitimes.com/opinion/dhanvantari/a-covid-19-exit-strategy-for-nepal">widely available cheap steroid called dexamethasone</a> that was the most effective in some groups. “Dexamethasone is the real winner by far, it is such an easy and cheap drug to use, followed by Tocilizumab and Baricitinib which are more expensive and difficult to access drugs but showed additional mortality benefits in severe patients,” said Peter Horby, infectious disease specialist and co-lead of the RECOVERY trial during a meeting in Kathmandu last month. He added: “Aspirin, azithromycin, hydroxychloroquine, plasma therapy, colchicine and lopinavir-ritonavir had absolutely no effect on survival rates. In fact, there are potential harms of using hydroxychloroquine.” Hydroxychloroquine gained much momentum after then-US President Donald Trump endorsed the antimalarial drug for use in Covid patients. The Oxford University RECOVERY trial with 49,051 patients enrolled and 189 sites with Nepal being the biggest only after the UK, is the largest randomised controlled clinical trial of Covid-19 treatments, more than twice as large as any other trial. It has so far produced clear answers on 13 different treatments, and no other trial has determined international treatment guidelines in the way RECOVERY has.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240524040532_29bd53f7eeda6d1b28894f37af7008bdf4792910aa3d5f6a893bf9381dce9164.jpg" data-media-id="editor_2" data-image-id="20240524040532_29bd53f7eeda6d1b28894f37af7008bdf4792910aa3d5f6a893bf9381dce9164" data-rendition-name="original" width="1750" height="1169" loading="lazy" alt="Still learning lessons from COVID Page 10-11 NT #1213"> <figcaption>Hospitals in Kathmandu ran out of beds during the Covid-19 pandemic in 2021 and patients had to be treated outside the wards on the floor. Photo: NEPALI TIMES ARCHIVE</figcaption> </figure>  The major finding of the RECOVERY trial that dexamethasone reduces mortality among patients admitted to hospitals with Covid-19 who need oxygen therapy saved over 1 million lives globally just in 2021. But before the trial, there was uncertainty whether or not this treatment would work. “Many well-known doctors actively discouraged the RECOVERY team against using a cheap steroid dexamethasone, but they had based their opinion on much smaller studies,” explains Buddha Basnyat, physician with the Patan Academy of Health Science and the Principal Investigator for the RECOVERY Trial for Nepal. He adds: “But Peter Horby decided we need to do a trial that was sufficiently large to be able to conclude if the drug works, he cut through the fog of confusion and the British review board went with it. It was science at its best.” The trial also demonstrated that powerful antiviral treatments such as <a href="https://archive.nepalitimes.com/news.php?id=19634">monoclonal antibodies </a>when directed against the virus could reduce mortality in patients who have not developed their own antibodies, which many doctors doubted would work. In Kathmandu, Horby recalled meeting a South American minister and found out that they still had aspirin in their Covid treatment guideline. He said: “There is still work to do to get this information through the policymakers about what works and what doesn’t.” The Covid-19 pandemic was an extraordinary global crisis, but in some ways it is similar to the tendency of governments to intentionally look for expensive and complex solutions to <a href="https://nepalitimes.com/here-now/nepal-s-frontline-workers-brave-it-out">medical emergencies </a>when proven cheaper solutions are available. For example, <a href="https://nepalitimes.com/news/remove-barriers-to-life-saving-drug-to-prevent-maternal-deaths">Misoprostol is a cheap drug that can prevent maternal deaths </a>from post-partum haemorrhage. It was a part of the program launched in the mid-2000s to protect women who give birth at home but now it faces opposition, neglect and shortages in Nepal because it is so cheap.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240524040532_e70428427a6f5a50955c544ff4f2e7f9c4c86a4065f4680a3d999dc3f667b957.jpg" data-media-id="editor_6" data-image-id="20240524040532_e70428427a6f5a50955c544ff4f2e7f9c4c86a4065f4680a3d999dc3f667b957" data-rendition-name="original" width="2000" height="1199" loading="lazy" alt="Still learning lessons from COVID Page 10-11 NT #1213"> <figcaption>Peter Horby speaking about the RECOVERY trial in Kathmandu last month.</figcaption> </figure>  “Tranexamic acid is another cheap drug for post-partum haemorrhage. The same steroid for Covid-19 called dexamethasone is the most effective drug for the treatment of severe altitude illness,” says Basnyat, who specialises in mountain medicine. “There is a tendency to underutilise some of these affordable, simple and easily available lifesaving drugs at our disposal.” The RECOVERY trial also turned out to help build medical research capacity in Nepal. The Infectious Diseases Hospital at Teku and the Armed Police Hospital were<a href="https://nepalitimes.com/here-now/nepal-s-doctors-are-like-soldiers-fighting-a-war"> at the forefront</a> while the Oxford University Clinical Research Unit Nepal spearheaded the campaign and convinced the Nepal Health Research Council to participate. “Nepal played a crucial role in the expansion of the trial from the UK to the rest of the world,” Horby told Nepali Times. “Nepal recruited more patients than any other country outside the UK.” &nbsp; Indeed, Nepal was the single biggest contributor to the trial and the research contributed to the global science, and it was a big boost for fledgling research culture in Nepal. Says Basnyat: “We stood to gain scientifically from this but also showed young doctors and nurses in Nepal were randomising patients in a very standardised way, learning new things despite the tragedy that was Covid-19.” The RECOVERY platform has now transitioned into finding treatments and better care for pneumonia and other influenzas which <a href="http://archive.nepalitimes.com/article/nation/Antibiotic-resistance,1974">still kill hundreds of thousands of people worldwide</a>. Added Horby: “RECOVERY has shown the benefit of large, streamlined trials and how they could be applied to any common health problem. Trials are essential if we are to know what is effective and what is not, so ensuring we can deliver more trials is important for public health.”

Still learning lessons from COVID

<a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay">Dengue ravaged Nepal last monsoon</a>, with over 55,000 hospitalisations and 88 fatalities. But that is just the official count, and many who died from the mosquito borne virus that caused haemmorhagic fever were healthy adults. Public health experts had warned last year that the virus would strike again in the 2023 rainy season because the virus hibernated with the larvae of infected mosquitos. They say the larvae are just waiting for the puddles to hatch, and with it the virus can again spread exponentially. Waiting until the monsoon to target mosquito breeding areas will be too late. “Local government must start the search-and-destroy larvae campaign now, we cannot wait for the rains,” warns virologist Sher Bahadur Pun at Teku Hospital. “Dengue is a real public health crisis and we cannot prevent it without the government and the communities working together, individual precaution can only go so far.” The key is to raise awareness, preferably through school children so that we can reach their families and subsequently the community at large, about the nature of aedes mosquito that carries the dengue virus and the protective measures. Last year, almost every family in Kathmandu had multiple members suffering from <a href="https://www.nepalitimes.com/news/state-of-malaise">dengue</a>. Although 90% of patients were asymptomatic, they helped spread the virus.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230408040436_c88bd2e1183ab33f7763f64b18be6b6945cfae7fa1a6c1b793c9ffdeb3cf739f.jpg" data-media-id="editor_2" data-image-id="20230408040436_c88bd2e1183ab33f7763f64b18be6b6945cfae7fa1a6c1b793c9ffdeb3cf739f" data-rendition-name="original" width="5827" height="3885" loading="lazy" alt="dengue"> <figcaption>Photos: SUMAN NEPALI</figcaption> </figure>  Dengue patients generally have two weeks of high-grade fever accompanied by extreme muscle and joint aches, loss of appetite, nausea, and pain in the eye sockets. Many who had both dengue and Covid said dengue was much worse. <a href="https://nepalitimes.com/news/another-covid-wave-but-milder">Covid-19 is also back again</a>, possibly with a circulation of a new variant in the region. So all three levels of government must prepare for both outbreaks simultaneously. “Dengue is among the biggest public health challenges of the 21st century, given the disease burden and its socioeconomic impact in these parts of the world,” says Buddha Basnyat, physician at Patan Academy of Health Sciences. “And there is every potential of another outbreak given that we have not learned our lesson from previous outbreaks or taken any measures to prevent another one this year.” Indeed, Kathmandu had a major dengue outbreak in 2019, just before Covid-19 spread out of China in December of that year. There were over 17,000 official cases that monsoon but they were largely adult patients, most of which had milder symptoms and the fatality was very low. But <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak">last year’s outbreak</a> was much more widespread and serious. Although debilitating, fatality from dengue is rare but there were more complications and deaths. The mosquito eradication campaign came too late, and by that point dengue was out of control. We did not learn the lessons of 2019, and we haven’t learned the lessons of 2022. “How not to get dengue? It is simple, do not get bitten by a mosquito,” says Pun. “But preventing a mosquito bite is anything but simple because we do not do anything until it is too late.” Unlike the anopheles mosquito which carries the malaria parasite, aedes is active during the daytime, particularly in the early hours of the morning and evenings. This means avoiding the outdoors during these hours, if possible. So, mosquito net or coils at night do not help. Insect repellents should not be toxic, and contain the active ingredient that the aedes mosquito avoids. Full-sleeve clothes are always a better alternative.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230408040436_960e7fc347fa61878bfa623db07296c1e068a4c932f1257bbc43b70a56e7421b.jpg" data-media-id="editor_5" data-image-id="20230408040436_960e7fc347fa61878bfa623db07296c1e068a4c932f1257bbc43b70a56e7421b" data-rendition-name="original" width="1000" height="699" loading="lazy" alt="dengue"> </figure>  Also important is the knowledge of the breeding habits of aedes mosquito. Any pool of water is a fertile breeding ground, even egg shells and water bottle caps in garbage piles. &nbsp;Fumigation, as some Kathmandu wards did two months into the outbreak last year, was ineffective because the virus was already spreading from already-infected people. In short, destroying the larvae by removing possible breeding sites is the best preventive measures. “Every step that the government took last year after the onset of the pandemic, take them now. In fact, the people should pressure their local governments to do so right away,” adds Basnyat. Unlike Covid and most other infectious diseases, a dengue reinfection is even more dangerous and can be fatal. <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30007-3/fulltext">Writing in the journal The Lancet</a> in 2020, authors Sudeep Adhikari, Buddha Basnyat and Kripa Maharjan explain: ‘Primary infection with any serotype in a non-immune population generally causes mild disease. When secondary infection with another serotype occurs in the same population, there is antibody-dependent enhancement, which usually causes severe dengue. Over time, this secondary infection might lead to a so-called explosion of the disease.’ Such an explosion occurred in 2022 in Nepal’s urban areas, affecting mostly children and young adults. Misdiagnosis also caused complications in patients. Hospitals were overwhelmed and many patients had to be turned away. There was rampant overtreatment, often with antibiotics which are ineffective against viruses. With global warming, disease vectors like mosquitos and the virus are also <a href="https://www.nepalitimes.com/news/nepal-s-dengue-outbreak-exposes-climate-risk">moving to higher altitudes</a> spreading not just dengue but malaria, kalazar and chikungunya. &nbsp; Additional reporting by Ritika Tewari.

New dengue outbreak likely this monsoon

Fever accompanied by chills, body aches, runny nose, sore throat or cough? You probably have Covid, and are likely over it.
After only recording a handful number of new Covid-19 cases for the last few months, Nepal registered nearly 400 in the last week. But these are only the official figures, doctors say there are flu-like cases recovering in almost every family.
The latest surge is once again in line with the rise of cases in India where the new sub-variant of <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care">Omicron</a> has been found to be responsible. On 4 April, there were 3,637 new reported Covid-19 cases across India and seven deaths in the past 24 hours. Some 60% of the new cases have been attributed to the new variant circulating in the country, XXB.1.16, a subtype of the Omicron variant.
“This is proof that when it comes to Covid-19, we are not out of the woods yet, it is a reminder that we need to continue to be careful, especially with the elderly and populations with comorbidities,” says Buddha Basnyat, physician at Patan Academy of Health Sciences.
However, unlike in India, it is not yet known which strain is driving the new infections in Nepal. A genome sequencing in last 2022 found that there were 17 sub-variants of <a href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron">Omicron</a> circulating in Nepal.
At Teku Hospital, virologist Sher Bahadur Pun has been observing a gradual increase in the number of Covid cases and old-age patients being admitted. Most symptoms are mild, but interestingly many are complaining of a lack of smell and taste, which was typical of pre-Omicron cases. Over time, Covid-19 symptoms have also gradually changed.
“What I’m seeing are breakthrough cases, these are people who have taken three shots, including a booster dose. This means we are likely to see a large number of such breakthrough cases in the near future,” explains Pun.
He adds: “This could very well be a new variant, a hybrid of these that were already circulating or XXB.1.16 like in India given there are no restrictions preventing the strain from travelling.”
But public health experts agree that while there has been a noticeable surge in the number of new cases being recorded, there has been no significant increase in hospitalisations and deaths.
In other words, while the newer variants are more infectious, they are less virulent and unlikely to cause complications, further helped by the fact the much of the population has gained some level of immunity due to natural infections as well as vaccinations.
Even so, it is important for <a href="https://www.nepalitimes.com/here-now/protecting-nepal-s-elderly-from-covid-19-c6e60vp6">vulnerable populations</a> to be protected, and the best way to do that is by taking a booster. As of February 2023, 76.5% of Nepalis have taken two doses of the Covid-19 vaccine which is nearly 96% of the target population. But the booster intake is much lower at about 27%, as of December 2022.
“Given that it has been quite some time since the second dose or even a booster was administered, I urge the elderly, immuno-compromised individuals and frontline workers to take a booster shot or a second booster even,” says Pun. “If there is an option, take a bivalent booster, it will protect you against both the original coronavirus strain and the Omicron variant.”
Back in February, Nepal received 345,600 doses of Pfizer-BioNTech’s bivalent vaccine under the <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax">COVAX initiative</a>, the first of the 1.5 million doses promised in four phases. But officials say the uptake has been discouraging, even in Kathmandu and other urban centres.
The new surge is likely to pass before long and without causing much impact on the overall population. But not taking preventive measures may endanger the elderly and people with comorbidities.
Warns Buddha Basnyat: “This surge is a reminder to continue to mask up and maintain hygiene not so much for Covid-19 at this point but to protect ourselves from a wide range of other equally prevalent infections in our part of the world like <a href="https://www.nepalitimes.com/opinion/comment/pandemic-eclipses-nepals-tb-epidemic">TB</a>, typhoid and a host of diseases caused by <a href="https://www.nepalitimes.com/here-now/warning-breathing-is-hazardous-to-health">air pollution</a>.”

Another Covid wave, but milder

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20230112100136/63bfd50f9c7e80680e0d30d0jpeg.jpg" alt="" width="1024" height="576"/><figcaption>Health workers transporting Covid-19 vaccines in rural Nepal. Photo: NARENDRA SHRESTHA/ADB NEPAL</figcaption></figure>It was exactly three years ago that the novel coronavirus first emerged from Wuhan. SARS-COV-2 has now come full circle as cases soar and hospitals are overwhelmed across China.Beijing abandoned its zero-Covid policy, and has stopped registering fatalities from Covid-19. Official case load and death figures are said to be underreported. International health experts believe more than 1 million people may die from the disease this winter.Several countries now require mandatory Covid tests from passengers arriving from China, after Beijing eased travel restrictions in the new year. Countries in the region including Nepal are on high alert.The Health Ministry last week made masks once again mandatory in public places while appealing to people to resume hand washing and social distancing. On 28 December Nepal reported only 8 cases and zero Covid deaths.The Ministry has also urged the public <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">to take booster shots, and second boosters</a> for people above 55 and the immunocompromised. The Drug Advisory Committee on 27 December granted emergency use approval for the Pfizer-BioNtech bivalent vaccine of which Nepal is set to receive 1.5 million doses from the COVAX global initiative by mid-January.Read also: <a href="https://www.nepalitimes.com/here-now/three-years-of-living-dangerously/">Three Years of living dangerously,</a> Sonia Awale“What is of utmost priority now is to protect our elderly and vulnerable populations. We need to fully vaccinate them if they have not or give them a booster, bivalent would be even more effective as it can fight both the original and Omicron strains,” explains Sher Bahadur Pun at the Teku Hospital.Pun likens what is happening in China now to the Omicron surge in Hong Kong earlier this year which also saw a significant rise in hospitalisations and deaths. Nepal also suffered a spike in fatalities among the elderly towards the end of the <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/">Omicron third surge in 2022</a>. In both cases, the unvaccinated were victims.“Omicron might be less severe but in vulnerable groups who have not been vaccinated, even this strain can cause complications,” he warns.More than 80% of Nepal's eligible population (above 5) have been fully vaccinated against Covid-19. But the booster uptake is much lower at only 27%. There is also concern that it has been more than a year since most Nepalis got their last shots, and their immunity might be waning. Officials recommend a booster even though memory cells could provide some residual protection.The WHO has asked China to reveal its true Covid figures, and the nature of the prevalent strain. Experts attribute its surge to vaccination hesitancy among the elderly, stringent zero-Covid strategy which suppressed natural immunity, and Chinese vaccines like Sinovac being less effective than mRNA jabs.Read also: <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">Why is there vaccine hesitancy in Nepal?</a> Sonia Awale“China did great with lockdowns and restrictions but took it to unnecessary levels, which means the population is Covid naïve compared to other countries. When they reopened, the variants already present multiplied rapidly,” explains Buddha Basnyat, physician at Patan Academy of Health Sciences. “It also seems they did not learn from the rest of the world, did not vaccinate their elderly sufficiently and relied only on their own vaccines.”The efficacy of Chinese-made vaccines has long been debated, but there are no studies to prove their efficacy, or lack thereof. However, experts agree that all the available vaccines recommended by WHO considerably reduce the severity of the disease.Media amplification of the China surge has caused some panic in the neighbourhood. Japan, Malaysia, Taiwan and India are the latest countries to require Chinese passengers to have Covid tests. India has also introduced nasal vaccine this week, those who had taken Covishield and Covaxin can take it as a heterologous booster dose.Read also: <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/">Nepal’s uneven Covid-19 deaths</a>, Ramesh KumarHowever, the BF7 Omicron strain has already spread around the world and it is not virulent, and does not seem to adversely affect vaccinated individuals. Experts also caution that although 1 million deaths sounds like a lot, it is a tiny fraction of China’s population. The Chinese government has accused the West of ‘hypocrisy and hyping the threat’.“The BF7 is not a new variant, it has been around for a while. It has been circulating in Europe, America and parts of Asia. It has been reported in India and chances are high it is in Nepal too, we probably just haven’t detected it yet,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal.He adds: “Nepalis have developed enough resistance through reinfections and vaccinations, especially as subsequent strains have been more contagious but less virulent.”The WHO says it is concerned about further mutations and the emergence of new variants, but mutations do not necessarily mean increased severity. Just like Omicron is more contagious but less severe than Delta.Says Pun: “There are at least 17 sub-variants of Omicron in Nepal. This means we have had enough immunity gained via reinfections. We also have protection from vaccination and the proof of this is how we marked our festivals, and elections without following safety measures and without any resulting surge.”Read also: <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/">Omicron may not be risky, but take care,</a> Sonia AwaleHaving said that, the <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">pandemic is not yet over.</a> Parts of China including Hong Kong, South Korea, Hong Kong and Japan which have high mobility of Nepalis are also seeing a Covid-19 surge this winter.The health desk at Kathmandu airport is not strictly checking vaccination or PCR tests anymore, and some experts say it should increase surveillance — especially when flights from Chinese cities resume on 8 January. After being locked down for so long, many Chinese are already booking holiday travel to Asian destinations.The Rasuwa border post also reopened this week to resume the cargo transport at Kerung and the trade between the two countries. The checkpoint which has been shut due to the pandemic since early 2020.Says Buddha Basnyat: “There is no harm in continuing to follow safety measures, it is now proven that masks and hand washing saves lives. It also protects us from a host of infections including typhoid and TB and more importantly from air pollution, all non-Covid silent killers.”

China’s surge: should Nepal be worried?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413114/63722f979c7e80680e0c2523jpeg.jpg" alt="" width="4096" height="2731"/><figcaption>Photo: AMIT MACHAMASI/NEPALI TIMES ARCHIVE</figcaption></figure>A new surge in Covid cases in Nepal has served as a reminder that <a href="https://www.nepalitimes.com/latest/not-over-till-its-over/" target="_blank" rel="noopener noreferrer">the pandemic is not over yet</a>, and on the need to keep masks one, avoid crowds, and get booster shots.Hospitals have not reported an increase in admissions, and no fatalities from Covid have been reported since March. But <a href="https://www.nepalitimes.com/opinion/omicron-is-coming-to-nepal-be-prepared/" target="_blank" rel="noopener noreferrer">highly transmissible</a> new sub-strains like BA.4 and BA.5 have also been detected in Nepal, as they have elsewhere in the world.“For the most part, people who have been fully vaccinated are unlikely to get very sick from the new strains, there has been no real increase in hospitalisation,” confirms Sher Bahadur Pun, virologist at Teku Hospital in Kathmandu.The fact that the new sub-strains are all Omicron variants means that, unlike the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">deadly Delta variant</a>, they mostly infect the upper respiratory tract and not the lungs. Delta was responsible for millions of deaths in India in 2021, and killed at least 8,000 people in Nepal as hospitals ran out of oxygen and vaccines were delayed.But with 82% of the eligible population now<a href="https://www.nepalitimes.com/editorial/deubas-mixed-report-card/" target="_blank" rel="noopener noreferrer"> fully vaccinated</a>, Nepalis are now more protected from severe illness. But the virus is still mutating, and scientists are engaged in a cat-and-mouse to stay one step ahead of new strains.“Covid-19 has proven itself to be even more cunning than we thought. It is clearly still prevalent, and can be life-threatening for some,” warns Buddha Basnyat, physician at the Patan Academy of Health Sciences. “This is not the end of the Covid story.”That is not to say that the present surge is a <a href="https://www.nepalitimes.com/latest/from-pandemic-to-epidemic-to-endemic/" target="_blank" rel="noopener noreferrer">new wave</a>. While each new sub-lineage of Omicron is more contagious, they are also milder. That is good news, but asymptomatic infected people are also spreading the virus wider.While active cases are on the rise in Nepal, hospitalisations are not, and infected individuals could be putting the elderly and <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">those with co-morbidities</a> at risk at home, or at work.Studies overseas have shown that up to half of those infected with the new sub-strains are asymptomatic. As people travel more this summer and shed masks, the BA.5 and other variants are<a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer"> infecting and re-infecting</a> even those who are vaccinated.“We must continue to vaccinate and take a booster, especially those who haven’t even had their first shot. It might also be the time to start thinking about a fourth dose for vulnerable populations,” says Buddha Basnyat.Because ‘immune escape’ is putting more people who have had Covid-19 still at risk of reinfection, scientists are trying to improve the <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">efficacy of vaccines</a> as they try to keep up with mutations of the coronavirus.“Eventually, Covid-19 will be like seasonal flu, and perhaps we will have vaccines for different strains,” says Sher Bahadur Pun at Teku.BA.4 and BA.5 were first seen in South Africa, and are currently the dominant strains in Nepal. This is surprising because it is BA.2.75 that was spreading in India last month, and the surge is now peaking there. Whatever happens in India <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">comes to Nepal with a two-week lag</a>,  experts say, and predict the same scenario could play out again here with the present surge.“Newer strains, and mutations are nothing abnormal but we have to continue to mask up and vaccinate. As for the new surge, it is peaking at the moment and it will have subsided by end-July,” predicts Sameer Dixit at the Centre for Molecular Dynamics.The Centre is leading Covid-19 gene sequencing in Nepal, and it worked with the Nepal Health Research Council, Birat Nepal Medical Trust, Liverpool School of Tropical Medicine and Oxford to study 1,800 Covid-19 samples collected from all over Nepal in the past year. The findings will be released soon, and could reinforce the importance of genetic sequencing in Nepal so scientists can predict the behaviour of the next variant.Nepal is also a part of the largest Covid-19 recovery study, currently being undertaken in the UK which has come up with significant findings, including the use of some steroids in the treatment of coronavirus diseases.But the fact that the new strains are milder does not discount the inherent correlation between health and the economy. Even the best health care systems can collapse as seen in Sri Lanka. Moreover, <a href="https://www.nepalitimes.com/banner/state-sponsored-economic-crisis-2/" target="_blank" rel="noopener noreferrer">we now have record inflation</a> brought on by the Russian invasion of Ukraine, which has made healthcare even more unaffordable for most Nepalis.“Nepal with its limited resources and government indifference needs to be even more prepared for a health crisis, which often spells disaster for those unable to afford treatment,” cautions epidemiologist Lhamo Yangchen Sherpa.She adds: “The new surge may look mild, but it is always better to be over-prepared than under-prepared.”

1. Mask Up. 2. Avoid Crowds. 3. Get Boosters

<figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101148/63720ee29c7e80680e0b7942jpeg.jpg" alt=""/><figcaption>BRIDGING THE HEALTH GAP: Community health worker Birma Devi Kunwar, 32, crosses a bridge in Darchula with a Covid-19 vaccine box on her back. Nepal’s success with previous vaccination drives is the main reason the country has now fully-inoculated 81% of its eligible population against Covid-19. But booster doses are trailing.</figcaption></figure>On 23 March, Nepal recorded 38 new Covid-19 cases, one of the lowest figures since early 2020. The pandemic does not make it to the headlines anymore, and Nepalis are going about as if the crisis is a thing of the past. 
But it is not over until it is over. Given the latest outbreaks in Hong Kong and China, the WHO has warned that we may only be ‘halfway’ through the pandemic. That surge is just across Nepal’s northern border. 
Parts of China are back under lockdown. Hong Kong with its world class health care system, is seeing high fatality rates from the Omicron and BA.2 sub-lineage.
Omicron and its stealth variant <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/" target="_blank" rel="noopener noreferrer">may have run their course in the Subcontinent</a>, but the Deltacron hybrid has been detected in several countries, including India. 
While there is no evidence yet to suggest that the recombinant virus is more contagious or virulent than previous strains, it is too early to make any assumptions. 
“If the new surges around the world are due to the BA.2 variant, we might not have to be as concerned,  but the same can’t be said for Deltacron since we have not yet established its transmissibility and virulence,” says virologist Sher Bahadur Pun at Teku Hospital.
Physician at Patan Academy of Health Sciences Buddha Basnyat agrees: “It is an unfolding story, but it will be prudent to assume that the pandemic is not yet over. And if there is anything we should learn from the past two years, it is that this is a very wily virus.”
In January, the WHO projected that the <a href="https://www.nepalitimes.com/latest/from-pandemic-to-epidemic-to-endemic/" target="_blank" rel="noopener noreferrer">acute stage of the pandemic would end in 2022</a> provided that there was necessary treatment and equitable distribution of vaccines worldwide. 
But citing the latest rise in case numbers, it has changed its forecast saying the world is only in the middle of the pandemic. 
Universal vaccine coverage is the only way to prevent another surge, and newer variants from coming up. In the last two years, SARS-CoV-2 has proven to be very adaptable, naturally mutating and attacking the unvaccinated. 
In Hong Kong, the majority of those hospitalised had not been vaccinated, or had received the less effective Sinovac jabs. 
Nepal’s inoculation status is now relatively high: over 93% of the adult target population is partially vaccinated while 81% have got both doses. Much of the credit goes to <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">grassroots health workers mobilised across the country</a> who built on Nepal’s past success with vaccination drives for other diseases (pictured above).  
However, the figure for booster doses is at only 9.8% even though Pfizer vaccines are now easily available, and the government may soon start offering it to children up to five years. 
Nepalis do not show vaccine denial so much, but there is some Covid complacency. 
“We have to keep up with the pace of vaccination, but we must continue prioritising vulnerable populations and children," adds Pun. "And it might help to provide the rationale and evidence to back the need for a booster because for most people, complete vaccination means only two doses.” 
Nepalis are slowly becoming careless about <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">masking up</a> and avoiding crowds but, experts say, this must continue to be a part of prevention measures. Testing needs to continue, especially as countries around the world open up for businesses and tourism. 
Nepal has also now <a href="https://www.nepalitimes.com/latest/no-more-pcr-for-nepal-passengers/" target="_blank" rel="noopener noreferrer">removed mandatory PCR test</a> and quarantine for fully vaccinated visitors, but the country cannot let its guard down.
Says Buddha Basnyat: “Masks are protecting us, there is no harm in continuing to wear them. They in fact defend Nepalis from a myriad of other infections, as well as air pollution.”

Not over till it's over

<img width="1808" height="1251" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e8e9c7e80680e0b7926jpeg.jpg" alt=""/>One month after <a href="https://www.nepalitimes.com/opinion/comment/ukraines-lessons-for-sandwiched-nations-like-nepal/" target="_blank" rel="noopener noreferrer">Russia’s invasion of Ukraine</a>, the fallout of the war on global fuel prices threatens to derail Nepal’s aviation and tourism sector which was finally reviving after two years of the Covid pandemic.
Nepal Oil Corporation (NOC) has raised prices for petrol and diesel at filling stations several times, but it is aviation turbine fuel (ATF) that has seen the steepest hike.
International airlines serving Kathmandu which had already seen some booking cancellations due to the Ukraine war are now paying double the rate for refuelling their planes at Kathmandu airport.
ATF cost in Kathmandu has risen steeply from $715 per kilolitre in June last year to nearly $1,500 after the latest NOC price hike on 17 March (see graph). 
But the NOC appears to be passing on the rising import bill for petroleum products to its customers, while keeping its profit margins intact. The <a href="http://noc.org.np/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://noc.org.np&amp;source=gmail&amp;ust=1648181914714000&amp;usg=AOvVaw2vxZrc3-FmibmlA9NtNpz7">state-owned monopoly’s own website</a> shows that the profit it makes from <a href="http://noc.org.np/fortnightly" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://noc.org.np/fortnightly&amp;source=gmail&amp;ust=1648181914714000&amp;usg=AOvVaw30xV_D5k1K3ycFpKU14IgA">ATF sold to airlines has risen</a> from Rs23.92 per litre inJanuary to Rs67.93 this week.
The NOC’s overall fortnightly losses have also soared from Rs1.83 billion to Rs4.66 in that same period. It is clear that NOC is compensating for its losses from petrol, diesel and LPG sales at fuel stations by doubling the price it charges airlines in order to subsidise Nepali customers.
NOC officials have justified the <a href="https://www.nepalitimes.com/business/petroleum-price-hike-3/" target="_blank" rel="noopener noreferrer">price hike</a> saying that the fuel needs to be transported in tankers from the Indian border, and the hike in diesel prices has added to the cost of ATF in the international market.
However, the price of aviation fuel at Indian airports was only $900 per kilolitre — which is $600 less than in Kathmandu. 
Nepal’s domestic airlines, which were <a href="https://www.nepalitimes.com/here-now/pokhara-will-be-a-game-changer/" target="_blank" rel="noopener noreferrer">seeing a boom</a> since the Omicron wave started to subside earlier this year, have passed on the added cost to passengers with a hefty fuel surcharge. 
However, it is medium and long haul operators to Kathmandu like Singapore Airlines, Korean Air, Turkish Airlines, Qatar Airways, Himalaya Airlines and Nepal Airlines which have been hit hardest. Airlines have started flying in on full tanks only topping up in Kathmandu to save on fuel costs. 
Read also: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/ukraine-climate-and-nepal/" target="_blank" rel="noopener noreferrer">Ukraine, Climate, and Nepal</a>, Sonia Awale
A Boeing 777 or Airbus 330 on a 7-hour flight from Kathmandu to Incheon or Istanbul, for instance, burn 40 tons of fuel at a cost of $75,000. That cost will now soar, but airlines cannot raise prices on pre-booked tickets.
“Because of the rise in passenger demand we were thinking of increasing our frequency to daily flights, but with this kind of fuel cost it is just not feasible,” says one Kathmandu-based international airline executive. “Aviation fuel prices have gone up everywhere, but in Kathmandu it is 50-90% higher than any other Asian airport.”
NOC first raised its price of aviation fuel steeply to $1,095 on 2 March after the Russian invasion sent international oil prices sky high. It then raised it to $1,295 on 4 March, and again hiked it to $1,495 on 17 March. 
Brent crude prices had dropped somewhat last week, but with Russian counter sanctions against oil and gas supplies to European countries and the spectre of a long-drawn war of attrition in Ukraine, it again climbed above the $120 per barrel mark.
Some US states have legislated to temporarily waive taxes on fuel to stabilise gas prices at filling stations and reduce burden on consumers. Nepal also has heavy taxes on all petroleum products, but it cannot afford to reduce the levee at a time when it faces budgetary pressures, a spiralling trade deficit, and plummeting foreign exchange reserves. 
To be sure, Nepal is not alone in being hit by volatile oil prices because of Russia’s invasion of Ukraine, and <a href="https://www.nepalitimes.com/here-now/ukraine-crisis-hits-nepal-economy-hard/" target="_blank" rel="noopener noreferrer">the entire economy is affected</a> — not just the aviation sector. However it could not have come at a worse time, just as the country’s tourism was starting to show signs of revival after two years of Covid closure.
Several European tour operators have cancelled bookings to Nepal at the last moment. The crisis has coincided with the start of the peak trekking and mountaineering season, and a large Ukrainian expedition to Mt Everest has been cancelled. The number of climbers who had booked Himalayan peaks is expected to go down by half.
More than 1 million people depend directly on <a href="https://www.nepalitimes.com/latest/nepal-reopening-for-tourists/" target="_blank" rel="noopener noreferrer">Nepal’s tourism industry</a> and they have been without income for more than two years because of the pandemic. There was considerable optimism that Spring 2022 would see a revival, but those hopes have been dashed. 
There have been other indirect impacts from rising energy prices in Nepal, with electricity rationing this week along industrial corridors in the Tarai. As the dry season flow of Himalayan rivers reduces generation capacity, demand this week outstripped supply by 600MW. 
The Nepal Electricity Authority (NEA) was meeting this shortfall with imports from the Indian grid, but on Tuesday and Wednesday it was outbid by other purchasers. Most of India’s electricity is generated from coal and diesel powered plants, and this has nearly doubled the price of peak power imports from India to INR13 per unit on Wednesday.
Read also: <a href="https://www.nepalitimes.com/latest/what-does-defending-europe-mean/">What does ‘Defending Europe’ mean?</a>, Slavoj Žižek

Sky high fuel price hits Nepal’s tourism, airlines

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e899c7e80680e0b7923jpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: ANTONIO BELTRÁN RODRÍGUEZ</figcaption></figure>Daily wage labourers Dharma and Gita lost their jobs during the pandemic. The young couple exhausted their meagre savings in less than a month, after which they started to buy food on credit. Still unable to repay loans, they limited their diet to one small meal a day.Soon, Gita started feeling weak. She often had a fever and cough. As the lockdown extended, her health deteriorated and the medicines were of little help. The couple even took a PCR test which came out negative. They visited five different health centers and bought bags full of medicines. The treatment was so expensive they had to sell their two cows. A month later, and heavily in debt, she was diagnosed with tuberculosis.Tuberculosis mainly afflicts the poorest. The numbers are staggering: one in every three people globally is infected by Mycobacterium tuberculosis, and even if they carry the bacteria most people do not get sick unless their immune system is weakened due to disease or malnutrition.And yet, this easily preventable and curable biblical disease thrives in Nepal and the Subcontinent due to inadequate measures taken to prevent, diagnose and treat the infection.A 2020 National TB Program report revealed that over 100,000 people are living with tuberculosis in Nepal. This figure is much higher than previously estimated but has most likely increased since as many patients have been unable to access treatment during the pandemic.Of these cases, 40,000 patients were not diagnosed or treated at government centres, which means nearly one in every two people were not diagnosed. Oftentimes, people reach standard TB treatment and care after months or even years. Their pathway to cure is complex, long and include misdiagnosis leading to unnecessary prescriptions. This in turn could lead to unnecessary death and suffering. Patients are also ostracised by friends and families, resulting in self-isolation from communities.These challenges are exacerbated by Nepal’s limited health infrastructure. Health care centres are understaffed and poorly managed, maintenance of laboratory equipment, as well as supply of quality chemicals for tests, are erratic.Across Nepal’s Tarai, settlements are overcrowded, people live in extreme poverty, hygiene and sanitation are at a bare minimum. In the hills and the mountains, difficult geographical terrain and poor road networks pose obstacles for people seeking health care.These deeply-rooted structural inequities collectively resulted in magnified impact on TB service delivery during the pandemic. As a result, we observed increased deaths from the disease.In 2018, global leaders committed to reducing TB by 2022. To meet this goal, we need comprehensive intervention programs with sufficient investment for prevention, early diagnosis and treatment. There are four key areas that require increased funding to decrease TB fatalities:1 PreventionWe saw how the world community got together to rapidly develop vaccines for Covid-19 with unprecedented funding and resources. TB on the other hand has only one vaccine and a very weak one at that. Developed over a century ago, BCG does not prevent adults from developing TB disease.UnderNepal's national TB program, young children living with adults who have TB are provided medicines to kill any TB bacteria they have inhaled and prevent the development of the disease. The Birat Nepal Medical Trust for the first time in Nepal is providing a shorter 12-dose course of TB preventative medicine to adults infected with the bacteria to stop them from getting sick and spreading the disease.In 2020, only $684 million of the estimated $2.16 billion needed globally for TB research and development was available from donors. Covid-19 on the other hand received over $100 billion in just two years to develop vaccines. The pandemic exposed this global inequity, and is proof of what sufficient funding and political commitment can achieve.If funding for the global TB prevention program is increased by 3-4 fold, we could design better community-based services, develop a more effective vaccine and promote shorter treatment regimens, all of which will achieve a TB-free Nepal sooner.TB awareness and health promotion messages also do not get as much coverage in the media as they used to. World TB Day, observed every year on 24 March, should serve as a reminder that TB is an epidemic and needs accelerated efforts for elimination.2 Diagnosis and InnovationGovernment health centres provide TB diagnosis and treatment free of cost. Yet, people spend a lot of money and time before they are correctly diagnosed and enrolled in treatment. This is because symptoms of the disease are common to many infections. People develop cough and fever and immediately resort to taking paracetamol and general antibiotics before realising that they have TB.Moreover, Nepal needs to quickly adopt GeneXpert machines which use PCR testing, and chest X-ray that diagnoses early-stage TB effectively and efficiently. Investment should be concentrated to expand, strengthen and maintain these diagnostic tools at health centers all over the country. Health care providers should be similarly trained to operate these machines.GeneXpert technology should be deployed with active case finding where community health workers make home visits to screen and identify TB patients. This method also commonly known as contact tracing was applied in containing the spread of the Covid-19 virus, and has been used in TB programs for decades.Although proven to be effective, new diagnostic technologies are expensive and active case-finding strategies require large and sustained financial commitments. One might question if a country like Nepal can afford such investments. But the question we should be asking is, can we afford not to?The costs of the continued TB epidemic are far greater than the investments required to reduce it. Investing in better  tools including tax waivers on the import of TB diagnostic machines and test kits, and increased global funding for implementation of active case finding strategies for low and middle-income countries like Nepal are urgently needed.3 Community-based Treatment and Care Incomplete or delayed treatment can cause drug resistant TB and even death. Therefore, the treatment of tuberculosis should be patient-centred.TB programs have been implemented in Nepal for over half a century, we now have plenty of experience to employ the best strategies and  to eliminate the scourge.One of the challenges to eradicating TB is the long duration of treatment. Under the DOTS program, tuberculosis patients have to visit health centres daily for medication to be taken in the presence of care providers. But this could expose them to other TB patients, and resulting stigma. It is also time-consuming and comes with additional transport expenses.Investment in research and development of shorter course treatment regimens, and scaling up telemedicine is a priority area.4 Social Protection TB and poverty form a vicious cycle, each fuelling the other. It is mainly the neediest in society who are most affected. Having TB increases financial strain in their families with far-reaching socio-economic consequences. Children may have to forgo education and seek employment to compensate for the loss of income in families with an infected adult. Providing cash to families after the diagnosis will alleviate the financial burden.TB also causes malnutrition making people more vulnerable. Providing diversified food packages with appropriate nutritional value will be a big support, it will also help reduce the mental stress of fulfilling family needs.But these are just a few recommendations, a study to identify feasible and acceptable support for people with TB will enable us to design an improved tuberculosis support program. These should incorporate health education to people with TB and their families to better understand the disease, cope with its treatment and overcome stigma.Ultimately, it is the government’s responsibility to protect the lives of its people. Therefore, investing in and incorporating locally appropriate social protection schemes within the TB program should be the key agenda and priority of policymakers.The slogan this World TB Day today on 24 March is ‘Invest to End TB. Save Lives’, which reiterates the need to increase funding to prevent, diagnose and treat TB. Without substantial investments that will accelerate collective efforts of the community, country and the world, it is unlikely we will win the fight against TB, reverse the huge setback caused by the pandemic or save lives.Kritika Dixit is the Research Manager at Birat Nepal Medical Trust (BNMT) and a doctoral student at Karolinska Institutet, Sweden. Rajan Paudel is the Research Associate at BNMT.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e8c9c7e80680e0b7924jpeg.jpg" alt="" width="80" height="109"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e8d9c7e80680e0b7925jpeg.jpg" alt="" width="82" height="109">Read also: <a href="https://www.nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control/">For Nepal, a game-changer in TB control</a>, Buddha Basnyat and Maxine Caws

Pandemic eclipses Nepal's TB epidemic

<img width="2048" height="1282" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101144/63720e1d9c7e80680e0b78fcjpeg.jpg" alt=""/>While many countries <a href="https://www.nepalitimes.com/latest/nepal-reopening-for-tourists/">lift mask mandates and coronavirus restrictions</a>, Hong Kong and China are reeling from an Omicrons surge. Britain, the US and some parts of Europe are seeing a new spike in cases. In Nepal, the <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/">public is determined to believe</a> that the worst is over. But there is a danger that China's Omicron surge will bring out a new variant. Hong Kong's Centre for Health Protection, Department of Health has urged all residents to avoid non-essential travel. The territory may soon impose a lockdown, just as China has isolated entire provinces. The surge in China and Hong Kong has been attributed to low natural immunity because of the zero-Covid strategy, the relative inefficacy of Chinese vaccines to Omicron, and the emergence of the Omicron BA.2 sub-variant.Meanwhile cases of a new hybrid strain that is as transmissible as Omicron and as serious as Delta, dubbed the 'Deltacron', has broken out in the United States and Europe.The WHO warned this week that the world is “only half-way” through the pandemic, and although news of <a href="https://www.nepalitimes.com/here-now/ukraine-crisis-hits-nepal-economy-hard/">Russia’s invasion of Ukraine</a> has overshadowed Covid-19, the virus is still spreading in unpredictable ways.Given all this, it may be prudent for Nepal not to lift all vaccine restrictions just yet. Masks and avoiding crowds must still be enforced to spread a future surge. Even though, as we have seen in the last two years, new variants can easily come in <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/">from travelers and spread in the community</a>.Read also: <a href="https://www.nepalitimes.com/latest/the-story-of-nepals-first-covid-19-fatality/">The story of Nepal’s first COVID-19 fatality</a>, Laxmi BasnetA number of European countries have relaxed restrictions and several states of the US have moved to eliminate mask mandates after a new guideline by the Centers for Disease Control and Prevention (CDC). The hope is that the pandemic is giving way to an endemic. An endemic has been described by the CDC as a ‘constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area’. "We're almost there, it is now the beginning of the end, at least in the UK," Prof Julian Hiscox at the University of Liverpool told the BBC recently. "I think life in 2022 will be almost back to before the pandemic.” CDC director Rochelle Walensky echoed this, saying earlier this year that the pandemic is likely to become endemic in the US and around the world. Virologist Ian Jones of the University of Reading in the UK also said recently: “There is now no doubt that Omicron is attenuated and taking as a step toward endemicity”. Medical historians argue that most pandemics last between two and a half to three and a half years. Without a clear explanation and vaccination, the <a href="https://www.nepalitimes.com/opinion/remembering-a-pandemic-100-years-ago/">1918 Spanish pandemic</a> that infected one-third of the world’s population and claimed over 50 million lives fizzled out in 1919. An analysis suggests that the Omicron variant has now changed the shape of the global pandemic and this is likely to lead to the 'endemic world'. Chris Murray of the University of Washington takes the fact that despite the surge in infections, hospitalisation and fatality rates are still low as indication that we are now entering an endemic phase.Stephen Kissler at the Harvard T H Chan School of Public Health has been quoted as predicting: “Omicron will soon become endemic much like flu." Read also: <a href="https://www.nepalitimes.com/editorial/survive-revive-thrive/">Survive, revive, thrive</a>, EditorialWhat is puzzling scientists is why Hong Kong’s fatality rate is so high, while Omicron has not killed people at the same rate elsewhere. The risk of reinfection from Omicron is estimated to be 5–fold higher and this poses a danger to the high risk groups, elderly and to those not yet infected.Epidemiologists warn that the worst may yet to come of new variants emerge from the spread in China. Spreading to other parts of the world not yet infected to Omicron, this could have a devastating effect. Nevertheless, turning back the pages of the history of pandemics, we have seen that viruses naturally mutate and slowly evolve into an endemic phase that circulates at more manageable levels. The 1918 <a href="https://www.nepalitimes.com/editorial/preparing-for-a-no-normal/">influenza strain may never have disappeared, and continued to mutate and circulate</a> to this day. What we need to develop and adopt is <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">sustainable coping strategies, including vaccinations</a>. What are critically missing and paying least attention to is social interventions such as behavioural change, communication for mask wearing and avoiding crowds for the near future.Medical historians also agree that the pandemic ends socially before it ends medically. And proof of that is Nepal, where mot people seem to think that they no long have to worry about the pandemic. What if the virus has decided not to enter an endemic phase just yet?Mohita Upreti is Journalism student at St. Xavier's College, she regularly contributes to the College’s monthly newsletter - The Xavierian Chronicles.Read more: <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">Why is there vaccine hesitancy in Nepal?</a> Sonia Awale

From pandemic to epidemic to endemic

Nepal’s former king Gyanendra was greeted by flag-waving supporters as he arrived at Kathmandu Airport on Sunday afternoon from Pokhara after attending pro-monarchy rallies in various parts of the country. Gyanendra and his family were escorted from the airport by supporters to his residence at Nirmal Niwas, where his family has been living since 2008 when the Constituent Assembly abolished the monarchy. The 2015 Constitution then turned Nepal into a federal democratic republic. The deposed monarch had been on a two-month long tour of religious sites and local communities across western Nepal, ending in a two-week stay in Pokhara. After staying out of controversy, Gyanendra made a statement on Nepal’s Democracy Day last month in which he said he was willing to play a role in “saving the country”. There has been a surge of pro-monarchy posts and videos on social media, where the country’s previous kings have been glorified as being nationalists who were respected by the international community.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_07b324fee8d082ed3f8566544e24d45fcd600bbb122374fc39c7a94ce3d044f2.jpg" data-media-id="editor_0" data-image-id="20250309120340_07b324fee8d082ed3f8566544e24d45fcd600bbb122374fc39c7a94ce3d044f2" data-rendition-name="original" width="1914" height="1276" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_769f688f3a5eb3602f4c24c350ba1caa6965a171c079d783e28db0f746b810d0.jpg" data-media-id="editor_1" data-image-id="20250309120340_769f688f3a5eb3602f4c24c350ba1caa6965a171c079d783e28db0f746b810d0" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>  Nepal’s monarchists, which include Gyanendra’s backers, several pro-monarchist parties and other anti-government figures, think <a href="https://nepalitimes.com/editorial/new-year-same-difference">public disillusionment </a>with the country’s ageing and ineffective leaders and institutions is at breaking point.&nbsp; There is also disappointment with elected leaders and technocrats from new parties like the Rastriya Swatantra Party (RSP), with its <a href="https://nepalitimes.com/news/rabi-s-detention-churns-nepali-politics">leader Rabi Lamichhane under investigation</a> for his alleged involvement in a scandal involving diverting funds from cooperatives. One of the staunchest backers of Gyanendra’s comeback as king is former BBC journalist Rabindra Mishra, who has been active on social media platforms posting videos and text extolling the monarchy. He has referenced recent street uprisings in Sri Lanka, Bangladesh, and Syria, cautioning Nepal’s mainstream leaders not to dismiss support for the monarchy. ‘Support for a return to monarchy is increasing even though the mainstream parties may dismiss it,’ wrote Mishra. ‘Like the leaders of Sri Lanka and Bangladesh, they should not try to suppress the voices on the streets.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_d8758f6b7474c9f3aea3661ccd60955d8553971cb0d799039bbfd232aa1a0691.jpg" data-media-id="editor_4" data-image-id="20250309120340_d8758f6b7474c9f3aea3661ccd60955d8553971cb0d799039bbfd232aa1a0691" data-rendition-name="original" width="1890" height="1260" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_63613759744c0fac33ff3eabc298079c3e525063882f4b3760954bbc0833b5cd.jpg" data-media-id="editor_5" data-image-id="20250309120340_63613759744c0fac33ff3eabc298079c3e525063882f4b3760954bbc0833b5cd" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>  But for all their bluster, Nepal’s mainstream politicians who have rotated leadership of the country between themselves, seem worried about the crowds on the streets in support of the monarchy. The TikTok ban last year, which the government said was to ‘maintain social harmony’ was put into effect to prevent pro-monarchy groups from organising on the platform. The ban on TikTok has now been lifted, and supporters of the monarchy have mobilised platforms to fan nostalgia of the golden age of royalty, and to brand former kings Mahendra and Birendra as <a href="https://nepalitimes.com/review/a-past-foretold">nationalists who upheld Nepal’s sovereignty during the Cold War</a> and commanded respect worldwide. Archival video clips of Mahendra being received by President Eisenhower in 1960 and <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">Birendra </a>by President Reagan in 1983 have been liked by thousands. Comments contrast this to the incompetence and poor standing of Nepal’s current prime ministers.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_7dab05f5703e17a82da73277f0b39bf178c1005e0758aa50077ffe1a037f4af6.jpg" data-media-id="editor_8" data-image-id="20250309120340_7dab05f5703e17a82da73277f0b39bf178c1005e0758aa50077ffe1a037f4af6" data-rendition-name="original" width="1810" height="1206" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_1ab38cdccfd076babd78579fa345520a7b2fa9c838322226a259540c8c290437.jpg" data-media-id="editor_9" data-image-id="20250309120340_1ab38cdccfd076babd78579fa345520a7b2fa9c838322226a259540c8c290437" data-rendition-name="original" width="1812" height="1206" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>  While most of the people present at the demonstration included the older demographic, younger people have especially used social media to express their support for the monarchy. Young Nepalis, disillusioned with leaders who have been prime minister multiple times since the mid-1990s, are attracted to the idea of reinstating the monarchy as a form of anti-incumbent protest, but also because they have little to no memory of living under an authoritarian absolute monarchy. ‘Those who say the monarchy is paramount today are the ones who did not live through it in the past, and are dissatisfied with the current state of affairs,’ wrote Guna Raj Luitel, Chief Editor of Nagarik Daily, in an op-ed in the newspaper on Sunday.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_720d0059207b9918def39e983d9b5c114b6afb4e7ac0ed1dadd2cba2f20f9aa6.jpg" data-media-id="editor_10" data-image-id="20250309120340_720d0059207b9918def39e983d9b5c114b6afb4e7ac0ed1dadd2cba2f20f9aa6" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_bfe50ebd413d1b177ebd02df5f837038d8a04c9d343afe39be1ebcde36db893a.jpg" data-media-id="editor_11" data-image-id="20250309120340_bfe50ebd413d1b177ebd02df5f837038d8a04c9d343afe39be1ebcde36db893a" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>  He added: ‘For those of us who have spent parts of our lives under the rule of the king… we have not yet forgotten those days, when the institution was unable to do any useful work, a disheartening period characterised by Nepalis being unable to speak freely.’ Commentators have especially been pointing to Gyanendra’s military coup in 2005 when he dissolved parliament, and tried to take the country back to the time of absolute monarchy, just like his father Mahendra did in 1960. Gyanendra became king after his brother and most of his family were killed in the royal palace massacre in 2001. Many Nepalis still seem to believe that Gyanendra was responsible, and some of this is reflected in comments on monarchist social media posts. As the monarchist rallies spread, Prime Minister K P Oli said last week that if Gyanendra really wanted power, he should form a political party and run in the next elections in 2027. Other leaders have urged the former king to honour the 2008 Constitutional Assembly decision to abolish the monarchy, as well as Nepal’s 2015 Constitution.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_978ef979c7774312ac00d3192803d974ea57ec45d704f89663b301f4f0cc9704.jpg" data-media-id="editor_12" data-image-id="20250309120340_978ef979c7774312ac00d3192803d974ea57ec45d704f89663b301f4f0cc9704" data-rendition-name="original" width="1832" height="1221" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250309120340_d11276de0161d258f135e8fba4d3eb37d0a9e579b06a4819c6609b4ecdbbe51e.jpg" data-media-id="editor_13" data-image-id="20250309120340_d11276de0161d258f135e8fba4d3eb37d0a9e579b06a4819c6609b4ecdbbe51e" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="The ghost of monarchy returns to haunt Nepal NT"> </figure>  &nbsp;In response, royalist leaders including Kamal Thapa, Rajendra Lingden, and Rabindra Mishra have responded that the monarchy is above the electoral system, calling for the reinstatement of a constitutional monarchy in which Gyanendra would be a figurehead. “There is no question of the king contesting an election, that is our job,” said RPP-Nepal chair Kamal Thapa in a tv interview. “The monarchy is a custodian of the nation, it is an institution above electoral politics.” However, there does seem to be a disagreement between hardline royalists who want a return to absolute monarchy in which Gyanendra would actually hold executive powers, and those who favour a ceremonial one. Gyanendra recently visited Bhutan, where he was given a royal welcome, and has made several trips to India where there is some support for reinstating Nepal as the world’s only Hindu kingdom.

The ghost of monarchy returns to haunt Nepal

Kathmandu was once a lake inhabited by <a href="https://nepalitimes.com/news/snakes-on-plains">serpents</a>, until Manjushree visiting from present-day China saw a fluorescent lotus in the water. To reach it, the sage used his flaming sword to cut a gorge <a href="https://nepalitimes.com/from-the-nepali-press/dry-port-at-chobhar-faces-resistance">at Chobhar</a>, draining the lake and turning it into a fertile valley. The Manjushree Trail Race (MTR) is inspired by this legend. There are five categories along a near-circular route around the rim of <a href="https://nepalitimes.com/banner/bringing-silicon-valley-to-kathmandu-valley">Kathmandu Valley</a>: 10k, 30k, 50k, 100k, and one that is 100 miles that is 157.7km (map, right). The 100 miles category starts at 8AM on 14 March, and runners have 52 hours until noon on 16 March to complete it. Arjun Kulung Rai’s 26:52:56 is the current record, set in 2024. “<a href="https://archive.nepalitimes.com/news.php?id=17327">The Manjushree legend</a> and the perfect loop make the race very meaningful, and I wanted to do it,” says participant Dong Sheng from the northern Chinese city of Harbin who started running in 2016 with 5k until he accomplished a 100 miler in 2022. “<a href="https://archive.nepalitimes.com/article/nation/first-edition-ultra-trail-kathmandu,1050">Running </a>is spiritual, as you are always trying to overcome what you could previously do.” Sheng is one of 131 international runners who have signed up for the Manjushree race, where there are a total of 502 participants this year, 94 of them women. The first edition of the race only had 7 runners total. Read also: <a href="https://nepalitimes.com/here-now/nepali-trail-running-champions">Nepali trail running champions</a>, Preeti Khattri “A reason this race is popular is because it is a good mix of rural and accessible,” says Jimmy Oostrom, a Dutch runner. “Often, 100-milers are way out of the way. Here, the start is only a short drive after landing in Kathmandu.”&nbsp; The 100 mile and 50km are now qualifier races for the Asia Trail Masters, an international series of trail races based in Hong Kong. Last year, a Nepali team competed and won in the Asia Trail Master Championship series in Borneo. The 100-mile category starts and finishes at Single Tree on Nagarjun, other distances have different start and end points. On the winning team was Rashila Tamang, who is part of Trailmandu that implements logistics for the race, such as recruiting and training volunteers, and marking the route. “Nepal has great <a href="https://archive.nepalitimes.com/news.php?id=9938">geography</a> for <a href="https://nepalitimes.com/here-now/mira-rai-racing-to-help-other-runners">trail running</a>, but it is still very hard to make it your career,” says Tamang.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025031219034_98b83aa3d42c7d5e8a2ef2f80dc03512374413e31eb55441234cd075bea7e113.jpg" data-media-id="editor_8" data-image-id="2025031219034_98b83aa3d42c7d5e8a2ef2f80dc03512374413e31eb55441234cd075bea7e113" data-rendition-name="original" width="1244" height="598" loading="lazy" alt="Manjushree Trail map "> </figure>  The MTR has a guidebook detailing the categories, route, checkpoints, rules and what is available at each stop.&nbsp; “If we say we’re going to start at 8, we’re going to start at 8,” says Narayan Acharya, the man behind naming the race ‘Manjushree’. “People tried to sign up after the deadline, we had to tell them no.” Acharya who builds <a href="https://nepalitimes.com/banner/foundations-for-sustainable-buildings-in-nepal">traditional rammed earth houses</a> through his company Sustainable Future Nepal, has been long involved with promoting trail running in Nepal, and hailing from Jumla himself, mentored <a href="https://nepalitimes.com/here-now/run-sunmaya-run">Sunmaya Budha</a> also from Jumla, now a trail running star in and outside Nepal. Read also: <a href="https://nepalitimes.com/here-now/sunmaya-budha-stays-in-the-running">Sunmaya Budha stays in the running</a>, Vishad Raj Onta&nbsp; The organisers are sponsoring up to 50 runners from <a href="https://nepalitimes.com/banner/portrait-of-a-photographer-in-rural-nepal">rural Nepal</a> who may not afford the Rs6,000 entry fee to participate. “It is hard to get sponsors to give us money because Nepal is still a pretty small market,” says Oostrom, currently on crutches due to an ACL injury. “We also have to take the necessary precautions to make sure we can quickly help a runner in trouble.” The logistics of an ultra trail race are more complicated than a <a href="https://archive.nepalitimes.com/news.php?id=1223">marathon</a>. Marking and maintaining the trail requires careful work, especially as signs often get lost. The <a href="https://nepalitimes.com/multimedia/the-steadfastness-of-a-long-distance-runner">long distances </a>also require runners to run through the night.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025031219030_19111e03939541b8980007437c89966dc7a8fd6246b8407440694503bf7890a3.jpg" data-media-id="editor_15" data-image-id="2025031219030_19111e03939541b8980007437c89966dc7a8fd6246b8407440694503bf7890a3" data-rendition-name="original" width="2250" height="1501" loading="lazy" alt="Manjushree Trail "> </figure>  A <a href="https://nepalitimes.com/business/buddha-air-gets-state-of-the-art-flight-tracking-system">live tracking system </a>would ensure a runner’s safety as well as prevent cheating, but for now organisers are relying on vigilant volunteers and fellow runners to find runners needing help. There are strict rules for the race, and breaking them can result in significant time penalties or even disqualification. Get food or drink assistance outside of the checkpoints and you get a penalty of 15 minutes. Miss any pieces of mandatory gear and an hour is added to your time. Take some sort of shortcut or cheat using a vehicle, and you are disqualified. There are dangers like cliffs <a href="https://archive.nepalitimes.com/page/cantilever-trail-nepal">along the trail</a>, lightning on exposed ridges, <a href="https://nepalitimes.com/banner/disasters-in-nepal-come-in-waves">landslides caused by earthquakes</a>, <a href="https://nepalitimes.com/banner/trekking-to-save-nepals-snow-leopards">leopards</a>, and hornet swarms. Ultra running takes a massive toll on the body. The brain may shut off certain areas to be able to keep going, so volunteers watch runners carefully.&nbsp; “After mile 50, your body starts digesting itself,” says Oostrom.&nbsp; Alongside Acharya and Oostrom, the organising crew is made up of race director Ashish Mishra, and Jeevan Lama and Rashila Tamang from Trailmandu. “We can execute this race well because we are all passionate runners ourselves,” says Acharya. The team has taken measures to make the race safe and comfortable for female participants. ‘Run freely, speak openly, and wear what makes you feel comfortable in our races,’ says the guidebook. Prize money is the same for male and female winners, across categories.&nbsp; Lately, Nepal has been steadily building itself as a destination for<a href="https://nepalitimes.com/banner/taking-the-high-line"> adventure sports </a>such as <a href="https://nepalitimes.com/here-now/nepal-pushes-mountain-bike-tourism">mountain biking</a> and trail running. And with the Manjushree race, enthusiasts have hopes to set the standard for other trail races in the country. Sheng has been part of big races in China. “The better the economy, and more money people have, the more they can get involved in such pursuits,” he says. “But I have to say, for the scale of this race, everything has been done very professionally.”&nbsp;

Around Kathmandu in 100 miles

Throughout human history, civilisations have been named after the rivers along which they flourished: Indus Valley, Nile, Tigris-Euphrates. Many of these cultures later collapsed, partly because they could not manage their water needs properly. Three recent books about Himalayan rivers look at their history and geography, and how they nourished civilisations downstream. The rivers gave birth to the world’s major religions, their waters and the mountains from which they sprang were revered. Mythology and geology converge in High Asia. Mt Kailash is holy to the Hindu, Jain, Buddhist and Bon faiths as the centre of the world and the abode of the gods. Indeed, from its vicinity emerge Asia’s great rivers: the Indus and Sutlej, Ganga and the Yarlung Tsangpo (Brahmaputra) and Karnali (Mapcha Tsangpo).&nbsp; Legend has it that Kathmandu Valley was once a primordial lake drained by Manjushree who cut a mountain with his flaming sword. There is scientific evidence that the paleo lake was indeed emptied in stages starting 40,000 years ago after a tsunami unleashed by a major earthquake epicentred in Langtang. The Bon faith describes the Tibetan Plateau being pushed up from a roiling primeval sea, confirming current evidence about the orogenesis of the Himalaya. In local lore, supernatural lha (animal deities) and lu (serpents, naga) moved from sea to land, just as the theory of evolution explains the emergence of early amphibians and land creatures. In <a href="https://www.routledge.com/Rivers-of-the-Asian-Highlands-From-Deep-Time-to-the-Climate-Crisis/Gamble-Tan-Xu-Beavis-Maurer-Pittock-Powers-Wasson/p/book/9781032490595?srsltid=AfmBOopjkpgcN1_7t1jTI_Z1_27yRthBTbdHA15OWcE9Ge3S409jhUX3">Rivers of the Asian Highlands: From Deep Time to the Climate Crisis</a>, Himalayan historian <a href="https://scholars.latrobe.edu.au/rgamble">Ruth Gamble</a> and co-authors begin by tracing the genesis of the Himalaya, citing evidence that the Tibetan Plateau pre-dated the collision of the Indian and Eurasian plates 50 million years ago. Asia’s main rivers co-emerged with the mountains, their waters cutting canyons through rocks as they were uplifted. The gigantic pileup acted as a moisture trap for the proto-monsoon, the rain and ice sculpting peaks as they rose. But so strong were tectonic forces that the uplift outpaced erosion on the Tibetan Plateau. These dynamic processes are still at work, but in many places across High Asia there is a new factor at play: modern infrastructure (like haphazard road-building in Nepal) is increasing erosion faster than the uplift rate.&nbsp; ‘This is an example of human action overcoming tectonics,’ write the authors in Rivers of the Asian Highlands, in which the chapters look at Himalayan rivers from a planetary scale, their socio-cultural histories, to present-day engineering to regulate them. An ongoing dam-building spree and anthropogenic climate breakdown combine to bring about the most rapid change the Himalaya and their rivers have seen for millions of years. One example is the Medog Hydropower Station being built on the Yarlung Tsangpo at a bend on the Brahmaputra before it enters India. The river drops 2,000m within a 50km stretch, the gradient allowing it to generate 60,000MW — the biggest single hydroelectric plant in the world. Gamble and the authors of Rivers of the Asian Highlands highlight the Gravitational Potential Energy (GPE) of the Himalaya that allows falling water to be converted into electricity. But GPE also unleashes landslides, rockfalls, avalanches, Glacial Lake Outburst Floods (GLOFs) and Landslide Lake Outburst Floods (LLOFs), the risks posed by them magnified by climate change and seismicity. <blockquote>The Asian Highlands’ abundance of Gravitational Potential Energy (GPE) can support the region’s energy transition, but it needs to be produced in much less hazardous and less environmentally and socially impactful ways. The best means of doing this is through off-river, pumped-storage hydropower stations that back up solar and wind energy generators. Smaller projects such as this would also involve less risky tunneling and displacement.</blockquote> Rivers of the Asian Highlands: From Deep Time to the Climate Crisis by Ruth Gamble, et al. There is geological evidence that megafloods on Himalayan rivers are more responsible than mass wasting in weathering down the mountains. One big LLOF, for example, could ‘move 1,000 times more sediment than would otherwise be transported over millions of years’. Permafrost melting in the Tibetan Plateau and inside moraines caused recent back-to-back GLOFs in Chamoli in the Indian Himalaya, Melamchi in Nepal, and the South Lhonak in Sikkim — all deadly disasters that together destroyed billions of dollars worth of infrastructure downstream. Rivers of the Asian Highlands travels from deep time to the present climate crisis, taking readers through neatly divided chapters titled Mountain Rivers, Climatic Rivers, Frozen Rivers, Living Rivers, Human Rivers, Territorializing Rivers, Agricultural and Pastoral Rivers, even NGOs and Rivers.&nbsp; Although the book’s title is about the ‘Asian highlands’, it <a href="https://www.himalmag.com/comment/eastern-himalaya-cradle-ethnogenesis">focuses mainly on the Dri Chu (Yangtse)</a> and Yarlung Tso (Brahmaputra). Readers looking for references to Nepal’s rivers will be disappointed, although there is quite a bit about Bhutan. This is surprising because 70% of the annual flow in the Ganga is from tributaries in Nepal, some of them rivers like Karnali, Arun or Bhote Kosi that traverse the Tibetan rimlands. As demand for water and energy grows in the large and increasingly affluent population of north India, and climate breakdown melts Himalayan glaciers, storing monsoon runoff on reservoirs in Nepal is going to be the geopolitical issue of the next decades.&nbsp; The chapter on NGOs and Rivers also fails to cite the work of Nepal’s civil society groups like the Alliance for Energy that built international solidarity in 1995 against the Arun III project on a river that starts in Tibet and flows into Nepal. Ultimately, the World Bank pulled out of the project and the Nepal government invested in smaller decentralised plants. Today, a cascade of power plants are being built by Indian companies on the Arun which do not seem to have taken into account the <a href="https://www.science.org/doi/10.1126/science.ads2659">2023 Sikkim GLOF</a> that swept away the $1 billion dollar Teesta III and destroyed other infrastructure. The World Bank itself is back with the Upper Arun project located directly below expanding glacial lakes in Tibet.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250222020256_f2b33e60e6b386308bdf59b58b59e116e90e2e4466a06200faf76fd851f53505.jpg" data-media-id="editor_4" data-image-id="20250222020256_f2b33e60e6b386308bdf59b58b59e116e90e2e4466a06200faf76fd851f53505" data-rendition-name="original" width="5712" height="3213" loading="lazy" alt="Teesta"> <figcaption>The Super Trisuli project in Nepal has ruined the most scenic and ecologically sensitive part of the river to generate just 100MW of power. Photo: KUNDA DIXIT</figcaption> </figure>  Despite geographical gaps, Rivers of the Asian Highlands reads like an encyclopedia of Himalayan rivers. The authors look at them not in isolation but as interconnected systems which need a multidisciplinary approach to study the geological, religio-cultural, infrastructure, climate and ecosystem services aspects of catchments.&nbsp; Mt Kailash (Kang Rinpoche) is a case in point. It is fascinating to think that it was part of a mountain range even before the collision of the continents that formed the Himalaya, and was probably buried in ice 3km thick till 15,000 years ago during the Last Glacial Maximum.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025022203020_23c02ec4671f5c3c561fa6b450c1f209720a25794e067b9bb5db0f4649b1b6dc.jpg" data-media-id="editor_5" data-image-id="2025022203020_23c02ec4671f5c3c561fa6b450c1f209720a25794e067b9bb5db0f4649b1b6dc" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Mt Kailash"> <figcaption>Mt Kailash. Photo: NABIN BARAL</figcaption> </figure>  Lake Mansarovar and Mt Kailash are also the subject of the new Nepali language book छालबाटो (Road by the Waves) by environmental journalist <a href="https://nepalitimes.com/news/nepal-and-china-to-study-trans-himalayan-railway">Ramesh Bhushal</a> in which he walked, rafted and drove from the source of the Karnali in Tibet, right through 500km of western Nepal, and on to India <a href="https://nepalitimes.com/banner/dancing-with-the-river">where the river meets the Ganga</a>. In his entourage is activist, <a href="https://archive.nepalitimes.com/regular-columns/Comment/rivers-fighting-back,993">Megh Ale</a>, who is on a campaign to stop dams and infrastructure on <a href="https://nepalitimes.com/banner/dams-and-dreams-a-journey-down-the-karnali">Nepal’s longest and only free-flowing river</a>. The book profiles his lonely upstream struggle to conserve the country’s rivers. “We worship rivers, but we don’t love them,” laments Ale. Bhushal’s book is as much about the landscape of this transboundary river as it is about the people he meets along the way, and their relationship with <a href="https://nepalitimes.com/banner/climate-denial-in-the-himalaya">a river that most regard as a curse </a>keeping them poor because they believe it flows out of Rakshas Tal (Lagngar Tso) in Tibet, regarded as a lake of demons, unlike the sacred Mansarovar nearby. The expedition is out to prove that the <a href="https://nepalitimes.com/banner/a-karnali-portrait">Karnali River</a> actually starts in the mountains 50km southwest of the Mansarovar (Mapamyu Tso) at the <a href="https://www.youtube.com/watch?v=jQ9Za5QDkvY">Peacock Falls (Mapchu Khambap)</a>. The Indus is called Sengge (Lion), Sutlej is Langchen (elephant) and the Brahmaputra is Tamchok (horse), all starting within 60km of Mansarovar but flowing out in different directions. <blockquote>“I have visited hundreds of rivers around the world, but for some reason I have never seen a river as beautiful as the Karnali. One day I would like to visit its source.”</blockquote> River conservation activist Megh Ale quoted in छालबाटो by Ramesh Bhusal. But all this reverence for the mountains and rivers may not be enough to save the region from the impact of climate breakdown. Heat stress in the Subcontinent will coincide with a shortage of water in the coming decades.&nbsp; <a href="https://www.nytimes.com/2018/12/01/opinion/himalayas-mountains-dams.html">Sunil Amrith</a> in his 2019 book, <a href="https://nepalitimes.com/here-now/the-monsoon-and-nature-s-arithmetic">Unruly Waters: How Mountain Rivers and Monsoons Have Shaped South Asia’s History</a> takes a broader look at how geotectonics, geopolitics, colonialism and nationalism have determined the relations between human beings and rivers. The Himalayan water cycle starts from monsoon moisture that precipitates with orographic uplift along the mountains, atmospheric rivers unleash cloudbursts, ground water emerges from springs that join up to flow down to rivers and the ocean. The Third Pole is the biggest repository of fresh water stored as ice after the polar regions. But it is a hotspot both because of the climate crisis and geopolitical tensions, which impacts on river basin cooperation, early warning data sharing, and ultimately in mitigation of greenhouse gas emission and planning for new risks faced by infrastructure. After independence, India adopted the colonial extraction model for rivers. Inaugurating the Bhakra-Nangal Dam in 1953, Jawaharlal Nehru called it “a temple of &nbsp;modern India … worthy of worship’. Gamble also alludes to this in her book about the European attitude about rivers as a resource to be ‘enclosed, extracted, scrutinised, commodified’. <a href="https://dialogue.earth/en/water/review-unrully-waters/" target="_blank">Amrith</a> profiles the work of Sir Arthur Cotton who was building canals linking rivers in British India at about the same time his contemporaries like botanist <a href="https://nepalitimes.com/here-now/republic-of-nepal-s-animal-kingdom" target="_blank">Joseph Dalton-Hooker </a>were exploring the <a href="https://nepalitimes.com/here-now/saving-kangchenjunga" target="_blank">Teesta and other rivers</a> in the Himalaya to catalogue new plant species. India's current National River Linking Project that would join 37 rivers with 9,000km of canals builds on Cotton’s early work. <blockquote>If there is one consistent lesson in Unruly Waters, it is that water management never has been, and can never be, a purely technical or a scientific question; neither can it be addressed on a purely national scale … the battle continues to understand the monsoons and mountain rivers that shape Asia.</blockquote> Unruly Waters: How Mountain Rivers and Monsoons Have Shaped South Asia’s History by Sunil Amrith And in Nepal, hydropower has become the holy grail as the government unveiled an Energy Development Roadmap to generate 28,500MW by 2035 at a cumulative cost of nearly $50billion. This means no river in Nepal will be left free-flowing. The Trisuli along the Prithvi Highway is being dammed for only 100MW of power, destroying the most scenic part of a river that has rapids famous internationally for white water rafters. Even before it was completed, the dam site suffered Rs200 million in damage in last September’s flood.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025022203020_d9610a11bccb593d32bf4d214479caa17dfbdd6cdfe5e8c38fdcb8eb752fc0ec.jpg" data-media-id="editor_18" data-image-id="2025022203020_d9610a11bccb593d32bf4d214479caa17dfbdd6cdfe5e8c38fdcb8eb752fc0ec" data-rendition-name="original" width="4032" height="2268" loading="lazy" alt="Trisuli"> <figcaption>Boulders and sediment 80m deep were brought down by the Teesta after a GLOF destroyed the $1 billion Teesta III plant in Sikkim in 2023. Photo: KUNDA DIXIT</figcaption> </figure>  In Sikkim, there is strong <a href="https://india.mongabay.com/2025/02/political-stir-follows-expert-panels-approval-to-rebuild-teesta-dam-in-sikkim/">local opposition to rebuild Teesta III</a> but investors are looking at the huge economic windfall from the river as it drops from 5,000m below Kangchenjunga to 300m within 80km — one of the highest Gravitational Potential Energy of any river in the world. Besides Nepal and Bhutan, the ‘watersheds’ of the Himalaya are turning into ‘powersheds’ as India and China compete for hydro-hegemony. India is said to be planning to dam the Brahmaputra to offset the disruption caused by China’s Medog Dam upstream (see map, below).&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025022203024_37c60bd2a45a32cd23928c900615b6c7045b2e0265050c4761c3749361181999.png" data-media-id="editor_20" data-image-id="2025022203024_37c60bd2a45a32cd23928c900615b6c7045b2e0265050c4761c3749361181999" data-rendition-name="original" width="1918" height="668" loading="lazy" alt="Himalayan rivers map"> </figure>  The thread running through all three books is the need to recognise the ecosystem services that the inhabitants of High Asia provide by protecting our rivers. Not all rivers need to be monetised, conserving rivers and the cultures they retain protects a nation’s natural wealth into the future as the humans of High Asia try to survive climate breakdown. The highlands will be under even more pressure in the coming decades as people in the plains migrate en masse to higher latitudes or higher altitudes to escape deadly heat and ocean expansion.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025022203028_524a74bf65111db3826bfd246576329c45cd4bd0a48b15024b6a520582bbf05a.jpg" data-media-id="editor_21" data-image-id="2025022203028_524a74bf65111db3826bfd246576329c45cd4bd0a48b15024b6a520582bbf05a" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="River of Asian Highlands cover"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025022203028_20c17a9b92b11c8bb33df5f2fc2781498464288533c310ccd61e1245e709d99c.jpg" data-media-id="editor_22" data-image-id="2025022203028_20c17a9b92b11c8bb33df5f2fc2781498464288533c310ccd61e1245e709d99c" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Unruly waters cover"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250222030212_649cc2ba02e806da2b128fccaf5de2e5c830e10646ba0b43d56da39f65a70f9f.jpg" data-media-id="editor_23" data-image-id="20250222030212_649cc2ba02e806da2b128fccaf5de2e5c830e10646ba0b43d56da39f65a70f9f" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Chaalbato cover"> </figure>

Saving what is left of Himalayan rivers

Frustrated with revolving door <a href="https://nepalitimes.com/news/the-geopolitics-of-nepal-s-politics">politics</a> with the same <a href="https://nepalitimes.com/editorial/tried-tested-and-failed">tired, tested and failed </a>leaders, Nepal’s cybersphere is harking back to the good old days when we had strongmen rulers like <a href="https://nepalitimes.com/multimedia/jung-bahadur-s-destitute-descendants">Jang Bahadur Rana </a>or <a href="https://nepalitimes.com/news/king-mahendra-didn-t-pay-hunting-bill-in-us">King Mahendra</a>. The<a href="https://nepalitimes.com/here-now/inside-story-of-nepal-s-rana-dynasty"> century-long Rana oligarchy</a> ended 74 years ago this week, and the Shah kings airbrushed <a href="https://nepalitimes.com/here-now/the-insect-that-changed-nepal-s-history">Nepal’s history</a> to downplay their achievements and glorify their own dynasty. After <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">the monarchy</a> was abolished in 2008, <a href="https://nepalitimes.com/review/the-role-of-rituals-in-royalty">the Shah kings</a> were similarly vilified. But Nepali society is mature enough to realise that the truth is not all black and white. Jang Bahadur may have usurped power in a ruthless coup, but he was a geopolitical strategist way ahead of his time. Whatever you may say about King Mahendra’s efforts in quashing <a href="https://nepalitimes.com/news/is-democracy-too-expensive-for-nepal">democracy</a> and pushing a unitary state, he defended <a href="https://nepalitimes.com/opinion/guest-editorial/nepal-should-recognise-palestinian-sovereignty">Nepal’s sovereignty</a> and projected its international image right through the sensitive Cold War period. Jang Bahadur in England is a new Nepali language book by journalist Gajendra Budhathoki about the visit in 1850 by Nepal’s prime minister to England and France, the first by a South Asian potentate. He met Queen Victoria and by all accounts was able to establish Nepal’s presence on the world stage. Historians have long mulled why a devout Hindu like Jang Bahadur would want to break the taboo and cross the Black Waters. Budhathoki recounts the incident upon his arrival at Southampton on 2 May 1850, when British customs officials tried to check the belongings of the Nepali entourage. Furious, Jang Bahadur threatened to sail right back to France if they opened any of the bags. Jang had three main reasons for his trip. Essentially he was on a spy mission to assess <a href="https://nepalitimes.com/here-now/a-forgotten-gurkha-rebellion-e8z403ab">British military</a> might to decide if it was worthwhile for Nepal to try to militarily take back territory ceded to British India in the Sugauli Treaty of 1816. So, Jang asked his perplexed hosts to show him cannon factories, artillery and naval yards. He even visited Woolwich Arsenal (now the Royal Arsenal) not once, but three times.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/looking-back-at-the-1923-nepal-britain-treaty">Looking back at the 1923 Nepal-Britain Treaty</a>, Santa Gaha Magar Suitably impressed, Jang decided to be Britain’s BFF, and even rode down to Lucknow with 3,200 Nepali troops to rescue the British from the Sepoy Mutiny of 1857. As a reward, the British gave back the Tarai districts of Banke, Bardia, Kailali, and Kanchanpur (Naya Muluk). This close relationship continued with Jang’s descendants right till the time the British left India in 1947. Jang Bahadur was also fed up with the Governor General Lord Dalhousie in Calcutta who tended to bully Nepal, and wanted to build direct contacts with his bosses in London. The British told him Dalhousie was their man in India, and Jang should deal with him. <a href="https://nepalitimes.com/banner/the-way-we-were">Jang’s visit to France</a> does not get as much attention in the book, but he was also trying to gauge France’s strength and to see if its military was more powerful than Britain’s. At that time, France was Britain’s main rival and was trying to make inroads in India. At the Louvre, Jang Bahadur was drawn to exhibits reflecting French military prowess. Later, when he met Louis Napoleon III, he asked if he could see a parade of 900,000 troops to assess France’s military might.&nbsp; Read also: <a href="https://nepalitimes.com/review/nepal-france-ties-in-photos">Nepal-France ties in photos</a>, Reeti KC Freshly returned from <a href="https://nepalitimes.com/here-now/a-long-way-to-europe">Europe</a>, an emboldened Jang Bahadur Rana led Nepal in a war against Tibet in 1855 which ended with the Treaty of Thapathali a year later. This was the third time Nepal and Tibet had fought, the first time being soon after <a href="https://archive.nepalitimes.com/regular-columns/guest-editorial/Prithvi-Narayan-Shah-a-visionary-leader,1102">Prithvi Narayan Shah</a> in 1788.&nbsp; The Qing Dynasty came to the rescue of Tibet, and while both sides claimed victory, the Sino-Nepalese War ended essentially as a stalemate with the Treaty of Betrawati.&nbsp; All of this is detailed in Axel Michaels’ book, Nepal: A History from the Earliest Times to the Present which is a recent English translation of his German Kultur und Geschichte Nepals published in 2018.&nbsp; Michaels is a Professor of Classical Indology and Religious Studies at Heidelberg University, and writes that Nepal mattered little to China. Proof of this is that while both Nepal and Tibet agreed to accept the suzerainty of the Qing emperor following the war, Nepal managed to retain its autonomy but Beijing asserted its control over <a href="https://nepalitimes.com/business/himalaya-to-lhasa">Lhasa</a>. And despite a clause in the treaty which stated, ‘if a foreign power attacks Nepal, China shall support Nepal’, China never did so during the1814–16 war with the East India Company.&nbsp; This practice has continued to this day. Aside from token petroleum shipments, Beijing did not help out Nepal during the Indian Blockade of 2015. Even though Nepali leaders have tried to play India off against China, the two do not find Nepal important enough to fight over and prefer to leave it as a buffer state between them.&nbsp; In that sense, Britain also did not press home its victory after 1816 and left Nepal alone. The malarial jungles to the south, rugged Himalayan terrain and the lack of marketable products (except soldiers) may have persuaded the traders at the East Indian Company that it was not worth the effort. There is a lesson from history here for Nepal: the country must look out for itself, and this requires deft diplomacy to understand what our giant neighbours really want and leverage it for our gain. This may require strategies like the ones made by Jang Bahadur and King Mahendra after all. Michaels is not a fan of either the Rana or the Shah dynasties. He says that although the Rana era is characterised as ‘a century of tyranny’, the description holds true for the Shah period as well.&nbsp; Michaels does not mince his words about Gurkha recruitment into the British and Indian Armies (another legacy of the Sugauli Treaty). He calls the mercenaries ‘cheap labour’ and Pushpa Kamal Dahal ‘represents a continuation of the King-Brahmin alliance’. In fact, he goes at length to discuss how the Khas-Arya used ‘Hindu state’ to homogenise a country that couldn’t have been more diverse. But democracy has not served Nepal well either. Corruption, impunity and lack of transparency are rife. And so, Michaels asks if Nepal is a failed state. No it is not, but it is a fragile state. He leaves us with these parting words: ‘If Nepal succeeds in continuing down this road, preserving its ethnic and cultural diversity, leaving the ethnic populations with a certain degree of autonomy, while at the same time integrating them into political decision-making processes, and if it manages the reforms needed for land-ownership, labour, education, infrastructure, then the country can become a model for unity in diversity, even in the age of leveling globalisation.’&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250222070248_a32db0a1e39c4a3a5158af81bbcf927aeb96524bcbc6b41086a223685642b367.jpg" data-media-id="editor_17" data-image-id="20250222070248_a32db0a1e39c4a3a5158af81bbcf927aeb96524bcbc6b41086a223685642b367" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Jang Bahadur in England "> </figure>  &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250222070252_e2fa5309f10d36f963243c24ea06d7d354d3dfaf24c7ef283d70369fbeabd02e.jpg" data-media-id="editor_18" data-image-id="20250222070252_e2fa5309f10d36f963243c24ea06d7d354d3dfaf24c7ef283d70369fbeabd02e" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Nepal Book"> </figure>  &nbsp;

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