<figure><img width="957" height="638" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141132/636bacb09c7e80680e077f49jpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>Nepal has been spared the worst of the COVID-19 pandemic so far, and Kathmandu Valley has been among the least affected areas of the country. But there has been a worrying increase in the capital since the lockdown was partially eased two weeks ago.
The detection of 23 new cases on Wednesday has brought the tally to 288, with 190 in Kathmandu, 53 in Bhaktapur and 45 in Lalitpur districts. From Thursday, three wards of Lalitpur’s Mahalaxmi Municipality have been put under strict lockdown after nine people were tested positive in those localities this week.
Public health officer Tek Raj Ojha said the nine were all returnees from abroad, patients at hospitals, and two were health workers themselves. They have been kept in isolation, and all are asymptomatic.<a href="https://www.nepalitimes.com/editorial/open-and-shut-case/" target="_blank" style="background-color: rgb(255, 255, 255); font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Open and shut case</a>, Editorial
“Until we can conduct mass testing and find out where they were infected, we cannot say that there is community transmission,” Ojha says. Forty others who had been in contact have been traced and are being tested.
The three wards of the municipality are back in lockdown with all shops closed, although provision stores and pharmacies are allowed to open from 7-9AM.
The daily bombardment of total new cases does sound alarming. However, Nepal’s PCR test rate per capita is one of the highest in South Asia, the fatality rate of 0.2% is one of the lowest, hospitalisation and ICU admissions are normal. Nepal’s positivity rate is at 6% for PCRs, little lower than India at 7%.
The Ministry of Health and its agencies keep track of the trends, but make blunders. For example, on two days last week several labs showed 100% positive cases among those in PCR tests. The daily tallies are transmitted by labs at 1PM to the National Public Health Laboratory, then to the Epidemiology and Disease Control Department, which then passes them on to the Health Emergency Operation Centre at the Ministry of Health, which then announces them at a daily press briefing. None of the agencies detected the anomaly.
After it created a stir on social media, the government finally admitted that there had been an “error in the submission” of the figures by the labs which had bundled all positive cases without giving the total samples tested.
Teaching Hospital’s Niranjan Shah says he had tested 249 samples on 1 July of which 114 were positive. “But the Ministry published the table with only the positive figures without the total numbers tested,” he said.
Faced with the growing numbers in Kathmandu, the government is now increasing surveillance testing in crowded areas to confirm if there is community transmission. Although not all the results have come in, so far they show that the virus is not spreading in this way yet.
However, public health experts warn that Nepal should look at worrying trends in India. The country recorded its highest ever daily new cases with 26,000 positives on Wednesday – two weeks after the government loosened its lockdown. This brings India’s total caseload to 770,000 with 21,000 fatalities.
More worryingly, the daily cases are now rising in states bordering Nepal. West Bengal now has 807 deaths from COVID-19, and Uttar Pradesh also has 800 and counting.
And even though these numbers are small compared to India’s total population size, experts say it shows how quickly COVID-19 can spread in crowded cities where citizens do not comply with precautions.

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We are being tested

<figure><img width="944" height="629" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141132/636bac979c7e80680e077f3fjpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>Nearing the 15th week of the lockdown is a decisive milestone to take stock of how Nepal is positioned vis-a-vis the coronavirus pandemic. The epicentres have been shifting across the world, with some  countries like the United States “knee-deep in the first wave”, as the country’s top infectious diseases expert Anthony Fauci described it this week.Brazil’s President Jair Bolsanaro, who refused to let his country deal seriously with the pandemic even as it became the country with the second highest death toll, himself tested positive this week. In India, the virus has spiked in the country’s metros with record daily cases just after Prime Minister Narendra Modi started relaxing the lockdown last month. However bad it may seem at the moment, Nepal is not doing too badly. Its PCR test rate in one of the highest in South Asia, the fatality rate is low, hospitalisation and ICU admissions are not above normal.Public health experts say the positivity rate is going down and the total case load is plateauing.Physicians, however, are <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNG5s5Q09s8YZEwIMzgB8hkaLowz8A">not as optimistic</a>. They have always pooh-poohed the idea that Nepalis have greater immunity because of our diet, or exposure to germs. The reason the case load is low, they say, is because there still have not been enough tests. And they warn that Nepalis are predisposed to diabetes and cardio-vascular diseases, and the prevalence of tuberculosis puts the whole <a href="https://www.nepalitimes.com/latest/has-nepals-lockdown-just-postponed-covid-19/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/has-nepals-lockdown-just-postponed-covid-19/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNGk5i1ADaO6W1djlf5Cpl8KZNtXcg">population at high risk</a>. The virus could just be waiting to strike. But one thing both agree on is that full re-opening is not advisable even after the ‘eased’ lockdown is over on 22 July, and a full scale public awareness campaign should be launched about wearing masks in public and physical separation. The government seems to be listening — on Tuesday it announced fines and punishment for those caught without masks in public.The dilemma for governments everywhere has been to <a href="https://www.nepalitimes.com/editorial/unlockdown/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/unlockdown/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNF94-ZoT361ymnOA93B03DBXJ2KpQ">balance lives and livelihoods.</a> Countries that have lifted lockdowns too early have paid for it with a resurgence, those which maintained strict lockdowns without widespread testing have squandered the sacrifice made by their citizens. As <a href="https://www.nepalitimes.com/editorial/fear-goes-viral/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/fear-goes-viral/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNErFR90JDaKUN2cmB2YggR1H4hScw">fear of hunger</a> overcomes the fear of the virus, some leaders opened up dreading public anarchy and loss of political control. The countries that have done well to quell the virus are the ones where politicians and technocrats have taken the advice of scientists, weighed the pros and cons, communicated clearly with their citizens, and eased restrictions in a carefully calibrated manner. In Nepal, the government of Prime Minister K P Oil has been so busy with political fire-fighting that his administration has bungled the response. In a quintessentially Nepali way, the government has muddled along with no real plan. Worse, it has allowed greedy politicians, bureaucrats and crony businessmen to profit from the pandemic.From the very start, it got the <a href="https://www.nepalitimes.com/banner/why-rapid-tests-are-doing-more-harm-than-good/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/why-rapid-tests-are-doing-more-harm-than-good/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNFyDXMLz8REixy0tj5-XZLKliyqvQ">wrong testing kits</a>. It was not prepared for the influx of returnees from India, it delayed overseas repatriation flights causing misery to tens of thousands of Nepalis stuck abroad. Even when it got the right PCR kits, <a href="https://www.nepalitimes.com/latest/why-nepal-lags-in-covid-19-testing/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/why-nepal-lags-in-covid-19-testing/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNHhPu9wciVS3_HAb9H3bLowkX30tQ">they were not compatible</a> with the machines already here. Valuable time was lost, and at one point there were <a href="https://www.nepalitimes.com/latest/far-western-province-stops-covid-19-tests/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/far-western-province-stops-covid-19-tests/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNH-i3ZuUAEDHdF9iBWbYVVUp1JIQw">35,000 swab samples</a> piled up at testing centres. Even then, it refused to allow private labs to conduct tests. It did not want to listen to specialists who offered a cheap solution — get cartridges for the 1<a href="https://www.nepalitimes.com/here-now/a-covid-19-game-changer-for-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/a-covid-19-game-changer-for-nepal/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNEexVq7uxXb_6etxRFUtHqopM-Iiw">00 GeneXpert PCR machines</a> that are already there for TB surveillance.And the latest scandal this week is that the Ministry of Health has been trying to cover-up its incompetence in the counting process which resulted in some government labs in Patan and Dhangadi showing 100% positivity rate on 1 July and 3 July. It did not even notice the error in its own daily tabulation, and when it did, tried to sweep it under the carpet.As we go to press on Thursday evening, the total number of confirmed cases have risen to 16,531, with about 8,700 in isolation and 24,000 in quarantine centres. There have been 35 fatalities so far, mostly dying of co-morbidity. Most cases are asymptomatic, and there has been no marked increase in hospitalisation. The good news is that <a href="https://www.nepalitimes.com/here-now/nepal-quarantines-hotspots-for-disease/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-quarantines-hotspots-for-disease/&amp;source=gmail&amp;ust=1594345240798000&amp;usg=AFQjCNFPbBpVFNMT4Ahbi4qs_J03QjgNhQ">quarantine centres are emptying</a> as the number of returnees from India goes down. The bad news is that the number of positive cases in Kathmandu is going up. Surveillance testing of focus groups and in crowded parts of the Valley may show community transmission.If that is the case, there is only one way out: test-isolate-trace-treat.

Open and shut case

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121120/636b8d7f9c7e80680e06b350jpeg.jpg" alt="" width="640" height="427"/><figcaption>Photos: BIKRAM RAI</figcaption></figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121120/636b8d849c7e80680e06b351jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121120/636b8d879c7e80680e06b352jpeg.jpg" alt="" width="640" height="427">One week into my US tour, Europe was being ravaged by COVID-19, and America had belatedly begun to come out of denial about the pandemic. President Trump announced a ban on non-Americans flying to the United States. Europeans already there were scrambling to get out.Our nine-member group from the Philippines, Vietnam, Cambodia, Uzbekistan, Sri Lanka, India and Pakistan had been briefed at the Environment Protection Agency in Washington DC, and had arrived in New Orleans to meet activists who worked on relief after Hurricane Katrina. There were reports of an outbreak in California where we were headed next.<a href="https://www.nepalitimes.com/latest/nepal-lockdown-to-be-extended/" target="_blank" rel="noopener noreferrer">Nepal lockdown to be extended</a><a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/how-nepal-should-plan-to-exit-lockdown/" target="_blank" rel="noopener noreferrer">How Nepal should plan to exit lockdown</a>, Ramesh KumarAfraid we might be stranded by flight bans, the organisers decided to send us home. Soon, I was on a 24-hour journey from New Orleans to Kathmandu, via London and Doha. Along the way the airline lost my checked-in luggage in Heathrow, and I have given up hope of ever getting it back.Since landing in Kathmandu in mid-March in one of the last regular flights, I have been in self-quarantine. As a health and environment reporter at Nepali Times, I have been covering the pandemic from home, connecting to our virtual newsroom on Zoom.I did not have any symptoms during that time, but because we have elderly family members, I maintained a strict isolation, obsessively sanitising everything I touch, wearing a mask even when I have locked myself in my room.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/nepal-vs-covid-19/" target="_blank" rel="noopener noreferrer">Nepal Vs COVID-19</a>, Rastraraj Bhandari<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">Prevention while searching for cure</a>, Buddha BasnyatWhen we got a call on Monday from the Municipality to come for testing, I was relieved because it meant that the government’s contact tracing system was working. Local governments were tracking down everyone in Lalitpur who had come back from abroad in the past month.I was never scared for myself, but for others in the family since the virus is so infectious. I extensively researched Rapid Diagnostic Test (RDT), Polymerase Chain Reaction (PCR) and what they entailed.That Tuesday morning I took a few steps out of my house for the first time in a month. Everything still looked and smelled the same, except the streets were deserted. We decided to walk to the Lagankhel testing centre, and on the way I had to tie my shoelace twice. Each time, I hand sanitised myself after I was done. I had turned into a certified germophobe.We avoided the main roads, and it was hot – Kathmandu had gone from winter to summer in the month I spent in self-isolation indoors. Buildings on the road to Lagankhel advertising ‘Study in Australia’ and ‘Learn Korean Language’ looked deserted, except for a few people peeking out of the windows.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/why-rapid-tests-are-doing-more-harm-than-good/" target="_blank" rel="noopener noreferrer">Why rapid tests are doing more harm than good</a>, Ramu Sapkota<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" target="_blank" rel="noopener noreferrer">Nepal must hope for the best, prepare for the worst</a>, Buddha BasnyatIronically, the tent for mass testing was placed right beside the temple where the idol of Machhindranath is bathed in milk before it is placed in the chariot for its annual festival. If it was not for the lockdown, just about now they would be preparing the temple for the jatra.Police were outside the tent telling people queuing up for tests to maintain a safe distance. The media was present in force in reflective green vests taking photos and videos of the returnees being tested, giving me a taste of what it feels like to be on the other side.All of us in the queue wore masks. Some even sported surgical gloves and sunglasses. Few wore jackets and hoodies. The person behind me was busy making calls to get his relative to also come for the test.Under the tent, there were puddles from the morning rain and flies were buzzing around nearby. They were all reminders that we already had a problem of unsanitary conditions spreading disease before this new infection came around.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">Post-pandemic mental health epidemic</a>, Sonia Awale<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/shape-up-the-lockdown/" target="_blank" rel="noopener noreferrer">Shape up the lockdown</a>, Marty LoganIt was my turn next. I was given sanitiser to apply on my hands. Two medical officers in PPEs asked my name, age, address, country I returned from and when I had flown in. Interestingly, a municipality official at the desk already knew my particulars and replied before I could. She was the person who had called my house that morning.We had been reporting on how despite the lockdown, Nepal was lagging behind in testing, but I was impressed with the coordination and the thoroughness of how it was being done. Local governments from the ward to municipality were being proactive in house-to-house contact tracing for new arrivals and symptoms. Someone was doing their homework, and that was reassuring.A lab technician drew a drop of blood from my finger, and gave me a cotton ball with disinfectant. That was it. Small kits with blood droplets were neatly arranged in multiple rows and columns, mine was placed next to them. So, this was a RDT, and not a PCR which would mean collecting an oral and nasopharyngeal swab sample.The test result came later that day – all of us in Lagankhel had tested negative. My blood did not have antibodies, which meant I had not been exposed to the virus.At home, I am still not taking any chances. I will continue to self-isolate amidst a nationwide lockdown. As for my parents, this is the first time they are happy that I failed a test.https://www.youtube.com/watch?v=LXCENWJLuKk&amp;t=6sSonia Awale is Associate Editor at Nepali Times, is a student of public health, and covers environment and healthcare issues.

Sonia Awale

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How COVID-19 puts us to the test

<figure><img width="1059" height="604" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cd29c7e80680e06b319jpeg.jpg" alt=""/><figcaption>Shekhar Golchha, Pashupati Murarka and Sudhir Mittal of Shree Airlines handing over PCR kits donated by Singapore's Temasek Foundation to Dipendra Taman Singh from the Ministry of Health on Friday after they were flown from Singapore to Kathmandu on special Shree Airlines flights. </figcaption></figure>Singapore’s <a href="https://www.temasekfoundation.org.sg" target="_blank" rel="noopener">Temasek Foundation</a> has provided 10,000 PCR test kits to Nepal for <a href="https://www.nepalitimes.com/latest/nepal-extends-covid-19-testing-but-no-new-cases/" target="_blank" rel="noopener">detecting COVID-19 cases</a> which will be deployed to frontline health workers to test patients all across the country.Called ‘Fortitude Kit 2.0’ the kits are designed by Singapore’s Agency for Science, Technology and Research (A*START) to detect the SARS-CoV-2 virus. The all-in-one 1-step RT-PCR kits come with all materials required for the reaction, which includes primer probes mix, enzyme mix, the positive control, negative control and internal control template. “In these difficult times, Temasek Foundation stands in solidarity with our friends from Nepal,” said Benedict Cheong, CEO of Temasek Foundation International. “We hope these test kits will be helpful to hospitals and medical professionals who are bravely managing the <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" target="_blank" rel="noopener">COVID-19 situation in Nepal</a>.”<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/why-rapid-tests-are-doing-more-harm-than-good/" target="_blank" rel="noopener">Why rapid tests are doing more harm than good</a>, Ramu SapkotaThe kits were flown from Singapore to Kathmandu on a special Shree Airlines CRJ 700 flight on Friday organised by Shekhar Golchha, Pashupati Murarka and Sudhir Mittal of Shree Airlines, and handed over to the Ministry of Health for distribution to hospitals across Nepal. Vijayendra Baral at Singapore General Hospital, and in Kathmandu Ranjit Acharya and Neil Pande facilitated the process. <img width="1116" height="1280" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cd59c7e80680e06b31ajpeg.jpg" alt="">Temasek Foundation had also helped Nepal strengthen public schools after <a href="https://www.nepalitimes.com/here-now/epicentre-of-two-disasters-in-west-nepal/" target="_blank" rel="noopener">the 2015 earthquake</a> and in post-disaster recovery management jointly with <a href="https://www.singhealth.com.sg" target="_blank" rel="noopener">SingHealth</a> and Ministry of Health in Nepal. The project built systems and capacity in the area of disaster healthcare training and management for the pre-hospital and in-hospital environments so as to improve preparations for future disasters. The project trained 432 specialist medical trainers and hospital leaders, 206 nurses and 38 physiotherapists in hospitals and venues across  Kathmandu, Biratnagar and Nepalganj and culminated in a mass disaster simulation droll in Kosi Zonal Hospital in November 2019. <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-to-test-covid-19-test-kits-from-china/" target="_blank" rel="noopener">Nepal to test COVID-19 test kits from China</a>, Ramu SapkotaA 30-member team identified by the Ministry Of Health Nepal as potential future master trainers were also travelled to Singapore in April 2019 for a 5-day training in disaster management.SingHealth has also signed an agreement with TU Teaching Hospital in Kathmandu to collaborate in Paediatrics and neonatology, liver transplants, orthopedics amongst other subspecialties. Friends of SingHealth also provided pediatric anaesthesia equipment for children having eye surgery at Tilganga Institute of Opthalmology.SingHealth is the largest healthcare cluster in Singapore with a network of acute hospitals, national speciality centres, community hospitals and polyclinics offering over 40 clinical specialities.

10,000 COVID-19 test kits to Nepal from Singapore

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8bca9c7e80680e06b2c1jpeg.jpg" alt="" width="480" height="854"/><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8bcc9c7e80680e06b2c2jpeg.jpg" alt="" width="480" height="854">Doctors in Jumla collects swab of a patient on 7 April. Photos: DHIRAJ GURUNGOn 13 April, the nose and throat swab of a woman in Kailali district tested positive for the COVID-19. The 65-year-old who was in quarantine had previously tested negative in a Rapid Diagnostic Test (RDT) and sent home.But only three days later, a <a href="https://www.nepalitimes.com/latest/nepal-extends-covid-19-testing-but-no-new-cases/" target="_blank" rel="noopener">Polymerase Chain Reaction (PCR) report</a> confirmed that she was infected with novel coronavirus, upon which she was taken to Seti Provincial Hospital for isolation. She is one of the eight people who had their swab and blood samples collected for both RDT and PCR, but officials didn’t wait for the PCR report.“She should not have been sent home without waiting for the PCR report confirmation. It was a grave mistake because she could have spread the virus after coming out of quarantine,” says Sameer Dixit, researcher at the Centre for Molecular Dynamics in Kathmandu.In fact the RDT can show false negatives in people for up to a week after infection because their bodies have not produced sufficient anti-bodies to be detected. In fact, public health officials say Nepal should have gone directly for PCR like Korea and other countries instead of RDTs.As of 16 April, 15,800 people have been tested for COVID-19, using both RDT and PCR. But a lack of distinction in the specificity of the two test methods in the public consciousness has led to unnecessary panic and stigmatisation of people and entire communities.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" target="_blank" rel="noopener">Nepal must hope for the best, prepare for the worst</a>, Buddha Basnyat and Sanjeev adhikari<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8bce9c7e80680e06b2c3jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8bcf9c7e80680e06b2c4jpeg.jpg" alt="" width="640" height="427">Health workers in Lalitpur conduct rapid diagnostic tests on 14 April for people who have come from abroad recently. Photos: BIKRAM RAIThe rapid diagnostic test can only monitor if an individual has developed antibodies to fight against the COVID-19, and can be detected only a week after infection and for at least six months after. The test cannot identify the virus itself and therefore cannot verify if the person has an active infection.When the virus enters a human body, the body’s natural immune system is activated and secretes a protein to kill the virus called antibody. There are two types of antibodies: Immunoglobulin G (IgG) and Immunoglobulin M (IgM). It takes at least six days for IgM and 15 days for IgG to develop after a virus enters the body.RDT kits being used to test COVID-19 can detect both types of antibodies, which is why rapid tests conducted in the early stage of infection will give a negative result even if the individual is actually infected. The case in point is the patient from Kailali who took a RDT before it could have detected the virus. The real-time PCR however was able to detect the coronavirus in her swab sample.“Tests conducted without proper scientific knowledge and guidelines will do more harm than good,” stresses lab specialist Umesh Prasad Gupta.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/ke-garne-attitude-kills-people/" target="_blank" rel="noopener">Ke garne attitude kills people</a>, Laxmi BasnetNepal has not yet developed a protocol to guide healthcare workers conducting mass testing for COVID-19, and the government’s decision to use RDT for mass testing actually contradicts the WHO recommendation and the Indian Council of Medical Research (ICMR) guidelines.Those protocols require RDT to be conducted only for individuals who have undergone 14 days of quarantine, healthcare workers, or for people placed in isolation in hospitals. And even if the result turns out to be negative, a retest with PCR is mandatory. High risk patients are to be placed under quarantine until the PCR confirmation.On the other hand, if a suspected individual tests negative in PCR, he/she should still be placed in quarantine and undergo RDT after 10 days. Only if the second test is negative, is the person to be released.The WHO has also recommended countries to use the real-time PCR for the COVID-19 testing because RDT is only 86% sensitive, and cannot detect new infections.However in Nepal, the Office of the Prime Minister and Cabinet on 4 April directed the health ministry to retest all people whose blood samples tested positive on RDT. The Health Ministry also decided to retest 20% of all negative RDT with PCR, when in fact PCR should have been the basis of further investigation.On 1 April, the Ministry of Health instructed that 75,000 RDT kits imported from China by a private contractor <a href="https://www.nepalitimes.com/latest/nepal-to-test-covid-19-test-kits-from-china/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-to-test-covid-19-test-kits-from-china/&amp;source=gmail&amp;ust=1587217332074000&amp;usg=AFQjCNG1Z_W10XJJ0rgDFUS-jmgFusJQxw">not be used because of doubts about their reliability.</a> The importer, Omni Business Corporate Internaitonal (OBCI) was also accused to inflating the cost of the kits and using its connections to the Prime Minister Oli to do the deal on 25 March.The Department of Health also announced on 2 April that it had cancelled the contract with Omni and confiscated its Rs50 million deposit. However, it looks like Omni is still in business and the Department said 30,000 of the rapid diagnostic kits that Omni brought are the ones being used all over the country to test people who have come from abroad recently.