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

Buddha Basnyat

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Staying safe in 2021 and beyond

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba78d9c7e80680e07378djpeg.jpg" alt="" width="957" height="638"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>The Nepal Health Research Council has decided to allow international researchers to conduct Covid-19 vaccine trials in the country as part of a global effort to stop the virus. However, this is not a panacea, and an exit strategy from this pandemic should not just include vaccines.Vaccines may or may not work, and their immunity rates will vary. Other methods for tackling SARS-CoV-2 need to include diagnostics and therapeutics.DiagnosisAt present the definitive diagnosis is made by a cumbersome and sophisticated RT- PCR (Reverse Transcription Polymerase Chain Reaction) with a sample taken from the back of the mouth or naso-pharynx.More user-friendly tests need to be made available soon if we are to make testing easier and more prevalent. Scientists are trying to see if saliva samples can replace the awkward oral or nasopharyngeal swab samples.Ideal would be a RDT (Rapid Diagnostic Test) like a dip stick test, similar to what is available for pregnancy that does not require well-trained technicians and can be performed at home. This is easier said than done, but scientists are feverishly (pun intended) working on trying to make a much simpler test than PCRs available now.If a diagnosis using RDT is promptly and accurately made available in large quantities, it will be easier to decide who to isolate, and hence inhibit transmission of the virus – the main tenet of Covid-19 control.In addition, the importance of prompt testing is underlined by the fact that as the Nepali winter approaches there will be influenza and other viruses which may be mixed up with SARS-CoV-2, leading to unending confusion about who to isolate if tests are not easily available.In Nepal we know all to well the consequences of a wrong diagnosis, using RDTs such as the Widal Test to diagnose typhoid fever. Post-2015 earthquake in Nepal, many false-positive Widal Tests lead to treatment for typhoid fever when the patient in reality had typhus fever, a totally different disease which required a different antibiotic. As a result, the typhus fever was not controlled, sometimes with fatal consequences.TherapeuticsTreatments make up the other important exit strategy to rid the world of the pandemic. If a single, effective treatment (none exists so far) is found, it will not only help the index patient but also mitigate transmission of SARS-CoV-2.In terms of treatment research, randomised controlled trials (RCTs) are much more reliable and superior to observational studies of patient treatment as bias can lead to incorrect conclusions. In addition a large sample size, RCTs may be able to give a definitive answer.The importance of a proper sample size is illustrated by this example. Chinese doctors in Wuhan did such a good job in controlling Covid-19 that when they performed RCTs on Covid-19 patients using Remdesivir (an expensive antiviral drug, now available in Nepal ) in their hospital, they ran out of patients to study and did not have a large enough sample size to arrive at a definitive conclusion.Subsequently other groups studied Remdesivir and showed that it cut down the days (not mortality) in hospital for the sick patient. It was a spot of good luck that the largest (9,000 patients) randomised trial in for Covid-19 from the UK (the Recovery Trial) showed that the cheap steroid, Dexamethasone, although not a silver bullet, significantly decreased mortality in patients requiring oxygen.In the treatment of Covid-19, cost effectiveness will be an even more important factor for countries like Nepal. Ventilators may be important, but they are the last resort. Worldwide up to 90 % of Covid-19 patients on ventilators succumb to their illness because their condition is already so serious when they are attached to the machines.In this part of the world where a functioning arterial blood gas machine to help with the ventilator settings and other technical issues like availability of adequate oxygen are already potential problems, getting ventilators to work properly may also be an issue.The Covid-19 pandemic is a saga, it is a marathon not a 100 metre sprint. It will be important to be psychologically ready for the long-haul with this virus until at least one of the strategies -- vaccine, diagnostics or therapeutics -- works well.Luck is obviously going to play a big part in all of this, including serendipitous findings of which there is a history in medical research. Remember Alexander Fleming’s accidental discovery of penicillin?The good news is that the best scientific minds in the world are devoting all their time and energy in finding a way out. There is a lot of punditry and advice floating about, but most of it is at best guess work because this is a very wily virus.The <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" 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=1598421240339000&amp;usg=AFQjCNH0zvBSZMMLSQvc5kYtRhr_xwj7_Q">Nepal government has got its work cut out</a> with the surge of the past month, it has to monitor the situation closely with the mantra of test, isolate and treat – as well as listen carefully to scientific facts, not rumours.Frequent hand washing is probably as important as distancing and wearing a mask, and adequate soap and water has to be provided including in quarantine areas. The government should not pretend the situation is getting better as it did when it <a href="https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/&amp;source=gmail&amp;ust=1598421240339000&amp;usg=AFQjCNHvrS-j-Z63qT-h62KmHeFUPcysYg">lifted the lockdown on 21 July</a>. It is better to be over-prepared than under-prepared with periods of on-and-off lockdowns in the coming months.<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1598421240339000&amp;usg=AFQjCNGHix4rBrAx8vz_0a47HkcVdlKHWg">Buddha Basnyat</a> is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1598421240339000&amp;usg=AFQjCNGHix4rBrAx8vz_0a47HkcVdlKHWg">frequent health columnist</a> for Nepali Times.

A Covid-19 exit strategy for Nepal

Samsung Nepal has opened pre-orders for the Galaxy A57 5G and A37 5G. Both phones run Samsung’s One UI 8.5, featuring AI capabilities like voice transcription, Circle to Search, and photo editing. They feature a 50MP triple-camera system, a Super AMOLED display, and six years of OS and security updates.

Galaxy A series

Know your Ministers

‘One early morning, we heard the ambassador’s wife cry out, “Ram, Ram, Ram!” A disaster has befallen Nepal!” She had heard on the radio that a fire had consumed Singha Durbar." This is not about the arson attack on 9 September 2025, but the one on 8 July, 1973. It started in the South Wing of the then single-largest building in all of Nepal. It took two days to bring the blaze under control, requiring the use of explosives to demolish one wing to protect the imposing western facade. As Bhekh Bahadur Thapa recalls in the English translation of his memoir A Life in Public Service: Nepal from Autocracy to Democracy, he was then on leave from the Nepal government serving with the IDRC in Ottawa.&nbsp; He had already served as Nepal’s Finance Secretary at age 25, went on to be Finance Minister and Governor of Nepal Rastra Bank. He was already younger than some of the GenZ ministers in Nepal’s present RSP government. Thapa, now 89, was at the launch of the book in February which was attended by former diplomats and bureaucrats. After speeches by panelists, there was a question from the audience about how Thapa had managed to be the diplomat he was, managing Nepal’s international relations on the world stage.&nbsp; Writer and journalist Akhilesh Upadhyay, who was moderating the panel, responded by going into the section of the book where we see Thapa as an ambassador to the US, playing tennis with White House officials, cultivating a network of contacts to project the identity and welfare of Nepal, and making it possible for a state visit by King Birendra to Ronald Reagan’s America. The book is full of anecdotes that suggest Thapa was a clever and strategic diplomat, always calm and unruffled, easily making friends in high places with his maturity and engaging sense of humour. Thapa’s memoir is heavy on details about Nepal’s administrative history during the years he was active in public service, serving as minister and ambassador under three kings: Mahendra, Birendra and Gyanendra, and alongside five prime ministers.&nbsp; Aside from an insider look on how certain treaties, development deals and research projects in Nepal came into fruition, Thapa goes into great detail about his personal and professional relationships with the kings, ministers, ambassadors, foreign leaders and politicians.&nbsp; As a reader, one is struck by the level of detail around the events that unfolded in Nepal over the years during Thapa’s tenure. Was Thapa recording a journal over the years of the events and the conversations that transpired, or were they committed to his phenomenal memory? Either way, the reader gets a glimpse of Nepal’s recent history from the early days of the Panchayat, through the People’s Movement and the democracy period, the Maoist insurgency, Royal Palace massacre of 2001, and Gyanendra’s coup of 2005.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041204048_125dc8ae300a1e33124f394abe724d42727f83e067b0201d2008b58d60c459a4.jpg" data-media-id="editor_0" data-image-id="2026041204048_125dc8ae300a1e33124f394abe724d42727f83e067b0201d2008b58d60c459a4" data-rendition-name="original" width="1584" height="1000" loading="lazy" alt="How to win friends and influence nations NT"> </figure>  Not enough is said about the political parties of the time whose presence led to the way Nepal’s multiparty democracy came to be shaped. The book keeps its focus on the administration and the key figures around it, mostly those in the Panchayat era. Towards the second half of the book, we do start to hear about political parties, but not in great depth. Another figure whose presence in the book is conspicuously less prominent is that of his wife, Rita Thapa — the person who seems to have rescued him every time financial quandary or family care became a challenge. Yet, we do not see her as a full person. Perhaps because of the personal tragedies in his life, the children are also barely mentioned.&nbsp; The book is therefore less personal and more technical. Throughout, we learn about Thapa’s thinking as he navigated the world of diplomacy to win him the trust of those who mattered. There are tips here for a new generation of Nepali officials and diplomats about how much commitment and focus is needed to be good at one’s job and serve the national interest. This book adds to tomes that have been written on Nepal’s fragile relationship with India. ‘India has always wished for Nepal to remain dependent on it,’ writes Thapa, who served as Nepal’s ambassador to India and later in the Eminent Persons Group &nbsp;on Indo-Nepal relations that has been allowed to languish. The book has several insights into the Indo-Nepal trysts with diplomacy and agency.&nbsp; China’s role is also recorded, viewed through conversations during a visit to Beijing, but all that was before Nepal’s neighbour to the north emerged as a world economic and military power. The book also has such sudden instances of quirkiness and humour. For instance, we see a young Thapa in America explaining to a government official why he would like to return to Nepal instead of settling down in the US. “Because, Nepal is beautiful,” he said. The text is immaculate and does not read much like a translation, credit for which clearly goes to the team that put the edition together: translator Prawin Adhikari, &nbsp;Anagha Neelakanthan and Bhekh Thapa’s daughter, Manjushree. As Nepal enters a new era of governance and diplomacy, A Life in Public Service: Nepal from Autocracy to Democracy should be essential reading for students of political science, economics and foreign affairs who can gain a fresh perspective on the country’s trajectory.&nbsp; There are dozens of forgotten state secrets recorded in the book, but the reader must also remember this is a story told from one person’s perspective and there may be others.&nbsp; So, what really made Thapa the diplomat he was? I met him in 2004 at the Kantipur TV studio when he was serving as king Gyanendra’s foreign minister. He was there for a studio interview, and I was just done with my English newscast.&nbsp; He surprised me at the door: “Pratibha! I’ve been reading your articles in The Kathmandu Post. You must keep writing.” I thanked him, glad to have been noticed for my work by a stranger. That was perhaps one of the things that set Thapa apart — he excelled at staying close to those in power, while also noticing those who were not.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260412040412_213e706136a038ec9f5e2b8c6d7f7c1e9ceed9479e22fe2884872ad7bd20955f.jpg" data-media-id="editor_1" data-image-id="20260412040412_213e706136a038ec9f5e2b8c6d7f7c1e9ceed9479e22fe2884872ad7bd20955f" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Book details"> </figure>

How to win friends and influence nations

Prime Minister Balendra Shah on Wednesday broke tradition and met with 17 foreign envoys collectively, a move that was a notable departure from how his predecessors operated.&nbsp;
Shah had already set himself apart by talking less, listening more, and delegating to trusted friends. But by meeting all ambassadors at one go in the presence of the Foreign Ministry, he signalled a paradigm shift in how he wants Nepal to be seen: no longer just balancing India and China, but as a country confident about its <a href="https://nepalitimes.com/opinion/guest-editorial/tripolar-contestation-over-nepal">strategic importance and place in the world</a>.
In just two weeks, the <a href="https://nepalitimes.com/news/rsp-dos-and-don-ts">RSP has sprung into action </a>on multiple fronts to implement its ambitious 100-point, 100-days action plan. It has taken short-term measures to mitigate the impact of the Gulf war, as well as medium- and long- term measures to streamline the bureaucracy. A few high-profile figures have been made examples of to drive the message home.
Earlier this week, the government recalled six politically appointed ambassadors, the most notable being long-serving Shankar Sharma from New Delhi. The Kathmandu District Court issued arrest warrants against former prime minister Sher Bahadur Deuba and his former foreign minister wife Arzu Rana on charges of money laundering and corruption.
Each ministry has been trying to clean up the accumulated rot from the past three decades: regulatory overhaul of microfinance, education, health and service delivery.&nbsp;
These actions widely disseminated campaign-style on YouTube and TikTok have made most Nepalis hopeful that the party they installed in power means business.
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BACKLASH
But such attempts to overhaul a long-entrenched political culture were bound to face backlash. In their impatience and enthusiasm to get things done, some of Prime Minister Shah’s ministers have over-reached.
It was common knowledge that government-paid advertising in the mainstream press was kickback-driven, but the PMO’s directive that official notices be published or broadcast only on state-run media has been denounced — especially as the media industry struggles to stay afloat.
More serious are some recent appointments by ministers of relatives and figures closely associated with the RSP to key positions. This has rankled because this party built its political plank on ending nepotism and graft.&nbsp;
News that Home Minister Sudan Gurung allegedly had not paid rent on leased land, which illegally encroached on the lake in Pokhara did not help. &nbsp;
Prime Minister Shah himself has come under scrutiny for appointing a kitchen cabinet full of male buddies from his time as Kathmandu mayor. To douse criticism he brought in as adviser investigative journalist Deepa Dahal, who has exposed corruption in high places of the previous coalitions.&nbsp;
Shah’s appointment of another political adviser Asim Shah to the head Constitution Amendment Task Force, is also seen as problematic. He is a filmmaker and former lawmaker, but does not have a background in constitutional law.&nbsp;
Even more controversial is the Cabinet’s decision to appoint RSP Chair Rabi Lamichhane’s legal counsel, Narayan Kandel, as Attorney General. Kandel used to be a UK permanent resident, and does not have as much experience practicing law in Nepal.&nbsp;
Kandel’s appointment drew flak and raised eyebrows, and with the pending legal cases against Lamichhane this appointment represents a flagrant conflict of interest.
Health Minister Nisha Mehta was also accused of favouritism after reappointing Junu Shrestha, wife of Labour Minister Dipak Kumar Shah, as member of the Health Insurance Board which had earlier suspended her. The Labour Minister’s rambling rant at the Board’s meeting on Tuesday has not helped the RSP’s image.&nbsp;
(UPDATE: On Thursday, Prime Minister Shah sacked the Labour Minister after the RSP found him in breach of the party's code of conduct and discipline. He served 14 days in the Cabinet, one of the shortest tenures for a minister in Nepal )
It is hard to know what <a href="https://nepalitimes.com/news/ball-in-balen-s-court">Balendra Shah is thinking</a>, and how Rabi Lamichhane is going to justify some of these moves. After all, making politics, governance, and bureaucracy a meritocracy has been the core tenet of the RSP, and it risks alienating its mainly youth base if these missteps persist.
But at least for now, most RSP supporters seem to be giving the party the benefit of doubt.

covid-19-therapy

Staying safe in 2021 and beyond

A Covid-19 exit strategy for Nepal

Galaxy A series

Know your Ministers

How to win friends and influence nations

Nepal’s new government springs into action