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.”

Sonia Awale

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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

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101140/63720d5e9c7e80680e0b78bdjpeg.jpg" alt="" width="1226" height="773"/><figcaption>Photo: NEPALI TIMES ARCHIVE</figcaption></figure>Travellers to Nepal now do not need to present previously mandatory PCR-RT test results to be granted entry into the country. The latest regulations released by the Department of Immigration and confirmed by international airlines say arriving passengers only need proof of vaccination.The provision of hotel quarantine has also been scrapped. Only those unable to present vaccination proof will need a PCR negative result, but the regulations say visitors must abide by health protocols including wearing masks in public and maintaining physical distance irrespective of vaccination status.Passengers will still need to fill out their <a href="https://www.nepalitimes.com/latest/ccmcs-serious-infringement-of-citizen-privacy/" target="_blank" rel="noopener noreferrer">CCMC forms</a> and get a digital QR code and show it at the health desk on arrival at Kathmandu airport.Outgoing passengers, however, need to abide by the regulations in the destination country as well as the rules set by airlines, which vary widely.The decision comes a week after Kathmandu Valley removed all Covid-19 restrictions due to a sharp decline in the number of daily new cases, and the positivity rate. <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/" target="_blank" rel="noopener noreferrer">The Omicron variant</a> which is thought to be the dominant strain circulating in the region is also largely mild, keeping hospitalisation figures low in Nepal.On Friday, there were 77 new Covid-19 cases against 7,981 PCR and RDT tests. There was only one fatality nationwide. The figure for active cases across the country is also down to 5,212 whereas a total of 189 individuals recovered in the last 24 hours. Nepal recorded 10,052 new cases on 20 January, it’s highest, during <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the third wave</a>.The easing of the restriction has come as a respite for tourism entrepreneurs and operators who have suffered heavily in the past two years due to the pandemic. Nepal's spring trekking and mountaineering season has already started and there were 16,000 tourists entering the country in February, about one-tenth of pre-pandemic figures for that mounth, but still higher than in February 2021.At least 1 million Nepalis depend on <a href="https://www.nepalitimes.com/editorial/survive-revive-thrive/" target="_blank" rel="noopener noreferrer">the tourism sector</a> which makes up nearly 8% of the GDP. Before the outbreak of the coronavirus crisis, the government had declared 2020 Visit Nepal Year with a target of bringing in 2 million tourists.However, the figures dropped to 230,085 in 2020 and further down to 150,962 in 2021 due to travel restrictions, lockdowns and <a href="https://www.nepalitimes.com/banner/call-to-ease-entry-of-tourists-to-nepal/" target="_blank" rel="noopener noreferrer">complicated entry provisions</a> when the country was periodically open for travellers.Heavy losses incurred during the pandemic forced many star hotels and restaurants to shut down. But perhaps the hardest hit are trekking porters and guides who depend on seasonal income during spring and autumn.Initial projections estimated that it will take <a href="https://www.nepalitimes.com/latest/nepal-tourism-may-take-5-years-to-recover/" target="_blank" rel="noopener noreferrer">five years for the industry to pick up</a> and tourists to return to pre-pandemic levels, but tour operators are optimistic with more businesses opening up and expanding with services geared towards adventure and nature tourism, which is expected to take off in the post-Covid world.Health experts have also predicted the pandemic to end in 2022 with equitable distribution of vaccines and access to treatment, further normalising the situation. But perhaps the biggest reassurance for the industry is the <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">increasing rate of vaccination</a> in and outside the country.A total of 62.5% of Nepal’s population has been fully inoculated while 74.5% have taken at least one dose. The figure for a booster dose is however low at 5.2%. Even so, Nepal is still on the travel red list of many European countries, the US, and Australia.

No more PCR for Nepal passengers

Nepal’s only international aviation gateway, at Kathmandu airport, will cut night-time operation hours to allow construction of taxiways, and airlines have been told to curtail flights. This is expected to lead to more than normal chaos during the height of peak autumn and spring tourist seasons at an airport that is congested even at the best of times. The airport will close from 10PM to 8AM from 8 November-31 March 2025. The taxiways will now connect to the thresholds at both ends of the runway, making the airport more efficient in handling higher frequencies of landings and takeoffs. The parallel taxiway extension will allow international flights to land every 4 minutes instead of the current every 7 minutes. At present planes have to wait to land until a plane taking off backtracks along the runway.&nbsp; Kathmandu is Nepal’s only airport with international operations, and it has only one runway that is only one way in from the south over the mountains. With the taxiway improvement, the airport will be able to handle 42 aircraft landings and takeoffs per hour — double the current capacity.&nbsp; The Civil Aviation Authority of Nepal (CAAN) has been trying to entice international airlines to also start flying to and from the other two international airports at Pokhara and Bhairawa (Lumbini) by slashing landing and handling charges. But so far only Nepal Airlines operates a weekly flight to Bhairawa from Kuala Lumpur.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32.jpg" data-media-id="editor_0" data-image-id="20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32" data-rendition-name="original" width="2356" height="1134" loading="lazy" alt="Kathmandu airport expansion"> <figcaption>Kathmandu Airport Expansion plan with extension of taxiways to the thresholds of runways 02 and 20 that will limit airport operations from 8 November 2024 - 31 March 2025. Areas in blue are existing structures, including the international terminal which in future will be the domestic airport, and the new international terminal near the north end of the runway,</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a.jpg" data-media-id="editor_1" data-image-id="20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a" data-rendition-name="original" width="1353" height="1328" loading="lazy" alt="Kathmandu airport NT"> </figure>  CAAN has reportedly told international airlines to cut their flight frequency to Kathmandu citing the shorter operation hours and has told budget airlines to shift some of their flights to Pokhara or Bhairawa, or face cuts. Many airlines currently operate regular flights to and from Kathmandu between 10PM and 8AM: Air Arabia to Sharjah, Fly Dubai to Dubai, Jazeera Airways to Kuwait, Cathay Pacific to Hong Kong, Singapore Airlines, several Nepal Airlines flights, and one of four daily flights by Qatar Airways to Doha. Jazeera Airways, FlyDubai, and Thai AirAsia have applied and got permission from CAAN to begin regular flights to Bhairawa’s Gautam Buddha International Airport. Starting 9 November, FlyDubai will start making a stopover in Bhairawa before flying on to Kathmandu. Immigration, customs and security are all fully functional in Bhairawa. In Kathmandu, the next phase of the airport upgrade includes converting the current international terminal for domestic operations, the construction of a new international terminal where the domestic departure area is now, as well as moving the hangars and the Nepal Army Air Wing to the eastern side of the runway. The apron area will also double its parking space for widebody jets. This is part of a Airport Capacity Enhancement Project that was initially funded through a $80 million loan from the Asian Development Bank (ADB), and the entire masterplan is expected to cost $800 million. This project is the latest upgrade to Nepal’s only international airport since it saw its first flight in 1949. The current international and domestic terminals are too small to handle the current annual traffic volume of 8.5 million passengers a year that is growing at 20% a year.

Kathmandu airport to cut flight hours

As Kathmandu becomes more congested and polluted, and with remote online work becoming the norm, many professional Nepalis are planning to retire in Pokhara, or move there.&nbsp; With its stunning mountain panorama, balmy winters and proximity to a profusion of wilderness areas, builders are responding to this demand with new townhouses, housing development and apartments. One such block of flats is the 10-storey <a href="https://sungavaapartment.com/">Sungava Apartment</a> located at Phulbari above the Seti River, near the point where it flows into and under Pokhara. The imposing structure near Manipal Hospital is almost complete, and on a recent visit the site was strewn with huge boulders unearthed while digging the foundation.&nbsp; The Seti brought down these boulders during a gigantic flood that geologists estimate happened 800 years ago when a chunk of Annapurna IV broke off and ploughed into the glacier below. Today, Sungava (means ‘orchid’) sits safely on a high terrace, 100m above the blue-green Seti and commands a view of Dhaulagiri, Annapurna South, Machapuchre, Annapurna III and IV.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9.jpg" data-media-id="editor_1" data-image-id="2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9" data-rendition-name="original" width="2016" height="1512" loading="lazy" alt="High living below the Himalaya NT"> </figure>  The soil here is conglomerate that has solidified like concrete, and the boulders were extracted by heavy earthmovers. It is intriguing to think that these metamorphic rocks as big as cars, rounded by glacial grinding, were once a part of a much higher Annapurna IV. Even for those with little interest in geology, Sungava is an ideal place to contemplate the tectonic forces that pushed these peaks into the sky to be sculpted into delicate shapes by wind, snow, earthquake and avalanche over millions of years. The view of the Himalayan panorama from Sungava’s many balconies are breathtaking when not obscured by clouds, or the haze that drifts in from across the southern border. On most days, just watching the towering pyramid of Machapuchre (Tamu name: कतासुँ क्लिको) play hide and seek with the clouds is mesmerising. There are rocks aplenty at Phulbari, and it is probably the flowers that grew along the flat terraces e that gave the place its flowery name. The boulders will hopefully be turned into a rock garden while landscaping. An nearby restaurant complex is making the best use of the stones in its design, using flat rocks as outdoor benches and tables. Sungava was designed by the husband-wife architect team of Deepak Sherchan and Jyoti Joshi of <a href="https://thedarkmermaidamarbshrestha.blogspot.com/2013/12/creative-builders-collaborative-cbc.html">Creative Builders Collaborative (CBC)</a>, which also built Heritage Plaza, Indreni Apartment and numerous other projects in Nepal. Sadbhavana retains CBC’s trademark Newari-style masonry and here it borrows from the orange brickwork of the old town of Pokhara, integrating it with modern design elements. A few of those heritage houses are still standing in Ganesh Tole and Ram Krishna Tole in Pokhara’s old quarter.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab.jpg" data-media-id="editor_3" data-image-id="2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab" data-rendition-name="original" width="1362" height="595" loading="lazy" alt="High living below the Himalaya NT"> </figure>  About 400m from the apartment past a bend on the river, and down below three tiers of terraces in the canyon is a suspension bridge. Below it, the Seti is still swollen with post-monsoon flow as it tumbles away in a hurry to head down south.&nbsp; Back at the apartment, it is quiet, far away from the hubbub of Lakeside a 15 minute drive away, and in the lap of greenery. There are 52 units at Sungava and it already has a close-knit prospective community of professionals, including doctors, publishers, engineers, and businesspeople from the renewable energy and IT sectors.&nbsp; Some residents say they opted for a second home in Pokhara to make it a ‘base camp’ to explore the Annapurnas with its many hiking trails made newly accessible with new roads. With the NRN citizenship law, overseas Nepalis can now also buy the flats. &nbsp; The floor plans include options for north and south-facing 3-bedroom apartments with verandas, and the facility has underground parking has EV charging, heated pool, sauna and gym. There are still some unsold apartments with panoramic views of the mountains and one can imagine oneself at the kitchen with its huge window, humming a ditty while preparing breakfast: “खाना पकाउँ हिमाल हेरेर...”

High living below the Himalaya

When the United Nations held its Summit of the Future at its headquarters in New York in September, many world leaders, including Nepal’s Prime Minister K P Oli, highlighted the effect of climate breakdown in increasing the frequency and intensity of natural disasters. What did not get as much attention was the long term impact of the climate crisis on food production. In fact, heat stress, weather extremes and the consequences on rain-fed agriculture is already being felt worldwide, undermining the chances of the <a href="https://unstats.un.org/sdgs/">UN’s Sustainable Development Goals (SDGs)</a> being met by 2030.&nbsp; The SDG’s 17 targets commit countries like Nepal to reduce poverty and inequality, end malnutrition, protect the natural environment, and ensure that citizens all enjoy health, justice and prosperity without leaving anyone behind.&nbsp; However, besides the impact of climate breakdown on agricultural production, in Nepal the area under cultivation is impacted by urban expansion, falling productivity and the need for expensive inputs like fertiliser and pesticides.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62.jpg" data-media-id="editor_1" data-image-id="20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Kathmandu's urban sprawl is eating into its fertile cultivable lands. Photo: TAYLOR MASON</figcaption> </figure>  Now, a new study led by Nepali researcher Prajal Pradhan at the University of Groningen in The Netherlands looks at how urban agriculture may offer a solution to falling food production and meeting SDG targets. The researchers evaluated 1,450 publications exploring the contributions of urban agriculture with both positive and negative effects, and published their findings in the journal Cells Report Sustainability. Urban agriculture can help achieve 17 SDGs, positively influencing 81 targets. However, it could also undermine 51 goals.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-vanishing-land">The vanishing land</a>, Taylor Mason “Urban agriculture offers immense potential for sustainable development, but realising this potential depends crucially on adopting practices that minimise its adverse effects while maximising its benefits,” Pradhan explains. Urban agriculture can substantially enhance urban food security, provide employment to the urban poor, serve as ground water recharge in built-up areas, and preserve open spaces that can serve as safe havens during disasters like earthquakes. However, it also presents problems like the potential health risks from contamination and the need for expensive inputs. &nbsp; “Urban agriculture plays a definitive role in advancing the SDGs, but achieving this requires tailored, context-specific solutions that address the unique challenges of different regions,” says Yuanchao Hu of Wuhan University in China and who is a researcher at the Potsdam Institute for Climate Impact Research. “But it needs equitable access and rigorous management of environmental risks.”&nbsp; Rapid urbanisation is eating into Nepal’s most fertile agricultural land, which means farming in remaining open spaces inside cities can be a viable alternative, especially as food prices rise.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8.jpg" data-media-id="editor_3" data-image-id="20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>A vegetable patch in between new houses in Thimi. Photo: TAYLOR MASON</figcaption> </figure>  “The conversion of Nepal’s most fertile land into cities is a severe problem,” Pradhan told Nepali Times. “Crop cultivation, horticulture, agroforestry, beekeeping, livestock rearing, or aquaculture can all be farming activities within and around cities.”&nbsp; The study makes recommendations for sustainable practices that build on the positive aspects of urban agriculture while mitigating the downsides, thereby promoting more resilient cities in future. Research shows that urban agriculture has been helping many countries attain SDG targets by enhancing food security and biodiversity while helping education and preservation of open spaces.&nbsp; Indeed, many farmers from the hinterland who have settled in Kathmandu Valley or other urban areas of the country have been practicing urban agriculture, leasing neighbourhood patches or cultivating roof gardens both out of necessity because of inflation and falling income to grow their own food, and also as a fulfilling hobby. Saurav Dhakal, a sustainability advocate with Story Cycle and now research fellow at the Asian Institute of Technology in Thailand, says there are socio-economic and environmental benefits of urban agriculture. “It provides benefits to all urban dwellers, regardless of their income status,” says Dhakal, “families get fresh food, and there are many other benefits like water retention, heat regulation and biodiversity. These are all public goods, so special government incentives may be needed.” It is not unusual to see vegetable patches and even paddy fields within inner city Kathmandu where an older generation of farmers are using available fertile land and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415">roof gardens to produce fresh, nutritious food </a>to reduce their dependence on food items that have to be bought after being trucked in from large distances.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77.jpg" data-media-id="editor_5" data-image-id="2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>An older generation of farmers are using any available fertile land to continue farming but it is getting more and more difficult. Photo: TAYLOR MASON </figcaption> </figure>  Nepal’s urban population grew rapidly from only 3.6% in 1991 to 25% today. There is large outmigration from the mountains to peri-urban areas of the Tarai, to Kathmandu Valley and Pokhara, with many young men then moving abroad for work. Kathmandu Valley’s population has swelled to nearly 3 million, and is growing at 6.5% a year. Dilip Shrestha, 71, used to work for Nepal Food Corporation, so he knew firsthand about inflation, shortages and vegetables with pesticide residue. So, when he designed his new house in Kathmandu, he built a spacious roof where he grows cucumber, ginger, garlic, coriander, onions, tomatoes, chili, beans, okra, pumpkin and lettuce. His family eats healthier, and he has reduced dependence on the market.&nbsp; The co-author of the Cell Reports Sustainability journal article, Daya Raj Subedi who is a PhD candidate at Beijing Forestry University, says urban agriculture also promotes inclusion and psycho-social wellbeing.&nbsp; He says, “A crucial finding of the study is the identification of opportunities and challenges associated with urban agriculture, it can promote sustainable transformation of society.” In Banepa, 55-year-old Bijaya Manandhar in her lifetime has watched the fertile farms of her neighbourhood that used to supply vegetables to Kathmandu, now completely built up with no open space left. The pandemic lockdown prompted her to turn to the family’s <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world">ancestral livelihood by growing food</a> not on terrace farms, but on the roof terrace. Manandhar is now a part of <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world%5C%5C">कौसी खेती र करेसाबारी क्रान्ती</a> (Rooftop Farming and Garden Revolution) which has an online membership of 52,000, and awards annual prizes to women who excel in urban agriculture.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d.jpg" data-media-id="editor_8" data-image-id="20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d" data-rendition-name="original" width="1600" height="736" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Rooftop farming is gaining popularity as a form of urban agriculture. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed.jpg" data-media-id="editor_9" data-image-id="20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed" data-rendition-name="original" width="4000" height="3000" loading="lazy" alt="urban agriculture in Kathmandu"> </figure>  Pradhan says the challenge now is to upscale such examples of successful urban agricultural practices so they support Neal’s efforts to meet SDG targets. He adds, “Crop cultivation around cities can be protected by land use plans and regulations. Promoting community-based agriculture, including rooftop gardens, requires community engagement and public-private partnerships across the food value chain.”&nbsp; Such support would accelerate the popularity of existing rooftop farming and community gardens in Kathmandu Valley, or kitchen garden initiatives in Pokhara, and building on traditional farming practices that are preserved and integrated into urban settings like in Bhaktapur and Banepa. In Lalitpur, the Women Entrepreneurship Facilitation Center promotes urban farming enhancing both sustainability and empowerment.&nbsp; Another co-author of the report, Yuanchao Hu from China says followup research of the team will aim to identify good practices in local urban agriculture practices. He adds, “There are examples of urban agriculture that optimise sustainability, ensuring that it remains a viable solution for cities globally while countries try to meet SDG targets.” Prajal Pradhan, Daya Raj Subedi, Kshitij Dahal, Yuanchao Hu, Prakriti Gurung, Sijal Pokharel, Sagar Kafle, Biplav Khatri, Sudeeksha Basyal, Monika Gurung, and Aruna Joshi. Urban Agriculture matters for sustainable development. Cell Reports Sustainability, 1:100217, 2024. [DOI: 10.1016/j.crsus.2024.100217] Prajal Pradhan (<a href="mailto:p.pradhan@rug.nl">p.pradhan@rug.nl</a>) This article is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_14" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>

Back to the land in the cities

The 700-year-old Lakshmi Narasingha temple in Bhaktapur houses a rare half-lion and half-human incarnation of Lord Vishnu carrying the Goddess Lakshmi. The temple was destroyed in the 1934 mega earthquake that killed 10,000 people and destroyed many monuments in Kathmandu Valley. It was rebuilt by a German project in the 1980s, but as a single-storey structure instead of its original two-tier pagoda design.&nbsp; With new findings from in-depth research, Bhaktapur municipality began re-restoring the temple in 2021, preserving its original architecture.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18.jpg" data-media-id="editor_0" data-image-id="20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “Our temples and heritage sites hold deep meaning. It is disheartening to witness how often they lose their original elements, whether by design or accident,” explains Kumar Chawal of the Consumer Committee of Bhaktapur. “There is a need to preserve our architecture and protect its historical value for future generations. Otherwise, we risk losing a vital part of our identity.” The Laksmi Narsingha restoration is similar to the Bhai Dega temple in Patan Darbar Square which also collapsed in 1934, but was rebuilt with a Moghul-style dome by the Rana government at the time. Only two months before the 2015 earthquake, heritage conservationists had started to rebuild Bhai Dega as the original three-tier based on early photographs. But priorities shifted when four other temples in the square were brought down by the 7.8M earthquake on 25 April 2015.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130.jpg" data-media-id="editor_1" data-image-id="20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  This showed how damage to monuments in Kathmandu Valley spanned from one earthquake to the next. Bhai Dega restoration remains half-complete to this day because money for its restoration ran out.&nbsp; Whereas Bhai Dega restoration was done by the Kathmandu Valley Preservation Trust with grants from western embassies and international foundations, in Bhaktapur it is the municipality itself that allocated the Rs30.7 million needed to restore the Lakshmi Narasingha temple. The expected date of completion is early 2025. The municipality and local communities are focusing on two main aspects: preserving the past and promoting localisation. The restoration team has designed a blueprint for the temple by using historical photographs and insights from older generations.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30.jpg" data-media-id="editor_2" data-image-id="20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30" data-rendition-name="original" width="1200" height="560" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “At first, the Lakshmi Narasingha temple had only one entrance, but during the demolition process, we uncovered the foundations of four doors. Now, we are restoring all of them. This is an example of how our ancient structures have changed over time, often without our knowledge,” says Chawal. “Constructing temples is not like building houses. They carry historical and spiritual values, which is why they hold a special place in our hearts,” he adds. By replicating ancient design elements and rebuilding the temple as accurately as possible to its original form, the team has stayed true to Bhaktapur’s soul. But the restoration also revived ancient techniques that were in danger of being forgotten, generating employment for woodcarvers, masons, and contractors. The community of Bhaktapur’s Gahiti neighbourhood near the famous Nyatapola Temple has also set aside specific days for locals to volunteer in the reconstruction work. This has encouraged young people to take pride in ownership of their heritage. Families have also supported the effort by donating funds for bells, the temple pinnacle, and other structural features to the temple.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6.jpg" data-media-id="editor_3" data-image-id="20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “I feel at peace knowing I have contributed my sweat to restoring this temple,” said one volunteer. “It is our duty to preserve our temples and heritage. The Nyatapola area will look magical once this temple is completed.” Community mobilisation is a long-standing tradition in Bhaktapur. In the past, locals have actively participated in the restoration of other temples in the city, such as Bhairav and Nyatapola fostering a strong sense of ownership. This collective engagement has not only been crucial in preserving the city's historical monuments but also in strengthening the bond between local communities and their heritage, says officials at the municipality. While securing funding is essential, and the municipality showed it values heritage conservation, the Lakshmi Narasingha restoration is proof that active involvement and sense of responsibility of the local community is as important, if not more. Local involvement also means that the monuments will be cared for into the future, When locals take ownership of these efforts, the restored monuments are not only protected in the present but are also cared for in the future.