<figure><img width="971" height="487" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204179c7e80680e0b2842jpeg.jpg" alt=""/><figcaption>Daily reported Covid-19 cases and deaths since January 2020, when the first case was detected in Nepal.</figcaption></figure>It was on 23 January 2020 that the first Covid-19 case was detected in Nepal. Two years later, the country is on the cusp of a <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">third wave</a>.The time to sound an alarm about a new surge is long over. Action should have been taken months ago. All the government can do now is to launch a massive campaign to inoculate the unvaccinated, offer boosters to frontline workers, the elderly, and people in densely populated areas.Evidence elsewhere, including in neighbouring India, show that while the <a href="https://www.nepalitimes.com/opinion/omicron-is-coming-to-nepal-be-prepared/" target="_blank" rel="noopener noreferrer">Omicron strain</a> is 12 times more transmissible than previous variants, most of those infected do not need critical care in hospitals – unless unvaccinated or immuno-compromised.    Cases are rising fast in Nepal, doubling every 2 days to 3,075 new recorded infections on Wednesday. The positivity rate has soared 10 times in a week to 23.5%. At this rate, there will be 12,000 new confirmed cases by 16 January, which will be higher than the peak of the second wave in May 2021.“With Omicron now spreading in the community, we don’t need to gene sequence anymore,” says Epidemiology and Disease Control Division director Krishna Prasad Paudel.He is hoping Omicron will show a similar trajectory to elsewhere, and those infected will have <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">milder symptoms </a>compared to Delta. The new variant mostly impacts the upper respiratory tract, with lungs largely unaffected, hence lessening the need for oxygen and ventilators.However, Nepal’s low vaccination rate (50% partially, 40% fully) means that individuals need to continue taking precautions with masks and distancing.Read also: <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/">“Nepal has all the conditions for an Omicron surge”</a>, Nepali Times <figure><img width="2048" height="1366" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204199c7e80680e0b2843jpeg.jpg" alt=""><figcaption> </figcaption></figure>A double dose of the vaccine is not as effective against Omicron, and most Nepalis have passed six months since they were inoculated, meaning that their antibody levels have fallen considerably by now. <a href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron/" target="_blank" rel="noopener noreferrer">Boosters would provide more protection</a>, but the government is only offering those to high risk groups from next week.Although Omicron is now the dominant strain, Delta is still circulating, and causing deaths. We know from the past two years that it takes a few weeks for mortality to pick up after <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">cases start rising</a>. This has been seen in India, and Nepal closely follows health trends there.“We need to keep a close watch on our mortality figures, find out which variant is causing most deaths, and we will have to prepare hospitals and healthcare workers once again,” warns epidemiologist Lhamo Yangchen Sherpa of IPAS.Across Nepal, many <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">rural hospitals are still understaffed</a> and do not have trained personnel to operate ventilators and run ICU wards. Not all new oxygen plants are functional yet.But Sangeeta Kaushal Mishra of the Health Coordination Division assures that the government is in a better position this time: “We are prepared for hospitalisations if cases are milder, but we don’t know how the virus will behave."The sheer transmissibility of Omicron could mean severe symptoms and even deaths among the elderly and those with pre-existing conditions like diabetes.  Elsewhere in the world, even vaccinated health workers have been infected, overwhelming hospitals.Read also: <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/">“All vaccines prevent severe Covid”</a>, Nepali Times <img width="1594" height="986" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/6372041d9c7e80680e0b2844jpeg.jpg" alt="">The first line of defence against Covid is still masks and distancing. The second is <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer">mass vaccination</a>. Nepal still has a stockpile of over 10 million doses in refrigerated stores, and 6 million more doses in the pipeline. A syringe shortage reduced the vaccination rate, but Mishra expects the drive to pick up next week. More than 200,000 people were vaccinated on Wednesday.“We were lucky Omicron is mild, but we should use this  opportunity to inoculate both the unvaccinated and boost the  vulnerable on war footing,” says physician Buddha Basnyat of Patan Academy of Health Sciences.The government is starting mass inoculation of children from 12-17 years, and has shut down schools for three weeks until 29 January due to the new surge. Gatherings of more than 25 people have been banned, masks are mandatory outdoors, and people will need vaccine cards to enter public spaces from next week.“The fact that Omicron is much milder has made people even more careless, so we must once again reinforce the importance of masks, ventilation and distancing,” warns virologist Sher Bahadur Pun at Teku Hospital.Equally important is the institutional isolation of active cases and contact tracing. Experts believe official <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer">figures are under-reported</a> and total cases and fatality figures are much higher. The Economist tracks ‘excess deaths’ across countries and estimates that 2.3 million people had died from Covid-19 by May 2021 in India, compared to only 200,000 official fatalities.Its calculations show that when Nepal recorded its highest daily Covid deaths of 246 on 19 May 2021, the actual number was 425. The real infection rate was also much higher than official data.Read also: <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/">Living with Covid in 2022</a>, Sonia Awale

Sonia Awale

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3rd wave in 2 years

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/6372030d9c7e80680e0b27e9jpeg.jpg" alt="" width="1378" height="919"/><figcaption>Photos: AMIT MACHAMASI</figcaption></figure>Be it by naïveté, misplaced optimism, or a great faith in the healing powers of Himalayan air and turmeric, no one in Nepal had expected that we would be in the global epicentre of the Covid-19 surge fuelled by the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant in the spring of 2021</a>.Our miscalculation and gross lack of preparation cost thousands of lives and left so many Nepalis bereaved during this Dasain and Tihar. Shortly after <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">the Indian wave began in March</a>, Nepal recorded the highest number of Covid cases per capita, and the worst viral transmission rates on the planet. While the world focused on India, Nepal's health system was overwhelmed in a matter of days.Remember how we <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">desperately searched for oxygen cylinders</a>, when every ICU bed was occupied and ventilators were in short supply? Remember rural communities where the situation was even worse, and so many Nepalis died without any medical attention? And there was the black market that forced many to pay exorbitant rates for life-saving oxygen, masks, and even paracetamol.We cannot afford to forget these terrible and deadly months. If we do, and do not prepare for the next wave, we will be bound to repeat them. With <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">the Omicron variant </a>now spreading like wildfire across the globe, let us remind ourselves that Nepal experiences a surge in Covid cases a few months after the rest of the world. The Delta variant (which has been proven to be less transmissible than Omicron) took more lives in just a few months than the 2015 earthquakes.The current low case numbers in Nepal are not going to last. Repeating our mistakes of under-preparedness and apathy has the potential to kill thousands of more Nepalis in the coming months.While preliminary data shows that the Omicron variant is <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">less likely to hospitalise infected individuals</a> than Delta did, we need to take into account that this new variant spreads at a much faster rate. The relief we may feel from a smaller percentage of Covid patients needing life-saving care is cancelled out by there being an exponentially higher number of total infections.Our medical facilities will still be overwhelmed, leading to unnecessary loss of life on a large scale. In short, Omicron is <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer">not to be underestimated</a>, especially for densely populated communities in Nepal.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203109c7e80680e0b27eajpeg.jpg" alt="" width="1221" height="814">We still have some time to prepare. Policy makers and individuals alike have important roles to play in the critical next weeks and months. We cannot squander this opportunity to save lives. National and local governments need time to act now on these critical areas:<ol><li><a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">Vaccinate Aggressively</a>: There are varying statistics on the percentage of Nepalis vaccinated, but no more than 40% of the population have been fully vaccinated. Booster shots are now necessary to adequately protect a population, so we still have a very long way to go.</li></ol>The good news is that even if we cannot fully vaccinate and provide boosters for the entire population, clinical experience shows that <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">vaccinated individuals</a> have less need for Covid-19 hospitalisations and are much less likely to die from the Omicron variant. Decision makers can make our limited vaccine supply go further by prioritising vaccines for densely populated cities and in areas where Delta infection was low, as people in these areas are less likely to have natural immunity.<ol start="2"><li>Border Control: The devastating wave of the Delta variant in Nepal began a few weeks after it had taken hold in India. This was largely attributed to a spillage of the virus through the open southern border. We can support municipalities along the border to help contain the Omicron by strict health desks to screen individuals crossing the border. This will require increased funding and other resources.</li></ol><ol start="3"><li>Isolation and Quarantine Centres: Delta spread from India and urban areas into the countryside because we could not properly accommodate and care for infected patients in quarantine and isolation centres. There is time to re-establish these facilities before the next wave hits, and train frontline health workers and local governments based on guidelines that already exist. Again, as the variants (and our knowledge about them) evolve, we need to remain agile and empower our managers and healthcare workers to address the changing ground situation.</li></ol><ol start="4"><li>Oxygen Supply: During and after the Delta wave last year, the Ministry of Health and Population made commendable efforts to expand oxygen plant availability in the country, with support from international aid groups. These new plants need to be brought online and tested in the coming months, and MoHP must accelerate its efforts to meet its own requirement of having an oxygen plant at every 100 bed-hospital in the country.</li></ol><ol start="5"><li>Using Female Community Health Volunteers: FCHVs have been a key for many of Nepal’s remarkable gains in public health, including reducing maternal mortality rates. This network of local health workers was not fully deployed during the last Covid wave. We can use FCHVs to disseminate public health information, vaccine knowledge, and to play a frontline role in enforcing community guidelines to reduce local transmission of the virus, and to care for the infected. These volunteers and other community-based health workers need to be adequately compensated, and equipped with materials, protective equipment, and training.</li></ol>Properly mobilising and empowering FCHVs is the fastest and most efficient way to support rural communities that lack other options for advanced care. This will have a ripple effect across the national health system, and may be a key factor in avoiding another total collapse. All of these steps depend on implementation by the government and private healthcare system. We commend recent steps taken by the health department to test Nepalis returning from India, and to establish quarantine centres along the border.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203139c7e80680e0b27ebjpeg.jpg" alt="" width="856" height="571">As individuals, we must <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">continue to take responsibility</a> for protecting our loved ones by following public health guidelines for another few months at least. History shows we will not know for certain that Omicron has arrived in Nepal until after the variant is endemic in the population. These proactive measures can slow the spread, starting now:<ol><li>Mask up in all public places and when in close contact with members of at-risk populations. Doubling up on masks is a good idea, given the extremely contagious nature of Omicron.</li></ol><ol start="2"><li>Avoid touching the face with fingers, and frequently wash hands - at least 20 seconds with soap and water.</li></ol><ol start="3"><li>Avoid all public gatherings. If not, maintain social distance of at least 1m.</li></ol><ol start="4"><li>Support the local government by following protocols and encouraging elected officials to take proactive measures to protect the community. Volunteer to spread awareness or set up facilities if you can, and be ready to support your community when the next wave arrives. We Nepali are great at using ‘source-force’ to get things done - now is a great time to use your connections and networks to encourage people in positions of influence to take proactive steps to prepare for Omicron.</li></ol>In the age of Covid, it’ is every country and every community for itself. Delta taught us in Nepal not to trust promises of international aid to save us from the pandemic. We are on our own, and we only have each other to get through this.The Delta wave, like <a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/" target="_blank" rel="noopener noreferrer">the 2015 earthquakes</a>, also taught us that when the going gets tough, Nepalis come together and achieve miracles. Remember the community groups that blossomed across the country to create isolation centres, distribute food and supplies, and invented improvised oxygen concentrators.Remember the FCHVs and community members who risked their lives to travel into every corner of the country to deliver vaccines to the most vulnerable citizens.  This time, we have an opportunity to harness this grit and compassion when it is needed most - before the disaster strikes.Ramu Kharel is an emergency medicine physician at Brown University and has worked extensively in the frontlines of Covid-19. He runs a non-profit organisation HAPSA in Nepal that is working on Covid response.Ben Ayers is an American citizen based in Nepal for over 20 years.

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Omicron is coming to Nepal, be prepared

How Nepal must prepare for 3rd Covid wave

<img width="640" height="438" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131140/636cf1eb9c7e80680e09d8d5jpeg.jpg" alt=""/>Many public health specialists in Nepal have been heaving a sigh of relief that the infection graph for the second wave is <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">starting to flatten</a>, but with reports of black fungus, third wave and new variants there is no respite.Everything that India has suffered since March has repeated itself in Nepal on a smaller scale. The  black fungus outbreak could be a microcosm of the post-second wave world, of  ‘epidemics within a pandemic’ as opportunistic infections and new Covid-19 waves prey on collapsed health systems.    In theory, Nepal should not have a strong flare-up like India because we have fewer risk characteristics, says epidemiologist Lhamo Yangchen Sherpa. “Covid is communicable so it spreads regardless of demographic factors, but black fungus is rarely contagious and selective.” she says. “India’s population has a higher proportion of elderly, diabetics and immunocompromised people than us, and these are the groups most vulnerable to black fungus,” she says.Indeed, there were reports in India of black fungus even pre-Covid, with 140 cases per million, which was the highest in the world. It currently has 12,000 cases and 300 deaths from the fungus that mostly affects Covid patients on ventilators and survivors on long-term steroid treatment.But for all we know, the infection may already spreading in Nepal, <a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/">starting from the Tarai and moving up</a> just like the Covid second wave. The ‘black fungus’ mucormycosis is found abundantly in the soil, and thrives on steroid overuse, especially on Covid patients with diabetes and other ailments. Cleared out easily by a healthy body, mucormycosis latches on to patients whose immune systems are compromised. “Covid treatment is a double-edged sword, it suppresses the virus-induced hyperimmune response but also raises blood sugar levels and weakens infection-fighting ability, making conditions perfect for mucormycosis,” explains Sherpa.The Health Ministry  announced in its daily briefing on Thursday that there were  6,825 new confirmed Covid-19 cases-- up from Wednesday's tally of 5,316--with 5,904 recovering. This brings the total number of active cases to 576,936, with 101,839 in isolation . Of the 1,444 in hospital ICUs, 398 are on ventilator support. Those in ICUs and ventilators face a double whammy as hospitals treat them with steroids and desperately reuse uncleaned humidifiers and discarded oxygen cylinders. According to the Health Ministry, 10 to 12 patients with black fungus have been detected so far, but there may be more.Covid survivors who needed critical ICU treatment and are continuing with steroids are left more susceptible to black fungus infection anytime. Nepal’s first recorded fatality from black fungus was a 60-year-old patient in Lumbini Provincial Hospital recently recovered from Covid.“Black fungus infection has been spotted even in those recovered from Covid for the past six weeks or more,” say Khemraj Bhusal a consultant physician at Greencity Hospital. But as stable survivors are sent home they become potential<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/"> blind spots in black fungus tallies.</a>Hospitals in the frontlines can ill-afford to meet new shadow caseloads. Diagnosing mucormycosis infection early requires biopsies, sample examinations and even follow-up CT scans, requiring specialised personnel and advanced equipment that most district hospitals in Nepal do not have.  <figure><img width="640" height="441" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131140/636cf1ed9c7e80680e09d8d6jpeg.jpg" alt=""><figcaption>TU Teaching Hospital is one of the few facilities equipped to sample and test black fungus</figcaption></figure>While manageable if caught on time, the invasive nature of the disease is difficult to treat. In the most common rhinocerebral variety, the fungi eats through subcutaneous tissue and leaves behind characteristic black lesions on the septum and oral cavity. Infected tissues must be removed and eyes even sacrificed to save the brain from lethal infection. If left untreated, the infection has a mortality rate of 50%.   Treatment in such cases involves multiple organs, thus requiring teams of microbiologists, internal medicine specialists, intensivist neurologists, ophthalmologists, dentists and surgeons. But with civil service exams for doctors in limbo for years, rural hospitals lack the specialists necessary to deal with severe cases.Similar to the pandemic at large, life-saving shots against mucormycosis infection <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">are in short supply.</a>“Liposomal amphotericin B is an effective treatment, but fungal infections are normally so rare that antifungal production, and therefore supply, is low,” says Associate Professor of Microbiology at Tribhuvan University Megha Raj Banjara. Amphotericin treatment is extensive, with as many as 60 to 100 vials of injections needed across 4-6 weeks depending on infection severity. In the event of an outbreak, huge stockpiles are needed. Treatment is also costly, with one-day therapy costing upwards of Rs50,000.  <figure><img width="500" height="284" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131140/636cf1f09c7e80680e09d8d7jpeg.jpg" alt=""><figcaption>India has acted quick, importing 200,000 vials of AmBisome amphotericin B from American pharma company Gilead Sciences</figcaption></figure>Meanwhile, alternative medications like posaconazole and isavuconazole have toxic side effects, are also expensive and less effective. Imports of amphotericin are the only solution, but as with the pandemic, prospects do not look encouraging. India has already <a href="https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNHfCYV-2Ni2HvdjXZzhn1JDrfiduQ">imposed restrictions on amphotericin B export</a>, itself shipping in 200,000 vials from Gilead Sciences in the US, with reports of hoarding and price gouging. Despite warning signs, there has been no appeal for amphotericin shipments from the Nepal government. If that ws not enough to worry about, India is seeing signs of an early third wave, with <a href="https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNF8kNzDFxj6SwwwJkab1rJ7ZWoPLA">8,000 children infected</a> in a single district in Maharashtra state. With low vaccine penetration in the under-18 cohort, children in Nepal could be next, just like the first two waves.Meanwhile, 1,350,000 Nepalis above age 55 are set to miss timely booster doses as there is no possibility of securing Covishield shipments from India, according to Chief of Family Welfare Division of the Health Ministry Taranath Pokhrel. He said Nepal is trying to procure the Oxford AstraZeneca from other countries for this cohort, but so far there are no firm deals.The third wave is set to hit India around July, giving Nepal about a month and half to rush vaccine doses for its vulnerable age groups.  Till then, Nepalis will be left once more to fend for themselves. Aggressive self-medication and quack remedies such as cow dung baths are rampant, leaving Covid patients at increased risk of co-infections like black fungus.  “Patients are able to buy medicines without prescriptions from lax pharmacies.” says Sherpa. “Covid patients should avoid self-medication and only medicate under the strict supervision of health professionals or risk being exposed to secondary infections.”Simple changes can mitigate black fungus. Hospitals should routinely change humidifier water for ventilated patients and avoid sharing oxygen tubes and masks, says Binita Sharma, Chief Medical Director of Netra Jyoti Sangh. She says those with symptoms should immediately get checked up.To prevent future Covid-19 waves, experts say high-disruption strategies are needed at a time when <a href="https://www.nepalitimes.com/latest/as-covid-19-crests-nepal-eases-restrictions/">lockdowns are being relaxed.</a> Ultimately, it<a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/"> will be vaccines</a> and they are needed before the third wave.

Learning to live with Covid

<img width="640" height="438" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121136/636b910a9c7e80680e06f0c6jpeg.jpg" alt=""/>Many public health specialists in Nepal have been heaving a sigh of relief that the infection graph for the second wave is <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">starting to flatten</a>, but with reports of black fungus, third wave and new variants there is no respite.Everything that India has suffered since March has repeated itself in Nepal on a smaller scale. The  black fungus outbreak could be a microcosm of the post-second wave world, of  ‘epidemics within a pandemic’ as opportunistic infections and new Covid-19 waves prey on collapsed health systems.    In theory, Nepal should not have a strong flare-up like India because we have fewer risk characteristics, says epidemiologist Lhamo Yangchen Sherpa. “Covid is communicable so it spreads regardless of demographic factors, but black fungus is rarely contagious and selective.” she says. “India’s population has a higher proportion of elderly, diabetics and immunocompromised people than us, and these are the groups most vulnerable to black fungus,” she says.Indeed, there were reports in India of black fungus even pre-Covid, with 140 cases per million, which was the highest in the world. It currently has 12,000 cases and 300 deaths from the fungus that mostly affects Covid patients on ventilators and survivors on long-term steroid treatment.But for all we know, the infection may already spreading in Nepal, <a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/">starting from the Tarai and moving up</a> just like the Covid second wave. The ‘black fungus’ mucormycosis is found abundantly in the soil, and thrives on steroid overuse, especially on Covid patients with diabetes and other ailments. Cleared out easily by a healthy body, mucormycosis latches on to patients whose immune systems are compromised. “Covid treatment is a double-edged sword, it suppresses the virus-induced hyperimmune response but also raises blood sugar levels and weakens infection-fighting ability, making conditions perfect for mucormycosis,” explains Sherpa.The Health Ministry  announced in its daily briefing on Thursday that there were  6,825 new confirmed Covid-19 cases-- up from Wednesday's tally of 5,316--with 5,904 recovering. This brings the total number of active cases to 576,936, with 101,839 in isolation . Of the 1,444 in hospital ICUs, 398 are on ventilator support. Those in ICUs and ventilators face a double whammy as hospitals treat them with steroids and desperately reuse uncleaned humidifiers and discarded oxygen cylinders. According to the Health Ministry, 10 to 12 patients with black fungus have been detected so far, but there may be more.Covid survivors who needed critical ICU treatment and are continuing with steroids are left more susceptible to black fungus infection anytime. Nepal’s first recorded fatality from black fungus was a 60-year-old patient in Lumbini Provincial Hospital recently recovered from Covid.“Black fungus infection has been spotted even in those recovered from Covid for the past six weeks or more,” say Khemraj Bhusal a consultant physician at Greencity Hospital. But as stable survivors are sent home they become potential<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/"> blind spots in black fungus tallies.</a>Hospitals in the frontlines can ill-afford to meet new shadow caseloads. Diagnosing mucormycosis infection early requires biopsies, sample examinations and even follow-up CT scans, requiring specialised personnel and advanced equipment that most district hospitals in Nepal do not have.  <figure><img width="640" height="441" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121136/636b910d9c7e80680e06f0c7jpeg.jpg" alt=""><figcaption>TU Teaching Hospital is one of the few facilities equipped to sample and test black fungus</figcaption></figure>While manageable if caught on time, the invasive nature of the disease is difficult to treat. In the most common rhinocerebral variety, the fungi eats through subcutaneous tissue and leaves behind characteristic black lesions on the septum and oral cavity. Infected tissues must be removed and eyes even sacrificed to save the brain from lethal infection. If left untreated, the infection has a mortality rate of 50%.   Treatment in such cases involves multiple organs, thus requiring teams of microbiologists, internal medicine specialists, intensivist neurologists, ophthalmologists, dentists and surgeons. But with civil service exams for doctors in limbo for years, rural hospitals lack the specialists necessary to deal with severe cases.Similar to the pandemic at large, life-saving shots against mucormycosis infection <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">are in short supply.</a>“Liposomal amphotericin B is an effective treatment, but fungal infections are normally so rare that antifungal production, and therefore supply, is low,” says Associate Professor of Microbiology at Tribhuvan University Megha Raj Banjara. Amphotericin treatment is extensive, with as many as 60 to 100 vials of injections needed across 4-6 weeks depending on infection severity. In the event of an outbreak, huge stockpiles are needed. Treatment is also costly, with one-day therapy costing upwards of Rs50,000.  <figure><img width="500" height="284" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121136/636b910f9c7e80680e06f0c8jpeg.jpg" alt=""><figcaption>India has acted quick, importing 200,000 vials of AmBisome amphotericin B from American pharma company Gilead Sciences</figcaption></figure>Meanwhile, alternative medications like posaconazole and isavuconazole have toxic side effects, are also expensive and less effective. Imports of amphotericin are the only solution, but as with the pandemic, prospects do not look encouraging. India has already <a href="https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://timesofindia.indiatimes.com/india/govt-imposes-restrictions-on-export-of-amphotericin-b-injections/articleshow/83141538.cms&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNHfCYV-2Ni2HvdjXZzhn1JDrfiduQ">imposed restrictions on amphotericin B export</a>, itself shipping in 200,000 vials from Gilead Sciences in the US, with reports of hoarding and price gouging. Despite warning signs, there has been no appeal for amphotericin shipments from the Nepal government. If that ws not enough to worry about, India is seeing signs of an early third wave, with <a href="https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.ndtv.com/india-news/maharashtra-preps-for-3rd-wave-as-covid-hits-8-000-children-in-1-district-2452564&amp;source=gmail&amp;ust=1622790971413000&amp;usg=AFQjCNF8kNzDFxj6SwwwJkab1rJ7ZWoPLA">8,000 children infected</a> in a single district in Maharashtra state. With low vaccine penetration in the under-18 cohort, children in Nepal could be next, just like the first two waves.Meanwhile, 1,350,000 Nepalis above age 55 are set to miss timely booster doses as there is no possibility of securing Covishield shipments from India, according to Chief of Family Welfare Division of the Health Ministry Taranath Pokhrel. He said Nepal is trying to procure the Oxford AstraZeneca from other countries for this cohort, but so far there are no firm deals.The third wave is set to hit India around July, giving Nepal about a month and half to rush vaccine doses for its vulnerable age groups.  Till then, Nepalis will be left once more to fend for themselves. Aggressive self-medication and quack remedies such as cow dung baths are rampant, leaving Covid patients at increased risk of co-infections like black fungus.  “Patients are able to buy medicines without prescriptions from lax pharmacies.” says Sherpa. “Covid patients should avoid self-medication and only medicate under the strict supervision of health professionals or risk being exposed to secondary infections.”Simple changes can mitigate black fungus. Hospitals should routinely change humidifier water for ventilated patients and avoid sharing oxygen tubes and masks, says Binita Sharma, Chief Medical Director of Netra Jyoti Sangh. She says those with symptoms should immediately get checked up.To prevent future Covid-19 waves, experts say high-disruption strategies are needed at a time when <a href="https://www.nepalitimes.com/latest/as-covid-19-crests-nepal-eases-restrictions/">lockdowns are being relaxed.</a> Ultimately, it<a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/"> will be vaccines</a> and they are needed before the third wave.

Nepal’s September protests and regime change created two major unexpected costs that Prime Minister Sushila Karki’s interim government is scrambling to deal with: reconstruction of destroyed government buildings, and holding elections on 5 March.
The buck stops at the desk of economist and former bureaucrat Minister of Finance Rameshore Khanal about where and how to spend limited resources.
“Rameshore-ji is a fresh face and the right person for the role. He is capable and interested, and he knows the system,” says Kalpana Khanal of the Policy Research Institute (PRI).
But Minister Khanal has to grapple not just with the immediate budgeting needs for elections and reconstruction, but also initiate longer term measures to restore investor confidence badly dented by arson and vandalism of 9 September, and mend the economy.
Immediately after taking office, he had set up a three-member task force to cut programs and free up budget to meet immediate expenses.
“We have to hold elections and we have to reconstruct. Both need money, and they are equal priorities for us,” said Ministry of Finance spokesperson Tanka Prasad Pandey. “It is important to find these funds internally, and not look to aid from abroad.”
But Minister Khanal flew into heavy flak last week for his decision to restore investor confidence by giving a strategic capital gains tax break to Nepal’s only foreign private equity fund.
The Mauritius-based Dolma Impact Fund has invested venture capital into Nepal’s hydropower, construction and biotech sectors as well as solar farms and hospitals. It said in a statement that its capital gains are only taxable in Mauritius as per its double-taxation avoidance agreement with Nepal, which predates and overrides the Income Tax Act of 2002 subsequent to the Treaty Act 1990.
“When you have investors from all over the world, you have to choose a domicile and Mauritius is probably the most popular for development finance institutions due to strong governance, AML, and treaties with developing countries like Nepal,” Tim Dolma Investment told Nepali Times on the phone from London.
He added: “Last June we applied for the government to uphold its treaty with Mauritius which under all country laws including Nepal treaty act supersedes any disagreement with domestic laws. But there were delays. It was when the new government decided to uphold the treaty that the whole hoo-hah started.”
Leaks to the media possibly by bureaucrats fearful of being hauled over the coals by the CIAA has set financial circles abuzz for the past week. The Internal Revenue Office refused to grant the exemption, citing the 2002 Act.
Prime Minister Sushila Karki asked Chief Secretary Eaknarayan Aryal for clarification, and learnt that the Cabinet’s decision was not official since it was not recorded in the minutes.
“We were raising a fund that could have brought $1 billion in for energy and we had to stop it due to the reputational damage to Nepal by not upholding an international treaty,” said Gocher.
Gocher added: “Under Nepal’s Treaty Act, if there is ever disagreement between an international treaty and domestic law, then international treaty takes precedence so it is crystal clear and the way international treaties are dealt with all over the world.”
Some experts worry that gifting the fund such perks can set a dangerous precedent and a loss in tax revenue. Professor and economist Pushkar Bajracharya says: “The most important thing is to have a consistent policy about tax cuts and not do it piece-by-piece. Besides, the evidence just isn’t strong that tax cuts lead to higher investment, or more jobs.”
Others hark back to the capital gains dispute of the sale of Ncell ownership, which went to the Supreme Court and all the way to the international tribunal in The Hague.
Khanal has said privately that he is responding to the damage to Nepal’s investment climate from the dramatic visuals beamed worldwide of an international hotel chain and government buildings set ablaze in September. Western embassies are also said to be lobbying to allow Dolma tax exemption and smooth profit repatriation.
There are tradeoffs. Private equity funds like Dolma could funnel foreign funds more efficiently towards successful Nepali companies than the government, which is slowed down by many layers of bureaucracy. The downstream multiplier effect of such investments would outweigh taxes to the government since much of it is misused and wasted.
For example, the government is not taxing income in FY 25/26 generated by the US-funded $697 million Millennium Challenge Corporation (MCC) projects to build transmission lines and upgrade highways.
Strategic tax exemptions do provide incentives to investors, to make sure these projects are carried out effectively, which in turn helps Nepal’s development which has been affected by corruption and mismanagement.
The main demand of the GenZ protests that led to the downfall of the government coalition two months ago was to control corruption and make government more efficient so there is investment and job creation. The interim government seems to be responding to that sentiment.
The Dolma issue has distracted from the larger and longer-term need to reform the country’s financial systems and streamline public expenditure. How to reduce corruption and spur development is going to be the main agenda for elections, and the criteria by which voters will select candidates and parties.
TASKED FORCE
Shortly after Rameshore Khanal was appointed he set up a three member task force made up of the heads of Budget and Program, Foreign Aid, and Revenue Management Divisions. The team sent through the budget culling items DOGE-style — projects deemed ‘inadequately prepared,’ ‘fragmented,’ or ‘included through political pressure.’
Khanal hoped to save up to Rs100 billion by cutting all projects less than Rs30 million. However, such a slash and burn method would hurt rural and remote area projects for health and education more, and much bigger corruption-ridden infrastructure projects would be unscathed.&nbsp;
Says Bajracharya, “There are thousands, maybe hundreds of thousands of low-return programs in the budget that are there because of political or personal influence. But the criteria for cutting them needs to be properly defined. Doing it arbitrarily is unacceptable.”&nbsp;
Kalpana Khanal of the Policy Research Institute was involved in the taskforce, and explains: “The decision to mobilise internal funds is a pragmatic move to fund elections and reconstruction.”
However, she also singles out the massively-funded Ministry of Physical Infrastructure and Transport as being particularly problematic: “Time and cost overruns are historically the norm, and many are ‘vote bank’ projects that are politically motivated rather than done for return on investment.”
For example, politicians use their influence to build roads to their home districts to secure popularity even if the funds would have been better spent elsewhere.
“Another problem is the amount of funds that are transferred randomly for things that outside the budget,” continues Khanal.
Bajracharya adds, “While reconstruction and elections are big financial commitments, Nepal could easily find the funds. Cancelling low impact programs is a good move by the ministry of finance, and another option could have been to raise customs or taxes by a few percent. The main problem is that a huge amount of funds are lost to corruption.”
Kalpana Khanal and Dilli Raj Khanal co-authored a technical report last year titled Improving Public Expenditure System in Nepal: Critical Areas of Reform which did a forensic examination of such wasteful projects.
The conclusion: recommendation to have stricter accountability measures in place to check the actual use of funds and merit-based appointments in the National Planning Commission, Ministry of Finance, and the CIAA.
The technocrats in Prime Minister Karki’s cabinet resonate with the latter point. Nepal is so entrenched in the ‘afno manche’ culture of nepotism and connections that it has become the norm.
The report also refers to the well-known off-budget ‘re-allocations’ of big outlays during the seventh and first months of the fiscal year that undermine in-built check and balance. Almost a quarter of the budget is spent in the last month, which results in low quality and low impact work.
The authors call for reward and punishment systems to prevent these practices. The CIAA could also be supercharged to build transparency into the digital Line Ministry Budget Information System, instead of being an agency for political vendetta.

Nepal needs to use its money better

At the opening plenary of COP30, which stands for the convolutedly named 30th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC), in Belém on Tuesday, Nepal brought up the threats to the Himalayan watershed. Nepal’s delegate Rajendra Prasad Mishra, Secretary at the Ministry of Foreign Affairs, also spoke on behalf of Bhutan and Bangladesh after the three countries formally called for tripling grant-based adaptation financing from 2015 levels to at least $120 billion per year by 2030, and to ensure a more simplified, scaled-up access to finance their National Determined Contributions (NDCs) to reduce emissions and adapt to climate impacts. “Bhutan has already graduated from Least Developed Country (LDC) status, while Bangladesh and Nepal are in the process of graduation,” said Mishra. “Graduation reflects development progress, but does not reduce our climate vulnerability nor the scale of support required to safeguard development gains.” The Loss &amp; Damage Fund is also finally coming into effect, so countries can now apply for $5-20 million to make up for damage from climate impact. But claiming damage and linking disasters to climate breakdown has not been an easy process. “When a 200MW hydropower plant is destroyed by a glacial flood, it is a big loss for Nepal’s GDP. Every megawatt costs us $20 million to build,” says energy entrepreneur Kushal Gurung. “Our lobbying should be top-notch, and hydropower can make a good case for us.” Belém marks the tenth anniversary of the Paris Agreement that brought the world together to pledge to keep global average temperature to ‘well below’ 2°C above pre-industrial levels and limit it to 1.5°C.&nbsp; COP has also returned to Brazil after 30 years of the Rio Conference in 1995. Since then there have been numerous summits, which have been criticised for being just hot air and being hosted by fossil-fuel exporting countries like UAE and Uzbekistan. Belém was selected because it is a gateway to the Amazon, but Brazil has now also become a major oil producer after new offshore finds. A recent report shows that compared to 2019, the world is set to reduce its emissions by 12% in 2035 if countries are to implement their Nationally Determined Contributions even though the figure needs to go up to 40% to meet temperature targets. There has been progress. Before the Paris Agreement the world was on a path for 4°C increase during this century, and this has now come down to 2.5°C because of the clean energy transition. But a lot more needs to be done to meet the Paris 1.5°C target. “This progress is proof that multilateralism is working, it is delivering,” Manjeet Dhakal of the Climate Analytics South Asia told us from Belém. “Having said that, it is simply not enough. Emissions need to go down much further, and a lot of it is tied to developed countries providing climate finance to do so.” Many developing countries have adopted ‘conditional NDCs’ which means their emission reduction targets cannot be met without international climate finance. In its third NDC, Nepal set a target of a 17.1% reduction in net greenhouse gas emissions and 26.8% by 2035. But achieving that has a price tag of &nbsp;$73.74 billion, with much of it from international climate finance. UNDERFINANCED However, the climate for climate finance is getting worse. The United States has exited from the Paris Agreement for the second time under President Trump, and there are cutbacks in foreign aid by European funders. Even so, the EU has committed to reducing its emissions by 90% in the next 15 years, 85% of which will be domestic emission cuts. The silver lining in all this is that the leadership in climate action is increasingly being taken by Nepal’s neighbours China and India with both investing heavily in renewable energy. China is the world leader in solar panels, wind turbines and electric vehicles, and Nepal has already taken strategic advantage of this.&nbsp; With expensive hydropower plants increasingly at risk from glacial lake outburst floods, experts say Nepal must diversify its energy mix and invest in solar power which has 10 times more potential than hydropower at 432 gigawatts with over 300 days of sunshine a year. Solar farms can also power pump storage, which are cheaper and quicker to build.&nbsp; China has drastically reduced the cost of photovoltaic cells, making such schemes more feasible. Nepal just needs to ease up its restrictive domestic energy policies, boost investment and resist geopolitical pressure on electricity generation. “First, we need to increase the cap on solar energy from 10% to 30%, and next, the bidding process should be made easier, or just have the first past the post system like that for hydropower,” says Kushal Gurung. The disadvantage of solar power is that it generates only daytime energy, but this can be solved with grid-scale battery storage or pump storage. But first, the government needs to fix the rate for solar purchase so that entrepreneurs are incentivised. “This is not happening because our government officials and engineers are comfortable dealing with hydropower, and are not just updated about the latest advances,” says Gurung. “As a result, we have no clear policies when it comes to solar.” Hydropower has become one of the biggest industries in Nepal with an installed capacity of over 3,400MW and the government’s target is to produce 28,500MW in the next ten years. But the recent climate disasters have made it clear that relying only on hydropower alone is too risky. The Nepal-Tibet glacial flood in July destroyed and damaged four hydropower plants and substations along the Bhote Kosi, and last September’s floods slashed the country’s total generation by half. Nepal now needs to build on the widespread adoption of battery-powered vehicles by extending it to electric public transport and for household appliances like stoves, rice cookers and refrigerators. Not only would this reduce Nepal’s per capita carbon footprint, but it would also reduce the country’s annual Rs300 billion petroleum import bill. At global platforms like UNFCCC, it is easy even for individual developed countries to get lost without an alliance. Now that Nepal is graduating from LDC status, it needs to have strong partners with a common goal to move forward in international negotiations. Says Kushal Gurung: “We won’t have privilege that came with LDC status anymore, which means climate finance will be even more limited. But there are a few things we can urgently do on our own like regulating the carbon credit market.”&nbsp; 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/20251118101116_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_3" data-image-id="20251118101116_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="Nepali Times SDG"> </figure>

Global warning bell in Belém

Youth protestors who sustained injuries at the hands of state security forces during the September protest staged a sit-in at Maitighar Mandala on Friday, protesting what they have called the interim government’s inadequate efforts to address the demands of the GenZ movements. The demonstrators also sought to bar the UML from gathering at Maitighar, where party chair K P Oli was expected to announce its Youth Volunteer Force on Friday. The organisers consequently relocated the event. Friday’s demonstration at Maitighar comes as UML and GenZ representatives agreed to sit down for talks in Simara, where a curfew was imposed this week after youth protestors and party cadres clashed near the airport as demonstrators sought to stop UML leaders from flying in for a political event to Simara from Kathmandu.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251121131148_c0b3bfb861f73bee456efbd12f523af55ce3c258742c39e1dea7dbf768774ea5.png" data-media-id="editor_0" data-image-id="20251121131148_c0b3bfb861f73bee456efbd12f523af55ce3c258742c39e1dea7dbf768774ea5" data-rendition-name="original" width="2160" height="1440" loading="lazy" alt="GenZ Maitighar"> <figcaption>Youth protestors who sustained injuries at the hands of state security forces during the September protest staged a sit-in at Maitighar Mandala on Friday. Photos: SUBASH SHRESTHA</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251121131152_85f3606728d137b334d782ac1b5d1ed6383544493f96ebcc0398fcd9f0c5add7.png" data-media-id="editor_1" data-image-id="20251121131152_85f3606728d137b334d782ac1b5d1ed6383544493f96ebcc0398fcd9f0c5add7" data-rendition-name="original" width="2160" height="1439" loading="lazy" alt="GenZ Maitighar"> </figure>  &nbsp;Nepal’s interim government is increasingly cautious about the nation’s sensitive security situation in the lead-up to the 5 March election, as evidenced by pro-monarchy businessman Durga Prasai’s midnight arrest earlier this week over his inflammatory remarks as he called for protests this month. On Thursday, the Supreme Court ordered the government to present Prasai before the court within 24 hours.&nbsp; As it stands, the UML’s inauguration of a youth collective amidst its disregard for the demands of Nepalis for party reforms and a change in leadership highlights party chair and former PM K P Oli’s continued lack of remorse for the excesses of 8 September.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251121131144_aaa296e2e812ef5f6473064bc4b679bf605e14e06ac0ec9be1d6d047b56f96f9.png" data-media-id="editor_2" data-image-id="20251121131144_aaa296e2e812ef5f6473064bc4b679bf605e14e06ac0ec9be1d6d047b56f96f9" data-rendition-name="original" width="2560" height="1707" loading="lazy" alt="UML Youth Volunteer Force NT"> <figcaption>The UML launched its Youth Volunteer Force on Friday. Photos: SUMAN NEPALI</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251121131148_bfa8df3fc382195b4cdb9c4804cd67e169d2d9c0b8d218e61bbef0c4c9dbdaad.png" data-media-id="editor_3" data-image-id="20251121131148_bfa8df3fc382195b4cdb9c4804cd67e169d2d9c0b8d218e61bbef0c4c9dbdaad" data-rendition-name="original" width="2560" height="1706" loading="lazy" alt="UML Youth Volunteer Force"> </figure>  Families of those killed and injured on 8 September have demanded that the ousted PM and home minister be held accountable for state brutality.&nbsp; This week, Human Rights Watch published a <a href="https://www.hrw.org/news/2025/11/19/nepal-unlawful-use-of-force-during-gen-z-protest" target="_blank">comprehensive report</a> concluding that security forces fired indiscriminately on youth-led protestors on 8 September.&nbsp; The human rights watchdog urged the Sushila Karki-led interim government to investigate the excessive use of force as well as arson, vandalism and mob attacks on individuals on 9 September. The government has created a judicial commission to inquire into the deaths of 76 people over two days of protests.&nbsp; “The recent violence in Nepal included serious human rights violations, and those responsible should be held accountable, whether they are security forces or political actors,” said Meenakshi Ganguly, deputy Asia director at Human Rights Watch.&nbsp; She added: “The government should ensure that the investigations are independent, time-bound, and transparent, and that no one found responsible for breaking the law is unfairly protected from proper prosecution.” HRW’s investigation was based on testimony from 52 witnesses, victims, journalists, healthcare workers, politicians, and sources close to security forces. Researchers also verified photos and video footage shared on social media and with researchers; and visited the scenes of protests, properties subjected to arson and vandalism, and hospitals.&nbsp; A police officer said that officers opened fire with lethal force five minutes after the District Administration Office declared an emergency curfew around Parliament. Witness accounts and analysed footage did not show grave and imminent danger to life that would justify the intentional use of lethal force, stated the human rights watchdog in the report.&nbsp; The protestors and witnesses identified security forces who fired live ammunition at the protestors by their uniforms as members of the Armed Police Force (APF) and Nepal Police’s Special Task Force (STF). &nbsp; “They literally aimed at us and started shooting,” said one witness who sheltered behind a barricade as police continued shooting.&nbsp; A retired senior police official said police had failed to follow procedures for dispersing protests and using lethal force.&nbsp; Pathologists at a Kathmandu morgue told HRW that they determined 35 cases of death caused by “high velocity gunshot wounds” to the head, neck, chest, or abdomen.&nbsp; The witness recounted being taken into custody along with 33 other protestors by STF officers in riot gear, and said that police police personnel beat him with batons. Detainees were threatened and their IDs destroyed. Several witnesses said that the mob attacks on businesses, politicians, media companies, and educational institutions were very targeted, noting the absence of security personnel on 9 September as arson and violence raged across the capital.&nbsp; Some suggested that the violence may have been instigated by infiltrators associated with various political movements.&nbsp; On Discord, the platform where a significant number of demonstrators organised, participants noted that while there were calls for peaceful movement in the days leading up to the protest, some on the platform advocated for violence.&nbsp; Human Rights Watch has said that any credible allegations of criminal acts contributing to the violence must be investigated.&nbsp; Said Ganguly: “The authorities should recognise that widespread impunity for human rights violations in the past helped enable the violence that occurred this time in Nepal. It is crucial to reverse the decades-long tendency by successive governments in Nepal to bury investigations and stall prosecutions, and to bring about accountability and security sector reform.”

Security forces targeted protestors disproportionately: HRW

As people move out of Nepal’s trans-Himalayan districts, their faiths migrate with them to the cities and all over the world. The ancient animist faith of Bon Po predates the advent of Buddhism in Tibet, and its last remaining priests and devotees are found in villages like Lubra in Mustang and Samling in Dolpo. But as those villages empty out, Bon centres can now be found as far afield as Kathmandu, New York and Tokyo. The first Triten Norbutse Monastery was founded in Tibet in the 14th century by the Bon Master Shen Nyima Gyaltsen. Its monastery in Nepal is below the forested hills of Ichangu on the western outskirts of Kathmandu.&nbsp; Many are surprised to hear that there is a Bon centre in Kathmandu, and that it is located so close to Swayambhu. This Triten monastery was established by Yongzin Tenzin Namdak Rinpoche only 40 years ago to cater to adherents of the faith who lived in the capital. True to its reverence for nature, the shrine is verdant, with plants and flowers amidst a contrasting backdrop of Kathmandu’s ugly urban sprawl below. The monastery practices Bon culture and passes on teachings to students as well, who after completing 15 years of study graduate to become ‘Gese’.&nbsp; It is believed that Bon Po was brought to Nepal from Tibet by Tonpa Shenrab Miwoche. Over the centuries, Bon and Buddhism have become syncretic in Dolpo and Mustang, despite the differences in their belief systems. Followers worship nature and consider the human body, speech and mind as jewels. The human body is said to be composed of five elements: earth, water, fire, air, and the cosmos.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111148_ce5d50db6757c4f5a7259c10d2879ee5f5b7b990e987bf3734378ba464afc9d5.jpg" data-media-id="editor_0" data-image-id="20251113111148_ce5d50db6757c4f5a7259c10d2879ee5f5b7b990e987bf3734378ba464afc9d5" data-rendition-name="original" width="5712" height="4284" loading="lazy" alt="The Bon Po way of life NT"> </figure>  The Bon faith was much more widespread during the reigns of Nyathi Chenpo, the first king of Tibet to Namri Srongchen, the 32nd king. But it was after King Srongchen Gompo that Buddhism started making inroads on the plateau, and spread also in the Himalayan rimlands. There are also Bon followers in Humla, Jumla, Baglung, Mugu, Kaski and Chitwan, as well as in the United States and 50 other countries, indicating the movement of people within Nepal and outside.&nbsp; The Bon religion believes in reincarnation and that everything, including positive and negative thoughts are a result of past life karma. Buddhism focuses more on attaining Nirvana, a state of no suffering, where the subject is released from all his/her karmas. Bon has also inducted some Tantric practices and rituals, some of which are in parts similar, yet still different from Buddhism.&nbsp; “In Buddhist culture, circumambulation of shrines is clockwise, but in Bon culture, circumambulation is in an anticlockwise direction,” explains Chhiring Lama of Triten Norbutse Monastery. “The main Bon mantra is Om Ma Tri Mu Ye Sa Le Du, while followers of Buddhism chant Om Mani Padme Hum. Buddhism emphasises enlightenment by meditation and moral behaviour, while Bon beliefs centre on nature and ancestor worship, and placating the spirits. In religious texts, it is mentioned that there were 1,008 Buddhas throughout time. Tonpa Shenrab is believed to be the 8th Buddha, and Bon practitioners are guided by his teachings contained in 140 sacred writings known as Kangyur and 300 more scriptures known as Katen.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251113111152_9813ce72805941af4b3bfb3c80c7e45ffc8aca4f2612eb967e84204f3a28bc07.jpg" data-media-id="editor_1" data-image-id="20251113111152_9813ce72805941af4b3bfb3c80c7e45ffc8aca4f2612eb967e84204f3a28bc07" data-rendition-name="original" width="4032" height="3024" loading="lazy" alt="The Bon Po way of life NT"> </figure>  “We worship nature and its elements and the prayer flags contain religious texts and when the wind blows through it we consider it a prayer,” says Chhiring Lama. “We also worship ponds for the water and consider fire as a sacred element as well. We also consider snakes sacred, therefore worship ponds, considering them as the place of residence.” The interdependence between human beings and nature is clearly depicted through such traditions and practices which carry relevance today as the planet faces the crisis of climate breakdown.&nbsp; Important gods worshiped include Satrig Ersang, Shenlha Okar, Sangpo Bumtri, and Tonpa Shenrab Miwoche. But what is similar to Buddhism is an offering known as ‘torma’, a cone shaped ritual offering made from flour dough. Many Bon faithful are vegetarian, or abstain from meat during festivals.&nbsp; Over time, the rise of Buddhism in Tibet and beyond overshadowed Bon, pushing many of its practices to the margins. Yet, the tradition continues to live on, carried by those who see in it a deep connection to nature, the spirit world, and the roots of Tibetan culture.&nbsp; In many ways, the endurance of Bon is a reminder that even the quietest faiths hold timeless truths, waiting to be remembered and valued. Followers of Bon today are far fewer, and the knowledge about its traditions is not as widespread.&nbsp; “As time goes on, people adopt rituals and cultures that are more convenient to their daily lives,” says Chhiring Lama. “But that means forgetting or leaving behind one’s indigenous and ancestral roots.”

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The Bon Po way of life