<figure><img width="2002" height="1452" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205409c7e80680e0b28a7jpeg.jpg" alt=""/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>While ‘long-Covid’ has come to mean lingering symptoms among survivors of Covid-19 infections, in Nepal it connotes the long-term socio-economic impact of the pandemic on children.Even as the Omicron third wave spreads across Nepal, the government is struggling to vaccinate children down to age 12 and protect this vulnerable and unvaccinated age group from the virus. No vaccination has been announced yet for those below 12.Side by side with that threat, more than one in five Nepali households continue to struggle for food due to lack of money and disruptions in supply caused by the Covid-19 pandemic, according to the latest findings of a nationwide survey.The survey showed that in November, 21% of households struggled to obtain enough food, and nearly 10% of them had to reduce the dietary intake of children. However, while 60% of households surveyed in July 2020 said <a href="https://www.nepalitimes.com/latest/half-of-nepalis-lost-jobs-in-past-month/">they had lost jobs</a>, this number had declined substantially to 33% by November last year. Still, this means one-third of Nepali families are <a href="https://www.nepalitimes.com/editorial/pandemic-of-poverty/">at risk of poverty</a>, and this undermines Nepal’s steady success in reducing the rate of absolute poverty over the past two decades.The tracking survey has been conducted periodically by <a href="https://www.sharecast.org.np/">Sharecast Initiative Nepal</a> with support from <a href="https://www.unicef.org/nepal/media/15281/file/Assessing_Secondary_Effects_of_COVID_on_Families_and_Children_In_Nepal_-_CFT_Endline_Report.pdf">UNICEF Nepal</a> since May 2020 to monitor household income, health and education during the pandemic. The <a href="https://www.unicef.org/nepal/media/15281/file/Assessing_Secondary_Effects_of_COVID_on_Families_and_Children_In_Nepal_-_CFT_Endline_Report.pdf">Child and Family Tracker</a> has so far conducted 8 nationwide surveys to monitor and gauge changes in the livelihoods of more than 7,000 households. It tracks their access to jobs, water, sanitation and hygiene (WASH) and children’s access to education, including food intake and health, breastfeeding and pregnant mothers. <a href="https://www.nepalitimes.com/latest/new-nepal-lockdown-may-cancel-gains/">Nepali Times</a> has partnered with Sharecast Initiative in analysing some of this data over the past two years. The latest survey shows that nearly one in three families are in need of financial assistance, and many families continue to be indebted. Disaggregated data shows that Dalit families are still more likely to incur debt, require food and financial support as an immediate need.The number of families reporting loss of jobs worsened in surveys conducted between <a href="https://www.nepalitimes.com/latest/covid-19-impact-on-food-and-school-in-nepali-children/">May and July 2020</a> (climbing to as much as 60%) but has now come down to 19% in the latest survey conducted in November last year.A similar situation is seen for other parameters like <a href="https://www.nepalitimes.com/latest/covid-19-impact-on-food-and-school-in-nepali-children/">food shortage</a> and children out of school, with the impact of the lockdowns extending till late 2020, before improving in the past year. The most dramatic impact is seen in the <a href="https://www.nepalitimes.com/latest/learning-during-the-pandemic-in-nepal/">proportion of children who were not studying at all</a>, which came down from a high of 41% in May 2020 to only 3% in November 2021. (See graph below). <figure><img width="2318" height="618" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205449c7e80680e0b28a8jpeg.jpg" alt=""><figcaption>Overview of Child Tracker Survey data for various parameters between May 2020 - November 2021.</figcaption></figure>Similarly, families which have members with disabilities, as well as female-headed households have said they have been reaching out for financial support, food, and money. Children of such families predominate in most deprivation indicators. The results in education are a bit more uneven. While 60% of parents polled were confident about sending their children back to school, 80% felt that their children are falling behind in their studies. Only six in every ten households said their schools had handwashing facilities, and only a quarter confirmed their children's classrooms practiced physical distancing.  As expected, the survey showed that children with disabilities were far more likely to face challenges with virtual learning, which has again returned to being the norm as schools stay closed after winter vacations due to the ongoing Omicron surge. Reports of domestic violence have gone up with 15% of households interviewed witnessing violence against women and children, including intimations, threats, insults and yelling. Girls are facing increasing pressure to marry early, and face discrimination in school enrolment.  One positive trend seems to be in the number of households that said they witnessed children working. Before the pandemic, a full 30% of families said child labour was present, this had gone down to 8% during the first lockdown in April 2020 and decreased further to 2% in the latest survey conducted in November 2021. Another positive trend was a higher level of awareness about Covid-19 transmission and precautions. Most families appeared to be taking the necessary precautions with 84% reporting that they wore masks during the holiday season, and 71% of those surveyed had already been vaccinated as of November 2021.  The rate of hand-washing and use of sanitisers also remain high. Together masking, distancing and hygiene could also have an impact on reducing other common water- and air-borne infectious diseases in Nepal like diarrhoea, typhoid, tuberculosis, measles, etc. <figure><img width="1190" height="1200" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205479c7e80680e0b28a9jpeg.jpg" alt=""><figcaption>Awareness about Covid precautions May 2020 and November 2021.</figcaption></figure>Unrelated to Covid, the survey also showed that among more than 7,000 households approached there appeared to be a high percentage of them with disabled members, with the highest proportion (21%) being in Karnali Province with Madhes Province and Bagmati at 16% each. (See graph below). <figure><img width="1604" height="1242" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/6372054a9c7e80680e0b28aajpeg.jpg" alt=""><figcaption>Households with disabilities. </figcaption></figure>Similarly, the survey also gives a glimpse of male out-migration with data showing one third of households in Gandaki Province being female-headed families. Madhes Province had the lowest proportion of women-led households (12%), with all other provinces showing about a quarter of families being female-headed. (See graph below) <figure><img width="1810" height="1092" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/6372054d9c7e80680e0b28abjpeg.jpg" alt=""><figcaption>Female headed households by Province.</figcaption></figure>Interestingly, the survey also showed that female-headed households had a disproportionately higher number of children living with them. Children made up 38% of the total members in households led by males, while in female-headed households children made up 43% of the members.  <img width="936" height="1324" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205509c7e80680e0b28acjpeg.jpg" alt="">Full report: <a href="https://www.unicef.org/nepal/media/15281/file/Assessing_Secondary_Effects_of_COVID_on_Families_and_Children_In_Nepal_-_CFT_Endline_Report.pdf">‘Equity Focused Assessment of Secondary Effects of COVID-19 on Families and Children in Nepal’ by Unicef and Sharecast Initiative’.</a>

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

Nepal’s ‘long-Covid’ impact on children

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171156/636bdbf89c7e80680e0802f0jpeg.jpg" alt="" width="640" height="323"/>Nepal is reeling under an explosive surge of Covid-19, particularly Kathmandu Valley which is facing acute shortage of hospital beds, ICUs, oxygen and ventilators for the seriously sick.But the pandemic has also brought out the best in people. Like sanitation expert Namastelal Bhumi Shrestha, who is convinced prevention is the only way to fight the virus.For the past three months, Shrestha has been busy importing paper soap from India and distributing it free of cost to hospitals, banks and other frontline institutions in Nepal. His only regret: not being able to reach to the neediest, those who cannot even afford soap."One of the route of Covid-19 infection is through touch points, so I am trying to spread awareness by distributing soap for handwashing,” says Shrestha. “I haven’t been able to distribute it yet daily wage workers, the ones who need it the most.”On the World Handwashing Day on 15 October, Shrestha did not only distribute the soap to the employees of various organisations he frequents, but also left more for them to redistribute elsewhere.In his hometown of Bandipur, Shrestha aims to distribute paper soaps to all residents. In fact, he has already started to do so with the help of his nephew. He is also planning to distribute the soaps through ward offices and schools.Shrestha who has been providing soaps for free of cost in Kathmandu, but is now limiting his daily distribution rounds. He is above 60, and although he is careful about safety measures he has to reduce the risk of Covid-19 infection for himself as well. But he still carries packs of the light soap strips whenever he goes out for work.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171156/636bdbfb9c7e80680e0802f1jpeg.jpg" alt="" width="1200" height="623">Shrestha repackages the soaps here, which are light and biodegradable. Each packet contains 10 sheets of soap-coated paper strips, and is easy to carry around even while travelling. Using one strip for every handwash, the item is easy to use and dispose of.And it is cheap: a pack of 10 strips costs Rs3 and even if it had to be bought is affordable to many. Shrestha has 30 years of experience in water and sanitation for UNICEF in Nepal, where he was involved in making Nepal an open-defecation free zone.He says even after the pandemic subsides paper soap would be an effective way to promote hygiene and water-borne diseases. “It could save thousands of lives of children who would otherwise die due to easily preventable diseases like diarrhoea,” he says.The paper soap campaign and other social service activities cost Shrestha up to 20% of his monthly income, but he says it is worth it. “You cannot measure in money the sense of fulfilment that comes from helping others,” he says.Part of his social service is the Kunti Memorial Foundation, which he set up in his mother’s name and which awards Rs500,000 to people doing exemplary work in the field of water and sanitation.Shrestha has been to all 77 districts in Nepal and has come across like-minded individuals and organisations who deserve recognition.

Free soap to fight Covid-19

<figure></figure> <img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba5129c7e80680e0736a1jpeg.jpg" alt=""/><figcaption>A woman with her mask down walks by Sneha Shrestha mural in Pimbahal, Patan this week. Photo: BIKRAM RAI</figcaption> Five months after the first COVID-19 case was detected in Kathmandu, and after many experts were puzzled about why the virus was not spreading as fast as elsewhere, parts of Nepal and Kathmandu city are now in the vortex of the pandemic.Hospitals in Tarai cities are fast filling up with symptomatic cases, and doctors say patients requiring ICU treatment and ventilator support are on the rise.On Thursday, Kathmandu Valley recorded its highest daily rise of 87 positive cases. All beds are occupied in hospitals with designated wards for coronavirus patients. Overwhelmed, doctors are sending asymptomatic patients to home isolation. Some were diverted to Kathmandu Medical College’s facility in Duwakot and Ayurveda Hospital in Kirtipur.<a href="https://www.nepalitimes.com/banner/experts-caution-against-extending-nepal-lockdown/" target="_blank" style="background-color: rgb(255, 255, 255); font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Experts caution against extending lockdown</a>, Sonia Awale<a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" style="background-color: rgb(255, 255, 255); font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Lockdown may be over, but pandemic is not</a>, EditorialThe government has approached private hospitals to start opening COVID-19 wards, and had set the maximum treatment charge per patient. However, private hospitals are balking, they say the fees are too low for the care needed.“Self-isolation at home has worked elsewhere but in Nepal where people don’t strictly follow safety measures, patients are ostracised, and there is a lack proper rescue mechanism, it might not be the best strategy,” cautions BaburamMarasini, former head of the Epidemiology and Disease Control Division. “It would be better to move asymptomatic cases to available government training centres, non-profit institutions, and if needed even hotels and hostels.” <figure></figure> <img width="955" height="594" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba5159c7e80680e0736a2jpeg.jpg" alt=""><figcaption> </figcaption> As of Thursday, Nepal has a total of 21,750 cases with 6,296 active. So far, 65 people have lost their lives, five of them on 6 August alone. Cases in Kathmandu Valley have reached 876, mostly in the capital city (see graphs). Eight people have been infected with coronavirus at the Ministry of Internal Affairs and Law and so has minister Gyanendra Kumar Yadav in Province 2.Says public health expert Sameer Dixit: “Local governments and security personnel should be facilitating self-isolation at homes. Admitting asymptomatic cases in hospitals depletes resources, as it exposes mildly infected patients to severe cases.”There are now 66 ICU cases across Nepal with 29 just in Bagmati Province (see map) where three patients are on ventilator support. Given the steep rise in symptomatic and severe COVID-19 cases, all 1,702 ICU beds nationwide and stock of 900 ventilators could be used up.“The rate of infection in Kathmandu is increasing, and this could lead to a shortage of hospital beds, equipment and heath workers,” warned Jageshwor Gautam of the Health Ministry, appealing to the public to remain at home and follow <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">safety measures</a>. Several hundred traffic police in Kathmandu are in quarantine after the infections spread, and the Nepal Police headquarters was sealed this week after seven staff tested positive. <figure></figure> <img width="949" height="606" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba5189c7e80680e0736a3jpeg.jpg" alt=""><figcaption> </figcaption> Special attention should also be given to the fact the virus SARS-CoV-2 is airborne, which is why <a href="https://www.nepalitimes.com/banner/masks-unmasked/" target="_blank" rel="noopener noreferrer">wearing mask</a> should be mandatory, spitting prohibited and ensuring cross ventilation in workstations at all times.Finance Minister and government spokesperson Yubaraj Khatiwada says the government does not want to re-impose a nationwide lockdown, but says some restrictions may have to be put into place.District administrations of Kathmandu, Lalitpur and Bhaktapur districts met on Thursday to draw up a joint strategy for the Valley. Among the measures being discussed are: strict protocols for government offices, banks, markets, and public transport. They are worried most people are not following guidelines for masks and physical separation, and warn that they may have to resort to punitive measures and fines to enforce the rules.Health experts fault Khatiwada’s <a href="https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/" target="_blank" rel="noopener noreferrer">announcement on 21 July</a> in which he categorically stated that the “lockdown has been lifted” even though it had only been relaxed. They said this had given people a <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">false sense of security</a>, and especially allowed Indian factory workers, vendors, barbers and drivers to stream back to Nepal <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer">across the open border</a>. This is the reason the Tarai cities were the first to be hit, and the virus is spreading to Kathmandu from there.    The COVID-19 Crisis Management Centre (CCMC) is said to be discussing modalities for a ‘smart lockdown’, including isolating areas where there are outbreaks and stricter enforcement of mask and separation rules. It is also going to decide this weekend whether or not to re-open long distance buses, as well as regular domestic and international flights which were supposed to resume on 17 August.Says Buddha Basnyat, a physician at Patan Academy of Health Sciences: “We are seeing a worrying surge in typical COVID-19 symptoms with advanced pneumonia, unlike before when most cases were asymptomatic and had co-morbidity.” <figure></figure> <img width="516" height="655" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba51a9c7e80680e0736a4jpeg.jpg" alt=""><figcaption> </figcaption> Experts say the rise of symptomatic cases is also due to co-infection such as seasonal flu, typhoid and <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/" target="_blank" rel="noopener noreferrer">dengue</a>, all infectious disease common during the monsoon. Some have pointed to high co-morbidity and delayed mass testing as  contributing factors to possible community transmission in the Tarai districts and Kathmandu.But despite the surge in symptomatic cases, health professionals have advised against re-imposing a blanket curfew, favouring a ‘<a href="https://www.nepalitimes.com/banner/experts-caution-against-extending-nepal-lockdown/" target="_blank" rel="noopener noreferrer">smart lockdown</a>’ where localities with cluster outbreaks are sealed off, and tested – while strictly enforcing masks in public places and preventing crowds.So far, shutdowns have been re-imposed in five Tarai districts, and semi-lockdowns in parts of nine others where there has been a surge in cases. <figure></figure> <img width="640" height="828" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba51d9c7e80680e0736a5jpeg.jpg" alt=""><figcaption> </figcaption> “We are already experiencing semi-lockdown of sorts because of floods and landslides. A lockdown now will cause more harm than good. The only way to fight this pandemic is <a href="https://www.nepalitimes.com/editorial/open-and-shut-case/" target="_blank" rel="noopener noreferrer">behavioural reform, surveillance and isolation</a>,” says Marasini.Indeed, most experts agree that a focus on the coronavirus should not shift attention away from more devastating conditions that can <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">affect people’s well-being</a> because of economic collapse.

Sonia Awale

Nepal’s virus vortex

<figure><img width="1509" height="1098" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141144/636baf439c7e80680e07803fjpeg.jpg" alt=""/><figcaption>It's business as usual at the Behaliya checkpoint in Rupandeni district near the Indian border. Photo: MUKESH POKHREL</figcaption></figure>As the number of cases and fatalities rose in the <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/&amp;source=gmail&amp;ust=1596011798028000&amp;usg=AFQjCNEDbXktgmxVbWUiksaw34QaJjjakQ">central Tarai districts</a> this week, the big debate is whether Nepal has now progressed from cluster to community spread of the disease. The Ministry of Health maintains that we are still in the cluster stage, as per the WHO definition. However, the hospitals in the Tarai say SARS-CoV-2 is now spreading in the community, and some cities have gone back into lockdown.Whether we are in the cluster or community spread stage is a moot point. This is an unfolding pandemic, total caseloads are still rising exponentially in neighbouring India and around the world, Southeast Asia and Europe are being hit by a second wave. The only thing we know for certain is that there is still a lot we do not know about the virus.But we do know that this is one super-intelligent strand of RNA. It  understands human behaviour and exploits it ruthlessly. Initially, after jumping the species barrier it spread human-to-human. Then it piggybacked on global mobility through asymptomatic infections, ensuring that carriers of the virus were not too sick to be bed-ridden. The virus has now figured out a way to lie low, allow people to get complacent, so it can make a comeback. It might even have mutated into strains to take advantage of different behaviour patterns and climatic conditions. The virus takes advantage of countries whose leaders are in denial or have underestimated it. After older people started taking precautions and started staying home, it is now inflicting the youth.From the experience of countries that have done well to keep the virus in check, we know only three things work: limited mingling, acceptance of masks, and physical separation. That message has to go out, and there has to be behaviour change in the population.But when Finance Minister <a href="https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/&amp;source=gmail&amp;ust=1596011798028000&amp;usg=AFQjCNG11Q9HQzbBVN6RoSJGjcxqeOhMVg">Yubaraj Khatiwada inexplicably announced</a> on 21 July that the lockdown had been lifted, he made a boo-boo. It was not even true — long-distance buses and regular flights had not yet resumed, bars, restaurants and schools were still closed, hotels would open only at the end of the month. But Nepalis itching to get back to business after four months of confinement only heard that ‘the lockdown is lifted’. It gave them a false sense of security, shops opened, and there was a rise in the daily number of returnees from India. The government’s announcement was premature, and it now threatens to undo the time we bought from the lockdown to put safeguards in place.On 28 July, Nepal recorded the highest number of daily cases in nearly a month with 319 new COVID-19 positive people out of 5,032 tested. For the past weeks, the daily total has been less than 200 out of 4,000 tests.  The government announcement that the lockdown was lifted coincided with record daily cases and fatalities in India, especially in states of Bihar and Uttar Pradesh which re-imposed restrictions. India has now seen 1.5 million cases and 35,000 deaths, third highest after the US and Brazil. More worryingly, <a href="https://www.nepalitimes.com/nepali-times-search/?q=covid19" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/nepali-times-search/?q%3Dcovid19&amp;source=gmail&amp;ust=1596011798028000&amp;usg=AFQjCNEx3-jfQePFsUpj3ZPFEpIWH6yIwg">it is now affecting rural India</a> across the Nepal border where health and hygiene conditions are poor.In Nepal, <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/&amp;source=gmail&amp;ust=1596011798028000&amp;usg=AFQjCNEDbXktgmxVbWUiksaw34QaJjjakQ">increased crossborder mobility</a> led directly to a surge in cases in border districts, and since long-distance buses will start operating again from 30 July it is only a question of time before the virus spreads up into the mountains. Let us not forget how the Spanish Flu spread in India in 1918, killing tens of millions — the virus travelled by train from the sea ports, carried by soldiers returning from World War I.Because it bungled the messaging, the government now needs to act on two fronts urgently: <ol><li>Launch a massive nationwide awareness campaign: ‘The lockdown may be over, but the pandemic is not. Take these precautions.’ </li><li>Mass testing in the community, quarantining and tracing, to keep infections within clusters. </li></ol>Read also: <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer">Heightened COVID-19 risks at India-Nepal border</a>, Mukesh Pokhrel

Lockdown may be over, but pandemic is not

mainNavigation

footerNavigation

opinionSubnav

hand-hygiene

Nepal’s ‘long-Covid’ impact on children

Free soap to fight Covid-19

Nepal’s virus vortex

Lockdown may be over, but pandemic is not