<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.

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Free soap to fight Covid-19

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba7ab9c7e80680e073797jpeg.jpg" alt="" width="1500" height="1000"/>UPDATE 29 August: Covid-19 fatality in Nepal now stands at 207. A total of 22 people are undergoing treatment with ventilator support: three in Province 1, 17 in Bagmati and two in Province 5.Although the initial wave of coronavirus cases in Nepal <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/">were from across the border in India</a>, public health experts now say it makes no sense to blame imported infection because the virus is now spreading in the community.India is now the country with the third largest caseload with over 3.3 million confirmed cases, and up to 70,000 new cases every day– the highest in the world. But compared to its 1.3 billion population, this is still a low figure and India’s fatality rate of 1.87% is one of the lowest.Yet, age-adjusted mortality rate paints an entirely different picture, which looks very similar to that of Nepal – SARS-CoV-2 is <a href="https://www.nepalitimes.com/latest/why-are-younger-people-in-poor-countries-dying-of-covid-19/">killing far higher percentages of younger people</a> than in the developed countries.Covid-19 similarities between India and Nepal do not end there: already poor health infrastructure in both countries <a href="https://www.nepalitimes.com/banner/nepals-virus-vortex/">are overwhelmed</a>, there is <a href="https://www.nepalitimes.com/banner/learning-from-hiv-to-fight-covid-19-in-nepal/">societal stigma</a>, health workers are infected, politicians have died, and the movement of migrant workers has affected people on both sides of the border.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba7ae9c7e80680e073798jpeg.jpg" alt="" width="640" height="707">What happens in India has always impacted Nepal because the two countries share an open border and this pandemic is no different, especially given Indian states bordering Nepal are some of the most affected: Uttar Pradesh, West Bengal and Bihar have 466,725 cases between them.Nepal saw the first surge of Covid-19 cases in late March when hundreds of thousands of Nepalis working in India come back home following lockdowns in both the countries. Between 8 March and 2 July alone, an estimated 500,000 Nepalis <a href="https://www.nepalitimes.com/here-now/workers-return-to-jobless-nepal/">returned from India</a>. While they were quarantined in the first few weeks, later arrivals were allowed to go straight home to their villages for self-isolation.“Nepal will always be at the risk because of the porous open border, even during the lockdown thousands of people managed to sneak in illegally,” says Sher Bahadur Pun of the Health Ministry. “Even if we are able to control the spread of the virus in Nepal and bring the cases down, we will never be safe until the virus spreading is not under control in India.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba7b19c7e80680e073799jpeg.jpg" alt="" width="2048" height="1366"><figcaption> </figcaption></figure>The second wave of infections happened after Nepal’s lockdown was <a href="https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/">relaxed on 21 June</a>, at a time when Covid-19 was raging across Bihar and Uttar Pradesh. Thousands of Indian workers poured across the border to rejoin jobs in factories along the Tarai industrial corridors.The border district of Parsa, which had brought the virus under control, was suddenly hit by an outbreak that spread like wildlife. From Birganj, the virus travelled easily to Kathmandu, making the Valley the next hotspot.As of 27 August, Nepal has registered 35,529 confirmed cases with 183 fatalities. Ten of Nepal’s 77 districts now have over 1,000 cases, Kathmandu leads with 3,455 cases, and the Valley saw a record 377 new cases on Thursday. Nationwide, the recovery rate has dropped from 73% in July to 56.7% now, since most new cases are symptomatic, or patients are serious enough to need ICU care.It is now clear that the clusters have merged and are spreading in the community, and just like with polio Nepal will not be able to fully defeat SARS-CoV-19 until it is under control in India.Because of this, public health experts say Nepal has no choice but to <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/">enforce distancing, mask wearing, hand-washing</a> and other precautions. The current lockdown in Kathmandu has been extended till 2 September.“If we can successfully implement safety measures and control the movement of the people at the border and inside the country, what is happening in India should not affect us so much,” says public health expert Sameer Mani Dixit.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba7b59c7e80680e07379ajpeg.jpg" alt="" width="1509" height="1098"><figcaption> </figcaption></figure>Despite India’s heavy daily caseload and fatalities, the country has opened limited domestic and international flights, trains, public transport and shops.There are also lessons to be learned from Delhi, which used to be a hotspot. The recovery rate there has surged from 55% in June to 90% this month. Delhi’s aggressive testing and tracing and home isolation are measures Nepal could easily emulate.The ‘<a href="https://www.nepalitimes.com/opinion/how-did-kerala-beat-covid-19-spread/">Kerala Model</a>’ is also worth noting: public health authorities there prioritised early detection through extensive testing, widespread contact tracing, and 28-day quarantines for everyone infected. Despite being the first state to report a case of Covid-19, Kerala has among the lowest fatality rates in India.“These models are particularly useful because over half of our cases are still asymptomatic, which means we need to keep up active contact tracing, mass testing and surveillance,” says Sher Bahadur Pun. “We also still need to better communicate safety measures, having a figure that the public trusts endorse masks and distancing will be very effective because lockdowns are not a long-term solution. Behavioural change is.”Indeed, lockdowns only seem to provide a false sense of security and would have been unnecessary if the public had adopted the safety measures after 21 July. The <a href="https://www.nepalitimes.com/banner/economic-cost-of-5-months-of-nepal-lockdown/" target="_blank" rel="noopener noreferrer">economic cost of five months of Nepal lockdown</a>, and the lack of treatment of existing diseases threaten to far outweigh benefits of the restrictions.Recently, the Nepal Health Research Council decided to allow international researchers to conduct <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/">Covid-19 vaccine</a>trials in Nepal as part of a global effort to stop the virus. There are at least 30 vaccines in clinical trials across India.Says Sameer Mani Dixit: “It looks like we are very close to peaking in Nepal, which is not to say there won’t be sporadic spikes, it will continue to happen until we have a vaccine. But in the meantime mandatorily wearing masks and not crowding will be the way of life into the future.”

Sonia Awale

As India peaks, Covid-19 spreads rapidly in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6a99c7e80680e073737jpeg.jpg" alt="" width="1365" height="2048"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>When Lalbahadur Shah of Birganj died last week, none of his relatives showed up for his funeral even though he tested negative for Covid-19. With no family, friends and neighbours attending, the Muslim community members took it upon themselves to perform his final rites as per the Hindu faith.Shah had hypertension and diabetes, although he had tested positive for <a href="https://www.nepalitimes.com/latest/dont-take-covid-19-lightly/" target="_blank" rel="noopener noreferrer">SARS-CoV-2</a>, he had recovered from the infection. He succumbed to other health complications.Across Nepal, people infected with the virus, even those who have recovered, have been <a href="https://www.nepalitimes.com/here-now/covid-19-sharpens-caste-discrimination-in-nepal/" target="_blank" rel="noopener noreferrer">shunned by neighbours and society</a>. Migrant returnees and their families have been singled out and humiliated. Doctors and health workers have been harassed by landlords.This is nothing new in Nepal. Tuberculosis and leprosy patients have been traditionally shunned. And the stigma associated with Covid-19 is very reminiscent of <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/stigma-ostracisation-for-HIV-patients-remain-in-western-nepal,1724" target="_blank" rel="noopener noreferrer">how people with HIV/AIDS used to be treated in Nepal</a> in the past, and may have lessons for dealing with SARS-CoV-2, since the virus (like HIV) is here to stay.“Physical distancing doesn’t mean discrimination and we should make people understand this,” says public health expert Aruna Uprety. “There is widespread panic about Covid-19 and this is turning people against those infected with it, exactly like it was with HIV/AIDS. This in turn is adding to the mental stress of the patients, undermining their recovery.”Says Anjana Rajbhandary, a counsellor and columnist: "Social stigma is attached to lack of knowledge and when people know less, they feel the need to blame someone else because they are afraid of the unknown. Fear and anxiety about death and disease can lead to gossip, which results in stereotyping and discrimination."Constant focus in the mass media on new infections and <a href="https://www.nepalitimes.com/latest/nepal-covid-19-deaths-cross-100/" target="_blank" rel="noopener noreferrer">fatalities</a> over those who have recovered has reinforced the misconception that Covid-19 is highly lethal, adding to the fear about it.On Tuesday, Nepal reported a total of 1,016 new cases, its highest daily rise with 205 in Kathmandu Valley alone, forcing the local governments in Kathmandu, Lalitpur and Bhaktapur <a href="https://www.nepalitimes.com/banner/kathmandu-valley-back-to-lockdown/" target="_blank" rel="noopener noreferrer">to reimpose lockdown for a week</a> starting Wednesday midnight. So far, 17,580 people have recovered while 114 have passed away.The number of new infections was down to 671 on Wednesday, 151 of them in Kathmandu Valley.The similarities between HIV/AIDS and Covid-19 goes beyond <a href="https://archive.nepalitimes.com/news.php?id=19019" target="_blank" rel="noopener noreferrer">stigma</a>. Just like HIV/AIDS  spread like wildfire in western Nepal among families with husbands working in India, most of the Covid-19 cases were imported from India and spread among the poorest sections of Nepal’s most underserved region. And just like with HIV, Covid-19 is felling people with compromised immune systems.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6ad9c7e80680e073738jpeg.jpg" alt="" width="300" height="400"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6ae9c7e80680e073739jpeg.jpg" alt="" width="300" height="400"><figcaption> </figcaption></figure>Long-time HIV/AIDS activist Rajiv Kafle also sees parallels between the current Covid-19 crisis and the HIV epidemic of the 1990s in <a href="https://archive.nepalitimes.com/article/nation/ending-AIDS-in-Nepal,2707" target="_blank" rel="noopener noreferrer">turning public awareness into behavioural change for prevention</a>  Both diseases are caused by viral infections and attack the immune-compromised – only the method of transmission is different. While HIV is spread through unprotected sex, sharing needles or blood transfusions, SARS-CoV-2 spreads human-to-human through aerosol particles.“As with HIV, I see a lot of denial about coronavirus. Back in the day, peer-pressure led people to partake in highly risky behaviour like sharing syringes. Peer-pressure today can be seen in the form of people pulling down their masks in presence of friends,” says Kafle.Mass media was a crucial tool in the battle against HIV/AIDS in the days before social media. In particular, tv serials and docudramas featuring popular faces like comedian duo Madan Krishna Shrestha and Hari Bansa Acharya were highly effective in creating awareness about preventive measures such as safe sex and clean needles as well as in lessening the stigma for some 50,000 people living with HIV in Nepal.Nearly 30 years later, Shrestha and Acharya are once more doing skits for public service announcements via social media and tv to <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">spread awareness about Covid-19 preventive measures</a>. The message is similar: while it was condoms and safe needles for HIV/AIDs, it is masks and distancing for Covid-19.“If we were able to change peoples’ behaviour in something as sensitive as sex, then we should be able to do it much more effectively for Covid-19,” says Rita Thapa of Nepal Public Health Foundation, who was formerly with the WHO. “We still have time to work together with local authorities, civil society and the government to run mass awareness campaign that reaches down to the grassroots.”Since this August, the government has started providing free TLD (once-a-day generic fixed-dose combination of tenofovir disoproxil fumarate, lamivudine, and dolutegravir), new antiretroviral drug considered the best regimen in the world for 17,000 people living with HIV in Nepal. Activists like Kafle credit this milestone to treatment literacy, community mobilisation and continued activism.“Only a similar kind of dedication will guarantee accountability and transparency in terms of testing and treating coronavirus in Nepal when the vaccine and therapies aren’t available,” he adds.Aruna Uprety recalls a recent field visit to Makwanpur district where she found Chepang nomads living without toilets or clean drinking water, who were not <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">wearing masks</a> and maintaining distance.“It is now pretty clear we will have to learn to live with Covid-19 just as we did with HIV. What would help is strengthening our immune system to fight against the infection, be it by applying traditional medicinal or by eating nutritious indigenous food,” says Uprety. “But to prevent infection for now our first line of defence are masks, distancing and hand-washing.”

Learning from HIV to fight Covid-19 in Nepal

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b796c9c7e80680e064700jpeg.jpg" alt="" width="335" height="490"/>Nepal has had three months of lead time to study the <a href="https://www.nepalitimes.com/latest/wait-and-watch/" target="_blank" rel="noopener">coronavirus pandemic</a> and behaviours that have been associated with flattening the curve of the COVID-19 infection. Every cultural circumstance has the potential to contribute a different solution, and we should attempt to link our own common practices with the pandemic to come up with <a href="https://www.nepalitimes.com/latest/all-nepal-flights-cancelled-22-31-march/" target="_blank" rel="noopener">novel ways of dealing</a> with it.One such behaviour could the Nepali habit of blowing the nose hard (seee-seee!) and the deep, loud, clearing the throat (haak-thoo!).The <a href="https://www.nepalitimes.com/opinion/global-thinking-and-local-action-on-coronavirus/" target="_blank" rel="noopener">COVID-19</a> spreads through droplets transmitted though the air from sneezing and coughing. If two people have not maintained social distancing, virus particles from an infected person may land on an uninfected companion and enter the latter’s body through her eyes, nose, or mouth. The particles then travel to the back of the nasal passages and to the mucus membrane at the back of the throat.The spiked protein of the <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">coronavirus</a> particles hook on to cell membranes at the back of the throat, and it is here that the virus’s genetic material enters the cells of the human body, resulting in infection. The symptoms of dry cough and sore throat start with this. The genetic material of the virus then uses the cells as the virus’s carriers and multipliers and starts to move down the bronchial tubes towards the lungs, where it does the most damage.If <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener">coronavirus</a> particles travel to the back of the nasal passage and the back of the throat to infect the individual in question, could it be that the loud Nepali habit of blowing the nose hard and clearing the throat can contribute to reducing the numbers of infected?If this is indeed the case, all that blowing and spitting must be done in an appropriate place. Doing it in public and where others are present risks spreading the virus even more widely.Given that the coronavirus resides at the back of the nose and throat before making its way to the lungs, could it be that our first line of defense – if we should get the virus – would be to wash our faces, including our eyes, and to blow our noses and clear our throats?We should <a href="https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/" target="_blank" rel="noopener">wash our hands several times a day</a>  as we have been instructed. Our hands can transfer the virus from one place to another. They can infect us if they bring the virus in contact with our own eyes, nose, or mouth, and if we are infected, they can pass the virus on by bringing the virus into contact with things that others will touch.But if the virus has in fact already found its way on to our bodies, then we will want to get it off of our bodies, and perhaps washing our faces and ejecting it from our noses and mouths – as so many Nepalis do – is the way.Once again, it is critical that we never spit or blow our noses in public places. Avoiding this restricts the spread not only of coronavirus but of major killers that have been around for much longer, such as <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>  If we must blow our noses or clear our throats in public, we should blow our noses into a handkerchief which we later wash, and we must swallow our saliva. If swallowed, the virus particles would be killed by the juices in the digestive tract.Perhaps, in addition to frequent hand-washing, we should wash our faces, blow our noses and cough out several times a day as part of an anti-coronavirus regimen.Shanta Basnet has a PhD in public health from Columbia University.

Keeping nose and throat clean

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