<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111136/636b83649c7e80680e067732jpeg.jpg" alt="" width="3563" height="2375"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Only a month ago, even prominent doctors in India were declaring that the country had defeated the <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1620014851520000&amp;usg=AFQjCNH26pr4ATCusVi4rW_jCSccSqOyNw">novel coronavirus. </a>They felt that herd immunity in cities like Delhi would protect people from infection and death. Based on a few dubious studies, they conceded that a large proportion of Indians had acquired herd immunity through mild or asymptomatic Covid-19 infections.Just like the theory that a lifetime exposure to germs would protect South Asians, herd immunity also turned out not to be true.Here in Nepal we are seeing a surge that is proportionately similar to India. The exponential rise in the number of cases, infection of younger cohorts, and the severity of the disease, bear all the hallmarks of the contagion sweeping across India.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111136/636b83679c7e80680e067733jpeg.jpg" alt="" width="1390" height="584"><figcaption> </figcaption></figure>While we try to treat the sick by increasing hospital space and ensuring oxygen supply, we must also plan for an <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNGreS-S3470fwa9xi8chTwsApsL8Q">exit strategy</a> that entails acquiring more effective herd immunity through mass vaccination, and partial lockdowns enforced with all <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNEgv4bMUglLS5mZDf0VcnTA8rrcwA">precautionary measures</a>.<a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNFOLiROFJhRqoWS8Lm4Rrizbt_w7w">Over-preparation rather than under-preparedness </a>needs to be our mantra. Widespread vaccination is the key to get us out of this pandemic, and we have lost precious time with the delays.This means our <a href="https://www.nepalitimes.com/latest/nepal-braces-for-new-wave-with-vaccine-drive/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-braces-for-new-wave-with-vaccine-drive/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNH7Un17CIezo7XVehWgZr4IVThqzQ">vaccine diplomacy</a> has to go into top gear. If <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/jabs-and-jab-nots/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNEHISgu64T2PwpgpRFk_IklnxurbA">Covishield from India</a> is not available, we must lobby for as many dosages of vaccines from <a href="https://www.nepalitimes.com/latest/the-gift-of-the-jab/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/the-gift-of-the-jab/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNFYyDtUVRKNT2a92xdtV6IBpGmKNQ">Chin</a>a, <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNGsbwsSUqjInkvevMv3Ycj6ryTa8w">Russia</a>, or the United States, and administer them urgently.All of these vaccines are in general at least 50% effective (the ‘pass mark’ for vaccine efficacy). None of the inoculations appear to have serious adverse effects, even though there are questions about whether they provide enough protection from the new strains, and duration of immunity.We are trying to immunise the population from SARS-CoV-2, which happens to be a wily killer that exploits the human need for social interaction and mobility. Analysing this sudden and rapid spread of the virus in the Subcontinent, it looks like South Asians are more vulnerable because of <a style="letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/nepals-virus-vortex/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepals-virus-vortex/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNFClAleG43b0LxtmN6SUTtqq0wUeA">our co-morbidities.</a>South Asians are known to be genetically more susceptible to diabetes and cardio-vascular diseases. The diet and lifestyle of people in the 40-70 age group increases the risk factor for obesity, diabetes and hypertension. Not unsurprisingly, the death toll due to Covid-19 is higher in this age cohort among South Asias than in Europe or the Americas.The other reason for the infection suddenly taking off again in our part of the world is that we let our guard down, attending festivals, religious ceremonies and political rallies.And then there is the presence in Nepal of both the UK variant of the virus ( B.1.1.7) and the B.1.617 (Indian variant) both of which are at least 20% more transmissible. The good news (at least so far) is that these variants may not be any more lethal than the standard virus. But even if they are not, we desperately need to stop transmission.And since this is a respiratory virus, the most effective way to do that is still to wear a mask, avoid crowds and use hand sanitiser.In a pandemic of this scale, the general public also needs to know what treatment works and does not. Oxygen, if available, is definitely helpful since it is a drop in oxygen level in the blood that leads to serious complications.A drug called dexamethasone saves lives, it is easily available and cheap. Tocilizumab, unavailable in Nepal, and expensive, can also be used to treat severely ill patients and should only be administered by a physician. There are web <a href="https://www.indiacovidsos.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.indiacovidsos.org/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNG9m03344ZEP5kR4-D9sw3xAz7ZjQ">links</a> with pragmatic tips that may come in handy if a hospital bed is not available, as we are now seeing in India and Nepal.There is a lot of fake news about the effectivity of treatment drugs. The following commonly used drugs for well-known illnesses do not work against Covid-19 although, even today, many are rampantly and unnecessarily prescribed in South Asia: Azithromycin, ivermectin, choloroquin, colchicine, convalescent plasma, vitamin D, zinc, lopinavir-ritonavir, favipiravir, and doxycycline.Even remdesivir, the drug that many desperate families try to acquire for their hospitalised relatives, does not save lives even though it is known to reduce hospital stay.Many of these drugs were studied for their efficacy by carrying out large randomised controlled trials by the biggest, adaptive Covid-19 tests undertaken by Oxford University’s <a href="https://www.recoverytrial.net/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.recoverytrial.net/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNFWVQpxuWW8Bb9WDrI4MR584LIUww">Recovery Trial</a>.The Nepal Health Research Council was the first country set-up outside the UK that recently started collaboration with Recovery Trial as part of a global effort to in order to help find a treatment drug against Covid-19.This tragedy has exposed the inadequacy and inequity in the health care system of Nepal and South Asia. The dominant method of health care delivery in the region, especially for curative services, are private enterprises that follow the corporate health care model patterned after the United States.Nepal has also increasingly gravitated towards this system of health care, with many new private hospitals all over the country. The pandemic will force us to question this model, and ask if alternatives like the UK National Health Service would be more suitable.Despite the vested interests behind the <a href="https://www.nepalitimes.com/here-now/kcs-fast-highlights-nepals-covid-19-failure/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/kcs-fast-highlights-nepals-covid-19-failure/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNGPAmj-NNRDt3JI_--ydl8p8gFc_A">medical-industrial complex</a> in Nepal, we need to plan for <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNGNZppXCvCMgFPm4GVAEVi5e8MJRg">universal health care (UHC)</a>, and even consider universal basic income (UBI), if we are going to improve health care to the vast majority of Nepali people.Even President Joe Biden is trying to reform US health care with a stimulus package that has clear aspects of UBI. We need to look at a combination of UHC and UBI in Nepal because even if we survive this pandemic, there is certain to be another one sooner or later.The international media has only taken notice of the second wave in Nepal after reports of infections at <a href="https://www.nepalitimes.com/banner/mt-everest-city/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mt-everest-city/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNEXmV4I4K_YnFSjorLfpqWrs5_c0g">Mt Everest Base Camp</a> last week. But it is reassuring to know that even up there at 5,364m, Nepali specialists are doing their best to follow protocols to deal with suspected Covid-19 among climbers and support staff.This work is critical because the ubiquitous ‘Khumbu cough’ and even the life-threatening high altitude pulmonary edema (<a href="https://www.nepalitimes.com/latest/high-alert/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/high-alert/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNHi0ktDBncK6SypHGzDbi44cBgObw">HAPE</a>) simulate the symptoms of Covid-19, and it can be difficult to tell them apart.Buddha Basnyat, MD, is a clinical researcher at the Patan Academy of Health Sciences and an <a href="https://www.nepalitimes.com/latest/sherpa-genes-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/sherpa-genes-for-covid-19-treatment/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNEJKfShTwfhNqAdP0GvlMmh5-IMfQ">expert in high altitude medicine</a>. He is also a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1620014851521000&amp;usg=AFQjCNF_WOWRO49qKaxdIzZ6QpXh6cnQpA">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

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How Nepal can survive 2nd Covid wave

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121152/636ce6409c7e80680e096759jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: RSS</figcaption></figure>The <a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/" target="_blank" rel="noopener noreferrer">Covid-19 vaccines</a> developed by AstraZeneca, Moderna, and Pfizer–BioNTech, and others are proving effective in preventing ‘symptomatic’ disease, but it is still uncertain how well they protect people from becoming infected, or from spreading the virus to others.A small percentage of people who are fully vaccinated are still getting <a href="https://www.nepalitimes.com/latest/first-signs-of-the-second-wave/" target="_blank" rel="noopener noreferrer">Covid-19</a> if they are exposed to the virus that causes it. These are called ‘vaccine breakthrough’ cases. This means that while people who have been vaccinated are much less likely to get sick, it may still happen. Research is on-going about how common these cases are.In the United States, a country with the most vaccinated people, the Centre for Disease Control (CDC) on 15 April reported that it has identified close to 5,800 confirmed cases of Covid-19 among the fully vaccinated people. Of those infected, 396 (7%) required hospital admission and 74 (1%) died.It is important to note that asymptomatic breakthrough cases may not be reported, since routine testing may not be done among those already vaccinated. Deaths among the vaccinated population in the US as of mid-April is 0.008 percent of the total inoculated population. This is an extremely low number.The bottom line here is that vaccines work very well against the most dominant variants in the US, but such benefits are reduced with less common variants. In a cohort of 417 persons in Rockefeller University Hospital, who had received the second dose of BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) vaccine at least two weeks previously, two women with vaccine breakthrough infection were identified.In a study in Israel, 170 SARS-CoV-2 infections among health care workers between 19 December, 2020 and Jan 24, 2021, 58% reported symptoms and were designated as Covid-19 cases. Of the 170 HCWs who were infected, 52% were unvaccinated, 46% tested positive after the first dose, and 2% tested positive after the second dose.This suggests that though the risk of infection remains a small percentage of the vaccinated population, it is significantly reduced two weeks after the final dose. Even among vaccinated people who test positive, there is evidence that severity and fatality are rare.What is happening in India <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">will have direct impact on us in Nepal</a>. There, the emergence of the term double mutant coincided with a massive increase of Covid-19 cases and deaths in India. It is not proven, but there is a broad consensus that these <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/" target="_blank" rel="noopener noreferrer">new mutations are more contagious</a>, and likely cause more severe symptoms. But the most important question is whether the mutant or other unknown mutants in India are able to evade vaccine immunity.The answer is: we do not know. The Indian Council of Medical Research (ICMR) has data that shows 4,208 people who had taken the first dose of the Bharat Biotech Covaxin  tested positive for coronavirus—this 0.04% of the 9,356,436 people vaccinated.This is a clever way of presenting data as all those who are vaccinated do not have the same level of exposure. That is why there needs to be a comparison group which there is not. The ICCMR also reports that 100,302,745 people in India have received the first dose of <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">the Covishield vaccine</a>  and 17,145 have tested positive after that, which is 0.02%. That does not mean taking only one dose is better than taking two doses. Based on this data the percentage of positive cases among those who have received one dose is lower than those who have received both.There have been reports in the Indian media that 10% of the new hospitalisations there is among those who have received at least one dose of a vaccine. Being so close to India, and with many people going <a href="https://www.nepalitimes.com/latest/nepal-braces-for-its-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">back and forth across the open border</a>, the vaccinated population in Nepal must take precautions: maintain distance, avoid crowds and wear a mask when out for at least a month or two.Meanwhile, AstraZeneca has sent the Serum Institute India a legal notice over delays in the vaccine supply and has threatened to cancel its production agreement. Serum Institute is planning to declare that it will not be able to meet its obligation to supply Covishield due to domestic demand.This has resulted in delays in delivery to all major countries, including Nepal which was planning to extend its <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">Covishield vaccination drive</a> through direct purchase and under the COVAX initiative.India is starting to vaccinate every one above 18 from 1 May. Currently, the Serum Institute is producing about 2 million doses a day and is likely to take a year or more just to meet Indian demand.All this means that those have been vaccinated should consider themselves extremely lucky. There will not be many (or any) vaccines available when the second wave peaks in Nepal.Data so far is actually quite encouraging about the protection that vaccines give, and the time will soon come when a sense of normalcy will return--being able to sit around and have coffee with vaccinated friends or family two weeks after the second dose.Masks, however, are going to be part of our lives for many years to come, as reaching a herd-immunity threshold is looking quite unlikely because of vaccine hesitancy, the emergence of new variants, and the delayed arrival of vaccines for children.Sushil Koirala is a public health expert with 23 years of international experience with USAID, UNDP, the Global Fund, and has worked as a technical adviser to the Nepal Ministry of Health.

Masks and vaccines to stop Nepal’s 2nd wave

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

Staying safe in 2021 and beyond

<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 src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8c4d9c7e80680e06b2efjpeg.jpg" alt="" width="4096" height="2730"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>With no proven <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNFhARSUb8HMQP_ZJgsaTmPoQDLWvA">cure or vaccine available yet for COVID-19</a>, various treatments with no proven benefits and potential deadly side-effects are being tried out on patients.One example of a desperate treatment measure is a New York City doctor carelessly declaring on primetime tv recently that COVID-19 pneumonia was similar to <a href="https://www.nepalitimes.com/latest/high-alert/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/high-alert/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGuDq-Ti_uWGlw-rY-q1PpyQQO54g">high altitude pulmonary edema (HAPE)</a>, and he recommended high altitude drugs like Diamox for the treatment of Covid-19.Trekkers in Nepal are familiar with <a href="http://archive.nepalitimes.com/news.php?id=19693#.Xp-oJy8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D19693%23.Xp-oJy8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGSLnJg3LMR2gIcZz9LMdKOvruqJA">Diamox</a>, a pill they take to acclimatise better when hiking at higher altitudes. There is no scientific basis that the drug will work, but this idea of very low oxygen (hypoxia) and pneumonia in both afflictions was appealing.To counter this some of us in Nepal and other countries have a forthcoming Opinion in the British Medical Journalcautioning against this rash treatment strategy using high altitude medicines. In medicine, doctors have to remember the maxim, Primum non nocere (‘above all do no harm’).But there are some silver linings <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGtTkAInA3D5xIkzd65kTSfDvYESg">if Nepal escapes the worst of COVID-19</a>. <a href="https://www.nepalitimes.com/banner/tb/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/tb/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGbOqrkOzN3uP_va7u0F-uhlxipaQ">Tuberculosis</a> rates, which are very high in South Asia (more than 400 per 100,000) could go down if people continue to use the masks since it will also mean that a tuberculosis patient will not spread the bacteria, not to mention other respiratory infections.Similarly, as more people get into the habit of washing hands with soap and water where available, the rates of diseases like typhoid and hepatitis A and E, caused by fecal oral transmission, will certainly be reduced.An average of <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNHn0HGje-Tq3pDeekYbQAbhZxJOwg">230 people used to be killed every month</a> on Nepal’s highways and streets. The lockdown has now lasted a month, and that is approximately the number of lives saved due to vehicles being off the roads.The importance of public health for both the rich and poor countries has been highlighted by the pandemic. Industrialised countries had thought they had been done with infectious diseases, except perhaps the odd HIV patient. This pandemic has given great pause to that argument. Developing countries which having tried to come to grips with pre-existing epidemics have used lessons learnt in dealing with coronavirus in prevention.The Indian state of Kerala for example, has done relatively better in dealing with COVID-19 partly because it utilised prior lessons from the Nipah outbreak a year ago. Other South Asian countries with robust public health infrastructure like Sri Lanka also have a better handle on the disease.They strengthened their public health system, and it has paid rich dividends. South Korea too had an outbreak of MERS Coronavirus in 2015 which was brought by a South Korean returning from Kuwait, but they were able to effectively control the spread, and have been dealing successfully (so far) with the novel coronavirus. Singapore had been doing well, but discovered last week that it had a blind spot in the migrant workers’ dormitories. It has now announced a ‘circuit breaker’ lockdown till 1 June.South Asian countries have had more time in preparing for the contagion, while they wait for a vaccine or drugs to treat COVID-19. Treatment trials are happening all over the world even as the patients and doctors await with bated breath (pardon the pun). In all likelihood, we will soon know if chloroquin works or not before we have a vaccine.Vaccines will be a game-changer against Covid-19, and competition is heating up because whoever makes this vaccine first will be the knight-in-shining armour. China, USA, UK are probably a few of the countries engaged in developing a vaccine, and among them are researchers at Oxford University Clinical Research Unit who <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNHKJgZ_d-vQIhZ5sdehQmMT7iWvHQ">collaborated closely with Patan Academy of Health Science</a> in a recent successful typhoid vaccine study.This Oxford University group lead by Professors Sarah Gilbert and Andrew Pollard are optimistic about producing a million doses of the vaccine by autumn. The vaccine will be eventually required not in the millions, but in billions of dosages. It also has to be affordable for countries like ours.For making vaccines promptly for neglected tropical illnesses, it is hard to beat the Chinese. When <a href="http://archive.nepalitimes.com/news.php?id=19220#.Xp-nMS8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D19220%23.Xp-nMS8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNEw-YGKhD3XomMEP736r5ileoWJ3g">Japanese Encephalitis (JE)</a> was raging in China and South Asia, it was the Chinese who tested, developed and made available the ‘Chengdu vaccine’ that revolutionised the prevention of the mosquito-borne disease. The earlier vaccine was expensive and only tourists in Nepal could afford it.Similarly, when <a href="http://archive.nepalitimes.com/news.php?id=18079#.Xp-m3S8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D18079%23.Xp-m3S8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNEndZvjwlu6D0uMBXFMGO9OgvSoXg">hepatitis E</a> was a scourge in China, the Xiamen Innovax Biotech came up with a vaccine in 2012 to protect vulnerable populations. Because there is no other commercial vaccine available against hepatitis E, it will be valuable in South Asia if the virus is rampant again and affect pregnant women with a fatal outcome.Nepal clearly needs to have a strong public health infrastructure in collaboration with a prestigious institute abroad to be able to tackle COVID-19 and other infections. Just like earthquakes, there will be more pandemics in future. Humanity needs to up its game in the control of emergent infectious diseases, and Nepal can make a small contribution by helping itself, especially by strengthening public health.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNFhARSUb8HMQP_ZJgsaTmPoQDLWvA">frequent health columnist</a> for Nepali Times.Prevention while searching for a cur

Prevention while searching for a cure

Nepal showed inconsistent performance at the T20 World Cup 2026 in Mumbai with flashes of brilliance, but ultimately snatched defeat from the jaws of victory. The <a href="https://nepalitimes.com/news/rhinos-hit-the-ground-running">near-win against England</a>, a test cricket team by an associate country, in the opening game showed promise and suggested that Nepal’s cricket was on the cusp of glory. The Nepal Premier League and a flawless performance in the qualifiers had raised hopes that perhaps the Rhinos could progress out of the group stage. However, subsequent losses against newcomers Italy and the West Indies were harsh reality checks about the true state of the game: there is a lot of catching up to do in the present, and structural changes to put in place to win big in the future. Head Coach Stuart Law summed it all up quite harshly: “To go from that high to then go to an extreme low four days later, that’s not showing mental toughness.” He was worried about the distraction of social media and lack of focus among players: “When you’re in cricket, do your cricket. It’s a difficult one for me because I’m a social media dinosaur, I don’t understand it. You don’t have to keep showing your face if we’re winning games.” Finally a late-night win against Scotland on Tuesday redeemed some of Nepal’s pride. A strong opening partnership, yet another rugged Dipendra Singh Airee innings and Sompal Kami’s vindictive 3 for 25 helped Nepal beat Scotland in their last group game at the T20 World Cup.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_6ca369f6aefc8b653c2572467f050e96b029c96b71fed5fb4213898c7d469325.jpg" data-media-id="editor_1" data-image-id="20260218010220_6ca369f6aefc8b653c2572467f050e96b029c96b71fed5fb4213898c7d469325" data-rendition-name="original" width="1366" height="2048" loading="lazy" alt="T20 World Cup Nepal"></figure>  There was nothing riding on the game but honour, it means at least that Nepal do not crash out on zero. The game ebbed and flowed. Scotland started well and looked set to score 200 before collapsing in the end at 170. The Nepal batting effort also started out well, but in the middle overs after some wickets had fallen, it looked like the team was whimpering out again. Boundaries dried up, the run rate creeped up to almost 13, before Airee and Jha woke up and took charge and got to 171 with a few balls to spare. The dhaka topi crowd in the stands loved it. A big part of the reason Nepal’s performance was so much better against England than in the other games was the mentality going in. Against England, Nepal were clear underdogs and could play freely. Even a nasty defeat would have been forgiven. Against newcomers Italy, these roles were flipped. Fans and perhaps the players underestimated Italy, a nation much better known for its football culture. But it had put together a smart, experienced team made up of Italian cricketers with South African, Australian, English, Indian, Pakistani and Sri Lankan heritage. And Nepal may have won a series against West Indies last year, but against the full strength Caribbean squad they were easily beaten.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_dc27adaa2102b493f940a97f9572769e695c2c1c41c8558fc4c23657cc1c3261.jpg" data-media-id="editor_2" data-image-id="20260218010220_dc27adaa2102b493f940a97f9572769e695c2c1c41c8558fc4c23657cc1c3261" data-rendition-name="original" width="2048" height="1366" loading="lazy" alt="T20 World Cup Nepal"></figure>  Another key difference is that Nepal was batting second against England. Against Italy and the West Indies, having to set a target rather than chase it, there was miserable batting failure. The front of the order — openers Kushal Bhurtel and Aasif Sheikh, captain Rohit Poudel — did not pace themselves well. They started much too slow, not able to take advantage of the first six powerplay overs. Airee’s 58 and Sompal Kami’s 26 off 11 against the West Indies were the only innings of any note. The middle order of Bam, Jha, Aarif Sheikh was not much better. Nepal really struggled with the ball too in that game, taking the one wicket against the West Indies and none against Italy. Of course, it is a huge ask of your bowling attack to defend anything below 150 in the modern T20 game. There were questionable tactical choices. Early wickets are essential when defending a low score. But key wicket taker Sandeep Lamichhane was not brought on until the middle overs, when the opponents had made too many runs to feel any fear. So they took him on and he had a really poor tournament, going for a lot of runs.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_b0301b854ddf235e1bcb84e8ed58060a68c8f3f13d3bb5a7596e1f51184e0d03.jpg" data-media-id="editor_3" data-image-id="20260218010220_b0301b854ddf235e1bcb84e8ed58060a68c8f3f13d3bb5a7596e1f51184e0d03" data-rendition-name="original" width="1366" height="2048" loading="lazy" alt="T20 World Cup Nepal"></figure>  To captain Poudel’s credit, he acknowledged the bad showing against Italy: “It was not a 123 all-out wicket. We are professionals and not turning up for the game was disappointing.” Coach Law thinks that Nepal is going to get to the next step. If the team is ambitious, and hopes to compete at the elite level, then it cannot celebrate a loss against England. If it wants to win consistently, it has to shed the ‘Cardiac Kids’ nickname. It is better to win than to be fun to watch but lose. The T20 game is so brisk and so it is often won in the margins. Good catching and fielding can create momentum and save a team the 5, 10 runs that win the game. Nepal were uncharacteristically poor in the field against Italy and West Indies, often fumbling and leaking boundaries. Airee didn’t get any of his usual run-outs either. Nepal lost cheap wickets through run-outs and stumpings. All these unforced errors right through the match add up on the scoreboard.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_1630c283f277631dfbddd3d7f29b930b124bde97c8f6a411cc2e1d089e452f45.jpg" data-media-id="editor_4" data-image-id="20260218010220_1630c283f277631dfbddd3d7f29b930b124bde97c8f6a411cc2e1d089e452f45" data-rendition-name="original" width="1366" height="2048" loading="lazy" alt="T20 World Cup Nepal"></figure>  SKILL SET Mentality is important but sport performance ultimately comes down to skill. There looked to be a large gap, and perhaps one of the reasons is because the Nepal team is so full of all-rounders. Airee’s two-way performance is undeniable, but Bhurtel, Paudel and Karan KC do plenty of both too and they do not do it super well very often. If the team wants to get consistent, it must have consistent performers with the bat and ball. That calls for some of these players to focus completely on one skill over the other. You do not see openers bowling so much in the top teams as Bhurtel does. The main reason for this skill gap, and one of the hardest parts about being an associate nation, is how little cricket the members of the team play compared to the test nations. Said Stuart Law: “The longer format is where you learn how to play the game. The shorter formats are where you have your fun. We need some sort of multi-day games.”  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_652ef3ba6fceab394a94c18cabd322dca8ba4a1266557660064339de9169c91d.jpg" data-media-id="editor_5" data-image-id="20260218010220_652ef3ba6fceab394a94c18cabd322dca8ba4a1266557660064339de9169c91d" data-rendition-name="original" width="2048" height="1366" loading="lazy" alt="T20 World Cup Nepal"></figure>  The contrast in experience showed during the Italy game. Most of the members of the Italy team were well into their thirties, had played a high volume of domestic cricket and were more self-assured. So, while the young Nepali team were more athletic, they seemed to lack the skill and experience to know what to do when things were going wrong. The Italians seemed to go about their game with a lot more self assurance. In the long run, this means setting up grassroot structures, getting kids into formal training when young, and setting up a longer format domestic league. In the short term, CAAN could organise frequent series with other associate nations, and individual athletes could go play long form club cricket abroad. Surely some team in the world has to have a spot for a player like Airee, for example. It has been Airee’s tournament. Scores of 44 v England, 58 v West Indies, and now a match-winning 50 against Scotland that gives the travelling Nepali support something to cheer for. The tournament could have been a lot more, but it is wholesome to end on a win.

Nepal goes in and out of T20

After his critically acclaimed 2023 book of essays सुन्यताको मुल्य on the state of women and children in the <a href="https://nepalitimes.com/banner/the-karnali">Karnali</a>, paediatrician and writer Nawaraj KC has come out with a next one, Swasparsh. The new book is almost a sequel to the first one, with real-life stories drawn from his medical practice and social engagement. Both are powerful accounts of suffering, resilience, and the search for human dignity in Nepal’s most remote and underserved districts. The book opens with deeply disturbing yet real incidents of the suicide of a Grade 2 student. A &nbsp;frantic mother rushes in with a son who had already written a suicide note but was saved at the last moment. There is a desperate call from a young woman threatening to jump into the Karnali River.&nbsp; We meet children carrying immense trauma: a toddler who refuses to eat after losing her mother, and another child who stops speaking after experiencing sexual abuse within the family. The emotional climax comes when KC himself falls into depression after being violently attacked by a drug addict patient, leaving him with a serious head injury.&nbsp; But this is not a book of only sad stories of deprivation and poverty. It is how people who find themselves in the worst circumstances struggle to overcome what life has thrown their way, and triumph in the end. By just surviving against all odds, people emerge stronger, often with a renewed commitment to helping others. As a paediatrician working out of his native Surkhet in Karnali Province, KC's work brings him face-to-face with the human side of what a centralised government’s neglect and apathy can do to communities in <a href="https://nepalitimes.com/banner/no-dasain-in-kalikot">Nepal’s most far-flung region</a>. KC shows empathy not just to human beings in trouble, but also animals and underlines the importance of coexisting with the natural world. By helping others individuals ultimately help themselves. Although a paediatrician by profession, KC demonstrates a deep understanding of structural oppression, gender discrimination, caste hierarchy, class inequality, and regional marginalisation within the Nepali state.&nbsp; He also captures moments of tenderness, such as young couples supporting one another through hardship. How poverty can drive families to take heartbreaking decisions — like a patient forced to discontinue life-saving medicine in order to qualify for disability allowances needed to repay debt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260217030252_ffd67815063cffe51a0310f10405a554f6094ba05564993f34086fe4b31543f6.jpg" data-media-id="editor_2" data-image-id="20260217030252_ffd67815063cffe51a0310f10405a554f6094ba05564993f34086fe4b31543f6" data-rendition-name="original" width="1646" height="2048" loading="lazy" alt="Swasparsha"> </figure>  A former teacher is forced to beg despite receiving treatment, exposing the failure of conventional development models that ignore sustainable livelihoods.&nbsp; Then there are inspirational stories like the one of Mandire, who ran away at age 12 to work as a labourer in India, suffered severe burns while unloading coal, and lost a hand. Despite this, his infectious smile and fortitude transformed him into a local symbol of hope both in India and Nepal.&nbsp; Even in old age, he is always smiling and helping others less fortunate.&nbsp; Through Mandire’s story, KC explores the science of the healing power of a smile, the positive psychology of a ‘mental gymnasium’ in which optimism is cultivated through conscious practice.&nbsp; For example, a young girl from the historically marginalised Badi community which faces deep social exclusion refuses to accept her circumstances, and grows into an advocate for other disadvantaged children. A devoted foster mother dedicates her life to raising orphans, empowering them despite her own hardships. One of the book’s strengths lies in its accessibility. In Nepali language, KC blends science, philosophy, and lived experience into everyday language that resonates with villagers and ordinary readers. He comes across not only as a doctor and healer, but also as a teacher, nature lover, and social activist. He tries to introduce greenery to a remote school, and how this transformed children’s learning experience. He reflects that his patients are his greatest teachers helping to expand knowledge beyond medicine and technology into the realms of humanity and ethics. I read Swasparsh after witnessing the recent GenZ movement. The book’s recurring calls to youth, appearing at the end of several chapters, has special relevance today. KC reminds young readers that hardship is part of everyday life, but within struggle lies the potential for healing and growth.&nbsp; He encourages self-reflection, self-healing, and cultivating a positive mindset. Above all, he asserts that humanity’s greatest gift is its own human capacity henceforth solutions to all problems lie within oneselves rather than outside forces. The GenZ movement represents an urban youth revolt against traditional political parties and state institutions that have failed to deliver opportunities and accountability. Rising unemployment, widespread corruption, and frustration with stagnant governance have fuelled demands for new political alternatives.&nbsp; With the 5 March election less than three weeks away, many young people hope that new forces will be capable of bringing systemic change. Yet whether these forces can truly meet their aspirations remains uncertain. Established political actors are reluctant to relinquish power, while emerging groups often lack organisational depth and historical experience. In many ways, these new political actors resemble the people of Karnali: resource-poor, And in the periphery of power, yet rich in commitment and determination. Drawing from Buddhist teachings that recognise suffering, understanding its causes, and seeking pathways to overcome it, KC indirectly inspires today’s youth. Every problem contains the seeds of its own solution, provided we learn to know ourselves, care for ourselves, and care for others. Ultimately, the title Swasparsh means self-healing, self-reflection, and self-confidence. At a time of political uncertainty and generational change, this book speaks directly to Nepal’s younger and the emerging alternative forces — reminding them that transformation begins from within.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026021704020_1d2a855730bc14acbea596cce7b3a00b20f85c79c3a7d8ca46274a15eb642f59.jpg" data-media-id="editor_3" data-image-id="2026021704020_1d2a855730bc14acbea596cce7b3a00b20f85c79c3a7d8ca46274a15eb642f59" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Swasparsha"> </figure>  Hisila Yami served as CA member, Minister of Physical Planning &amp; Works, Minister of Tourism &amp; Minister of Land Reform. At present, she is a member of Central Political Council in Pragatishil Loktantrik Party and is a lecturer in IOE Pulchok.

Essays on self-realisation and self-healing

Chronic winter drought and decades of unmanaged forest biomass have turned wildfires into a systemic risk for Nepal. We need to re-learn to convert fire fuel in forests into fertilizer for crops.&nbsp; On 11 January, a huge forest fire spread rapidly from China into the forests of Sindhupalchok, 40km northeast of Kathmandu. The newly-opened Tatopani border checkpoint was closed. Smoke from the fire spread across central Nepal, blocking the sun.&nbsp; The fire burnt itself out within a few days, but the border stayed closed for longer. Such wildfires were once rare in mid-winter, and traditionally peaked between March and May as temperatures rose ahead of pre-monsoon showers. What is unsettling is not just the early onset of the fires, but also their scale. This shift is not accidental, the pattern has been unfolding over years due to winter drought, weakening post-monsoon moisture, and the accumulation of dry forest biomass as Nepal’s forest area doubled in the past 30 years.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009024_5f4a84bb389f9b56f4fa47d4f694adcd464eb13b192d184af0f1eb20efdfeebf.jpg" data-media-id="editor_0" data-image-id="2026022009024_5f4a84bb389f9b56f4fa47d4f694adcd464eb13b192d184af0f1eb20efdfeebf" data-rendition-name="original" width="2000" height="1055" loading="lazy" alt="Wildfire season NT"> <figcaption>A NASA FIRMS image of Nepal with red dots signifying fires in February 2025.</figcaption> </figure>  Together, these factors have made forests tinder dry in spring, just waiting for a spark. Nepal has experienced winter drought in eight of the past ten years (this winter was an exception). Winter rain and snow at higher elevations play a decisive role in maintaining surface moisture, recharging shallow aquifers, and keeping forest floors damp enough to resist ignition. When winter rains fail, forests dry out months earlier than usual. Satellite-based assessments show a steep decline in surface moisture across the middle mountains of Nepal, particularly in areas with dense forest cover but limited undergrowth management. Springs that once flowed year-round are now seasonal.&nbsp; More than half of the springs in the mid-hills have either dried up or show significantly reduced discharge, a trend closely linked to declining soil moisture and disrupted recharge zones. Dry soil does not just threaten water security — it helps the vegetation ignite. FUEL WITHOUT FUNCTION For decades, Nepal’s forests have been accumulating dry leaf litter, fallen branches, shrubs, and deadwood. Historically, this biomass was not considered waste because rural households regularly collected leaf litter for livestock bedding, which was later composted and returned to farms as fertilizer.&nbsp; Forest floors were therefore relatively clean while the mulch fertilized farms. That relationship has steadily eroded due to outmigration, changes in livestock systems, restrictions on access to community forests, and the growing availability of chemical fertilisers.&nbsp; Community forests across the country today are thick with dry twigs, branches and leaves — a highly combustible carpet. When prolonged drought dries this biomass, even a small spark from a herder’s intentional fire, a cigarette, or lightning strike can trigger massive fires.&nbsp; Under such conditions, the question is no longer whether fires will occur, but how intense and widespread they will be. Forest fires are often framed as an environmental issue concerning trees and wildlife. In reality, their impact extends far beyond forest boundaries.&nbsp; Smoke travels faster and further than flames. Fine particulate matter, especially harmful PM2.5, spreads across countries. In recent fire seasons, air quality monitors in Kathmandu have recorded air quality levels several times higher than WHO guidelines. The smoke adds to Kathmandu’s own pollution and lingers for days.&nbsp; Flights are cancelled or delayed in cities like Pokhara, and poor visibility blocks mountain views affecting tourism. Health facilities report spikes in respiratory complaints, particularly among children and the elderly. Just as wildfires have multi-sectoral causes, the impact of forest fires go beyond forests. One critical dimension remains largely invisible: the soil. The fires cause silent damage beneath the ash, and the emergency does not end when the flames subside. Beneath the surface, soil suffers long-term damage. Organic matter burns away, beneficial microorganisms die. The soil structure weakens, reducing the land’s ability to absorb and retain water. The scorched earth is more prone to erosion, increasing the risk of floods and landslides once the rains return.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009028_cc54ff056b2cac8b789cfd4d11afef9eaf943368e47b99aabd57c7b63b776cf2.jpg" data-media-id="editor_1" data-image-id="2026022009028_cc54ff056b2cac8b789cfd4d11afef9eaf943368e47b99aabd57c7b63b776cf2" data-rendition-name="original" width="1717" height="2143" loading="lazy" alt="Wildfire season NT"> <figcaption>Wildfire risk map based on the validated Random Forest model (a) Overall reclassified wildfire risk map of Nepal, (b) District level wildfire risk, and (c) Municipality wildfire risk map.</figcaption> </figure>  In many of Nepal’s agricultural areas, soil organic matter levels are already below 2% -- lower than what is needed for resilient and productive farming. Repeated fires push these levels even lower, undermining soil fertility and forcing farmers to rely more heavily on chemical fertilisers, unleashing a vicious cycle of higher costs and food insecurity.&nbsp; Climate breakdown is often cited as the primary culprit, and rightly so. Rising temperatures and erratic rainfall have intensified fire risk. But fires in Nepal are increasingly the result of human intervention.&nbsp; The response of all three levels of government remains too little, and too reactive. Each year, resources are mobilised to extinguish fires once they have already spread. Far less attention is paid to managing the fuel load within forest undergrowth that makes such fires inevitable.&nbsp; Meanwhile, forestry and agriculture policies are not coordinated, missing opportunities to address shared challenges. Forest fires are not natural disasters, but predictable outcomes of governance choices. National plans and climate pledges set an ambitious target of raising soil organic matter to 4%. The science behind this goal is solid. Higher organic matter improves water retention, stabilises yields, reduces fertiliser dependence, and enhances long-term food security. What remains unclear is the pathway.&nbsp; Where will the organic inputs come from? How will they be processed and applied safely at scale? Without practical answers, the 4% target risks remaining aspirational rather than achievable. Forest undergrowth can be turned into fuel and fertiliser. Biochar is produced by heating organic biomass in a low-oxygen environment, converting it into a stable form of carbon that can be added to soil.&nbsp; When properly produced and applied, it improves soil structure, enhances water and nutrient retention, supports microbial activity, and locks carbon into the ground for decades. In Nepal biochar addresses two interconnected problems: reducing the accumulation of combustible biomass in forests, lowering fire risk, while simultaneously rebuilding depleted soils. In doing so, it restores the broken link between forest management and agriculture.&nbsp; Done well, biochar is not merely an environmental intervention. It is an economic one, with potential to create local employment, reduce farmers’ input costs, and support climate-smart agriculture. But biochar propagation depends on improved governance. If promoted as isolated pilots or short-term projects, it will fail. What is needed is institutional clarity: standards for production and safety, quality control mechanisms, farmer extension services, and coordination across local, provincial, and federal levels.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009028_e6e2218f38fae5b1fe81d9f99078fe01f58d04b4b3b2c41447f017c3f838a1d4.jpg" data-media-id="editor_2" data-image-id="2026022009028_e6e2218f38fae5b1fe81d9f99078fe01f58d04b4b3b2c41447f017c3f838a1d4" data-rendition-name="original" width="1536" height="2048" loading="lazy" alt="Wildfire season NT"> <figcaption>Freshly prepared biochar under control tempature (350-600°C).</figcaption> </figure>  Community forest user groups could manage biomass collection. Local governments then support safe, decentralised production units. Agricultural extension services guide farmers on application, linked to soil testing and monitoring. Such an approach would reduce fire risk, improve soil health, and generate rural livelihoods.&nbsp; Poorly produced biochar or contaminated feedstock can harm soils and human health. Without training, standards, and oversight, good intentions can backfire. Nepal needs to move beyond fire-fighting to fire prevention and confront the structural causes that make them a growing risk. It is not just a technical choice – it is one that demands political will from newly-elected leaders after March. &nbsp;&nbsp; Ngamindra Dahal is a hydrometeorologist with the Nepal Water Conservation Foundation specialising on climate and water management issues.&nbsp;

RED ALERT: Get ready for the wildfire season

Party flags and banners wave from electric poles, houses and e-rickshaws are festooned with posters. Madhes Province is in the grip of election fever, and in a tour through four of its districts, there is the sense that any efforts by mainstream political parties at reforms have come too little too late. Among the banners, the sky blue of the<a href="https://nepalitimes.com/news/new-vs-new-in-nepal"> RSP is more prominent </a>here this time, and the rallying cry across the country for new and improved leadership is echoed on the ground. “For the people around here, whatever these old leaders are saying has become just noise,” says a lassi shop operator in Janakpur, waving a dismissive hand at flags with the NC’s tree symbol across the street. In Janakpur, UML nominee Raghubir Mahaseth was barred from canvassing door-to-door. Campaign posters of the mainstream parties have been torn from walls and replaced with RSP posters.&nbsp; In Inarwari village of Rautahat in the Madhes heartland, local elected officials whose parties have been merged into the Nepali Communist Party hope to retain enough supporters this election. But not many residents say they would vote for its candidate. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022005024_a793e3a19cbd536fde50708c4a41b8b0d39a4716c6973feddad889097b655641.jpg" data-media-id="editor_1" data-image-id="2026022005024_a793e3a19cbd536fde50708c4a41b8b0d39a4716c6973feddad889097b655641" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Battleground Tarai NT"> <figcaption>Photos: SHRISTI KARKI</figcaption> </figure>  A first-time voter in Sarlahi’s Haripur is home on a semester break from medical school in Kathmandu, and is waiting excitedly for 5 March. “You can’t really say out loud whom you’re voting for around here,” he says, as he mimes ringing a bell. “It is time for someone new to be in-charge." In the highway town of Bardibas, an elderly teashop owner says that all she hears are calls for घण्टी, the RSP’s bell symbol. “After all, bells are rung in the house of gods,” she says. “It seems like the right choice.” The RSP wave sweeping the nation after the GenZ movement is seen in Madhes, and the PR ballots might reflect that, notes political analyst Tula Narayan Shah.&nbsp; “But the socio-cultural networks, organisational setup, and legacy of democratic movement of traditional parties might still give them a fighting chance on the first past the post ballot,” he says. &nbsp;“The door-to-door campaign style of candidates has always been more prominent in Madhes than elsewhere.”&nbsp; Villages like Dhankaul in Sarlahi-4 where <a href="https://nepalitimes.com/news/grand-split-in-nepal-s-grand-old-party">Gagan Thapa</a> of the Nepali Congress (NC) is running against incumbent Amresh Singh, is an NC stronghold. Singh won the election here twice before in 2013 and 2017 when he was an NC leader, and still had goodwill among NC voters when he ran and won as an independent during the 2022 election. “I voted for him twice before when he was in the NC, but he did not do anything for this or other villages. Once he is elected, he has not set foot here,” says Rajiv Yadav, a voter in Dhanakul. “The RSP will get more votes here than last time, but Gagan is sure to win. This village will vote for him.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022005024_26691bb5a37edf705cc197a632d0bf032f984079a838d31bcd943bc0b9c97ff3.jpg" data-media-id="editor_3" data-image-id="2026022005024_26691bb5a37edf705cc197a632d0bf032f984079a838d31bcd943bc0b9c97ff3" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Battleground Tarai NT"> </figure>  Madhes is in the spotlight this election because two prime ministerial candidates have focused their attention in the region. Balen Shah began his campaign in Janakpur (main picture, left) in January as a ‘Son of Madhes’, and Gagan Thapa chose Sarlahi-4 as his constituency over Kathmandu-4, from where he has been elected since 2013.&nbsp; The Madhes has always been the battleground for Nepal’s electoral politics, and candidates from here, like Krishna Prasad Bhattarai from Parsa, Pushpa Kamal Dahal from Siraha, Jhala Nath Khanal from Sarlahi, and Madhav Kumar Nepal from Rautahat, have all been prime ministers. Despite electing politicians to high office in Kathmandu, districts of Madhes have consistently ranked low in development and service delivery indicators, especially in basic healthcare and education. Socio-economic inequalities stemming from a lack of opportunities has also meant that Madhes districts have the highest rate of out-migration in the country.&nbsp; What is different this time is that the people of the province have a Madhesi prime ministerial candidate who will represent them in national politics, and the main competition ultimately will be between the NC and RSP prime ministerial candidates. Interestingly, voters seem to be looking beyond Madhes-based parties who have historically campaigned on identity and federalism.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022005024_1b5c1134fb02ded72a12221200918df584b0cd003139bb2be44951efe9a65bf1.jpg" data-media-id="editor_4" data-image-id="2026022005024_1b5c1134fb02ded72a12221200918df584b0cd003139bb2be44951efe9a65bf1" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Battleground Tarai NT"> </figure>  “Leaders of Madhes parties have glorified their struggle for votes but failed to perform on good governance at local and provincial levels,” explains Tula Narayan Shah. “Now, Balen has become a PM candidate as a face of the region, and as someone who will deliver based on his work as Kathmandu mayor.” If the RSP wins, it will be governing in the absence of provincial leadership that would play a crucial mediatory role between Kathmandu and local units. On Wednesday, RSP’s Madhes province chair Mamta Sharma resigned from the party and joined the NC. There is also some underlying tension between RSP cadre loyal to Balen Shah and Rabi Lamichhane. “It is not prudent to predict who will win the election and whether parties will deliver on promises,” says Tula Narayan Shah. “But win or lose, there is little basis at this time to believe that the RSP will be committed to making the federal system and provinces more functional.” Voters here in the heart of the federalism movement, however, are willing to give the RSP the benefit of the doubt. &nbsp;Resident Brahma Dev in Janakpur told us: &nbsp;“The RSP, like parties that came before them, deserve a chance to prove their leadership in the next five years. If they do not deliver, we can always vote them out next time.”&nbsp; On Wednesday, NC leaders unveiled the party’s 10-point election manifesto at a large rally in Janakpur (main picture, right). Gagan Thapa began by addressing a cheering crowd in Maithili, and said the NC was reformed, adding:&nbsp; “The GenZ did not reject us, they told us to change our ways.” Also on Wednesday 800km away at the other end of the country in Dhangadi, Balen Shah, in a speech that lasted just three minutes, he said: “Don’t vote for us, give us work to do.”&nbsp;

handwashing