<figure><img width="2400" height="1600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebac9c7e80680e09ad1ejpeg.jpg" alt=""/><figcaption></figcaption></figure>Amidst a dramatic surge in Covid-19 infections in Nepal, Prime Minister K P Oli has announced that all big government and private hospitals and medical colleges will be turned into Covid-19 treatment centres. Wearing a surgical mask in his televised address to the nation on Monday, Oli said hospitals like Bir and the Tri-Chandra Army Hospital in Kathmandu and other big private hospitals in the country would serve only people with Covid-19 infections, while smaller hospitals would be designated for non-Covid-19 patients.   He added that the Nepal Army would be adding 1,000 beds for coronavirus patients in each province as well as in Kathmandu Valley, which has been recording half of all new daily infections nationwide in the past week. Bigger hospitals will be setting up their own oxygen plants, Oli said.  The prime minister’s address appears to have been prompted after widespread criticism that his government had ‘surrendered’ to the second wave that has seen a dramatic increase in daily case load and fatalities in the past month. The daily new Covid-19 cases on Saturday, Sunday and Monday were the highest so far in the pandemic with  5,763, 7,211 and 7,448 testing positive. On Monday, there were 37 fatalities in the past 24 hours, bringing the total tally for Covid-19 deaths to 3,362. Altogether 2,021 people recovered from the disease on Monday, with the number of active cases reaching over 50,000 nationwide. Nepal’s Ministry of Health has said that the Covid-19 spread in the country is not just out of control, but that the proportion of those infected who are seriously ill has also gone up. The Ministry’s statistics show that the number of patients needing ICU and ventilator care has increased rapidly in the past two weeks. Of those patients who needed hospital treatment, 17% were serious enough to need intensive care. The number of active cases in Nepal as of Monday is 54,041, of which 50,171 have mild symptoms and are in home isolation. But there are 3,869 Covid-19 patients in private and government hospitals, of which 578 are in ICU, and of them 141 are on ventilator support. Most of the seriously ill are in Bagmati Province, where Kathmandu Valley is located. Of those hospitalised, 22% in the province are seriously ill, and there are 320 patients in ICU and 88 on ventilators. In Province 2, 26% of those in hospital need intensive care, and the proportion is 33% in Karnali Province. However, only 5% of patients in hospitals in Gandaki Province and 6% in Far-West Province need to be in ICU. <figure><img width="1200" height="621" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebaf9c7e80680e09ad1fjpeg.jpg" alt=""><figcaption>A patient at an isolation ward in Nepalganj. Photo: UMA MAGAR</figcaption></figure>The Ministry of Health warned over the weekend that hospitals were full, and that the pandemic had gone “out of control”, asking people to strictly observe precautions. The government is advising people not to come to hospital unless their oxygen levels drop below 92, but most Nepalis do not have oximeters at home and do not go to hospital until it is too late.This has prompted local municipalities and wards to set up their own isolation centres, and even oxygen-equipped spaces for those needing treatment.In Nepalganj, Bheri Hospital and other hospitals are full, and infected health personnel are forced to treat Covid-19 patients because there has been no backup support from the central government. Nepalganj has therefore converted its training centre into its own isolation and treatment centre with 50 oxygen equipped beds. “We are trying to do what we can, and already the centre has ten patients who need oxygen,” says Nepalganj mayor Dhawal Shumshere Rana, who has spent Rs2 million of the city’s own budget to set it up and staff it with doctors and nurses who work in three shifts. Patients are provided free food and ambulance service. “it was much cheaper to cover the training centre, and we could bring the isolation ward into operation within a week, and we hope this will provide some respite to the overwhelmed hospitals,” Rana says. “We now want to add another centre with 100 beds. We want to make sure no one has to die because they could not get oxygen, or a hospital bed.”Banke district on the Indian border is finding 400 new Covid-19 cases every day, and about a third of them need hospital admission. The new isolation centres are designed to take the pressure off the district’s hospitals which are treating patients from all over Karnali and Far-western Province. Only those needing ICU and ventilators will be sent to hospitals, Rana says.<a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/&amp;source=gmail&amp;ust=1620125152099000&amp;usg=AFQjCNEFm7L2FXwPP4VPNvvbKh_wensRNg">Health Minister Hridayesh Tripathi</a> told Nepali Times last week that his government would be adding 1,000 hospital beds in Kathmandu to deal with the rush at hospitals in the capital. “Our health system cannot sustain this level of infections,” he said.In Kathmandu, the Social Welfare Council that regulates the activities of non-profit local and international voluntary organisations on Sunday issued a directive requiring them to set aside from 5-20% of their annual budget for Covid-19 related relief.The Council’s Durga Bhattarai said non-profits with main annual budgets up to Rs50 million need to spend 20% of it on helping with the national coronavirus effort, while those with budgets above Rs500 Millie have to set aside 5%. It says the revenue will be used to buy oxygen cylinders, ICU equipment and ventilators, as well as relief for returnee workers from overseas.With more than 25 of Nepal’s 77 districts under some form of lockdown, local governments have been told to enforce the restrictions more strictly, allowing only essential services, medical emergencies and funerals.Government spokesperson Parvat Gurung said the Cabinet on Sunday decided tis suspend all domestic flights from Monday midnight, and all international flights from Wednesday midnight. However, international airlines serving Kathmandu had not been officially notified of the decision.The Cabinet decision on Monday also said that as per the ‘air bubble’ agreement with India, there would be two weekly flights in both directions between Kathmandu and Delhi, but all passengers would have to spend ten days in hotel quarantine in Kathmandu and it would be strictly enforced.Speaking in English at the end of his address, Oli said: "We are of the view that vaccines and critical care medicines are global goods and everyone should have access to it."

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Nepal designates more hospitals for Covid-19 treatment

<figure><img width="2400" height="1600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83899c7e80680e067741jpeg.jpg" alt=""/><figcaption></figcaption></figure>Amidst a dramatic surge in Covid-19 infections in Nepal, Prime Minister K P Oli has announced that all big government and private hospitals and medical colleges will be turned into Covid-19 treatment centres. Wearing a surgical mask in his televised address to the nation on Monday, Oli said hospitals like Bir and the Tri-Chandra Army Hospital in Kathmandu and other big private hospitals in the country would serve only people with Covid-19 infections, while smaller hospitals would be designated for non-Covid-19 patients.   He added that the Nepal Army would be adding 1,000 beds for coronavirus patients in each province as well as in Kathmandu Valley, which has been recording half of all new daily infections nationwide in the past week. Bigger hospitals will be setting up their own oxygen plants, Oli said.  The prime minister’s address appears to have been prompted after widespread criticism that his government had ‘surrendered’ to the second wave that has seen a dramatic increase in daily case load and fatalities in the past month. The daily new Covid-19 cases on Saturday, Sunday and Monday were the highest so far in the pandemic with  5,763, 7,211 and 7,448 testing positive. On Monday, there were 37 fatalities in the past 24 hours, bringing the total tally for Covid-19 deaths to 3,362. Altogether 2,021 people recovered from the disease on Monday, with the number of active cases reaching over 50,000 nationwide. Nepal’s Ministry of Health has said that the Covid-19 spread in the country is not just out of control, but that the proportion of those infected who are seriously ill has also gone up. The Ministry’s statistics show that the number of patients needing ICU and ventilator care has increased rapidly in the past two weeks. Of those patients who needed hospital treatment, 17% were serious enough to need intensive care. The number of active cases in Nepal as of Monday is 54,041, of which 50,171 have mild symptoms and are in home isolation. But there are 3,869 Covid-19 patients in private and government hospitals, of which 578 are in ICU, and of them 141 are on ventilator support. Most of the seriously ill are in Bagmati Province, where Kathmandu Valley is located. Of those hospitalised, 22% in the province are seriously ill, and there are 320 patients in ICU and 88 on ventilators. In Province 2, 26% of those in hospital need intensive care, and the proportion is 33% in Karnali Province. However, only 5% of patients in hospitals in Gandaki Province and 6% in Far-West Province need to be in ICU. <figure><img width="1200" height="621" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b838d9c7e80680e067742jpeg.jpg" alt=""><figcaption>A patient at an isolation ward in Nepalganj. Photo: UMA MAGAR</figcaption></figure>The Ministry of Health warned over the weekend that hospitals were full, and that the pandemic had gone “out of control”, asking people to strictly observe precautions. The government is advising people not to come to hospital unless their oxygen levels drop below 92, but most Nepalis do not have oximeters at home and do not go to hospital until it is too late.This has prompted local municipalities and wards to set up their own isolation centres, and even oxygen-equipped spaces for those needing treatment.In Nepalganj, Bheri Hospital and other hospitals are full, and infected health personnel are forced to treat Covid-19 patients because there has been no backup support from the central government. Nepalganj has therefore converted its training centre into its own isolation and treatment centre with 50 oxygen equipped beds. “We are trying to do what we can, and already the centre has ten patients who need oxygen,” says Nepalganj mayor Dhawal Shumshere Rana, who has spent Rs2 million of the city’s own budget to set it up and staff it with doctors and nurses who work in three shifts. Patients are provided free food and ambulance service. “it was much cheaper to cover the training centre, and we could bring the isolation ward into operation within a week, and we hope this will provide some respite to the overwhelmed hospitals,” Rana says. “We now want to add another centre with 100 beds. We want to make sure no one has to die because they could not get oxygen, or a hospital bed.”Banke district on the Indian border is finding 400 new Covid-19 cases every day, and about a third of them need hospital admission. The new isolation centres are designed to take the pressure off the district’s hospitals which are treating patients from all over Karnali and Far-western Province. Only those needing ICU and ventilators will be sent to hospitals, Rana says.<a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/&amp;source=gmail&amp;ust=1620125152099000&amp;usg=AFQjCNEFm7L2FXwPP4VPNvvbKh_wensRNg">Health Minister Hridayesh Tripathi</a> told Nepali Times last week that his government would be adding 1,000 hospital beds in Kathmandu to deal with the rush at hospitals in the capital. “Our health system cannot sustain this level of infections,” he said.In Kathmandu, the Social Welfare Council that regulates the activities of non-profit local and international voluntary organisations on Sunday issued a directive requiring them to set aside from 5-20% of their annual budget for Covid-19 related relief.The Council’s Durga Bhattarai said non-profits with main annual budgets up to Rs50 million need to spend 20% of it on helping with the national coronavirus effort, while those with budgets above Rs500 Millie have to set aside 5%. It says the revenue will be used to buy oxygen cylinders, ICU equipment and ventilators, as well as relief for returnee workers from overseas.With more than 25 of Nepal’s 77 districts under some form of lockdown, local governments have been told to enforce the restrictions more strictly, allowing only essential services, medical emergencies and funerals.Government spokesperson Parvat Gurung said the Cabinet on Sunday decided tis suspend all domestic flights from Monday midnight, and all international flights from Wednesday midnight. However, international airlines serving Kathmandu had not been officially notified of the decision.The Cabinet decision on Monday also said that as per the ‘air bubble’ agreement with India, there would be two weekly flights in both directions between Kathmandu and Delhi, but all passengers would have to spend ten days in hotel quarantine in Kathmandu and it would be strictly enforced.Speaking in English at the end of his address, Oli said: "We are of the view that vaccines and critical care medicines are global goods and everyone should have access to it."

https://youtu.be/Fcpz1Dj-ZFcThere is <a href="https://www.nepalitimes.com/editorial/preparing-for-a-no-normal/" target="_blank" rel="noopener noreferrer">a feeling of déjà vu</a> in Nepal as the country goes into a Covid-19 lockdown all over again one year later. The only difference this time is that the disease threatens to be much worse. On Monday, the three district administrations of Kathmandu Valley announced a week-long lockdown 29 April-5 May as the country suffers a <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">rising trajectory of infections and deaths</a> similar to neighbouring India. In fact, data shows that the rate of increase in the number of cases may be even higher in Nepal than India’s national average, and public health experts warn that the implications are even more dire because of a comparatively <a href="https://www.nepalitimes.com/latest/as-virus-spreads-kathmandu-hospitals-strain-to-cope/" target="_blank" rel="noopener noreferrer">less developed health infrastructure</a>.“Both the government and the public ignored all the warning signs, the government did not respond in time and the people got complacent and gathered in crowds without masks,” explains Sher Bahadur Pun, virologist at Teku Hospital. “We are already experiencing what we did during the peak last year. It is anyone’s guess what will happen in the next few weeks, but one thing is for sure: it will get much worse.”Under the lockdown rules, all public and private cars will be off the roads for a week starting Thursday. Everyone entering Kathmandu by air or road will have to go into mandatory quarantine. Restaurants, bars, pubs and public functions are suspended. Marriage ceremonies cannot have more than 15 guests. Exceptions will be vehicles for food, water supply, ambulances and other essential services, medical personnel, journalists with press passes. Food shops will be allowed to open till 10AM and 5-7pm only. Passengers on international flights can go directly to the airport by showing tickets and visas, but there is no mention of domestic flights in the order by the district administrations.The <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/" target="_blank" rel="noopener noreferrer">country’s second wave</a> is now clearly visible in a graph of active cases, which rose from a low of 550 on 21 February to nearly 20,000 by Monday.Nepal recorded 3,556 new Covid-19 cases on Monday of 13,293 PCR and RDT tests, and the total number of cases has now exceeded 300,000. The positivity rate has risen to more than 30%, compared to less than 4% in February. This figure was down to 28% even at the peak of the first wave. Of the total positive cases, 1,912 were in Kathmandu Valley, with 1,567 in Kathmandu, 223 in Lalitpur and 122 in Bhaktapur.The rate of infection is much steeper in this <a href="https://www.nepalitimes.com/latest/nepal-braces-for-its-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">second wave</a>, and it is also more lethal and affects younger people. There were 12 additional deaths from the coronavirus in the past 24 hours, bringing the official total to 3,176.		
							<figure><img width="1494" height="886" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce70a9c7e80680e09679djpeg.jpg" alt=""/><figcaption>A near vertical rise in active cases across Nepal in April. Photo: WORLDOMETERS</figcaption></figure>Last year this time, Nepalis were worried about being infected. This time, the main concern is finding ICU beds and oxygen cylinders. Another difference is that this time, working age people are patients requiring ICU and ventilator support. 
“Before it’s too late we need to be prepared with treatment and management guidelines for children with Covid, as they may require a new set of health professionals and infrastructure,” adds Pun.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/kathmandu-homes-and-hotels-turn-into-hospitals/" target="_blank" rel="noopener noreferrer">Hospitals in major cities</a> in the Tarai are full, and those in Kathmadu are turning away serious patients. The Ministry of Health on Monday issued a directive for all non-medical industrial uses of oxygen, to be stopped or reduced.
Nepal had two <a href="https://www.nepalitimes.com/banner/nepal-goes-into-lockdown-for-a-week/" target="_blank" rel="noopener noreferrer">lockdowns in 2020</a>  but the country got back to pre-Covid normalcy in the first three months of this year as the numbers of daily new infections went down to as low as 59 in March.
“We got hit by a triple whammy, the original coronavirus, and the doubly aggressive UK strain, and the Indian mutant,” says Sameer Dixit of the Centre for Molecular Dynamics. He says a whole genome sequencing study has yet to be done, but thinks Kathmandu got hit first by the UK variant, and then the Indian strain was carried across the open border from India.
Health experts say public complacency because of low infection rates and the arrival of vaccines contributed to <a href="https://www.nepalitimes.com/latest/first-signs-of-the-second-wave/" target="_blank" rel="noopener noreferrer">the rapid spread</a>. In addition, Nepal’s political leaders did not set the correct example to the public about precautions by holding mass rallies, indoor meetings and lavish inaugurations.
“The first time around people were scared of the new virus and everyone followed safety measures but over a year later, the public has abandoned it all taking the latest surge lightly at a time when we face the more contagious and lethal variants,” says epidemiologist Lhamo Langchen Sherpa.
She cautions that a <a href="https://www.nepalitimes.com/latest/lockdown-breakdown/" target="_blank" rel="noopener noreferrer">lockdown is not the solution</a>, and must be used to contact trace aggressively and identify the variants circulating in Nepal. “And despite all the new developments, the best defence against the pandemic remains the same: masks, hand washing and physical distance,” she adds.
Dixit agrees that a lockdown should have been the last resort, only when the pandemic could not be controlled by masking and ban on gatherings. He says, 
“A lockdown is the easy way out for the government, it should have strictly enforced masks and ban on crowds and political leaders should have set a good example.”
The Coronavirus Control and Management Committee (CCMC) recommended the indefinite lockdown and the three CDOs of Kathmandu, Lalitpur and Bhaktapur endorsed it before the Cabinet passed it on Monday. Districts including Banke, Surkhet and other Tarai cities have also announced lockdowns.
“The decision was necessary to break the chain of infection and protect citizens,” Kathmandu CDO Kali Prasad Parajuli said. “But we decided to give people two days to go home or finish urgent chores.”
<a href="https://www.nepalitimes.com/latest/nepal-covid-19-lockdown-extended-till-7-april/" target="_blank" style="font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">The lockdown</a> will stop all non-essential travel, businesses and services, but will allow people from 5-10AM to buy essentials. 
Nonetheless, the shutdown could buy the government time as it tries to come up with a bigger oxygen stockpile, more High Dependency Units and ICUs in hospitals, drugs including remdesivir, and vaccines. India is overwhelmed with its own cases, and is too busy with its own emergency to help.

Kathmandu locks down again

<figure><img width="2048" height="1364" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110919118/636bed424b0ad905ca02eed4jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Going by the Ministry of Health figures, Nepal’s Covid-19 pandemic has peaked, and the number of daily cases, the positivity rate and the number of active cases are all going down. The recovery rate now exceeds 90%. Is Nepal turning the corner on the pandemic? Experts say no. The number of fatalities is at an all-time high. There were 29 deaths reported each on Monday and Tuesday, taking the total to 1,538. And the reason the daily case rate is lower is because the government is conducting fewer tests, there is virtually no official contact tracing, and active cases are at home and going to hospital only when they are really serious. These are ideal conditions for community spread. “The fact that the fatalities are increasing, especially in Kathmandu, won’t allow us to say that fewer people are getting infected. This coronavirus isn’t going anywhere just yet,” explains Sher Bahadur Pun of the Ministry of Health. “Yes, the positivity rate has gone down, but the government has also more or less stopped contact tracing.” Since the government started charging for RT PCR tests and hospital admissions, patients and their families are reluctant to have tests despite symptoms, and do not want to go to hospital. The rates have remained high because <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">those infected during Dasain-Tihar</a> are developing symptoms. The current marriage season is another super-spreader event.   There are 77 hospitals and labs across the country conducting an average of  9,000 PCR tests a day, which went down from a daily total of 15,000 after the government directive to charge Rs2,000 for PCR tests in public facilities. The positivity rate went down, which is a good thing – but it happened for the wrong reason. In October a quarter of people tested came out positive, it is now down to 15% despite the onset of the winter season.   “The risk cannot be underestimated based on numbers of infected people by reducing tests itself at a time when increasingly more people are getting sick or dying of coronavirus,” says infectious diseases specialist Pravat Adhikari. “This argument would be valid only if the infection rate goes down despite an increase in total tests. However, very few tests are being conducted at the moment.” In fact, such hidden positives lead to more unidentified Covid-19 deaths, adding to the risk. It is reckless of the government to still not launch low-cost PCR tests with quick results, adds Adhikari. <figure><img width="2340" height="1216" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110919118/636bed454b0ad905ca02eed5jpeg.jpg" alt=""><figcaption> </figcaption></figure>The problem is further exacerbated by unmanaged home isolation, and quarantine cases. According to the Ministry of Health, 10,741 people across seven provinces are self-isolating at home, often without much resources or knowledge on how to manage their condition.Ideally, asymptomatic or mildly symptomatic <a href="https://www.nepalitimes.com/latest/kathmandu-homes-and-hotels-turn-into-hospitals/" target="_blank" rel="noopener noreferrer">people self-isolating at homes</a> should have a separate room and a bathroom. Patients should confine themselves in their rooms, wash their own utensils, wear masks while going to the toilet and sanitise it after use and wipe touch points with disinfectant.  Individuals need to keep track of their temperature and symptoms, measure oxygen saturation level if possible, take paracetamol for body ache and fever and make sure to eat nutritious food. One must be aware of danger signs: oxygen level below 93, chest pain, difficulty in breathing and blue tint to lips and limbs.But most families who have members in home isolation do not have this information, or live in such crowded quarters that it is impossible to fulfil all precautions. Conflicting directives from the government haven’t helped.At one point, overwhelmed with the surge of Covid-19 cases in Kathmandu, the Ministry of Health spokesperson Jageswar Gautam advised people live on television to go to hospital only if they feel faint. By then it is too late because it means the patient’s oxygen saturation is already dangerously low.The government has left the people to their own devices, and ignored expert advice on <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">increasing the number of beds in wards with basic oxygen supply</a> instead of spending money on ICUs and ventilators."When I tested positive for coronavirus and had slight difficulty breathing, I called a government health expert for advice, and he himself dissuaded me from going to a public hospital," says Rajendra Dahal, Editor of the magazine Shiskyak. “This is why the death rate is going up, while the positive totals are going down. People are at home, and their oxygen levels are falling, and they have no idea. The main point is that the people have lost their trust in the government health system.”The chief consultant at the Infectious Diseases Hospital in Teku Anup Bastola agrees that the risk has been heightened because health experts are unaware about the actual condition of people isolating at homes. “Nepalis have a tendency to not visit hospitals until it’s too late. We have found that this is even more true for coronavirus,” he says. With much of the 2020 overshadowed by the pandemic and its impact on all the sectors, young people wanting to get back to their lives are now ignoring the signs and symptoms, preferring not to voluntarily test in case they might have to isolate for two weeks.Even according to government figures, the number of people testing positive in Kathmandu Valley is not going down. With the marriage season, and people intermingling indoor in banquet halls, the surge is not expected to subside. At Pashupati Aryaghat, there are five times more <a href="https://www.nepalitimes.com/latest/with-3rd-covid-19-fatality-nepal-issues-funeral-guideline/" target="_blank" rel="noopener noreferrer">cremations</a> happening compared to the same period last year, according to reports. It is not clear how many of these extra deaths are due to Covid-19.The movement of the younger people has had a <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">direct impact on the elderly</a>, as they take home the virus and make parents and grandparents seriously sick. People in their sixties and above now make up over 60% of Covid-19 fatalities in Nepal.Even without the added risk of coronavirus, senior citizens are prone to <a href="https://www.nepalitimes.com/latest/covid-19-will-get-worse-before-it-gets-better/" target="_blank" rel="noopener noreferrer">pneumonia and other chronic respiratory illness in winter</a>. Public health experts advise being alert in regards to their condition even before they complain of symptoms and keeping communication channels open.Says Sher Bahadur Pun: “These are extraordinary times and we need to take extraordinary measures to protect the more vulnerable among us. <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Until we get a vaccine</a>, we must realise our responsibility in containing the virus and not become a medium for more deaths.”

Sonia Awale

Why Nepal’s Covid-19 figures are deceptive

<figure><img width="2048" height="1364" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be6219c7e80680e08778bjpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Going by the Ministry of Health figures, Nepal’s Covid-19 pandemic has peaked, and the number of daily cases, the positivity rate and the number of active cases are all going down. The recovery rate now exceeds 90%. Is Nepal turning the corner on the pandemic? Experts say no. The number of fatalities is at an all-time high. There were 29 deaths reported each on Monday and Tuesday, taking the total to 1,538. And the reason the daily case rate is lower is because the government is conducting fewer tests, there is virtually no official contact tracing, and active cases are at home and going to hospital only when they are really serious. These are ideal conditions for community spread. “The fact that the fatalities are increasing, especially in Kathmandu, won’t allow us to say that fewer people are getting infected. This coronavirus isn’t going anywhere just yet,” explains Sher Bahadur Pun of the Ministry of Health. “Yes, the positivity rate has gone down, but the government has also more or less stopped contact tracing.” Since the government started charging for RT PCR tests and hospital admissions, patients and their families are reluctant to have tests despite symptoms, and do not want to go to hospital. The rates have remained high because <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">those infected during Dasain-Tihar</a> are developing symptoms. The current marriage season is another super-spreader event.   There are 77 hospitals and labs across the country conducting an average of  9,000 PCR tests a day, which went down from a daily total of 15,000 after the government directive to charge Rs2,000 for PCR tests in public facilities. The positivity rate went down, which is a good thing – but it happened for the wrong reason. In October a quarter of people tested came out positive, it is now down to 15% despite the onset of the winter season.   “The risk cannot be underestimated based on numbers of infected people by reducing tests itself at a time when increasingly more people are getting sick or dying of coronavirus,” says infectious diseases specialist Pravat Adhikari. “This argument would be valid only if the infection rate goes down despite an increase in total tests. However, very few tests are being conducted at the moment.” In fact, such hidden positives lead to more unidentified Covid-19 deaths, adding to the risk. It is reckless of the government to still not launch low-cost PCR tests with quick results, adds Adhikari. <figure><img width="2340" height="1216" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be6249c7e80680e08778cjpeg.jpg" alt=""><figcaption>Total Covid-19 cases from January 23 until 1 December in Province 2 and in Bagmati province. Source: MINISTRY OF HEALTH</figcaption></figure>The problem is further exacerbated by unmanaged home isolation, and quarantine cases. According to the Ministry of Health, 10,741 people across seven provinces are self-isolating at home, often without much resources or knowledge on how to manage their condition.Ideally, asymptomatic or mildly symptomatic <a href="https://www.nepalitimes.com/latest/kathmandu-homes-and-hotels-turn-into-hospitals/" target="_blank" rel="noopener noreferrer">people self-isolating at homes</a> should have a separate room and a bathroom. Patients should confine themselves in their rooms, wash their own utensils, wear masks while going to the toilet and sanitise it after use and wipe touch points with disinfectant.  Individuals need to keep track of their temperature and symptoms, measure oxygen saturation level if possible, take paracetamol for body ache and fever and make sure to eat nutritious food. One must be aware of danger signs: oxygen level below 93, chest pain, difficulty in breathing and blue tint to lips and limbs.But most families who have members in home isolation do not have this information, or live in such crowded quarters that it is impossible to fulfil all precautions. Conflicting directives from the government haven’t helped.At one point, overwhelmed with the surge of Covid-19 cases in Kathmandu, the Ministry of Health spokesperson Jageswar Gautam advised people live on television to go to hospital only if they feel faint. By then it is too late because it means the patient’s oxygen saturation is already dangerously low.The government has left the people to their own devices, and ignored expert advice on <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">increasing the number of beds in wards with basic oxygen supply</a> instead of spending money on ICUs and ventilators."When I tested positive for coronavirus and had slight difficulty breathing, I called a government health expert for advice, and he himself dissuaded me from going to a public hospital," says Rajendra Dahal, Editor of the magazine Shiskyak. “This is why the death rate is going up, while the positive totals are going down. People are at home, and their oxygen levels are falling, and they have no idea. The main point is that the people have lost their trust in the government health system.”The chief consultant at the Infectious Diseases Hospital in Teku Anup Bastola agrees that the risk has been heightened because health experts are unaware about the actual condition of people isolating at homes. “Nepalis have a tendency to not visit hospitals until it’s too late. We have found that this is even more true for coronavirus,” he says. With much of the 2020 overshadowed by the pandemic and its impact on all the sectors, young people wanting to get back to their lives are now ignoring the signs and symptoms, preferring not to voluntarily test in case they might have to isolate for two weeks.Even according to government figures, the number of people testing positive in Kathmandu Valley is not going down. With the marriage season, and people intermingling indoor in banquet halls, the surge is not expected to subside. At Pashupati Aryaghat, there are five times more <a href="https://www.nepalitimes.com/latest/with-3rd-covid-19-fatality-nepal-issues-funeral-guideline/" target="_blank" rel="noopener noreferrer">cremations</a> happening compared to the same period last year, according to reports. It is not clear how many of these extra deaths are due to Covid-19.The movement of the younger people has had a <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">direct impact on the elderly</a>, as they take home the virus and make parents and grandparents seriously sick. People in their sixties and above now make up over 60% of Covid-19 fatalities in Nepal.Even without the added risk of coronavirus, senior citizens are prone to <a href="https://www.nepalitimes.com/latest/covid-19-will-get-worse-before-it-gets-better/" target="_blank" rel="noopener noreferrer">pneumonia and other chronic respiratory illness in winter</a>. Public health experts advise being alert in regards to their condition even before they complain of symptoms and keeping communication channels open.Says Sher Bahadur Pun: “These are extraordinary times and we need to take extraordinary measures to protect the more vulnerable among us. <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Until we get a vaccine</a>, we must realise our responsibility in containing the virus and not become a medium for more deaths.”

<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.

Nepal’s virus vortex

Many of us former Nepal Peace Corps volunteers (PCVs) would agree that our time in Nepal changed in significant but very different ways our perspectives on life if not the future paths we chose to follow. Of no one was this truer than Dorothy Mierow. Dorothy was born in 1920, in Colorado Springs. Her father Charles C Mierow was a classics scholar and Latin professor, who served for ten years as president of Colorado College.&nbsp; Dorothy developed an interest in animals as a child, graduated with a BA degree in natural history from Carlton College in 1942, a Master’s in biology from the University of Pittsburgh, and another Master’s in geography from the University of Minnesota.&nbsp; As a young woman, Dorothy traveled with her father throughout Europe, including a visit to ancient Greek ruins, and took a Magellan Tour by cruise ship around the world in 1958.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262.jpg" data-media-id="editor_0" data-image-id="2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262" data-rendition-name="original" width="903" height="1178" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>HOME AWAY FROM HOME: Dorothy Mierow as a college student in her native Colorado.</figcaption> </figure>  She was a college teacher during much of the 1940s, also teaching at a girls’ school in Hawaii. Then back to her native Colorado in 1953, where she became a curator and later director of the Colorado College Natural History Museum. She taught geography classes, and in her free time, Dorothy climbed 22 of Colorado’s 14,000-foot peaks. Traveling in India in 1960, Dorothy decided to spend two weeks in Nepal. In late 1961, she filled out an application to join the Peace Corps and specified that she wanted to go to Nepal, ‘because I admired the people so much when my father and I were there on our trip’.&nbsp; Dorothy reached Kathmandu in September 1962 as the first group of American Peace Corps volunteers in Nepal. She stood out from the others: one of the few women in that group, surely the oldest at age 41, a world traveler, and a woman who already had established a professional career.&nbsp; One doubts if Dorothy had had a husband and children whether she would ever have gone to work and spend much of the rest of her life in Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515.jpg" data-media-id="editor_1" data-image-id="2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515" data-rendition-name="original" width="1259" height="910" loading="lazy" alt="How th Peace Corps changed a volunteer's life NT"> <figcaption>Pokhara Bazar in 1962.</figcaption> </figure>  The Peace Corps assigned Dorothy to teach geography at Tri-Chandra College. After the school closed in the winter due to lack of heating, USAID and the College of Education asked Dorothy to help train general science teachers.&nbsp; She taught for two months and became involved in a textbook-writing project, commenting: ‘I would like the children to know something about public health, conservation (the trees are going fast and so is the soil), and learn the names of some of their common birds, trees, and flowers. They are more impressed with electricity, airplanes, and cell structure.’ When a new college opened in Pokhara in 1963, Dorothy was transferred there and lived with a Nepali family. The college boasted 30 students and no permanent buildings.&nbsp; In October 1963, Dorothy wrote: ‘Pokhara is a town of almost 5,000 people … We are in a fertile valley surrounded by foothills … There is a small Mission Hospital … a Leper Hospital and Tibetan Refugee Camp started by the Red Cross and now run by the Swiss. With winter approaching, more Tibetans are appearing in town, often with pack horses or donkeys. Some have been carrying large boxes of powdered milk,donated (by USAID) to the camp from the airport … There is no electricity, and the transportation problems make many items scarce and expensive. I am really a sort of a museum. The landlord brings all kinds of people in to see how I live and count my shoes and dresses. They express amazement at my books, pictures, tin oven, Nepali dolls from Kathmandu, screened food shelves and curtained closet.’ The standard term for Peace Corps volunteers was two years, but Dorothy extended her term and was still at Prithvi Narayan College at the end of 1965, when she wrote that she had 20 Geography students in the first-year class and 6 in the second year preparing for the IA Examination. The college enrollment was 125 students, and the foundation for a new science building was being excavated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29.jpg" data-media-id="editor_2" data-image-id="2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29" data-rendition-name="original" width="902" height="605" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow and friends at Phewa Lake.</figcaption> </figure>  Dorothy noted that she ate one meal a day at the (Shining Mission) Hospital but otherwise lived on dal-bhat, momo, and potato curry at local shops. However, she had developed a new passion: to build what she initially called the Pokhara Museum of the Himalaya. In commendable Peace Corps fashion, Dorothy always worked with Nepalis and respected the culture. ‘The greatest joy and satisfaction I have had has been from the building of a Museum-Library in memory of my parents … It has been possible to feel like a wealthy benefactor with the money saved by father for the family’s education and now available for the education of others… (Father) would have loved to be in on the founding of a new college and be able to plan a library. Several hundred of the books to be in the museum-library came from his collection and were carefully selected to be of use for students in Nepal…’&nbsp; ‘The museum part is to satisfy my own inclinations and was thought of when I found how little diversion there was for the people of Pokhara… It is part of the University requirements for the college that it should have a geography and biology museum. The museum building is small but adequate.&nbsp; I have tried to design it in harmony with Nepalese architecture and decorate it with some of the art of the best artists or woodcarvers… Posts holding up the porch roof are carved by Cottage Industries to represent different peoples of Nepal in typical costumes. The door was carved by a local wood carver and has typical birds of Nepal around it. Inside are 10 roof-support carvings designed by the retired Director of the National Museum in Kathmandu, Mr. C.M. Maskey.&nbsp; They were carved by the best wood carvers in Patan very skilfully. The building has three rooms: the library, the exhibition room, and a smaller workroom which can be used by our newly formed Woman’s Club as well as other groups or classes.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8.jpg" data-media-id="editor_3" data-image-id="2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8" data-rendition-name="original" width="629" height="599" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow with local women in Pokhara in 1969.</figcaption> </figure>  Dorothy promoted her project to influential Nepalis connected with organisations whose support she solicited: The Department of Archaeology, the Department of Agriculture, the Godavari Botanical Gardens; Tribhuvan University’s Science and Education Department, Nature Conservation Society.&nbsp; The museum was opened officially in early 1967. The Annapurna Natural History Museum, the building Dorothy designed and had constructed, is still open and features some exhibits which she created many years ago.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26.jpg" data-media-id="editor_4" data-image-id="2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>The Annapurna Natural History Museum.</figcaption> </figure>  Dorothy returned to America in 1967, but she longed for Nepal. In the spring of 1969, she again tried to enroll as a Peace Corps volunteer but was told that as she had spent more than four years, she would not be eligible for another assignment. Undeterred, she persuaded the college in Pokhara to invite her to return as a teacher.&nbsp; UNICEF and the Forestry Department sponsored Dorothy to prepare charts on trees, birds, animals and flowers in colour for distribution to the schools of Nepal. Dorothy, back in the Peace Corps, returned to Pokhara and the Museum in 1972. She formed a friendship with her former geography student from Sikles, Chandra Prasad Gurung, and in 1974, she brought Chandra to America, where he enrolled in Colorado College and studied cultural anthropology.&nbsp; Chandra subsequently earned his PhD in geography from the University of Hawaii and returned to Pokhara to become director of the Annapurna Conservation Area Project. Gurung actively promoted ecotourism, landscape conservation, and biodiversity conservation in Nepal. His life was cut short along with those of 23 other Nepalis and foreigners who perished in a helicopter crash near Taplejung in September 2006.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314.jpg" data-media-id="editor_5" data-image-id="2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314" data-rendition-name="original" width="2500" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow's four books on Nepal and its biodiversity. </figcaption> </figure>  Dorothy worked with several well-known Nepalis to publish her paintings and photos in beautifully illustrated books. She and Hemanta Mishra of the National Parks and Wildlife Service wrote Wild Animals of Nepal (Ratna Pustak Bhandar, 1976). More than 400 photos Dorothy took on treks to the Everest region, Gosaikunda, Muktinath, Jumla and Rara Lake, as well as travels in the Tarai, appeared in Himalayan Flowers and Trees (Sahayogi Prakashan, 1978).&nbsp; The botanist Tirtha Bahadur Shrestha identified the species. Dorothy and Kesar Lall published This Beautiful Nepal (Sahayogi Press, 1981). Birds of the Central Himalayas (1988) contained Dorothy’s paintings of 250 species of birds found along the areas of the Kali Gandaki River, Pokhara, Chitwan and the central Tarai. Dorothy summed up her life and work in Nepal in Thirty Years in Pokhara (Pilgrims Book House, 1997). Dorothy returned to Pokhara and her adopted Gurung family several times during the 1980s and 1990s to celebrate festivals and meet old friends. Her final years were spent at her mountain cottage in Green Mountain Falls north of Colorado Springs. She died at the age of 79 in August, 2000. Nepal gave new meaning and purpose to Dorothy Mierow’s life. Daniel W Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. The author thanks Special Collections, Tutt Library, Colorado College.

How the Peace Corps changed a volunteer’s life

Does anyone know that 2023-33 was declared the <a href="https://nepalitimes.com/banner/visit-nepal-again">Visit Nepal</a> Decade? Or that Pokhara announced that 2025 is a Special Tourism Year? The fuselage of Nepal Airlines jets still carry the Visit Nepal Year 2020 logos. Such ad hoc and unnoticed promotion is emblematic of the way Nepal has tried to increase visitor arrivals <a href="https://nepalitimes.com/news/nepal-hopes-for-tourism-rebound-in-2021-rk4dlo9t">post-Covid</a> — and of the country’s wider political disarray. Deepak Raj Joshi of the Nepal Tourism Board (NTB) has his work cut out to coordinate various agencies of the government to boost arrivals.&nbsp; He says, “We have been working on marketing strategies to revive the tourism sector, and are hopeful that this year will mark a 8-10% increase in arrivals compared to the pre-pandemic times.” On paper, tourist numbers have rebounded to pre-Covid numbers with over 1 million last year, but official figures do not give a true picture of duration of stay, average spending, and the fact every visitor is counted as a ‘tourist’, even repeat visitors who come on business. The few bright spots are largely a result of private sector promotion of niche tourism products, individual social media posts of <a href="https://archive.nepalitimes.com/page/top-10-treks">adventurous treks in Nepal</a>, or the fact that Indians are allowed to enter China again to visit Lake Mansarovar and Mt Kailash via Nepal. Indeed, Simkot airport has up to 15 flights a day from Nepalganj bringing in <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims</a> who are then ferried by helicopter to the border in Hilsa, or Lapcha Pass from where the holy sites in Tibet are visible. The rudimentary hotels and rest houses along the route in Humla have been bursting at the seams for the past month, to the point that some establishments are no longer able to provide patrons basic amenities.&nbsp; Last year, 1.14 million tourists visited Nepal, and the government has projected up to 10% increase in tourist arrivals this year. International tourist arrivals to Nepal have been steadily increasing, especially from the US, Europe, and India. Domestic and regional travel has also increased after the <a href="https://nepalitimes.com/news/lockdown-5-utlzqtvs">Covid lockdowns</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505.jpg" data-media-id="editor_5" data-image-id="20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505" data-rendition-name="original" width="1145" height="668" loading="lazy" alt="Tourist numbers"> </figure>  The tourism industry employs at least 1 million people, trekking injects money directly into the <a href="https://nepalitimes.com/editorial/not-rising-nepal">rural economy </a>and sustains ancillary sectors like handicrafts and domestic aviation. In the last fiscal year, tourism brought in Rs82.33 billion, according to Nepal Rastra Bank. But the industry has been affected by negative publicity about poor infrastructure, air pollution in Kathmandu, travel safety and news of disasters like the <a href="https://nepalitimes.com/news/rasuwa-flood-likely-a-glof">China-Nepal flood last week</a> that made international headlines. Growing worries about the climate crisis is also affecting youth travel, especially from Europe. Read also: <a href="https://nepalitimes.com/news/missing-out-on-nepal-s-tourism-potential">Missing out on Nepal’s tourism potential</a> “The limitations of airport and road infrastructure has hindered the development of the tourism sector,” admits Joshi. “And many are put off by the appalling state of our road network, especially during <a href="https://nepalitimes.com/opinion/managing-the-monsoon">the monsoon season</a>.” Nepal is home to 20 protected areas, 10 heritage sites, and eight out of the world’s 10 highest mountains, and despite all the obstacles it is still the perfect destination for the modern social media savvy traveller, who are experience-driven and inclined to look for itineraries that emphasise wellness and cultural immersion.&nbsp; Some hotels around Kathmandu, Pokhara, Jomsom and the Khumbu have strived to adapt to this new tourism landscape, expanding facilities with significant international investment. <a href="https://nepalitimes.com/business/a-thamel-within-thamel">Luxury hotels like Aloft Kathmandu</a> in Thamel were inaugurated just before the pandemic lockdowns, survived the crisis and thrived as it. Says General Manager Vikram Singh (pictured, below): “Our prime location in Thamel enhances the guest experience, especially for those seeking convenience and immersion in the local scene and travellers who want to be in the centre of it all.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d.jpg" data-media-id="editor_11" data-image-id="2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d" data-rendition-name="original" width="1066" height="1600" loading="lazy" alt="Aloft GM"> </figure>  <a href="https://nepalitimes.com/here-now/what-sustainable-tourism-means-in-practice">Sustainability </a>and environmental consciousness has also become an integral part of the hospitality industry. ISO certifications as well as sustainability initiatives like the Travelife sustainability certification for eco-friendly resorts validate credibility of hotels. Aloft is the first five-star hotel in Nepal to have earned the Waste Smart Certificate, and it has also been awarded the ISO 14001:2015 certification, which is the internationally recognised standard for environmental management systems (EMS). But such investments will not amount to much unless Nepal makes serious efforts to promote itself as a<a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz?utm="> tourism destination</a>, especially to its two giant neighbours. More importantly, the country needs to increase activities in which tourists can spend the money they want to. “While <a href="https://nepalitimes.com/here-now/nepal-pushes-mountain-bike-tourism?fbclid=IwAR1MNH0iFGv1vRz5G9uZ4AzUlKxB6nY7JKq0qT6je_FV4_SuxPZqviwKGn0">mountaineering and adventure tourism</a> are extensively promoted, we have fallen short of marketing other elements such as wildlife, pilgrimage and cultural heritage,” says Joshi. “There is a need to diversify promotion to increase income from the tourism sector.” Meanwhile, making Nepal more accessible to international and domestic visitors, must also be a priority. Kathmandu remains the sole aerial gateway despite new airports in Pokhara and Bhairawa. “International airlines have shown interest, and if access and flights are increased these airports can be fully functional,” says Joshi. But Sichuan Airlines has stopped flying to Pokhara, and there does not seem to be much interest from Thai, Vietnamese and Cambodian carriers to fly directly to Lumbini. Says Singh: “There’s tremendous opportunity to strengthen Nepal’s destination marketing by telling richer, more compelling stories that <a href="https://nepalitimes.com/opinion/comment/culture-cannot-be-an-afterthought">connect travellers with our culture</a>, nature, and people.”

Tourism needs a new push

This week at the National Population Policy launch Prime Minister K P Oli exhorted Nepalis to get married by age 20 and have three babies by the time they are 30. This was the first indication that the highest office in the land has understood the need to address Nepal’s dramatically <a href="https://nepalitimes.com/news/nepals-demographic-window-is-closing">falling birth rate</a>, but Oli’s statement was greeted with ridicule on<a href="https://nepalitimes.com/banner/avoiding-the-quicksand-of-social-media"> social media</a> — especially by women. Most urban young are already grappling with economic pressures and shifting life priorities. Even with a university degree,<a href="https://nepalitimes.com/here-now/workers-return-to-jobless-nepal?%2F"> many cannot find jobs</a>, and are taking the first flight out for overseas employment. Having a child is now a fraught decision shaped by income, individual autonomy, and family pressure. The <a href="https://www.unfpa.org/swp2025">UNFPA’s State of the World Population report </a>released last month, highlighted a significant <a href="https://nepalitimes.com/here-now/migrating-males-and-population-decline">decline in fertility rates </a>around the world. The global average fertility rate is 2.25 children per woman, and 18% of the reproductive adults said they will not be able to have the number of children they desire. The total fertility rate in Nepal has plummeted to 2.1 births per woman — down from 5 just 30 years ago. This is considered replacement level, meaning the newborns will replace their parents.&nbsp; However, birth rates are not declining as rapidly everywhere. The Tarai in has a total fertility rate of 2.20, and northwestern mountains is still 2.24.&nbsp; There are multiple factors in play, and the report broadly divides them into four categories: health issues, economic concerns, fears about the future, and lack of a supportive partner or their absence. More than half of the respondents said finance, which includes unemployment and increased cost of housing, as well as parenthood, was a barrier to having children. “More and more people prefer one or two children at maximum. Many women also decide to have children at a much later age,” says Kamala Devi Lamichhane of Tribhuvan University. “The opportunity cost is far higher for women.” But there is also a cost for the country, as the National Population Policy notes. At the rate the total fertility rate is falling it will soon be below replacement level — meaning that in the next three decades Nepal will be confronted with an <a href="https://nepalitimes.com/opinion/the-future-is-older">ageing population</a>.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291.png" data-media-id="editor_6" data-image-id="20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291" data-rendition-name="original" width="1302" height="501" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b.png" data-media-id="editor_7" data-image-id="20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b" data-rendition-name="original" width="1125" height="500" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>  Besides income, there are also cultural factors at play in women having fewer babies — they are expected to do all the childcare duties, even putting their careers on hold. In general, there is little help from spouses, and with more nuclear families there is less support from relatives. “Women today are well educated, career-oriented, and economically independent, allowing them to delay marriage as well as being conscious about their body and <a href="https://nepalitimes.com/multimedia/nepal-far-from-hitting-contraceptive-target?%2F">reproductive rights</a>,” says Laxmi Tamang of the International Confederation of Midwives (ICM). Also present at the policy launch was demographer Yagya Bahadur Karki, who said that women are more educated and hence, empowered to take their own informed decisions regarding having children.&nbsp; He adds, “But the fertility rates have reached replacement rate, and that stands as a warning for the future.”&nbsp; Fertility rates have fallen in inverse proportion to the rise in female literacy. The regions of Nepal where couples have more babies is where women are less educated. Couples in Madhes and Sudur Paschim provinces, where child marriage, gender-based discrimination, menstrual huts and dowry are still widespread are where the fertility rate is still high.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39.jpg" data-media-id="editor_9" data-image-id="20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39" data-rendition-name="original" width="994" height="682" loading="lazy" alt="TFR Map"> </figure>  And because female literacy also has a direct correlation with <a href="https://nepalitimes.com/news/fatal-discrimination">infant and child mortality</a>, couples in those regions tend to have more babies so some of them survive.&nbsp; But it is Nepal’s urban centres among the educated where the increased choices in reproductive health, including alternative methods of conception like IVF and treatment for infertility, as well as <a href="https://nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor">contraceptives</a> offer more options for family planning. “There are more choices regarding reproductive health, and there is more awareness as well, which is why people decide carefully on whether or not to bear a child,” says population expert Yogendra Gurung. <a href="https://nepalitimes.com/here-now/migrants-returning-from-the-gulf-with-infertility">Migration is another factor</a> adding to the decline in fertility rates. Many young Nepalis of reproductive age leave every day in pursuit of better jobs overseas. Spousal separation means fewer children.&nbsp; “Once away, even if not educated, they realise that child-rearing costs are high, and try to have fewer and even no children in some cases,” Gurung adds. Recent studies have also shown that men returning after their stint in the Gulf and Malaysia, where they are <a href="https://nepalitimes.com/news/gulf-workers-need-protection-from-heat">exposed to extreme heat </a>for extended periods as well as various chemicals and toxins in their work environment &nbsp;have a range of health problems, including infertility. To increase the birth rate, Nepal will have to reverse its family planning strategy of the past 40 years. Complicating this is that some regions of Nepal will need measures to control the birth rate, while urban areas will need a strategy to help parents have more babies. One way to help families have more children is to develop more <a href="https://nepalitimes.com/here-now/future-proofing-nepal-s-population-strategy?s=04&amp;fbclid=IwY2xjawFQf-NleHRuA2FlbQIxMQABHRxSwwGPfm7_2cBhDVAowPxEmFXP0Os-KRs1DXqIW_84wDhciExtZuNi1g_aem_jzRqN2cEVAppfwr5qedxRg">family-friendly policies</a> that favour women and youth as the Nordic countries, which also have falling birth rates, have done. They have introduced flexible parental leaves for both parents, including financial and health incentives. China, also concerned about its declining birth rate and an ageing population, now has a three-child policy as well as tax deductions, expanded childcare services, and leave policies to encourage couples to have more children. “We must work towards childbirth and childcare policies and plans that are suitable for Nepal, so that couples planning for children do not have to think twice about it because of finances or other reasons,” adds Gurung. Tamang of the International Confederation of Midwives says a gender transformative approach is needed to address the issues of the gender gap which is adding to the decline in childbirth. Husbands need to play a more important role in child-rearing. Instead of increasing fertility for the sake of it, the objective should be to assist young people to start the families they desire, at a point and time of their choice. Respect for everyone’s rights and dignity lays a foundation for a more balanced demographic trend. Lamichhane sums it up: “If fertility rates are to be sustained, it requires changes in the gender roles and behaviour, keeping the youth’s aspirations in mind.”

Nepalis are having fewer babies. Why?

Local residents of Mustang, including a sitting MP and several politicians, submitted a petition to Prime Minister KP Oli in Kathmandu this week urging the government to lift the region’s ‘restricted’ status. This is not the first time such a demand has been raised, and as infrastructure the region’s accessibility improved over the years, calls to remove the long-standing restriction have grown louder.&nbsp; Upper Mustang is no longer weeks away <a href="https://nepalitimes.com/here-now/postcards-from-kathmandu">from Kathmandu.</a> Nearly 85% of the road from Beni to Kagbeni has been blacktopped, and one can drive from Kathmandu to Lo Manthang with an overnight stop in Pokhara. Between April 2024 and April 2025, Lower Mustang received 144,745 international tourists, a near 50% increase compared to the previous year. Most of these were <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims </a>travelling to Muktinath. <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a> is also gaining popularity among Nepali visitors, with 700,000 visiting the region in 2024. A hotel operator in Kagbeni estimated that about 20% of Nepali visitors to Muktinath also travel to Korala, the trade and transit checkpoint on the <a href="https://nepalitimes.com/latest/north-of-the-border">China border</a>. That would mean that nearly 100,000 domestic tourists visit Upper Mustang annually. In stark contrast, international tourist numbers to Upper Mustang (north of Kagbeni) have remained stagnant, hovering around 4,000 visitors per year. The primary reason is the continued enforcement of the region’s restricted status. Foreign visitors must pay a steep permit fee: a minimum of $500 for 10 days, with an additional $50 per day thereafter. Tourism some entrepreneurs, politicians, and residents want these fees to be abolished so Upper Mustang can attract a broader range of international travellers. The success of Lower Mustang, where relaxed restrictions have led to a<a href="https://nepalitimes.com/here-now/boom-time-in-central-tarai"> tourism boom</a>, is often cited as proof of what lifting restrictions could achieve. Upper Mustang is not the only region in Nepal with a restricted status. Several northern areas prefixed with ‘Upper’ (Upper Manaslu, Upper Dolpo, Upper Kanchenjunga, and Upper Arun) also need similar permits and fees. Although no clear official explanation exists, these areas were primarily restricted due to historical inaccessibility, ecological and cultural fragility and security concerns. Read also: <a href="https://nepalitimes.com/news/upper-mustang-opposes-prohibited-areas">Call to scrap Upper Mustang tourist fee</a> In the 1960s and 1970s, these remote regions served as shelters for Khampa guerrilla fighters who launched cross border ambushes on the <a href="https://nepalitimes.com/here-now/the-last-days-of-the-khampa">Chinese military </a>across the border.&nbsp; Though the Khampa have long gone, security concerns rooted in that era seem to persist. The government in Kathmandu is seemingly unaware of the changed political and security landscape. If concerns do remain, they are not made public. One of the main reasons for maintaining the restricted designation is to limit visitor numbers. But with <a href="https://nepalitimes.com/opinion/the-road-out-of-nepal">improved road access and services</a>, as Upper Mustang has seen, this justification no longer holds. When Upper Mustang first opened to international tourists in 1992, it had no formal lodges or hotels, and it took four to five days of trekking from Jomsom to Lo Manthang.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f.jpg" data-media-id="editor_8" data-image-id="20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f" data-rendition-name="original" width="2000" height="509" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: DINESH SHRESTHA</figcaption> </figure>  Without a nechyang (a household with traditional friendship), it was difficult to find a place to stay or get a proper meal. Only a few elite households offered accommodation. Today, there are now more than 80 lodges and hotels above Kagbeni, spread across nearly every village. Several upmarket hotels now struggle to stay afloat during the off-season, relying on low-spending domestic visitors to survive. Lo Manthang, once a remote destination, is now just a few hours’ drive from Jomsom, easily reachable by lunchtime for early starters. Once the remaining road sections are blacktopped, travel time will be further reduced. Yet, the government still charges a flat $500 fee for a 10-day permit based on outdated &nbsp;assumptions from a bygone era. There has been no serious review of the permit structure to align with current realities, nor any response to local aspirations to attract more international tourists and <a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz">harness tourism for economic development</a>. Concerns about over tourism are valid. There is a risk that increasing visitor numbers could erode Upper Mustang’s <a href="https://nepalitimes.com/here-now/a-million-mantras-in-mustang">cultural heritage</a>, social fabric, and fragile natural environment, precisely the features that make it special. However, the region’s 33 years of tourism experience have been largely positive.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a.jpg" data-media-id="editor_11" data-image-id="20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a" data-rendition-name="original" width="1400" height="1050" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: MUKESH POKHREL / NT ARCHIVE</figcaption> </figure>  Tourism has contributed significantly to the restoration and <a href="https://nepalitimes.com/here-now/the-history-of-heritage?%2F">preservation of religious and historical sites</a> like the Thubchen and Jampa monasteries in Lo Manthang, the ongoing conversion of the old palace in Ghami into a premium hotel, and the rehabilitation of many monasteries and chortens.&nbsp; These efforts, supported by international donors and heritage experts, demonstrate that tourism—when well managed—can be a powerful driver of <a href="https://nepalitimes.com/here-now/shrinking-tourism-s-ecological-footprint">conservation</a>. The high permit fees have been somewhat effective in limiting international visitors, but they have no influence on the growing number of domestic tourists, particularly during the Dasain and Tihar holidays. The most pressing need now is for all levels of government—federal, provincial, and local—to<a href="https://nepalitimes.com/news/why-invest-in-nepal"> invest in </a>managing tourist flows and maintaining tourist sites. These efforts are essential not only to enhance visitor experience but also to build long-term resilience and sustainability for the destination. Read also: <a href="https://nepalitimes.com/news/greening-nepal-s-tourism">Greening Nepal’s tourism</a>, Hanna Wells Visitor numbers are central to any tourism development strategy that aims to balance economic, social, and environmental goals. Clinging to obsolete policies and concerns to justify Upper Mustang’s restricted status is not only unfair, it also suggests an undemocratic and discriminatory attitude toward a remote district.&nbsp; Shailendra Thakali, PhD, is from Jomsom and is a freelance consultant on protected areas, tourism, conservation, and sustainable livelihoods.