<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."

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

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.

icu

Nepal designates more hospitals for Covid-19 treatment

Nepal designates more hospitals for Covid-19 treatment

Kathmandu locks down again

Why Nepal’s Covid-19 figures are deceptive

Why Nepal’s Covid-19 figures are deceptive

Nepal’s virus vortex