Most disasters strike without warning. But dengue fever which spreads when infected mosquitos breed in monsoon puddles, is largely predictable and preventable. Densely populated Kathmandu with stagnant pools of water has all the ingredients for another outbreak like the deadly one in 2022. Last year there were about<a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon" target="_blank"> 55,000 infections and 88 fatalities</a> officially reported across Nepal in its biggest dengue outbreak yet, the real figure is probably higher. Hospitals were out of capacity, over-medication was rampant, and almost every house in Kathmandu had multiple members struck down with infection. This year, Nepal had already seen <a href="https://kathmandupost.com/health/2023/07/08/dengue-spreads-to-66-districts-one-person-dead-over-1-200-test-positive" target="_blank">over 1,000 dengue infections </a>by end-June. Starting in Dharan where one person has already died, the disease has now reached most of the 77 districts. Even so, many cases are never reported, and many recuperate at their homes. Furthermore, 80% of dengue cases are asymptomatic. “We are not even at the peak of the dengue season, and cases are already surging. It is very likely that this will further increase as rains begin to dwindle post-monsoon,” warns Sher Bahadur Pun, virologist at the Sukraraj Tropical and Infectious Disease Hospital in Kathmandu. “Nepal’s poor surveillance and record keeping also means diseases like dengue are seriously under-reported.”&nbsp; Lack of public awareness about dengue management and prevention adds to the problem. A third of dengue patients admitted to Teku Hospital last year <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak" target="_blank">did not even know</a> that the disease is mosquito-borne and spreads in the daytime.&nbsp; “At least this wasn’t the case with Covid-19, but with dengue, people struggled to adopt the correct precautions due to lack of knowledge,” explains Pun. “Even more alarming: once infected, people took strong medications like painkillers and antibiotics unaware that they are ineffective and often even harmful in dengue.”&nbsp; Although there is no specific medication for dengue, doctors recommend paracetamol to ease the fever and enough fluids to replenish the body. Dengue has no cure.&nbsp; Dengue was first reported in Nepal in 2004, but it was not until 2019 that it spread like wildfire in major urban centres. Two years of Covid lockdowns significantly reduced the caseload after the 2019 outbreak, but last year, it struck again.&nbsp; Read also: <a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon">New dengue outbreak likely this monsoon</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230717150716_97f01f95d37cc29c4c2a68ba54185635449829fa53a3064d0b83ba5714263db9.png" data-media-id="editor_4" data-image-id="20230717150716_97f01f95d37cc29c4c2a68ba54185635449829fa53a3064d0b83ba5714263db9" data-rendition-name="original" width="1072" height="577" loading="lazy" alt="Dengue graph NT"> <figcaption>Trend of dengue cases in Nepal 2006 - 2023 June, SOURCE: MoHP Situation Update</figcaption> </figure>  But even as dengue starts to spread in Kathmandu Valley, elected local officials do not seem to be too concerned. When the Ministry of Health and Population called on all local unit representatives in the Valley to discuss the outbreak on 9 July, 12 out of the 18 units <a href="https://kathmandupost.com/health/2023/07/11/dengue-search-and-destroy-campaign-to-be-launched-in-kathmandu-valley" target="_blank">avoided the meeting altogether.</a> Although there are some fumigation and dengue search and destroy campaigns <a href="https://kathmandupost.com/health/2023/07/11/dengue-search-and-destroy-campaign-to-be-launched-in-kathmandu-valley" target="_blank">set to be launched in Kathmandu</a> soon, with the monsoon already started, it may be a case of too little <a href="https://www.nepalitimes.com/banner/state-of-malaise" target="_blank">too late</a>. It should have started before the onset of the monsoon. “Though not as many as last year, we are already seeing a worrying number of mosquitoes near areas with stagnant water. And when they fly into homes, chances are the virus is already spreading from those infected,” explains Pun.&nbsp; This negligence and delay in action comes despite repeated warnings from experts. Officials knew far in advance that <a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon" target="_blank">last year’s virus is still in mosquito larvae, waiting for the monsoon</a>, and yet, preventive measures, emergency preparedness, and capacity building were ignored. The risk of dengue fever will rise in the coming months of August and September, although some public health experts say serious dengue outbreaks seem to happen after a gap of two years. With climate change, mosquitos are moving up the mountains in Nepal, bringing mosquito-borne disease like malaria, encephalitis and dengue higher. The number of cases officially recorded between January and June this year is nine times higher than last year. Districts like Sankhuwasabha are on the <a href="https://edcd.gov.np/uploads/resource/64a3d5414aad6.pdf#:~:text=This%20figure%20was%20more%20than,of%20cases%20reported%20in%202019.&amp;text=As%20of%2030th%20June%2C%202023,listed%20details%20in%20Figure%202." target="_blank">top-ten list</a> for most cases reported, even though it is in the high mountains, and indicating how global warming is <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms" target="_blank">pushing mosquito breeding grounds further north.</a> Bagmati is once again the hardest-hit province, possibly due to higher population density. Read also:<a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay"> Dengue days are here to stay</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230717150716_b1a8b5c7b8e50f5e388f04a41877f2520ffa8f334c04343b357fd034d4166e6d.png" data-media-id="editor_12" data-image-id="20230717150716_b1a8b5c7b8e50f5e388f04a41877f2520ffa8f334c04343b357fd034d4166e6d" data-rendition-name="original" width="1088" height="433" loading="lazy" alt="Dengue graph"> <figcaption>Dengue cases reported by province in 2023 January to June.  SOURCE: MoHP Situation Update</figcaption> </figure>  Tackling Dengue: what does it really take? Ugonnaya Caleb-Ugwuowo recalls treating children and pregnant women struck down with dengue fever in a local hospital in Lagos. The Nigerian doctor and public health expert specialises in managing outbreaks, and says she often felt helpless at being unable to correctly diagnose and treat them due to lack of facilities. Nepal could learn from Nigeria's experience. Dengue fever is endemic in almost all states in Nigeria. “Although the country is still struggling, the challenges and epidemics Nigeria has faced over the years have shaped our understanding of what it takes to tackle outbreaks like the ones Nepal faced last year and in 2019,” says Ugonnaya.&nbsp; It starts with surveillance, she says, adding: “The government in Nepal should, as a matter of urgency, conduct dengue surveys in all provinces to assess the proportion and magnitude of different <a href="https://www.nature.com/scitable/topicpage/dengue-viruses-22400925/#:~:text=The%20Dengue%20Serotypes,antibodies%20in%20human%20blood%20serum." target="_blank">dengue serotypes</a> circulating freely. Following this, dengue should be made reportable from all local health institutions directly into the national health information system." Dengue fever for the first time, though debilitating, often does no harm. But getting it a second time with a different serotype poses a significantly higher risk of the disease progressing to haemorrhagic fever, where blood thins out and can start leaking from veins, causing potentially fatal internal bleeding. This is what makes serotype surveys so important. A <a href="https://academic.oup.com/jtm/advance-article-abstract/doi/10.1093/jtm/taad034/7087081?redirectedFrom=fulltext" target="_blank">study</a> aiming to report dengue serotypes seen in Kathmandu during last year’s outbreak showed DEN-1 and DEN-3 to be the dominant serotypes, with only negligible cases of DEN-2 reported. But such studies should be conducted nationwide, so that the risk of infection with other serotypes can be correctly determined. Sri Lanka and Bangladesh, both of which have reported elevated levels of dengue infections this year, have direct flights into Nepal. “Although the inflow of infected tourists also poses a great threat, the greater concern should be the mosquitoes in and around places where these tourists go, like airports, temples and major tourist sites,” warns Pun. If barring flights is not an option, vector control is the best way to minimise transmission. For this, fumigation and dengue search and destroy efforts should be concentrated in tourist sites first. Simple source reduction strategies like covering open water containers, using insecticides in canals, parks and fields exist, but deploying genetically modified mosquitoes to reduce the population of disease carriers can also control vector-borne diseases. Caleb-Ugwuowo adds that Nepal already has a decentralised framework of healthcare, so proper surveillance is possible. More importantly, the two previous outbreaks have given experts an idea of what needs to be done: capacity building in hospitals, sanitation and drainage facilities, public awareness, and emergency preparedness before the disease strikes. Pun agrees: “We must learn from other countries as well as from our own past experience, and act to contain this outbreak. Things will get progressively worse in the next few weeks, so there is no time to beat around the bush, especially with dengue already knocking at our doors.” Read also: <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms">Mosquitoes move up mountains as the earth warms</a>, Sonia Awale

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Dengue danger returns with monsoon

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/637235369c7e80680e0c4975jpeg.jpg" alt="" width="5827" height="3885"/><figcaption>All Photos: Suman Nepali</figcaption></figure>For the past two years, the preoccupation of the government and people of Nepal has been with the pandemic. But just as the fourth wave of Covid-19 started to subside, Kathmandu and other towns across Nepal have been hit by dengue outbreaks.For the past few weeks, Shukraraj Tropical and Communicable Disease Hospital in Teku has been crowded with patients with fever. At first, epidemiologists there thought it was a new Covid strain, but the symptoms were different: severe body ache, eye pain, high fever and nausea.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/6372353a9c7e80680e0c4976jpeg.jpg" alt="" width="2304" height="1536"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/6372353d9c7e80680e0c4977jpeg.jpg" alt="" width="2304" height="1536">In Kathmandu Valley, there were hotspots mostly in inner city Patan and the outskirts. Hundreds of patients have been admitted into hospitals, and the number of cases diagnosed in hospitals has surpassed 1,000 -- more than in the previous outbreak in the summer of 2019.Last year, there were only 10 patients at the Teku hospital in the second week of August last year, whereas there were 295 dengue patients just in the past week.This week, 120 dengue cases were reported in Lalitpur, 70 in Rupandehi, 110 in Kathmandu, and dozens more in Nawalparasi West and Bhaktapur, seven each in Dhading, Gulmi and Kapilvastu, six from Arghakhanchi, and five each from Tehrathum, Sindhuli and Makwanpur. There are six patients with dengue in ICU.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235419c7e80680e0c4978jpeg.jpg" alt="" width="2304" height="1536">The number of dengue patients in hospitals has now exceeded those suffering from Covid. Doctors say there are probably thousands more with dengue fever recovering or being treated at home.  Dengue is transmitted from one infected person to the next by bites of the Aedes aegyti mosquitos during the day, and is caused by four different virus sero-types. Patients infected with one serotype of the virus will not have immunity against the other three types and there can be multiple infections.  Also called 'break-bone fever' patients contract the disease 3-7 days after the mosquito bite, and the high fever usually lasts up to a week, although it leaves the weak for up to a month.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235459c7e80680e0c4979jpeg.jpg" alt="" width="2304" height="1536"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235489c7e80680e0c497ajpeg.jpg" alt="" width="2304" height="1536">There is no treatment for dengue, since antibiotics are not effective against viruses. Doctors recommend paracetamol to ease pains and to bring down fever, and plenty of fluids. More severe cases of dengue can result in internal haemorhage and may require hospitalisation.“People still do not believe that mosquitoes bite during the day. While sleeping at night, they adopt all the safety standards from the hammock, but they ignore it during the day," says Sher Bahadur Pun, the head of the hospital’s clinical research unit.He says that measures should be taken to avoid mosquito bites in schools and offices as well as at home. “People are aware when they are at home, but they should be most aware in schools, offices, areas where houses are under construction and there are pools of stagnant water,” he says.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/6372354b9c7e80680e0c497bjpeg.jpg" alt="" width="5905" height="3937">Pun's informal survey among patients at Teku showed that a third of them do not even know that dengue is transmitted by mosquito bites during the day. This is why the viral fever is spreading among students, with cases of entire classes of some schools being sick.Pun also warns against taking strong medications for dengue, and says that certain pain-killers and antibiotics can actually make the patients' condition worse.“Dengue causes severe body ache, so people look for strong medications for this. We have been giving cetamol for fever, which sometime does not alleviate pain like other painkillers,” says Pun. "However, using Brufen, Flexzone, Nims can be very harmful."<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/6372354f9c7e80680e0c497cjpeg.jpg" alt="" width="5210" height="3473">A study conducted  at Teku Hospital on the outbreak of dengue in Nepal from 2006 to 2019 found that many patients had become sicker because of prescription medicines they took without consultation, or because doctors had prescribed the wrong medicine thinking it was some other kind of fever.Recently, Pun came across a dengue patient  who was bleeding from the eyes after taking Flexzone continuously for five days. "I had never seen such a case before," he says, "patients who are being treated at home should be admitted to the hospital immediately if they have serious problems."Read more: <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/">The dangers of the dengue virus</a>, Tom Robertson

As Covid abates, Nepal sees dengue outbreak

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861ea79c7e80680e0ccddajpeg.jpg" alt="" width="799" height="536"/><figcaption></figcaption></figure>There have been few days without rain this April and May in Kathmandu. That means more disease for Kathmandu. Not COVID-19, but the virus we used to talk about -- last year's scary unknown disease, dengue.The year 2019 saw Nepal's worst ever outbreak of dengue, with 15,000 people infected, many times the previous high. Dengue was particularly bad in the Kathmandu Valley. At least six people died.The medical journal The Lancet has warned that Kathmandu could see a dengue ‘explosion’ because it has become ‘an ideal breeding ground’ for the mosquito that carries dengue -- the notorious Aedes aegypti. Already in 2020, four cases have been reported in Kathmandu, and four in Lalitpur.<a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer">Big story of smallpox in Nepal</a>, Tom Robertson<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/viruses-past-present-and-future/" target="_blank" rel="noopener noreferrer">Viruses past, present and future</a>, Tom RobertsonDengue spiked in 2019 with outbreaks around the developing world. In recent years, Delhi, Dhaka, Ho Chi Minh City, Senegal and Singapore have faced bad outbreaks. A dengue outbreak in Delhi in 2015 inundated hospitals and clinics across the city.Dengue likes warm humid conditions. Before corona, dengue was the world's fastest growing dangerous virus, increasing four-fold in just over a decade. Two of every five people around the world, nearly 3 billion people, live in dengue risk areas where it is a leading cause of illness. Each year approximately 100 million people contract the disease, and over 20,000 die.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eaa9c7e80680e0ccddbjpeg.jpg" alt="" width="961" height="540"><figcaption> </figcaption></figure>Like malaria, dengue is actually several different diseases that we give a single name. There are four dengue viruses: Dengue 1, 2, 3, and 4. A person can catch each one, and get sick as many as four times.A first infection generally brings only mild flu symptoms, if any at all. But a second infection can cause ‘severe dengue’ with plasma leakage, bleeding, and shock. This can kill. No treatment exists for dengue, but generally symptoms can be managed.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/climate-health-emergency/" target="_blank" rel="noopener noreferrer">Climate health emergency</a>, Sonia Awale<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener noreferrer">Mosquitoes move up mountains as the earth warms</a>, Sonia AwaleDengue's main mosquito host, Aedes aegypti, is no ordinary mosquito. In a species known for death and deviousness, it has few rivals. Not many mosquitoes have so successfully defied human efforts at control, including in recent decades.Long before dengue, Aedes aegypti carried a far deadlier disease: yellow fever. During the 16th and 17th, slave ships brought yellow fever carrying A. aegypti from Africa to the Americas, devastating indigenous populations and reshaping the region's balance of power. In the early twentieth century, the A. aegypti -- yellow fever combination almost blocked the construction of the Panama Canal.Most wildlife avoid humans. Not A. aegypti. It loves us, particularly the ecological disorder we often create. The more humans, the more disturbed ecosystems, the more A. aegypti. Cities, especially disorganised cities, create ideal habitat: lots of standing water for breeding and lots of humans for feeding.Dengue's other mosquito carrier is A. albopictus.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eac9c7e80680e0ccddcjpeg.jpg" alt="" width="640" height="463"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eaf9c7e80680e0ccdddjpeg.jpg" alt="" width="640" height="635"><figcaption> </figcaption></figure>The Lancet points to dengue's major causes: climate change, relentless and haphazard urbanisation, brisk trade and transit from dengue-infested areas, and poor health infrastructure. As Kathmandu grows and gets more connected to other parts of Asia, dengue spreads.Climate change has been overrated as a cause. Warming temperatures can extend the range of Aedes carriers but other causes deserve more attention. ‘Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNHqCreNEFDji4GDyS_wUW1JkpUOGA">blamed on climate change</a>,’ the Nepali Times recently noted, ‘but it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon.’The real problem is disorganised urbanisation. The A. aegypti carrier thrives in small collections of clean water in flower pots, old car and truck tyres, uncovered water containers, and even puddles. It bites people early morning and at dusk.<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener noreferrer">"Nepal is a microcosm of all of the changes in world health"</a><a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/ke-garne-attitude-kills-people/" target="_blank" rel="noopener noreferrer">K garne attitude kills people</a>, Laxmi BasnetNepal, like much of the developing world, has witnessed dramatic and disorderly urban growth in recent years, much in the lowlands along highways. ‘Nepal's Tarai," Mukesh Pokhrel recently wrote also in this newspaper, "is turning into one endless elongated metropolis.’Kathmandu itself grew four-fold between 1980 and 2010, and is one of the fastest growing cities in one of the world's fastest urbanising regions.'<a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNHqCreNEFDji4GDyS_wUW1JkpUOGA">Cities like Kathmandu are perfect breeding grounds</a> for the Aedes mosquito,' says Jeremy Farrar of the Wellcome Trust in an interview with this paper. 'Kathmandu’s climate is changing, the city is growing exponentially in a haphazard way and the mosquito loves highly dense populations of people.'<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/east-west-city/" target="_blank" rel="noopener noreferrer">East-West City</a>, Mukesh Pokhrel<a href="http://archive.nepalitimes.com/news.php?id=19301#.XtI_7y2B3-Y" target="_blank" rel="noopener noreferrer">Dengue fever</a>, Buddha BasnyatThe Lancet highlights what might happen in a dengue explosion in Kathmandu. ‘A tug-of-war might occur between the worried well and the truly sick,’ it says. ‘Hospitals might be overwhelmed and many needy patients with other diseases could be turned away.’Doctors inexperienced with the disease pose a particular worry. They could misunderstand its dynamics and cause unnecessary deaths by over-treating with unneeded antibiotics, transfusions, and excessive intravenous fluids. This has happened elsewhere.The dengue-carrying Aedes aegypti mosquito is difficult to control. Brazil eradicated it twice, in the 1950s and in the 1970s, and twice it returned. Several factors explain why: a lack of sustained careful epidemiological surveillance, insecticide resistance, the high costs of materials and wages, insufficient community participation and coordination with the health sector, and, crucially, the spread of haphazard urban development. Narrow control programs inevitably run into trouble.The World Health Organisation (WHO) stresses both micro and macro efforts to fight dengue. Individual families can put tight lids on water containers. They can eliminate breeding spots such as empty cans, bottles, and tires. It also says community engagement and building country capacity for environmental management and disease surveillance is important.“Locally adapted vector control measures such as household water storage management and, more importantly, engaging individuals and communities to manage their immediate environment are essential to controlling the spread of the disease,” says Raman Velayudhan, head of WHO’s Vector and Ecology Management Unit.School-based awareness programs, The Lancet authors noted, can help block dengue's spread. ‘Students are good learners and can be taught to effectively use repellents and mosquito nets and get rid of water collections near their homes and schools; students will then spread this information to their parents.’ Several countries have implemented successful school programs.Historian Frank Snowden sums it up: "Dengue takes full advantage of societal neglect and the absence or cessation of vector control programs."Tom Robertson, Ph D, is an environmental historian who writes about the history of malaria in Nepal. And just wrote a <a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNFk193f6QnfjiWqivawrVZt2FPA4A">five-part series on smallpox</a> for Nepali Times as part of his History of Disease column.

Tom Robertson

The dangers of the dengue virus

Fenerbahçe Beko won the Turkish Airlines EuroLeague finals in Abu Dhabi, held 23-25 May, defeating Monaco 81-70 in the final. Olympiacos, who defeated Panathinaikos 97-93, finished the series in third place. The Most Valuable Player (MVP) of the final match, Nigel Hayes-Davis from Fenerbahçe Beko, received a prize of 1,000,000 Miles&amp;Smiles from Turkish Airlines’ Chief Commercial Officer Ahmet Olmuştur. The carrier has been the title sponsor of the Turkish Airlines EuroLeague, a top tier tournament, since 2010.

Turkish Basketball

While Nepal was hosting the Sagarmatha Sambaad international climate conference in Kathmandu this month, on Mt Everest it was pretty much business as usual.&nbsp; The signs of climate breakdown are all there: a river now runs through Base Camp in summer, the Khumbu Icefall is more unstable, and there are more &nbsp;frequent avalanches. When expeditions arrived in March, the mountains were bare: it had not snowed since September, but then blizzards dumped unseasonal snow in May. And despite climate worries, such is the pull of Himalayan mountaineering that the Everest Industry showed no signs of slowdown. More than 600 international climbers and their Nepali guides had made it to the summit of the world’s highest mountain. At one point there were an estimated 2,000 people in the tent city on the Khumbu Glacier. All the ropes and ladders on the Icefall came down on Thursday, marking the official end of the spring climbing season, and just in time to avoid a monsoon cyclone approaching from the Bay of Bengal. It has been an action-packed season. One factor could be that Everest fees will go up from September: each foreign climber needs to pay a $15,000 royalty, up from the present $11,000. The cost for a Nepali climber on the South Col route will also go up: from Rs75,000 to Rs150,000.&nbsp; The fee to climb Everest in autumn is $7,500 (up from $5,500), but most climbers still prefer spring. Winter permit fee (December-February) is only $3,750 per person and the mountain is now also open for monsoon (June-August) climbs, when the fee is ever lower at $2,750. The revised rule also makes it mandatory for every two climbers on an 8,000m peak to hire one Nepali mountain guide.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025053004050_67f856fe52714e4bdcf21ae7d45c6f18c82117b9d0a5f73ed1efa04c96de1046.jpg" data-media-id="editor_0" data-image-id="2025053004050_67f856fe52714e4bdcf21ae7d45c6f18c82117b9d0a5f73ed1efa04c96de1046" data-rendition-name="original" width="931" height="732" loading="lazy" alt="The Everest Industry graph 1"> </figure>  In addition, climbers also have to pay for porters and guides, equipment, Base Camp costs, Ice Fall and fixed rope team fees, so climbing Everest does not come cheap. But such is the draw of climbing the world’s highest peak that some say the increased fees will not diminish the crowds next year. The government has tried to spread expeditions out to other seasons and other 8,000ers, but with not much success. Earlier this year, Nepal unilaterally increased the number of 8,000m peaks to 14 by adding six more sub-summits to broaden the choice for climbers. Added were: Yalung Kang (8,505m), Yalung Kang West (8,077m) &nbsp;Kangchenjunga Central (8,473m), Kangchenjunga South (8,476m), Lhotse Middle (8,410m) and Lhotse Shar (8,400m).&nbsp; The announcement could go against the accepted topographic criteria that a stand alone peak has to be at least 300m higher than an adjoining prominence, and at more than 3km isolation from it. The UIAA (Union Internationale des Associations d'Alpinisme) still recognises only 14 mountains as eight-thousanders, and only eight of those are in Nepal, or on the border with China. Nepal’s revised mountaineering regulations also increased the insurance coverage of high-altitude workers to protect porters and high altitude guides who usually take more risks on the mountains. Rescue teams and clean-up campaigners to collect trash and remove bodies of dead climbers up to Camp IV of Mt Everest do not need permits.&nbsp; The Sagarmatha Pollution Control Committee is now using drones to fly down trash in 20kg sacks. Each climber is also required to bring down at least 6kg of waste and not just their own, but this rule is erratically enforced. With five fatalities on Everest and Lhotse, Spring 2025 had a historically low death toll. Another five climbers died on Annapurna, Kangchenjunga and Makalu.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025053004050_38681de22f0fefb6faa12b01755566d09c5064d0ff84e12ccc7b5d68ea9ba38a.jpg" data-media-id="editor_1" data-image-id="2025053004050_38681de22f0fefb6faa12b01755566d09c5064d0ff84e12ccc7b5d68ea9ba38a" data-rendition-name="original" width="665" height="740" loading="lazy" alt="The Everest industry graph 2"> </figure>  Journalist Ben Ayers who ran the Everest Live social media channel from Everest Base Camp with daily updates credited the low death rate to dramatic rescues of climbers from the ‘Death Zone’ by their Nepali guides and longline helievacs — the visuals all uploaded on YouTube.&nbsp; “Ironically, this perception of safety is bringing more and more inexperienced climbers to the mountain, and they need more rescues,” Ayers said in one of his dispatches.&nbsp; American expedition chronicler and summiteer Alan Arnette suspects there is a lot of under-reporting given that the jet stream and storms were lashing Everest even till late in the season. He told us: “I heard a lot about frostbite and rescues that were not made public. It’s become practically impossible to cover the details on Everest. All the teams report nice news, and they don’t talk about bad stuff to avoid hurting businesses.” Although trash on Nepal’s mountains makes headlines, what does not receive as much attention is the climate impact of so many expeditions. The Sagarmatha Sambaad conference sidestepped this issue, which is ironic given that the impact of climate breakdown is most evident on Himalayan peaks and their glaciers.&nbsp; <h2>Need for Speed</h2> The big stories this year have been about speed-running from their home cities to the top of Everest. Ukrainian entrepreneur Andrew Ushakov flew out of JFK on 15 May at 10:15AM Nepal time, and was on the summit 3 days, 23 hours, and 7 minutes later on 19 May at 9:22AM.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250601080640_1c5cc6fc991307861768f07037ed9d30930fb20f35dbb57dc31c9a92a9e1a885.jpg" data-media-id="editor_2" data-image-id="20250601080640_1c5cc6fc991307861768f07037ed9d30930fb20f35dbb57dc31c9a92a9e1a885" data-rendition-name="original" width="1440" height="1800" loading="lazy" alt="The Everest Industry"> <figcaption>Andrew Ushakov at the summt. Photo: ELITE EXPED</figcaption> </figure>  “I could never find the time for the traditional 40-50 days of acclimatisation,” Ushakov explained matter-of-factly. His ‘Everest Sea-to-Summit’ climb was possible because he spent 400 hours in hypoxic sleep tents over the past four years in New York. However, Ushakov did use ropes already fixed, hired four Nepali guides, helicoptered to Base Camp, and used much more oxygen than an average climber. And after the climb, Ushakov was arrested at Kathmandu airport for being in possession of $20,000 of undeclared cash and spent a night in jail and fined $60,000.&nbsp; The other speedsters were Garth Miller, Alastair Cairns, Anthony Stazicker, and Kev Godlington, all former British Army commandos. They left London and summited five days later on 21 May, and flew right back. They also used hypoxic tents to simulate the thin air high on Everest.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250601080644_90c8dd5cc07b4b43f2989b1dc0c0650ab80f10ebb06680c25a6909c519957bd8.jpg" data-media-id="editor_3" data-image-id="20250601080644_90c8dd5cc07b4b43f2989b1dc0c0650ab80f10ebb06680c25a6909c519957bd8" data-rendition-name="original" width="810" height="668" loading="lazy" alt="The Everest Industry "> <figcaption>All four members of the Furtenbach team at the summit. Photo: Sandro Gromen-Hayes</figcaption> </figure>  But more controversial was their use of xenon gas therapy in a German hospital to ramp up the production of oxygen-carrying haemoglobins in their blood. Xenon is banned by the World Anti-Doping Agency for being performance enhancing in sports. Expedition leader Lukas Furtenbach said this rule does not apply to mountaineering, as it is not a regulated sport like swimming. Nepal has no rules about xenon, but the Department of Tourism said it was launching an ‘investigation’ to decide on future policy since it is difficult to ban xenon, but allow oxygen. The controversy has also divided the mountaineering community, with some climbers saying they just want to maximise their chances of survival. Spending less time on the mountain could make climbing safer by reducing avalanche risk. It would also mean less trash on the mountains, but it would reduce the income of Nepal’s expedition industry. It is also unclear how much of the success was due to xenon therapy and whether the ex-special forces were already in good physical shape.&nbsp; The need for speed hides the fact that climbing in the Himalaya is dangerous business, and climbers cannot sprint to the top just by huffing xenon. But ultra-fast climbs could be charged more, and the revenue generated can be used to establish state-of-the-art rescue operations, and increase pay and insurance for guides. Two other speed chasers this season were Swiss-Ecuadorian Karl Egloff and American Tyler Andrews, both on Everest without oxygen. Andrews choppered to Base Camp to catch a weather window, but turned back from 8,500m due to high winds. Heavy snow and wind also forced Egloff to descend from 7,000m. Slow and steady climbers like Anja Blacha from Germany did make it to the summit without oxygen, while Kami Rita Sherpa broke his own record with his 31st Everest summit as he led a 26-strong Indian Army group. There were 468 permits issued for foreign climbers from 48 expeditions to Everest this spring. Nepal’s other eight-thousanders together had only 17 expeditions. Nepal has more than 1,000 peaks above 6,000m, and has opened only 476 of them for climbing.&nbsp;

The Everest Industry

While Nepal marked <a href="https://nepalitimes.com/news/mt-everest-pvt-ltd">Mt Everest</a> Day on 29 May, on the other side of the planet in the US state of Colorado dozens of Nepalis who have climbed the world’s highest peak multiple times were busy working as chefs and Uber drivers. Among them is Nima Doma Sherpa, who climbed Mt Everest in 2019 after her husband Tshering Wangchu was among 16 crushed by an avalanche on <a href="https://nepalitimes.com/banner/on-thin-ice-in-the-khumbu">the Khumbu Icefall</a> five years earlier. A large serac broke off the West Shoulder of <a href="https://nepalitimes.com/news/the-everest-industry">Mt Everest </a>and fell directly on a group of <a href="https://nepalitimes.com/opinion/more-porters-sick-on-everest-trail">porters and guides</a> making their way up the Icefall at 5,800m. Their bodies were flown by helicopter to Khumjung where Tshering Wangchu was born. He was excited about climbing Mt Everest for the first time.&nbsp; In Khumjung, Nima Doma felt like her own life had also ended. This was the kind of news Sherpa wives, mothers and sisters dreaded every <a href="https://nepalitimes.com/here-now/peak-climbing-season-2025-s4abrxny">mountaineering season</a>. She stayed home for more than two years grieving, but ultimately gathered up all her emotional strength to take care of her 6-year-old son and 3-year-old daughter. Nima had grown up in Khumjung hearing <a href="https://nepalitimes.com/review/stories-of-nepal-s-summiteers">tales of adventure on the mountains </a>from their father, Ang Chubi Sherpa who had climbed Everest in 1993. He used to bring her and her sisters and brother European chocolates after every expedition, and used to tell them that the chocolate bars grew on the mountains. “It was only after we got older did we realise that he told us that chocolates grew in the mountains so we would not worry about him putting himself in harm's way,” Nima Doma recalled with a faraway look at her home in Boulder this week. Nima went to the school that <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/commemorating-edmund-hillary-in-nepal,4145">Edmund Hillary</a> opened in Khumjung till Grade 8, and then dropped out to help in the kitchen and <a href="https://nepalitimes.com/here-now/when-yaks-go-so-does-culture">tend yaks</a>. She was married off to Tshering Wangchu, who was also a high altitude guide. When Tshering went on expeditions, Nima also started working as a porter from Namche to Base Camp. It was perhaps her father’s tales of mountains of chocolates that had always attracted her to <a href="https://nepalitimes.com/here-now/knowing-our-mountains-43v4iyvo">the peaks</a>. After her husband was killed ten years ago this month, being a widow with children was not easy for Nima Doma. But she was not alone: there were at least 200 single mothers in <a href="https://nepalitimes.com/here-now/khumbu-since-1950-jaww4qn0">the Khumbu</a>, and 20 of them just in Khumjung whose husbands had been killed in <a href="https://archive.nepalitimes.com/article/nation/tragic-start-to-himalayan-spring-nepal,3695">mountaineering accidents</a>. Some were not even 20 years old, and had children growing up without fathers. But there were also women in the 50s whose husbands had been killed in the 1980s. Nima found sponsors for her children’s education, and moved to Kathmandu. In the capital, Sherpa widows used to meet to help each other. Some of them had joined the Nepal Mountaineering Association (NMA) training for rock and ice climbing. “I decided that it was no use sitting home and crying anymore, after meeting other single mothers I felt less alone,” remembers Nima, who joined the Juniper Foundation and enrolled in an NMA training camp in Manang. There she climbed Chulu East (6,584m) and met Furadiki Sherpa, whose rope-fixing husband had also been <a href="https://nepalitimes.com/news/on-mt-everest-s-70th-records-and-fatalities">killed on Everest</a> in 2013. They set themselves the goal of climbing Everest one day, and started a fund-raising drive.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250530090544_621be0724b9182c8e3594b2c562a71ec32ac01d985a71d0cf31646de9d51e15a.png" data-media-id="editor_12" data-image-id="20250530090544_621be0724b9182c8e3594b2c562a71ec32ac01d985a71d0cf31646de9d51e15a" data-rendition-name="original" width="2678" height="1274" loading="lazy" alt="Everest summiteers find new life in the US"> </figure>  “We decided we had to overcome society’s stigma of <a href="https://archive.nepalitimes.com/article/nation/widows-personal-happiness-comes-last-in-face-of-social-financial-hardships,1855">widowhood</a> and prove that <a href="https://nepalitimes.com/here-now/remembering-junko-tabei">women could also climb mountains</a>,” Nima said, adding that she was inspired by Nepal’s first woman Everest summiteer Pasang Lhamu Sherpa, who died during her descent in 1993. Nima Doma and Furdiki climbed the technically-difficult Ama Dablam (6,812m) and then arrived at Everest Base Camp in April 2019 as part of their Two Widows Expedition with the motto, ‘So Can We’. While climbing up the Icefall Nima passed the spot where her husband had been killed. It was a jumble of constantly-shifting ice blocks bigger than houses. She closed her eyes and said a prayer. “I remember thinking, this is so difficult and dangerous. This is what my husband had to do to support our family,” Nima Doma said. “I was determined to fulfil my husband’s dream of climbing Chomolungma, and to prove to ourselves that we two women could do it.” It was 23 May 2019 when <a href="https://www.reuters.com/article/world/two-sherpa-widows-scale-everest-and-smash-stigma-idUSKCN1SU0MV/" target="_blank">Nima and Furdiki stepped on the summit</a> and looked over into Tibet, and down at Tengboche Monastery to the south.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250530090544_6b822582b5d88ba5e972db084f184690b40653c6efd9901b2dd082ffba2a263b.png" data-media-id="editor_16" data-image-id="20250530090544_6b822582b5d88ba5e972db084f184690b40653c6efd9901b2dd082ffba2a263b" data-rendition-name="original" width="2700" height="1522" loading="lazy" alt="Everest summiteers find new life in the US"> </figure>  Nima Doma hugged Furdiki, took off her mask and wept. But for the first time in five years, it was not from grief but relief — relief for being free of all the sadness and sacrifices and for fulfilling her husband’s dream. They had found <a href="https://nepalitimes.com/here-now/life-after-death">life after death</a>. “I felt this immense joy to be on top of the world, it was indescribable,” Nima Doma said, “I have wept only twice in my life. Once when my husband died, and once there on top of Everest.” The tears had frozen on Nima Doma’s cheeks, as she and Furdiki headed back down the mountain.

Everest summiteers find new life in the US

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