<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131124/637233e59c7e80680e0c4905jpeg.jpg" alt="" width="760" height="443"/>Monkeypox cases are increasing worldwide and now with India seeing more infections, public health experts have warned that Nepal needs to be vigilant.While the disease does not pose the same degree of threat as Covid-19, officials say it is better to remain cautious. The World Health Organization (WHO) has already declared a health emergency.“Monkeypox symptoms take time to show. If the infection spreads in Nepal, it could be too late by the time it gets identified,” warns Sher Bahadur Pun, infectious disease specialist at Kathmandu’s Teku hospital. Infected people may be reluctant to be tested.Meanwhile, officials say they have already started preparations against monkeypox with increased surveillance at the Nepal-India border area and health workers on high alert.“We have instructed border personnel to check people with visible rashes and send them to dermatologists,” says Sameer Adhikari of the Health Ministry. “Lab personnel have been alerted and health workers have been provided with guidelines.”Monkeypox is not a new disease but is a rare zoonotic infection caused by a virus similar to smallpox but not as severe. The virus was first discovered in monkeys in 1958 and the first human case was identified in 1970. The disease was previously confined to central and West Africa.Monkeypox is primarily transmitted from rats and monkeys, and from one person to another by coming in contact with an infected person’s lesion, by touching a contaminated object or from respiratory droplets. It can also be spread by kissing, hugging, touching, or sex.A person taking care of an infected individual, children, infants, pregnant women and immune-compromised individuals are especially at a high risk of contracting monkeypox.Monkeypox does not yet have a vaccine but some smallpox jabs can prevent the infection, including the ACAM2000 and Jynneos shots. Because smallpox and monkeypox are caused by related viruses, smallpox inoculation is effective for both.Monkeypox is usually a mild condition and symptoms appear within 6 to 13 days and resolve within 3 weeks. Common symptoms include fever, headache, back and muscle ache and swollen lymph nodes and exhaustion. People quickly develop rashes that are contagious till they dry up and burst.Monkeypox is rarely fatal, however, it can be dangerous and cause pneumonia, and skin and eye conditions in some individuals. Previously up to 10% of infected individuals died due to the infection.At least 75 countries have reported monkeypox cases so far with Spain registering the highest at 3,125 followed by the US at 2,316, the UK 2,137, Germany 2,268, France 1,453, Canada 615, the Netherlands 712, Brazil 592 and Portugal 588.Most monkeypox cases do not need medical attention but if fever is too high, certain medicines can be taken. Individuals need to hydrate themselves, have a healthy diet and get good sleep. Scabs should not be scratched, hands should be kept clean and the skin dry.The good news is that many of the safety measures to prevent Covid-19 from transmitting such as masking up, avoiding crowded spaces and sanitising can also keep monkeypox at bay.Translated by Aria Parasai from the <a href="https://www.himalkhabar.com/news/131330?fbclid=IwAR2jdwW01dFzVzjh_nHfRSr2d5sGoj_KyHtVrwAjM8jGJsKWuL4evSLZXco">Nepali original</a> at Himalkhabar.comRead more: <a href="https://www.nepalitimes.com/banner/1-mask-up-2-avoid-crowds-3-get-boosters/">1. Mask Up. 2. Avoid Crowds. 3. Get Boosters</a>, Sonia Awale

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Preparing to prepare for monkeypox

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205539c7e80680e0b28adjpeg.jpg" alt=""/><figcaption>Frontline workers waiting for their booster dose at a hospital in Kathmandu last week. Photos: AMIT MACHAMASI</figcaption></figure>As elsewhere in the world, the <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> in Nepal is starting to peak, but experts say the pandemic is far from over. The Health Ministry had previously projected new cases to soar to 20,000 a day, and the Omicron surge to peak in mid-February. But the fact that the variant spread rapidly like wildfire right across the country giving a majority of the population milder symptoms meant that it equipped them with antibodies to fight the infection.At Nepal’s biggest infectious diseases centre at Teku Hospital, virologist Sher Bahadur Pun predicts that the third wave will most likely peak in a few days, or by the end of next week.“For the past week, I have observed that the number of people coming in for tests and consultation every day has decreased by a half,” Pun says. “Of course, not everyone is coming to the hospital, but this is the beginning of the end of this wave.” To be sure, the government’s daily Covid-19 figures are gross under-estimations. Mostly symptomatic patients are testing, thus registering a very high positivity rate. Infected people with flu-like symptoms are isolating at home without a PCR test. There are also people self-testing with kits available at pharmacies, and these infections are not in the official tally.Even so, figures from elsewhere show <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the Omicron surge</a> lasts only for a month or two. South Africa, where the variant was first detected in December, is over the hump. The UK and parts of the US have also passed their peaks. Many countries, including Australia, are now removing restrictions."It is too early to be sure about exactly when the high number of cases will subside completely," Andrew Pollard, of the team that developed the Astra Zeneca vaccine, told Nepali Times in an email interview from Oxford. "The main issue with rapid spread of Omicron is for the unvaccinated who may be at risk of severe disease, particularly if they are older adults and those with other health conditions."The spread of Omicron in Kathmandu Valley is expected to reach an equilibrium soon, with a steep fall in cases, says Bangkok-based public health expert Sushil Koirala. But he warns slower-moving outbreaks may continue outside the valley where the population is thinly spread. “These next 10 days are critical. It will tell us if the Omicron variant is indeed a quiet pass to a pandemic end-game, or we still have a big human cost to pay,” Koirala adds. “There is still little clarity on how severe this variant will be to those who are still unvaccinated and those who had the vaccines many months ago.” <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205569c7e80680e0b28aejpeg.jpg" alt=""><figcaption> </figcaption></figure>The World Health Organisation (WHO) last week issued an <a href="https://news.un.org/en/story/2021/12/1108932" target="_blank" rel="noopener noreferrer">optimistic projection</a> that the pandemic would probably be over during 2022 — provided inequalities in the vaccine coverage and treatment are addressed.  Global health researcher and economist Christopher J L Murray <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext" target="_blank" rel="noopener noreferrer">writing for the journal Lancet</a> also said that after the Omicron wave, ‘Covid-19 will return but the pandemic will not.’ Pollard also explains that once health systems can cope with Covid-19, the pandemic could be considered over, but that doesn’t mean that the virus will be gone. "We have a pandemic because of pressure on health systems and deaths. With growing global immunity as a result of vaccination and previous waves of infection, both severe disease and deaths should decline during 2022," he says. Despite this, health experts in Nepal warn that severe infections needing hospitalisation have a lag of a few weeks after the surge in infections. And despite being a <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">milder strain</a> that primarily only affects the upper respiratory tract, Omicron can still lead to serious diseases in the elderly and people with co-morbidities. Indeed, ICU admissions and those needing ventilator support in hospital have tripled in one month, although nowhere near the figures in April-May. Also, the seven-day average for daily fatalities have remained below five.  Says infectious disease specialist Anup Subedee: “It will still take some time and a few more variants before the pandemic comes to an end. So our health system should be ever ready with the management and treatment of Covid-19, isolation and contact tracing.” Virologist Pun at Teku agrees: “We are now moving from pandemic to endemic, but this does not mean that we can sound the all clear. We must continue mass vaccinations and safety measures.” The general consensus is that increased vaccine coverage with boosting, more testing, whole genome sequencing to detect variants, and public adherence to safety measures will determine whether there will be a new surge, or if the virus will taper off. Nepal has 20 million doses of vaccines in stock for those waiting for first and second jabs, and has started booster shots for high risk groups. However, communication on location, eligibility and requirements for <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">vaccination</a> centres is confusing and inadequate. With reports from India, Denmark and the Philippines of the even more transmissible ‘stealth Omicron’ sub-variant BA.2 that can evade PCR detection, Nepal needs to continue vigilance. This is also important to determine if the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a> is still circuiting and how dominant it is. “Our Covid figures from the last four days strongly suggest that we have passed the peak,” confirms Sameer Mani Dixit of the Centre for Molecular  Dynamics. “But we must keep a close watch on next week’s numbers to know for sure if the cases are just levelling off, still peaking, or if it was just a momentary decline.”

Sonia Awale

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Omnipresent Omicron starts to lose its edge

<figure><img width="1050" height="685" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110915114/636bb3d59c7e80680e07bb68jpeg.jpg" alt=""/><figcaption></figcaption></figure>Until vaccines and therapies are available, we in Nepal like everywhere else in the world, have to learn to live with this scourge. Extending the lockdown is not the answer unless other measures such as mass testing and sero-prevalence surveys are done.Which is why good sense has prevailed and the CDOs of Kathmandu Valley met at the Home Ministry on Wednesday and decided to be <a href="https://www.nepalitimes.com/banner/experts-caution-against-extending-nepal-lockdown/" target="_blank" rel="noopener noreferrer">smarter about the lockdown</a>, allowing people greater freedom and asking them to take necessary precautions to remain safe.From Thursday, odd-even number vehicles will be allowed back on the roads, including bigger size public buses. Provisions shops will be allowed to be open from 5-11AM, and 5-7PM. Restaurants will also be allowed to do takeaways and online deliveries for limited periods, but with strict compliance. Department stores, shopping malls and other shops can open Mondays, Wednesdays and Saturdays. Detailed do's and don'ts have also been issued, but somewhat ambiguously, the directive also states that 'services similar to the above' will also be allowed. Experts have also questioned how wise it is to limit opening time for shops because it could lead to overcrowding.But something is not quite right about the way this decision has been taken. By handing over discretion on lockdowns to CDOs across the country who are under direct command of the Home Ministry, the government is passing buck. Leaders in Kathmandu forget that Nepal is a now a federal state, decision-making has been devolved to local governmentsThe most effective strategy to deal with the pandemic is to let elected local leaders to decide how to handle it, with the central government only ensuring that they have adequate resources, equipment and medical personnel. Unfortunately, the national level leaders are taking self-isolation a bit too seriously, and are nowhere to be seen. They have centralised power, and have gone into hiding with it.What we do see every day is the Nepal Ministry of Health’s coronavirus press briefing. It is an endless listicle of statistics read out by Jageshwor Sharma Gautam, who may be a fine obstetrician and gynaecologist, but has such dreary delivery that he should have been the last choice for a spokesperson.During the Vietnam War, the US military had daily press briefings at Saigon’s Rex Hotel which were called the ‘Five O’clock Follies’ in which a spokesman read out a long list of American victories that day. Invariably, the number of Viet Cong dead would exceed American fatalities by a factor of ten.Prof Gautam’s four o’clock briefings are beginning to sound like that. During the Covid-19 emergency, this should have been the job for a person with extraordinary communication skills, and a screen personality that commands credibility and respect. Most readers will agree that Prof Gautam has none of those attributes, even though by now many of us have got used to his visage and voice.Do a video search on Google and you will find a clip of the good doctor picking his nose ahead of his daily televised briefing. Good thing he was not live on tv then, but this unhygienic on camera performance has been <a href="https://www.youtube.com/watch?v=Q0x_n0oPVLE" data-saferedirecturl="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DQ0x_n0oPVLE&amp;source=gmail&amp;ust=1599742744580000&amp;usg=AFQjCNHlV-QPqo4OypbSeAH4DIsMlohZJA">immortalised on YouTube</a>.To be sure, replacing the spokesperson is not the most serious or most urgent problem that needs to be fixed right now. But it is an indication of the lack of professionalism for a job that needs a person with effective communication skills to combat an infectious disease in which communication is the first line of defence.The soporific teleprompter recitation of the day’s statistics delivered in a deadpan monotone does not reflect the seriousness with which we should be responding to this contagion.The media is also partly to blame for carrying the briefings live, and using it as a filler in the evening tv bulletins. There is very little analysis of the figures, how the total confirmed cases are functions of how many tests are done, and who is tested. Or what the positive rates are for contact traced people. Also, asking questions like why <a href="https://www.nepalitimes.com/editorial/ministry-of-education-gets-an-f/" target="_blank" rel="noopener noreferrer">schools</a> should be closed in districts with no or very few cases.To some extent, scaring the people is effective. Otherwise, with the easing of restrictions in Kathmandu Valley, we will again get the kind of reckless behaviour that followed the <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">lifting of the lockdown on 21 July</a> that resulted in the current surge. But there is <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">no need to unnecessarily panic the public</a>. After all, SARS-CoV-2 has an identical mode of transmission as another deadly pathogen, <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener noreferrer">the tuberculosis bacillus</a>, which has for centuries been endemic in Nepal.As the Nepali Congress MP and former health minister Gagan Thapa wrote on a social media post this week: ‘The political leadership is hiding behind the CDO and the bureaucracy, they don’t have the guts to address the people directly … the people’s patience is running out and it could explode at any moment.’

Nepal’s leaders are in isolation

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

As India peaks, Covid-19 spreads rapidly in Nepal

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Preparing to prepare for monkeypox

Omnipresent Omicron starts to lose its edge

Nepal’s leaders are in isolation

As India peaks, Covid-19 spreads rapidly in Nepal