<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ac9c7e80680e0b2875jpeg.jpg" alt="" width="960" height="641"/><figcaption>Crowd of people lining up for Covid vaccination outside Teku Hospital on Tuesday. Photos: AMIT MACHAMASI</figcaption></figure>During the devastating second wave last year, hundreds of people were dying every day. Hospitals had <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">run out of ICU beds and oxygen cylinders</a>.This time, hospitals are running out of medical staff.As elsewhere, <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the third wave</a> in Nepal is infecting healthcare workers, endangering not only patients with Covid pneumonia, but also those suffering from pre-existing conditions like kidney failure, diabetes, cancers or cardio-vascular diseases.This acute shortage in medical staff across Nepal due to the rapid spread of Omicron has prompted the Ministry of Health to consider shortening the isolation period for doctors, nurses and paramedics to five days. The US and India have already done so.Hundreds of <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health workers</a> are testing positive daily in hospitals all over the country, turning health facilities themselves into a hotbed of the virus.On Tuesday, there were 10,258 new cases out of 22,828 tested, bringing the positivity rate up to 45%. This is the highest ever daily new cases for Nepal and also the highest positivity rate.International airlines flying out of Kathmandu are reporting a sharp increase in the number of passengers who cannot fly because of the PCR positive test results. So far passengers on domestic flights are not required PCR tests, only vaccine cards from next week.“Omicron is spreading like wildfire through all hospitals, in ours alone we have 35 staff testing positive,” says <a href="https://www.nepalitimes.com/banner/nepals-far-sighted-eye-care/" target="_blank" rel="noopener noreferrer">Sanduk Ruit</a> of Tilganga Eye Hospital in Kathmandu.One of the bigger facilities in Kathmandu, HAMS Hospital, has 16 of its clinical staff in isolation after testing positive. On 17 January, 52 staff of the Trauma Centre Hospital tested positive in one day, affecting emergency care of accident victims.Teaching Hospital and Bir Hospital in the Valley also have a similarly high number of doctors and nurses infected and isolating.“Health workers in every ward are infected, Covid has now spread from the emergency to the general ward, the blood bank, physiotherapy, ICU and even the administration,” director of the Trauma Centre Pramod Joshi told Nepali Times.The hospital is now primarily treating patients that need emergency care and surgery. “The hospital is full of patients and the ICU is packed as it always is,” he said.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ae9c7e80680e0b2876jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The third wave has now even affected hospitals outside Kathmandu, which are struggling to cope due to a shortage of staff.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital</a> in remote Achham district has curtailed some critical services like C-sections because of sick staff. Charikot hospital in Dolakha district which had finally stopped reporting new Covid infections only last month is back to caring for an increasing number of coronavirus patients but with fewer staff.“Some of us have mild but manageable symptoms but we are still working, we had a shortage of healthcare workers even before this third wave,” Binod Dangal of Charikot Hospital said. “In fact, we have fewer people than we had during the second wave, we have equipment but no trained staff. We are no better prepared than we were before.”The only respite during the third wave is that the new strain is much milder. Because Omicron’s impact is largely confined to the upper respiratory tract, physicians say their patients do not need as much oxygen or ventilator support as was the case with the Delta variant which primarily affected the lungs.Most doctors in and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">outside Kathmandu</a> say they expect infected staff to be back at work in a week after another test. Even so, given Nepal’s largely unprepared and limited healthcare infrastructure which works on a shift basis, medical staff having to isolate just a few days can seriously disrupt medical care, especially in rural areas where hospitals and doctors were always few and far between.Indeed, this latest crisis reflects on a pre-existing chronic shortage of doctors, nurses and trained medical staff, says <a href="https://www.nepalitimes.com/opinion/diary-of-a-covid-frontline-worker-in-nepal/" target="_blank" rel="noopener noreferrer">Bikash Gauchan</a> of the Gandaki Province Infectious and Communicable Disease Hospital in Pokhara.“What we are experiencing now is both an acute and chronic shortage of healthcare workers, and this carries a lesson for our government, to strengthen and prepare its medical resources for future pandemics,” he adds.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron/" target="_blank" rel="noopener noreferrer">Booster shots for frontliners</a> including healthcare workers in Nepal  started this week, and the additional dose will provide much needed protection to doctors and nurses who work in close contact with possibly infected patients.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b29c7e80680e0b2877jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b49c7e80680e0b2878jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b79c7e80680e0b2879jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ba9c7e80680e0b287ajpeg.jpg" alt="" width="960" height="641">But crowded vaccination centres (pictured above) themselves risk being breeding grounds for infection. This time the queues are not just of the unvaccinated getting their first jabs, but also those waiting for boosters. Even if vaccinated, doctors say masks and physical distancing are mandatory.They warn the public <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">not to be complacent</a> because they are vaccinated and that Omicron is milder. Binod Dangal of Charikot Hospital says: “Most people are treating Omicron as a normal cold but it is very important for us to monitor the progress of the disease in the next few weeks, and prepare for adequate critical care.”At Nepal’s biggest infectious disease centre Teku Hospital, virologist Sher Bahadur Pun cites scientific studies to say that the shortage of healthcare workers will not persist, and the isolation period can be reduced. Nepal has likely passed the most infectious stage of <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">Omicron spread</a> and it is now time to keep a close watch on people isolating at homes and in hospitals.Pun adds: “We must also investigate which strain is causing Covid deaths in Nepal because if Omicron had indeed replaced Delta, our figures for mortality should not be as consistent as it was before the third wave.”

Sonia Awale

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3rd Covid wave infects Nepal’s frontliners

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/6372030d9c7e80680e0b27e9jpeg.jpg" alt="" width="1378" height="919"/><figcaption>Photos: AMIT MACHAMASI</figcaption></figure>Be it by naïveté, misplaced optimism, or a great faith in the healing powers of Himalayan air and turmeric, no one in Nepal had expected that we would be in the global epicentre of the Covid-19 surge fuelled by the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant in the spring of 2021</a>.Our miscalculation and gross lack of preparation cost thousands of lives and left so many Nepalis bereaved during this Dasain and Tihar. Shortly after <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">the Indian wave began in March</a>, Nepal recorded the highest number of Covid cases per capita, and the worst viral transmission rates on the planet. While the world focused on India, Nepal's health system was overwhelmed in a matter of days.Remember how we <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">desperately searched for oxygen cylinders</a>, when every ICU bed was occupied and ventilators were in short supply? Remember rural communities where the situation was even worse, and so many Nepalis died without any medical attention? And there was the black market that forced many to pay exorbitant rates for life-saving oxygen, masks, and even paracetamol.We cannot afford to forget these terrible and deadly months. If we do, and do not prepare for the next wave, we will be bound to repeat them. With <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">the Omicron variant </a>now spreading like wildfire across the globe, let us remind ourselves that Nepal experiences a surge in Covid cases a few months after the rest of the world. The Delta variant (which has been proven to be less transmissible than Omicron) took more lives in just a few months than the 2015 earthquakes.The current low case numbers in Nepal are not going to last. Repeating our mistakes of under-preparedness and apathy has the potential to kill thousands of more Nepalis in the coming months.While preliminary data shows that the Omicron variant is <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">less likely to hospitalise infected individuals</a> than Delta did, we need to take into account that this new variant spreads at a much faster rate. The relief we may feel from a smaller percentage of Covid patients needing life-saving care is cancelled out by there being an exponentially higher number of total infections.Our medical facilities will still be overwhelmed, leading to unnecessary loss of life on a large scale. In short, Omicron is <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer">not to be underestimated</a>, especially for densely populated communities in Nepal.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203109c7e80680e0b27eajpeg.jpg" alt="" width="1221" height="814">We still have some time to prepare. Policy makers and individuals alike have important roles to play in the critical next weeks and months. We cannot squander this opportunity to save lives. National and local governments need time to act now on these critical areas:<ol><li><a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">Vaccinate Aggressively</a>: There are varying statistics on the percentage of Nepalis vaccinated, but no more than 40% of the population have been fully vaccinated. Booster shots are now necessary to adequately protect a population, so we still have a very long way to go.</li></ol>The good news is that even if we cannot fully vaccinate and provide boosters for the entire population, clinical experience shows that <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">vaccinated individuals</a> have less need for Covid-19 hospitalisations and are much less likely to die from the Omicron variant. Decision makers can make our limited vaccine supply go further by prioritising vaccines for densely populated cities and in areas where Delta infection was low, as people in these areas are less likely to have natural immunity.<ol start="2"><li>Border Control: The devastating wave of the Delta variant in Nepal began a few weeks after it had taken hold in India. This was largely attributed to a spillage of the virus through the open southern border. We can support municipalities along the border to help contain the Omicron by strict health desks to screen individuals crossing the border. This will require increased funding and other resources.</li></ol><ol start="3"><li>Isolation and Quarantine Centres: Delta spread from India and urban areas into the countryside because we could not properly accommodate and care for infected patients in quarantine and isolation centres. There is time to re-establish these facilities before the next wave hits, and train frontline health workers and local governments based on guidelines that already exist. Again, as the variants (and our knowledge about them) evolve, we need to remain agile and empower our managers and healthcare workers to address the changing ground situation.</li></ol><ol start="4"><li>Oxygen Supply: During and after the Delta wave last year, the Ministry of Health and Population made commendable efforts to expand oxygen plant availability in the country, with support from international aid groups. These new plants need to be brought online and tested in the coming months, and MoHP must accelerate its efforts to meet its own requirement of having an oxygen plant at every 100 bed-hospital in the country.</li></ol><ol start="5"><li>Using Female Community Health Volunteers: FCHVs have been a key for many of Nepal’s remarkable gains in public health, including reducing maternal mortality rates. This network of local health workers was not fully deployed during the last Covid wave. We can use FCHVs to disseminate public health information, vaccine knowledge, and to play a frontline role in enforcing community guidelines to reduce local transmission of the virus, and to care for the infected. These volunteers and other community-based health workers need to be adequately compensated, and equipped with materials, protective equipment, and training.</li></ol>Properly mobilising and empowering FCHVs is the fastest and most efficient way to support rural communities that lack other options for advanced care. This will have a ripple effect across the national health system, and may be a key factor in avoiding another total collapse. All of these steps depend on implementation by the government and private healthcare system. We commend recent steps taken by the health department to test Nepalis returning from India, and to establish quarantine centres along the border.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203139c7e80680e0b27ebjpeg.jpg" alt="" width="856" height="571">As individuals, we must <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">continue to take responsibility</a> for protecting our loved ones by following public health guidelines for another few months at least. History shows we will not know for certain that Omicron has arrived in Nepal until after the variant is endemic in the population. These proactive measures can slow the spread, starting now:<ol><li>Mask up in all public places and when in close contact with members of at-risk populations. Doubling up on masks is a good idea, given the extremely contagious nature of Omicron.</li></ol><ol start="2"><li>Avoid touching the face with fingers, and frequently wash hands - at least 20 seconds with soap and water.</li></ol><ol start="3"><li>Avoid all public gatherings. If not, maintain social distance of at least 1m.</li></ol><ol start="4"><li>Support the local government by following protocols and encouraging elected officials to take proactive measures to protect the community. Volunteer to spread awareness or set up facilities if you can, and be ready to support your community when the next wave arrives. We Nepali are great at using ‘source-force’ to get things done - now is a great time to use your connections and networks to encourage people in positions of influence to take proactive steps to prepare for Omicron.</li></ol>In the age of Covid, it’ is every country and every community for itself. Delta taught us in Nepal not to trust promises of international aid to save us from the pandemic. We are on our own, and we only have each other to get through this.The Delta wave, like <a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/" target="_blank" rel="noopener noreferrer">the 2015 earthquakes</a>, also taught us that when the going gets tough, Nepalis come together and achieve miracles. Remember the community groups that blossomed across the country to create isolation centres, distribute food and supplies, and invented improvised oxygen concentrators.Remember the FCHVs and community members who risked their lives to travel into every corner of the country to deliver vaccines to the most vulnerable citizens.  This time, we have an opportunity to harness this grit and compassion when it is needed most - before the disaster strikes.Ramu Kharel is an emergency medicine physician at Brown University and has worked extensively in the frontlines of Covid-19. He runs a non-profit organisation HAPSA in Nepal that is working on Covid response.Ben Ayers is an American citizen based in Nepal for over 20 years.

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Omicron is coming to Nepal, be prepared

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1e259c7e80680e0af3f5jpeg.jpg" alt="" width="1524" height="1000"/><figcaption>The 4.1 million doses of Moderna and J&amp;J vaccines sent by Germany via COVAX facility arrived in Kathmandu this week. Photo: UNICEF</figcaption></figure>Till a few months ago, Nepal was struggling with a critical shortage of vaccine doses, and the situation was so dire that the 1.4 million senior citizens were <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">waiting past the due date for their second doses</a>.How the tables have turned. Today, the vaccine stockpile is so large that there is a danger of vials having to be destroyed because of the lack of refrigerated storage — and there are millions more vaccines in the pipeline.“There is no shortage of vaccines anymore, there are millions of doses in stock and we now need to inject them into arms as soon as possible,” says Buddha Basnyat, a physician at the Patan Academy of Medical Sciences.“The best strategy now is to continue inoculating those who haven’t yet been vaccinated while simultaneously also administering boosters, given the decreasing antibody levels and the rise of new variants,” he adds.Health experts are now recommending that the Nepal government also <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">start booster shots for high-risk populations</a> such as the immuno-compromised, senior citizens and frontline workers. They urge better planning and clarity from the government about booster shots, and who should get them to prevent influential people from jumping the queue, or misusing the doses.So far Nepal has got 20 million doses of vaccines, and has used an estimated 10 million. In the next three months, the country will be taking delivery of over 34 million doses of AstraZeneca, Coronavax, VeroCell, J&amp;J, Moderna and Pfizer vaccines. This week alone, Germany sent 4.1 million doses of Moderna and J&amp;J vaccines via the COVAX initiative. It also supported the procurement of ultra-low temperature freezers.But it is not only the lack of storage facility and nearing expiry date that validates the logic behind booster shots. Studies have shown that the antibody levels afforded by vaccines and natural infections wane significantly over time. The memory cells also provide immunity against the infection, but there is uncertainty about how long that lasts.“From the perspective of science, a booster dose is necessary especially with <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">Omicron in the picture</a>, boosters have been shown to significantly reduce hospitalisations” explains Lhamu Yangchen Sherpa, an epidemiologist with IPAS Nepal.She adds, “However, we in Nepal have a moral dilemma because a majority of our population haven’t yet received even a single dose. We need to balance this and come up with protective mechanisms that will save the most lives.”Indeed, despite adequate vaccines in the stock and millions more in the pipeline, only 30% of Nepal’s target population have been fully vaccinated against Covid-19. Some 36% have been partially inoculated.Some of Kathmandu’s hospitals are starting to observe an increase in hospitalisations, severity and deaths among people who had been fully vaccinated six months ago. This makes the case for boosters, starting with those with co-morbidity, or those above 60.“This can be an early warning for what is in store for us, the best way to prevent future surge is proper management and distribution of the vaccines we have,” says Sher Bahadur Pun, a virologist at Kathmandu’s Teku Hospital.“Nepal’s priority remains <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">vaccination for all</a>, but this does not mean we leave those who have taken two doses to die. Individuals above 60 and those more vulnerable to Covid-19 must get boosters on time and that is now,” Pun adds.Going by this week’s figures, Nepal is registering on an average of 260 new Covid a day with the positivity rate at 2.3%. While this figure is not as alarming as <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave in April-May</a>, the arrival of the Omicron variant is of serious concern.The new variant has been credited for a steep increase in the number of infections across the globe. The UK reported over 76,000 cases a day on Wednesday, and the WHO has warned that Omicron is spreading at an unprecedented rate across the world.“The new variant while comparatively less virulent than the Delta is at least two to three times more transmissible, which means it can still cause a significant number of deaths given the higher number of infections and more morbidity, underwhelming our health infrastructure,” warns Anup Subedee, infectious disease specialist at HAMS hospital.“It may not lead to another big surge like the second wave but we have to be on a high alert,” he adds.Nepal’s poor health infrastructure is not <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">fully prepared for another spike</a> in infections. While doctors and nurses may have experience with the pandemic, and city hospitals are mostly well-equipped, ventilators are gathering dust due to the lack of skilled workers to operate them. New oxygen plants have not been monitored properly, and ICUs do not have enough trained nurses.“Everything Covid wise is now under control, we haven’t had a single case in the last two weeks but we are no better prepared,” says Binod Dangal of Charikot Hospital in Dolakha District. “If there is another wave, we are done for. <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">Our equipment is not functional</a> and we don’t have trained staff either.”There is once again a false sense of security, and the public cannot wait to go back to pre-Covid days with marriage parties, political conventions, packed classrooms, and crowded markets. For the foreseeable future, experts say we must continue to mask up and follow safety protocols despite the vaccine rollout, especially with the rise of new variants.Says physician Buddha Basnyat: “The mask is the best vaccine. It is cheap and effective, while we attempt to vaccinate everyone and give boosters.”

From scarce vaccines, to storage shortage in Nepal

<figure><img width="906" height="1943" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06499c7e80680e0a5f54jpeg.jpg" alt=""/><figcaption>Photo: UMA THAPA MAGAR</figcaption></figure>Third grader Sona Lama lives in the uplands of Rasuwa and <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">has not been to school for more than a year</a>. But since Nepal Telecom built a cellphone tower on a nearby peak, there is now 3G connection — enough for her to attend class on her mobile phone.Her teachers have partnered with a school in Kathmandu that offers volunteers to guide students like Sona to use <a href="https://www.nepalitimes.com/opinion/back-to-school-season-goes-remote/" target="_blank" rel="noopener noreferrer">Google Classroom or Zoom</a>, and also offer tuition so they can catch up with school work.“This is no substitution for going to an actual school and meeting friends and teachers face-to-face, of course, but at least the online classes partly make up for the disruption, and has introduced the students to new technology,” says Samata Regmi, a Grade 12 student herself, who is a volunteer mentor for Sona and others like her. Regmi lists many <a href="https://www.nepalitimes.com/latest/online-classes-may-widen-digital-divide/" target="_blank" rel="noopener noreferrer">challenges</a>: the network often goes off in the middle of class, video uses too much bandwidth, the children are frequently distracted by household chores. “Many of the parents are out of work, so the children have to help at home, and it is difficult to get them to concentrate. They have very short attention spans on screen,” adds Regmi, who despite the challenges, is glad to be helping children in remote areas with remote learning. Sona Lama shares her mobile with three other older siblings, and since the tower brought data internet it is now in high demand for browsing TikTok videos and Facebook as well. She is still luckier than most Nepali children — a recent survey showed that 80% of students have neither been to school since March 2020, nor do they have access to classes online or by radio/tv.There was <a href="https://www.nepalitimes.com/editorial/ministry-of-education-gets-an-f/" target="_blank" rel="noopener noreferrer">a class divide</a> among Nepal’s 6 million school students even before Covid-19. But there is now also a <a href="https://www.nepalitimes.com/here-now/digital-divide-exposes-class-divide-in-nepal-schools/" target="_blank" rel="noopener noreferrer">digital divide</a> that has widened the gap between private and government schools. While most urban private schools have been conducting classes quite smoothly, government schools have had less success because their students are from poorer families. https://www.youtube.com/watch?v=M-z9K0iuDdoStill, <a href="https://www.nepalitimes.com/banner/lockdown-gives-distance-learning-a-boost-in-nepal/" target="_blank" rel="noopener noreferrer">distance learning</a> is catching up and where young students are logging on for online classes, the process has made them more tech-savvy and more confident with digital technology.  In Mangal Prasad School in Nepalganj has been encouraging its children to get online so they can catch up with missed school. Says teacher Sandhya Sharma: “Those who are attending digital classrooms are doing well, we are happy with their progress. But I am sorry to say that there are many who have just not been logging on.”The Annapurna School in Bharatpur trained its teachers using online tools like Google Classroom and Zoom, but only half the students are attending online classes. The school did a survey and found out why: of its 700 students, less than 20% had wifi and only 10% could access mobile data.Even after Yasodhara School in Lalitpur offered to pay data fees for mobiles of students to take online classes, only half the children did. The parent body of the school is mainly made up of daily wage earners. After last year’s lockdown, a Unicef survey showed that 95% of families surveyed said their children had stopped going to school. A third of the respondents said their children had <a href="https://www.nepalitimes.com/banner/lockdown-gives-distance-learning-a-boost-in-nepal/" target="_blank" rel="noopener noreferrer">access to distance learning</a>, but only half were using it. ‘The continued loss of access to education in low-income families might have an irreversible negative impact on the country’s economy,’ Unicef said then. However, students did attend schools for about two months between the two Covid waves earlier this year, and the uptake of online glasses has gone up.As <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave crests</a>, the government has eased the lockdown. Public transport, shops, airlines are back in operation and only restaurants, bars, cinemas and schools are still closed. But in Kathmandu Valley many schools are preparing to reopen even as the infection rate continues to remain high, with a quarter of those being tested being positive for Covid-19.  <figure><img width="640" height="746" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d064c9c7e80680e0a5f55jpeg.jpg" alt=""><figcaption></figcaption></figure>Public health experts are also warning of a second peak in the second wave because the <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">lockdown is being relaxed too quickly</a>. Crowding in buses and markets without adequate precaution, they say, could mean that the Delta variant could spread rapidly again among <a href="https://www.nepalitimes.com/latest/vaccines-too-little-too-late-for-nepal/" target="_blank" rel="noopener noreferrer">the unvaccinated</a>. This week, the total confirmed Covid-19 cases in Nepal crossed 650,000, and the daily active cases started rising again after the lockdown was lifted to total 26,500. The daily fatality total also rose again to 28 after dipping below 20 for the first time in the second wave. There is also a warning out that the new variant is mostly infecting people in the 21-40 age group, which means schools may have to rethink re-opening. However, other experts say a blanket nationwide ban on schools reopening does not make sense, especially in areas where new infections are negligible, and enough precautions are taken.

Nepal’s class divide widens

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92f69c7e80680e06f17cjpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>This op-ed is being simultaneously published in the Indian Express (India), The Daily Star (Bangladesh), Nepali Times (Nepal) and DAWN (Pakistan).In February 2021, Covid-19 numbers started increasing again in South Asia with official daily case counts rising beyond 400,000 in India, 6,000 in Pakistan and 7,500 in Bangladesh, straining health systems.The massive surge in India soon <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">spilled over across the border into Nepal</a>, leading to ‘apocalyptic’ scenes of overwhelmed hospitals.This virus knows no borders. Containing it has necessitated global cooperation among scientists, policy makers and society. Despite a wide variation in how nations have responded to the pandemic, the most successful strategies adhere to science, and attention to local context.The <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">deadly surge in 2021</a> makes a regionally-coordinated, evidence-driven strategy even more critical. The virus continues to challenge us with its mutations and new lines of attack. If we are to move at the speed of the virus, it is necessary to construct multi-stakeholder regional coalitions to devise new solutions and frugal innovations that can be applied across South Asia.Given our shared and mostly similar social, economic and cultural contexts, local successes must find means to be amplified across the region.Is that even possible, given the troubled history South Asian countries share? The mutual mistrust appears to have hit a new low, as <a href="https://www.nepalitimes.com/editorial/shared-futures/" target="_blank" rel="noopener noreferrer">SAARC</a> has not even managed to hold its summit since 2014.But today we write a positive, hopeful story about a new consortium we are involved in, with core team members from India, Pakistan, Nepal, and Bangladesh jointly developing Covid prevention strategies. The emerging consortium provides an example of how neighbours can work together for mutual benefit, despite political differences.Every country in South Asia has struggled to ensure consistent <a href="https://www.nepalitimes.com/opinion/the-economics-of-masks/" target="_blank" rel="noopener noreferrer">mask-wearing</a> to stem the spread of Covid. Beliefs, priorities, traditions, and aversions to behaviour change are more similar across South Asia than we care to admit. These commonalities mean that interventions that are successful in changing behaviour in one place are likely applicable in other parts of the Subcontinent.We have experienced this with Community-Led Total Sanitation (CLTS) campaigns to solve the <a href="https://www.nepalitimes.com/here-now/nature-calls/" target="_blank" rel="noopener noreferrer">problem of open defecation</a> -- originally developed by Bangladeshi NGOs in partnership with an Indian consultant --- and now broadly applied across South Asia and beyond.The Grameen Bank microcredit model was an indigenous South Asian innovation that spread rapidly. BRAC’s recent ‘Graduation’ program targeting the ultra-poor in Bangladesh was replicated with success in India and Pakistan. India’s digitised social protection ecosystem with Aadhar IDs and Jan Dhan accounts serves as a model (albeit with cautionary notes) for other countries in the region. E-governance programs in Pakistan, like eVaccs and Citizen Feedback Model have been replicated and provide strong models ready to be deployed regionally and globally.The new pan-South Asian consortium in response to Covid-19 evolved out of an experiment conducted in Bangladesh, that successfully changes social norms around mask-wearing in rural communities. We observed that a combination of No-cost distribution, Offering information, Reinforcing the message in markets, mosques and other public spaces, and Modelling and endorsement by community leaders (NORM) leads to large, sustained increases in mask usage that persisted beyond the period of active intervention.This <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">four-part NORM intervention</a> was originally examined in a cohort of 350,000 individuals across 600 villages. BRAC is implementing the model to reach 81 million people across Bangladesh.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92f99c7e80680e06f17djpeg.jpg" alt="" width="1600" height="876">The team is now partnering with several organisations across Pakistan, India, Nepal, and Bangladesh to start adapting the model to fit each country’s context, and set up partnerships to pilot, implement, tinker, and learn.The Self Employed Women’s Association (SEWA) quickly implemented the model to reach over one million members in Gujarat. An additional 1.5 million masks were shipped from Bangladesh to support SEWA’s outreach to other states. Lahore’s Commissioner worked with our research team to adapt the NORM model to an urban setting, and devised new creative ideas to improve effectiveness.For example, it has prepared to deliver <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/" target="_blank" rel="noopener noreferrer">masks</a> at doorsteps using Pakistan’s postal service, and is targeting beneficiaries on the basis of billing information from utility companies. Philanthropists and private corporations are sponsoring the masks. We are re-importing some of these innovations back to Dhaka, inspiring further scale-ups in Dhaka, Chittagong, Rajshahi and Kathmandu.Effective mask promotion requires visits to thousands of remote villages, and those same visits can be used to prepare for more effective community-based healthcare responses. To that end, a host of physicians, scientists and community based organisations created the Swasth Community Science Alliance, committing to pragmatic, science-based protocols to manage mild and moderate cases of Covid-19 in rural India, where institutional health care access is limited.These guidelines (available at https://science.swasth.app) were translated to training tools for healthcare workers by digital health innovators like Noora Health, making them widely available across the region.NORM implementation teams based in Lahore, Ahmedabad, Peshawar, Hyderabad, Dhaka, Kathmandu, and Delhi are learning from each other’s successes and failures. The process usually starts with the original research team sharing evidence-based insights with implementing agencies, as the implementers adapt the design, co-create localised implementation protocols, and are threaded together in a collaborative environment across countries where each implementing team iterates while learning from others’ prior iterations, and all our sub-teams are connected in an active learning system that allows us to course-correct in real time. This coalition is poised to change mask-wearing norms amongst hundreds of millions of people across all of South Asia.The CSA is working with partners across rural, tribal belts around India. A team of physicians from India and the Indian diaspora work with local implementing partners to support design, implementation and monitoring of home-based programs and Covid-19 centres providing rigorously protocolised treatment for moderate cases, with oxygen, proning and steroids.Combining the NORM and CSA interventions, our Masking-Treatment-Vaccine Preparation (MTV) approach offers a sensible strategy to mitigate the pandemic until universal vaccination is achieved. These are regional solutions that thoughtfully apply scientifically sound interventions to the local context.The <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">Covid-19 crisis</a> has increased policymakers’ appetite for evidence-informed policy measures that can be quickly implemented to stem transmission. This drive for quick action has created some unprecedented opportunities for enhanced cross-country collaborations that are normally hampered by politics and mistrust.We hope that the consortium that first formed around <a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">mask-promotion</a>, and now around science-based treatment approaches, and that developed quickly and organically without regard to national boundaries, can serve as a model for a broader and deeper collaborative ecosystem that endures.We need to come together to solve problems that affect us all. Let the lasting legacy of this pandemic be a new era of partnership in social innovations that can benefit all South Asians.https://www.youtube.com/watch?v=d0hpuXRByic&amp;t=9sMushfiq Mobarak is Professor of Economics, Yale University, and Director of the Yale Research Initiative on Innovation and Scale. Twitter: @mushfiq_econ Maha Rehman is director of policy at the Mahbub-ul-Haq Research Centre at the Lahore University of Management Sciences. Twitter @MahaRehman1Satchit Balsari is assistant professor of emergency medicine, and of global health and population, at Harvard University. Twitter: @satchit_balsari

What can we do till vaccines arrive?

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91cc9c7e80680e06f10fjpeg.jpg" alt="" width="640" height="428"/>One thing we cannot complain about is that, for once, the world is not ignoring a humanitarian disaster in Nepal. They have even named a variant after us.Worried about the Delta strain spreading in his country, a UK official blamed the ‘Nepal variant’ for spoiling summer holiday plans for many Brits. The tabloid press, but even the BBC, dutifully headlined this, despite a WHO denial about a Nepali strain. But the damage was done. Just google ‘Nepal variant’ now.What the publicity has done is pushed the world to rush oxygen and medical supplies to Nepal. All help is useful in a crisis like this, but much of the aid being flown in contains items that Nepal is already buying in bulk in China.While there was a dire shortage of oxygen cylinders three weeks ago that led to loss of lives, the nature of the emergency has changed. Nepal’s 29 oxygen factories are now working at 100% capacity producing only medical oxygen, and soon there will be a surplus. The problem is not supply, but logistics and equitable distribution.What we really need are vaccines — most urgently for the 1.4 million Nepalis above 65 who got their first dose of Covishield AstraZeneca three months ago, and are now past the default date for their second after India banned its export.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91cf9c7e80680e06f110jpeg.jpg" alt="" width="640" height="318"><figcaption>India's total vaccine exports before it was stopped in March.</figcaption></figure>The lockdown should have bought us time for a mass vaccination drive, but once more we squandered two months shutting people in their homes. The restrictions did bring down the daily caseload, but infections are likely to spike again once mobility increases, just like last year.Instead of #NepalVariant trending on Twitter, we need #NepalVaccines to go viral. To be sure, the United States has pledged 80 million surplus doses, but only 7 million of that in the first phase is for the whole of South and Southeast Asia with a population of 1.5 billion. Supply bottlenecks mean the first shipments will not include AstraZeneca.Europe has a stockpile of AstraZeneca and more on order that are not going to be used, either because of slow uptake or because of fears of clots. In France, tens of thousands of doses have gone to waste. Norway and Denmark are not using  AstraZeneca anymore, and some of this may be channeled to Europe’s pledge to donate 100 million doses this year, sell 1.3 billion doses at cost price to low and middle-income countries, and donate another 1.3 billion doses in 2022, mostly through COVAX.The International Monetary Fund (IMF) last week announced a $50 billion plan to vaccinate 40% of the world population within 2021, and 60% by mid-2022. This is all encouraging news if it happens, but the long and short of it is that for Nepalis, neither the second doses nor vaccines for the larger population are getting here any time soon.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91d19c7e80680e06f111jpeg.jpg" alt="" width="640" height="282"><figcaption>Number of patients in ICU and ventilators in Nepal in May.</figcaption></figure>Even Andrew Pollard of Oxford University, an old Nepal hand, and one of the developers of the AstraZeneca vaccine says he feels helpless. <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNEqHFh4Fbf8IcsJ4g-XnTG5qP1SzA">He wrote in a column</a> in this paper recently: ‘I felt so proud when I saw the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNE6-2fepjLEOU19PSLjzWqAvKa05A">first doses of the Oxford vaccine being administered in Kathmandu</a>, and the hope that it brought to Nepalis, but I am now saddened to hear that further supply is delayed.’On Tuesday, the 60-65 age group in Kathmandu Valley, and 62-65 outside started being vaccinated with the 1 million extra doses of Sinopharm VeroCell donated by China. However, we need to get jabs to at least 19 million Nepali arms in the next few months to reduce the danger of a pre-Dasain surge, not to mention younger cohorts who are likely to be more vulnerable to a predicted third wave. Negotiations with Sinopharm to procure another 2 million doses are bogged down over a confidentiality clause in the contract.The only ‘Nepali variants’ we should be worried about are the country’s feckless and mutated politicians. Prime Minister Oli has replaced five Health Ministers since 2018, three of them since the pandemic began.Since vaccines are unlikely soon, <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNFBpfK-x_4CespExs5Gd3dW9_6oMA">public health experts have warned</a> us repeatedly that even after the lockdown is eased, and even if some people are vaccinated, the only way to prevent future surges is through <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNFrVgv5oLBXzAWQyNuTw7uc_DdWQA">proper masks and physical distancing</a>.A recent <a href="https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNHgAojjRlhejojvnimKSVT8uOMRbA">Yale study in Bangladesh</a> involving over 300,000 people showed that four simple actions led to a 10-time increase in mask wearing. Their <a href="https://docs.google.com/document/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://docs.google.com/document/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNGV_AM4_ATLpwI_uAwFRandfzstdA">four-fold path</a> includes: 1. Giving away free masks, 2. Spread information about how to wear them properly, 3. Get celebrities to promote mask-wearing, 4. Enforce mask-wearing through persuasion and punishment.Official figures <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNH48dysJncU5jxSSYZYwIF57tBcRw">grossly underestimate</a> the spread and fatality from Covid-19 in Nepal. A projection by the <a href="https://covid19.healthdata.org/nepal?view=daily-deaths&amp;tab=trend" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/nepal?view%3Ddaily-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNH24lI1y0n0i0mWO_OHRW4ckwQBxA">Institute for Health Metrics and Evaluation (IHME)</a> of the University of Washington School of Medicine in Seattle shows that on 31 May when the government reported 96 deaths from Covid-19, the actual number was closer to 363.IHME calculations also show that 1,000 fewer Nepalis will die by 1 September if 95% of people wore masks while outdoors. The government is hinting that the lockdown rules will be eased on 14 June. Since vaccines are still a long way off, our only protection is masks and minimising movement.

Nepal goes viral

<figure><img width="960" height="639" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83c09c7e80680e067754jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Every day, many Nepalis across the country religiously tune in to the Health Ministry’s website, Facebook or Twitter at 4PM. It is the <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">same grim statistics every day</a>: another day, another record that should not be broken.On Wednesday, Nepal registered 8,659 new cases and 58 fatalities. The number of active cases is now 66,352 – a hundred-fold increase from mid-March. Half of everyone who gets a PCR test is Covid-19 positive.These numbers may seem low compared to neighbouring countries like India, but in proportion to the population, it is one of the highest in the world: 211 per 1 million population. In India the figure is 278, but in both countries the tally is said to be a gross underestimate. The virus is also replicating faster in Nepal than in India, and most other parts of the world.  “Nepal saw 127% increase in infections this week, the pace of the spread of Covid-19 here is much higher than most of the countries in the world,” said Archana Shrestha of Kathmandu University during the Ministry of Health’s daily briefing on 5 May.All seven provinces had more than a 100% rise in infections with Gandaki reporting a whopping 384% increase. Similarly, test positivity was highest in Karnali at 67.9%, much higher than in Bagmati where it was 25.9% on Wednesday.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">The second wave with new and deadly variants</a> breaking across Nepal has devastated the country. Oxygen cylinders are in short supply, doctors are overwhelmed with patients and families are running from hospital hospital to find beds for the sick. The death toll has soared to 3,475.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/kathmandu-electric-crematorium-running-non-stop/" target="_blank" rel="noopener noreferrer">Kathmandu’s only electric crematorium</a> at Pashupati in Kathmandu, designated for Covid-19 patients could not handle the increasing number of fatalities even while running round the clock. Officials had to arrange pyres for coronavirus dead on the banks of the Bagmati.Nationwide, 4,764 Covid-19 patients are in hospitals, 600 of them are seriously ill, requiring ICU treatment and 156 more are on ventilator support. Unlike last year, most of them are in the 25-39 age group. The Health Ministry has procured 128,000 vials of remdesivir, and 4,000 more are on the way. However, the antiviral medication that many desperate families try to get for sick relatives, has not been proven to save lives even though it reduces hospital stay of patients.With over half of new cases concentrated in Kathmandu Valley (Kathmandu, Lalitpur and Bhaktapur recorded a combined total of 3,835 cases in the past 24 hours), hospital beds and oxygen cylinders in such short supply in the capital. But the situation in provincial and district hospitals is even more dire. The Tarai districts bordering India have been ravaged by the virus, as Nepalis returning from India brought the disease back. But by now it has moved up to the mountains as well, and is spreading in rural communities with rudimentary medical services. <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">In Banke district</a>, the positivity rate is as high as 70% and one-third of them require hospital admission, doctors and nurses with Covid-19 are forced to care for patients undergoing treatment for the same disease in Banke district.Physician Prakash Bahadur Thapa at Bheri Hospital told Nepali Times on Tuesday: “In the coming days, it will be the availability of oxygen that will determine how many live and how many die.” With no help coming from Kathmandu, the Covid-19 hotspot of Nepalganj has converted its district training centre into an isolation ward and treatment hub with 50 oxygen-equipped beds. The idea is to take the pressure off the district’s two designated Covid hospitals: Bheri and Nepal Medical College in Kohalpur which are treating patients from all over Karnali and Far-western Province. Nepalganj 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.In Biratnagar, the head of Kosi Hospital Chumanlal Das and his staff are working day and night. “Test positivity rate is extremely high,” he said during the Ministry of Health’s briefing in Kathmandu on Wednesday.Over 50 districts in Nepal are now under some form of lockdown. With hospitals at full capacity, the government has advised citizens that they have to protect themselves.With the federal government <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/" target="_blank" rel="noopener noreferrer">waving a white flag</a>, local municipalities and wards are setting up their own isolation wards. Nepal Engineering College and the local government in Changu Narayan of Kathmandu Valley has set up a 100-bed isolation centre, neighbourhoods in Patan have added small wards with oxygen for patients who cannot find a hospital. Butwal has established an oxygen bank and independent activists have set up free services for those in need.Collectively, local initiatives are stepping in to fill the gap left by the government. But public health experts say the only way out of the pandemic is <a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">mass vaccination and personal precautions</a>. They say the lockdown period should not be allowed to go waste again, and the government must step up tracing and testing, expedite vaccine procurement and launch a massive public awareness drive.  <figure><img width="1566" height="992" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83c39c7e80680e067755jpeg.jpg" alt=""><figcaption> </figcaption></figure><h2>Subcontinent under seige </h2> It is not just Nepal, the Subcontinent itself is reeling under the new surge that threatens to reverse global gains in health, education and nutrition and has a disproportionate impact on children.Disruption of essential health, immunisation and nutrition services during the first surge in South Asia cost the lives of an estimated 228,000 children and 11,000 mothers, according to UNICEF. “We may be exhausted, but the virus is not yet exhausted,” warns George Laryea-Adjei, UNICEF Regional Director for South Asia. “Now more than ever, we must commit ourselves to wearing masks, handwashing with soap as often as possible, keeping physical distance and getting ourselves vaccinated if we have the opportunity to do so.”Effective contact tracing has also been noted as a much faster and cost-effective way than <a href="https://www.nepalitimes.com/banner/lockdown-2-0/" target="_blank" rel="noopener noreferrer">lockdowns and prohibitory orders</a> in reducing transmission and controlling the pandemic.Says Archana Shrestha of Kathmandu University: “We have over 8,000 new infections a day but we have only reached the first of the third phase of the new wave, we have to survive through the rest. But stringent contact tracing can reduce 85% of infections.” <h2>Covid Helpers</h2> To donate to the group setting up isolation centres in Kathmandu <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.facebook.com/anmfUS" target="_blank" rel="noopener noreferrer">America Nepal Medical Foundation</a>: http://anmf.org/ For any information regarding Covid symptoms, how to take care at home etc Covid Alliance for Nepal: 9880035000 (8am to 8pm) For Ambulance 24-hour free Covid ambulance service: 9851277342, 985123942, 9851312417 Free ambulance service from KMC: 1180 For oxygen Hamro Team Nepal: 9851102652 9851102653: 9851102654, 9841669170, 9851054280, 9741710493 For bed with oxygen: Youth for Nation: 9861116456 ,9857030887 ,9841309599,9863322793 For Bed: Siyana Karki  9841730903 Dr Utsav Timilsina  9847023345 For Oxygen : Anil Rijal  9847297745 Shisir GC 9857025765 For ICU : Arjun Chand 9851206644 Dr Amrit Bhusal 9841375180 For food: Juju Kaji: <a href="https://www.facebook.com/kajijuju" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/kajijuju&amp;source=gmail&amp;ust=1620307494671000&amp;usg=AFQjCNEnkcqkYhKPMB4dKq_Ev6cf61dUAQ">https://www.facebook.com/kajijuju</a>  Covid-19 hotline service: 113 (8am to 8pm), 1115 (6am to 10pm), 9851255839, 9851255837 The list has been compiled based on the information available on social media. Updated covid directory: <a href="https://www.facebook.com/groups/453859702218765/permalink/573621080242626/" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/groups/453859702218765/permalink/573621080242626/&amp;source=gmail&amp;ust=1620307494671000&amp;usg=AFQjCNFpWuUlaMcsr86-vkIF9fnOuhchqw">https://www.facebook.com/groups/453859702218765/permalink/573621080242626/</a>

Microcosms of a pandemic

<figure><img width="3500" height="2333" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebdd9c7e80680e09ad2fjpeg.jpg" alt=""/><figcaption>Photo: KRISHNA MANI BARAL</figcaption></figure>Kaski has become the latest in the list of districts to be placed under strict lockdown following the surge in new variant of SARS-CoV-2 as Nepal battles the devastating second wave of the pandemic. Following the decision in place until 14 May, Nepal’s tourist city of Pokhara bore a look of a ghost town: fishermen have abandoned their boats, Lakeside is void of tourists and locals are keeping away from outdoors.The positivity rate in Gandaki province was close to 50% with 429 new cases in the last 24 hours. With this, total number of active cases has now soared to 2,546, of which 2,354 are in home isolation.

Pokhara locked down

<figure><img width="3500" height="2333" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83b99c7e80680e067752jpeg.jpg" alt=""/><figcaption>Photo: KRISHNA MANI BARAL</figcaption></figure>Kaski has become the latest in the list of districts to be placed under strict lockdown following the surge in new variant of SARS-CoV-2 as Nepal battles the devastating second wave of the pandemic. Following the decision in place until 14 May, Nepal’s tourist city of Pokhara bore a look of a ghost town: fishermen have abandoned their boats, Lakeside is void of tourists and locals are keeping away from outdoors.The positivity rate in Gandaki province was close to 50% with 429 new cases in the last 24 hours. With this, total number of active cases has now soared to 2,546, of which 2,354 are in home isolation.

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

Buddha Basnyat

How Nepal can survive 2nd Covid wave

Nepal’s only international aviation gateway, at Kathmandu airport, will cut night-time operation hours to allow construction of taxiways, and airlines have been told to curtail flights. This is expected to lead to more than normal chaos during the height of peak autumn and spring tourist seasons at an airport that is congested even at the best of times. The airport will close from 10PM to 8AM from 8 November-31 March 2025. The taxiways will now connect to the thresholds at both ends of the runway, making the airport more efficient in handling higher frequencies of landings and takeoffs. The parallel taxiway extension will allow international flights to land every 4 minutes instead of the current every 7 minutes. At present planes have to wait to land until a plane taking off backtracks along the runway.&nbsp; Kathmandu is Nepal’s only airport with international operations, and it has only one runway that is only one way in from the south over the mountains. With the taxiway improvement, the airport will be able to handle 42 aircraft landings and takeoffs per hour — double the current capacity.&nbsp; The Civil Aviation Authority of Nepal (CAAN) has been trying to entice international airlines to also start flying to and from the other two international airports at Pokhara and Bhairawa (Lumbini) by slashing landing and handling charges. But so far only Nepal Airlines operates a weekly flight to Bhairawa from Kuala Lumpur.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32.jpg" data-media-id="editor_0" data-image-id="20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32" data-rendition-name="original" width="2356" height="1134" loading="lazy" alt="Kathmandu airport expansion"> <figcaption>Kathmandu Airport Expansion plan with extension of taxiways to the thresholds of runways 02 and 20 that will limit airport operations from 8 November 2024 - 31 March 2025. Areas in blue are existing structures, including the international terminal which in future will be the domestic airport, and the new international terminal near the north end of the runway,</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a.jpg" data-media-id="editor_1" data-image-id="20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a" data-rendition-name="original" width="1353" height="1328" loading="lazy" alt="Kathmandu airport NT"> </figure>  CAAN has reportedly told international airlines to cut their flight frequency to Kathmandu citing the shorter operation hours and has told budget airlines to shift some of their flights to Pokhara or Bhairawa, or face cuts. Many airlines currently operate regular flights to and from Kathmandu between 10PM and 8AM: Air Arabia to Sharjah, Fly Dubai to Dubai, Jazeera Airways to Kuwait, Cathay Pacific to Hong Kong, Singapore Airlines, several Nepal Airlines flights, and one of four daily flights by Qatar Airways to Doha. Jazeera Airways, FlyDubai, and Thai AirAsia have applied and got permission from CAAN to begin regular flights to Bhairawa’s Gautam Buddha International Airport. Starting 9 November, FlyDubai will start making a stopover in Bhairawa before flying on to Kathmandu. Immigration, customs and security are all fully functional in Bhairawa. In Kathmandu, the next phase of the airport upgrade includes converting the current international terminal for domestic operations, the construction of a new international terminal where the domestic departure area is now, as well as moving the hangars and the Nepal Army Air Wing to the eastern side of the runway. The apron area will also double its parking space for widebody jets. This is part of a Airport Capacity Enhancement Project that was initially funded through a $80 million loan from the Asian Development Bank (ADB), and the entire masterplan is expected to cost $800 million. This project is the latest upgrade to Nepal’s only international airport since it saw its first flight in 1949. The current international and domestic terminals are too small to handle the current annual traffic volume of 8.5 million passengers a year that is growing at 20% a year.

Kathmandu airport to cut flight hours

As Kathmandu becomes more congested and polluted, and with remote online work becoming the norm, many professional Nepalis are planning to retire in Pokhara, or move there.&nbsp; With its stunning mountain panorama, balmy winters and proximity to a profusion of wilderness areas, builders are responding to this demand with new townhouses, housing development and apartments. One such block of flats is the 10-storey <a href="https://sungavaapartment.com/">Sungava Apartment</a> located at Phulbari above the Seti River, near the point where it flows into and under Pokhara. The imposing structure near Manipal Hospital is almost complete, and on a recent visit the site was strewn with huge boulders unearthed while digging the foundation.&nbsp; The Seti brought down these boulders during a gigantic flood that geologists estimate happened 800 years ago when a chunk of Annapurna IV broke off and ploughed into the glacier below. Today, Sungava (means ‘orchid’) sits safely on a high terrace, 100m above the blue-green Seti and commands a view of Dhaulagiri, Annapurna South, Machapuchre, Annapurna III and IV.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9.jpg" data-media-id="editor_1" data-image-id="2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9" data-rendition-name="original" width="2016" height="1512" loading="lazy" alt="High living below the Himalaya NT"> </figure>  The soil here is conglomerate that has solidified like concrete, and the boulders were extracted by heavy earthmovers. It is intriguing to think that these metamorphic rocks as big as cars, rounded by glacial grinding, were once a part of a much higher Annapurna IV. Even for those with little interest in geology, Sungava is an ideal place to contemplate the tectonic forces that pushed these peaks into the sky to be sculpted into delicate shapes by wind, snow, earthquake and avalanche over millions of years. The view of the Himalayan panorama from Sungava’s many balconies are breathtaking when not obscured by clouds, or the haze that drifts in from across the southern border. On most days, just watching the towering pyramid of Machapuchre (Tamu name: कतासुँ क्लिको) play hide and seek with the clouds is mesmerising. There are rocks aplenty at Phulbari, and it is probably the flowers that grew along the flat terraces e that gave the place its flowery name. The boulders will hopefully be turned into a rock garden while landscaping. An nearby restaurant complex is making the best use of the stones in its design, using flat rocks as outdoor benches and tables. Sungava was designed by the husband-wife architect team of Deepak Sherchan and Jyoti Joshi of <a href="https://thedarkmermaidamarbshrestha.blogspot.com/2013/12/creative-builders-collaborative-cbc.html">Creative Builders Collaborative (CBC)</a>, which also built Heritage Plaza, Indreni Apartment and numerous other projects in Nepal. Sadbhavana retains CBC’s trademark Newari-style masonry and here it borrows from the orange brickwork of the old town of Pokhara, integrating it with modern design elements. A few of those heritage houses are still standing in Ganesh Tole and Ram Krishna Tole in Pokhara’s old quarter.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab.jpg" data-media-id="editor_3" data-image-id="2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab" data-rendition-name="original" width="1362" height="595" loading="lazy" alt="High living below the Himalaya NT"> </figure>  About 400m from the apartment past a bend on the river, and down below three tiers of terraces in the canyon is a suspension bridge. Below it, the Seti is still swollen with post-monsoon flow as it tumbles away in a hurry to head down south.&nbsp; Back at the apartment, it is quiet, far away from the hubbub of Lakeside a 15 minute drive away, and in the lap of greenery. There are 52 units at Sungava and it already has a close-knit prospective community of professionals, including doctors, publishers, engineers, and businesspeople from the renewable energy and IT sectors.&nbsp; Some residents say they opted for a second home in Pokhara to make it a ‘base camp’ to explore the Annapurnas with its many hiking trails made newly accessible with new roads. With the NRN citizenship law, overseas Nepalis can now also buy the flats. &nbsp; The floor plans include options for north and south-facing 3-bedroom apartments with verandas, and the facility has underground parking has EV charging, heated pool, sauna and gym. There are still some unsold apartments with panoramic views of the mountains and one can imagine oneself at the kitchen with its huge window, humming a ditty while preparing breakfast: “खाना पकाउँ हिमाल हेरेर...”

High living below the Himalaya

When the United Nations held its Summit of the Future at its headquarters in New York in September, many world leaders, including Nepal’s Prime Minister K P Oli, highlighted the effect of climate breakdown in increasing the frequency and intensity of natural disasters. What did not get as much attention was the long term impact of the climate crisis on food production. In fact, heat stress, weather extremes and the consequences on rain-fed agriculture is already being felt worldwide, undermining the chances of the <a href="https://unstats.un.org/sdgs/">UN’s Sustainable Development Goals (SDGs)</a> being met by 2030.&nbsp; The SDG’s 17 targets commit countries like Nepal to reduce poverty and inequality, end malnutrition, protect the natural environment, and ensure that citizens all enjoy health, justice and prosperity without leaving anyone behind.&nbsp; However, besides the impact of climate breakdown on agricultural production, in Nepal the area under cultivation is impacted by urban expansion, falling productivity and the need for expensive inputs like fertiliser and pesticides.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62.jpg" data-media-id="editor_1" data-image-id="20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Kathmandu's urban sprawl is eating into its fertile cultivable lands. Photo: TAYLOR MASON</figcaption> </figure>  Now, a new study led by Nepali researcher Prajal Pradhan at the University of Groningen in The Netherlands looks at how urban agriculture may offer a solution to falling food production and meeting SDG targets. The researchers evaluated 1,450 publications exploring the contributions of urban agriculture with both positive and negative effects, and published their findings in the journal Cells Report Sustainability. Urban agriculture can help achieve 17 SDGs, positively influencing 81 targets. However, it could also undermine 51 goals.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-vanishing-land">The vanishing land</a>, Taylor Mason “Urban agriculture offers immense potential for sustainable development, but realising this potential depends crucially on adopting practices that minimise its adverse effects while maximising its benefits,” Pradhan explains. Urban agriculture can substantially enhance urban food security, provide employment to the urban poor, serve as ground water recharge in built-up areas, and preserve open spaces that can serve as safe havens during disasters like earthquakes. However, it also presents problems like the potential health risks from contamination and the need for expensive inputs. &nbsp; “Urban agriculture plays a definitive role in advancing the SDGs, but achieving this requires tailored, context-specific solutions that address the unique challenges of different regions,” says Yuanchao Hu of Wuhan University in China and who is a researcher at the Potsdam Institute for Climate Impact Research. “But it needs equitable access and rigorous management of environmental risks.”&nbsp; Rapid urbanisation is eating into Nepal’s most fertile agricultural land, which means farming in remaining open spaces inside cities can be a viable alternative, especially as food prices rise.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8.jpg" data-media-id="editor_3" data-image-id="20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>A vegetable patch in between new houses in Thimi. Photo: TAYLOR MASON</figcaption> </figure>  “The conversion of Nepal’s most fertile land into cities is a severe problem,” Pradhan told Nepali Times. “Crop cultivation, horticulture, agroforestry, beekeeping, livestock rearing, or aquaculture can all be farming activities within and around cities.”&nbsp; The study makes recommendations for sustainable practices that build on the positive aspects of urban agriculture while mitigating the downsides, thereby promoting more resilient cities in future. Research shows that urban agriculture has been helping many countries attain SDG targets by enhancing food security and biodiversity while helping education and preservation of open spaces.&nbsp; Indeed, many farmers from the hinterland who have settled in Kathmandu Valley or other urban areas of the country have been practicing urban agriculture, leasing neighbourhood patches or cultivating roof gardens both out of necessity because of inflation and falling income to grow their own food, and also as a fulfilling hobby. Saurav Dhakal, a sustainability advocate with Story Cycle and now research fellow at the Asian Institute of Technology in Thailand, says there are socio-economic and environmental benefits of urban agriculture. “It provides benefits to all urban dwellers, regardless of their income status,” says Dhakal, “families get fresh food, and there are many other benefits like water retention, heat regulation and biodiversity. These are all public goods, so special government incentives may be needed.” It is not unusual to see vegetable patches and even paddy fields within inner city Kathmandu where an older generation of farmers are using available fertile land and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415">roof gardens to produce fresh, nutritious food </a>to reduce their dependence on food items that have to be bought after being trucked in from large distances.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77.jpg" data-media-id="editor_5" data-image-id="2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>An older generation of farmers are using any available fertile land to continue farming but it is getting more and more difficult. Photo: TAYLOR MASON </figcaption> </figure>  Nepal’s urban population grew rapidly from only 3.6% in 1991 to 25% today. There is large outmigration from the mountains to peri-urban areas of the Tarai, to Kathmandu Valley and Pokhara, with many young men then moving abroad for work. Kathmandu Valley’s population has swelled to nearly 3 million, and is growing at 6.5% a year. Dilip Shrestha, 71, used to work for Nepal Food Corporation, so he knew firsthand about inflation, shortages and vegetables with pesticide residue. So, when he designed his new house in Kathmandu, he built a spacious roof where he grows cucumber, ginger, garlic, coriander, onions, tomatoes, chili, beans, okra, pumpkin and lettuce. His family eats healthier, and he has reduced dependence on the market.&nbsp; The co-author of the Cell Reports Sustainability journal article, Daya Raj Subedi who is a PhD candidate at Beijing Forestry University, says urban agriculture also promotes inclusion and psycho-social wellbeing.&nbsp; He says, “A crucial finding of the study is the identification of opportunities and challenges associated with urban agriculture, it can promote sustainable transformation of society.” In Banepa, 55-year-old Bijaya Manandhar in her lifetime has watched the fertile farms of her neighbourhood that used to supply vegetables to Kathmandu, now completely built up with no open space left. The pandemic lockdown prompted her to turn to the family’s <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world">ancestral livelihood by growing food</a> not on terrace farms, but on the roof terrace. Manandhar is now a part of <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world%5C%5C">कौसी खेती र करेसाबारी क्रान्ती</a> (Rooftop Farming and Garden Revolution) which has an online membership of 52,000, and awards annual prizes to women who excel in urban agriculture.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d.jpg" data-media-id="editor_8" data-image-id="20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d" data-rendition-name="original" width="1600" height="736" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Rooftop farming is gaining popularity as a form of urban agriculture. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed.jpg" data-media-id="editor_9" data-image-id="20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed" data-rendition-name="original" width="4000" height="3000" loading="lazy" alt="urban agriculture in Kathmandu"> </figure>  Pradhan says the challenge now is to upscale such examples of successful urban agricultural practices so they support Neal’s efforts to meet SDG targets. He adds, “Crop cultivation around cities can be protected by land use plans and regulations. Promoting community-based agriculture, including rooftop gardens, requires community engagement and public-private partnerships across the food value chain.”&nbsp; Such support would accelerate the popularity of existing rooftop farming and community gardens in Kathmandu Valley, or kitchen garden initiatives in Pokhara, and building on traditional farming practices that are preserved and integrated into urban settings like in Bhaktapur and Banepa. In Lalitpur, the Women Entrepreneurship Facilitation Center promotes urban farming enhancing both sustainability and empowerment.&nbsp; Another co-author of the report, Yuanchao Hu from China says followup research of the team will aim to identify good practices in local urban agriculture practices. He adds, “There are examples of urban agriculture that optimise sustainability, ensuring that it remains a viable solution for cities globally while countries try to meet SDG targets.” Prajal Pradhan, Daya Raj Subedi, Kshitij Dahal, Yuanchao Hu, Prakriti Gurung, Sijal Pokharel, Sagar Kafle, Biplav Khatri, Sudeeksha Basyal, Monika Gurung, and Aruna Joshi. Urban Agriculture matters for sustainable development. Cell Reports Sustainability, 1:100217, 2024. [DOI: 10.1016/j.crsus.2024.100217] Prajal Pradhan (<a href="mailto:p.pradhan@rug.nl">p.pradhan@rug.nl</a>) This article is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_14" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>

Back to the land in the cities

The 700-year-old Lakshmi Narasingha temple in Bhaktapur houses a rare half-lion and half-human incarnation of Lord Vishnu carrying the Goddess Lakshmi. The temple was destroyed in the 1934 mega earthquake that killed 10,000 people and destroyed many monuments in Kathmandu Valley. It was rebuilt by a German project in the 1980s, but as a single-storey structure instead of its original two-tier pagoda design.&nbsp; With new findings from in-depth research, Bhaktapur municipality began re-restoring the temple in 2021, preserving its original architecture.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18.jpg" data-media-id="editor_0" data-image-id="20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “Our temples and heritage sites hold deep meaning. It is disheartening to witness how often they lose their original elements, whether by design or accident,” explains Kumar Chawal of the Consumer Committee of Bhaktapur. “There is a need to preserve our architecture and protect its historical value for future generations. Otherwise, we risk losing a vital part of our identity.” The Laksmi Narsingha restoration is similar to the Bhai Dega temple in Patan Darbar Square which also collapsed in 1934, but was rebuilt with a Moghul-style dome by the Rana government at the time. Only two months before the 2015 earthquake, heritage conservationists had started to rebuild Bhai Dega as the original three-tier based on early photographs. But priorities shifted when four other temples in the square were brought down by the 7.8M earthquake on 25 April 2015.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130.jpg" data-media-id="editor_1" data-image-id="20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  This showed how damage to monuments in Kathmandu Valley spanned from one earthquake to the next. Bhai Dega restoration remains half-complete to this day because money for its restoration ran out.&nbsp; Whereas Bhai Dega restoration was done by the Kathmandu Valley Preservation Trust with grants from western embassies and international foundations, in Bhaktapur it is the municipality itself that allocated the Rs30.7 million needed to restore the Lakshmi Narasingha temple. The expected date of completion is early 2025. The municipality and local communities are focusing on two main aspects: preserving the past and promoting localisation. The restoration team has designed a blueprint for the temple by using historical photographs and insights from older generations.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30.jpg" data-media-id="editor_2" data-image-id="20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30" data-rendition-name="original" width="1200" height="560" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “At first, the Lakshmi Narasingha temple had only one entrance, but during the demolition process, we uncovered the foundations of four doors. Now, we are restoring all of them. This is an example of how our ancient structures have changed over time, often without our knowledge,” says Chawal. “Constructing temples is not like building houses. They carry historical and spiritual values, which is why they hold a special place in our hearts,” he adds. By replicating ancient design elements and rebuilding the temple as accurately as possible to its original form, the team has stayed true to Bhaktapur’s soul. But the restoration also revived ancient techniques that were in danger of being forgotten, generating employment for woodcarvers, masons, and contractors. The community of Bhaktapur’s Gahiti neighbourhood near the famous Nyatapola Temple has also set aside specific days for locals to volunteer in the reconstruction work. This has encouraged young people to take pride in ownership of their heritage. Families have also supported the effort by donating funds for bells, the temple pinnacle, and other structural features to the temple.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6.jpg" data-media-id="editor_3" data-image-id="20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “I feel at peace knowing I have contributed my sweat to restoring this temple,” said one volunteer. “It is our duty to preserve our temples and heritage. The Nyatapola area will look magical once this temple is completed.” Community mobilisation is a long-standing tradition in Bhaktapur. In the past, locals have actively participated in the restoration of other temples in the city, such as Bhairav and Nyatapola fostering a strong sense of ownership. This collective engagement has not only been crucial in preserving the city's historical monuments but also in strengthening the bond between local communities and their heritage, says officials at the municipality. While securing funding is essential, and the municipality showed it values heritage conservation, the Lakshmi Narasingha restoration is proof that active involvement and sense of responsibility of the local community is as important, if not more. Local involvement also means that the monuments will be cared for into the future, When locals take ownership of these efforts, the restored monuments are not only protected in the present but are also cared for in the future.