In a repeat of India's devastating surge, Covid-19 is ravaging Nepal

The country's fragile healthcare system collapsing under weight of pandemic cases

An estimated up to three million Nepalis work in India and once the lockdowns began, the jobless migrants began returning, carrying home the fast-spreading B.1617.2, the variant first detected in India.Picture courtesy Twitter/ @amnesty

Penny MacRae   |   TT  | 31.05.21: A tsunami of coronavirus infections has overwhelmed Nepal’s fragile healthcare system, government officials and doctors say. Hospitals in the impoverished landlocked nation have been refusing admission to Covid-19 patients because of a lack of oxygen, beds, drugs, and other medical supplies.

“This virus, it’s like a war we are fighting. Nobody expected the second wave to be so deadly -- nobody,” Dr Retiesh Kanojia, who works at a private hospital in Nepalganj, close to the India-Nepal border, said in an interview.  Families, desperate to treat loved ones stricken by the virus, have been paying black-market profiteers for drugs that sometimes are spurious.

As a result of India’s halt to Covid-19 vaccine exports after getting engulfed by its own devastating second coronavirus wave, Nepal has also run out of vaccines. That has allowed China, which has long been cultivating relations with Kathmandu, to step into the breach with its own brand of “vaccine diplomacy.” Nepal Airlines Corp said it would fly to Beijing late Monday to take delivery of 800,000 vaccines pledged by the government. Another 200,000 vaccines will be transported from Lhasa. 

For weeks, around 40 per cent of Covid-19 tests conducted in Nepal have been returning positive, which is “an incredibly high number,” noted Sara Beysolow Nyanti, the UN Resident Coordinator in Nepal. (By comparison, in India, the current pandemic global epicentre, the positivity rate now has fallen to 9 per cent as the second wave abates). With around 1,500 ICU beds and 600 ventilators, Nepal’s weak health care system is collapsing under the strain of the flood of Covid-19 patients, doctors say.

“In this second wave, people are falling sick far more rapidly. The virus is much more infectious and we are seeing many more people getting infected who are younger, from 30 to 50 years,” Dr Sher Bahadur Pun, clinical research chief at the Sukraraj Tropical and Infectious Disease in the capital Kathmandu said in an interview. 

“We don’t have enough staff, we don’t have enough beds, we don’t have enough oxygen. We need vaccines. If we had the resources, more patients could survive,” Pun said. “We’ve got people on the lawn outside the hospital, we have got them in the hallways, anywhere a person can sit or lie down,” he said.

Nepal had been faring reasonably well after experiencing, like India, a lighter-than-expected first Covid-19 wave. But the picture changed suddenly when India was swept by the devastating second wave and many state governments ordered lockdowns. An estimated up to three million Nepalis work in India and once the lockdowns began, the jobless migrants began returning, carrying home the fast-spreading B.1617.2, the variant first detected in India. The “Indian variant” now accounts for virtually all of Nepal’s caseload, the health ministry says. 

Also, the Nepalese, like Indians, had become complacent about Covid prevention after the mild first wave made many believe Covid-19 was beaten. People staged big weddings, there were religious festivals and political rallies, many called by Prime Minister Oli, who’s been accused by critics of playing power politics while coronavirus cases pile up.

Few people wore masks at the public events. Oli initially dismissed the virus as a “normal flu” and proposed unproven remedies like gargling with guava leaves. As in India, Oli and other figures in his political camp encouraged the narrative that the virus was over in Nepal, telling citizens they had superior immune systems that made them resistant to Covid-19.

These factors created a “perfect storm” situation for Covid-19 to rampage through the population. Nepal has recorded more than 557,124 Covid cases so far since the outbreak of the pandemic while total deaths stand at nearly 7,400, according to Nepal’s health ministry. But, similar to the situation in India, epidemiologists believe that weak record-keeping, especially in rural areas where the healthcare infrastructure is virtually non-existent, means the actual number of Covid-19 cases is far higher. 

"If you don't test very much, you're most likely to miss Covid deaths," Christopher Murray, the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine, said. Nepal conducts only 713 tests per million people and contact tracing is virtually non-existent,

While official numbers of cases have been declining, experts say it’s too soon to declare that the virus is in retreat. On Saturday, the government announced that 4,311 people had tested positive for Covid, which was half the level for a week ago, and 116 more people had died in 24 hours from the virus. But modelling by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine suggests that the actual number of new daily infections on Saturday was probably closer to 120,000 -- over 30 times the official figures and that the 24-hour death toll was 28,256, the Nepali Times reported.

Now, adding to the pandemic turmoil, Nepal’s president has dissolved parliament for a second time in less than six months and called snap elections. “While the house is on fire, we are still fighting (over) who’s going to sleep in the master bedroom,” Nepali billionaire businessman Binod Chaudhary, an opposition member of parliament, told CNBC. Chaudhary said elections, slated for November, should only take place when Nepal’s health situation and the economy stabilise.

The problems facing the country, whose number of doctors at 7.5 per 1,000 people is even lower than India’s 8.6 physicians, in fighting Covid are daunting. “Kathmandu, our biggest healthcare centre, is in crisis. And the crisis is even more terrible in rural areas because there is so much less healthcare available,” Dr Samir Kumar Adhikari, the health ministry’s chief spokesman said by telephone. Particularly hard-hit has been more heavily populated Kathmandu Valley. The western lowland region on the border with Uttar Pradesh that is one of Nepal’s poorest areas with few healthcare resources is also struggling badly.

Doctors say the death toll is expected to keep mounting. “Symptoms are generally mild during the first week of Covid. But you have to watch out in the second week as it is then that patients ”may take a turn for the worse and start needing oxygen, steroids,” says Pun. 

“We can’t conclude right now the situation will be over soon. A large number of people are in home isolation and many of these people are or will be passing through the time when things can turn critical,” said Adhikari.

Adhikari said Nepal is having big trouble meeting oxygen requirements. Nepal gets most of its medical oxygen from India as it does most of its supplies. “We cannot bridge that difference of what we have and what we require,” he said.  

But India has put the brakes on oxygen exports as it has done on vaccine shipments. India is supplying some oxygen but not sufficient for the country’s needs. “We don’t blame India for the oxygen situation. We understand that India is in a difficult situation,” said Adhikari,

Medical equipment and medicines from India, a key supplier, have also dwindled as the country has diverted shipments to meet its own health requirements.  The Nepal government has put a limit on the number of oxygen cylinders per hospital in an attempt to ensure fair distribution, prompting many institutions to reject new patients. “Every day we talk among ourselves about whether the oxygen will last,” Pun said

New Delhi’s suspension of vaccine exports has left Nepal in the lurch and forced it to scramble for other suppliers. Nepal started vaccinating its population in January with India’s Covishield. But due to domestic supply shortages, the Serum Institute of India (SII) has been unable to dispatch the doses that Nepal had ordered. SII has sent one million doses and shipment of the remainder is on hold. That means many of those who received a first shot of the company’s Covishield are now in limbo. Just 1.9 per cent of the population is fully vaccinated.

SII has offered to reimburse Nepal, which had made an advance 80 per cent payment on the order. But Nepal government is insisting that the company honour the contract. India also provided 1.1 million doses of Covishield, the Indian version of AstraZeneca’s jab, as grant assistance in January and March and Nepal received another 348,000 doses of Covishield from the WHO-backed COVAX program in March.

On top of the one million doses being transported to Nepal this week from China, Beijing supplied 800,000 doses of vaccine in March. Nepal, like many other nations, is completely reliant on other countries that can manufacture Covid-19 vaccines. Samar S.J.B. Rana, a researcher at Nepal’s Institute for Integrated Development Studies, called it an “inevitable situation” that Beijing would attempt to plug the gap as far as medical assistance with the halt to India’s “Vaccine Maitri.” 

China has also been airlifting empty oxygen cylinders and ventilators, PPE and other medical supplies. But Nepal really needs to source its supplies from India due to the long overland journey to Nepal from China in the north. “It’s just not logistically feasible,” Adkhikari said.

The US is working on sharing some of its stockpiled AstraZeneca vaccine doses with Nepal.  Anthony Fauci, US President Joe Biden’s chief medical adviser on COVID-19, warned last month that delaying the second dose of a COVID-19 vaccine could increase the likelihood of an escape variant emerging, so the world has an interest in ensuring that all countries get fully immunised. “It may not be the case, but it gets risky,” Fauci said.

“This country is being devastated by the virus. There will be a third and a fourth wave in Nepal if the country doesn’t get vaccines,” warned UN representative Nyanti, saying that ensuring “vaccine equity is basic humanity.”