Three weeks earlier, the daily Covid-19 positive rate was as high as 44.67%. The infection rate dropped to 34.18 percent after a week, then then dropped to 31.35 percent the following week.
Because most regions of the country have been under lockdown for the previous 40 days, the infection rate has already dropped below 30% this week. As of Sunday, it remained at 28.9%.
Doctors and health professionals are concerned, however, because community transmission of Covid-19 has been reported in rural Nepal as well.
Calculating the dimensions
Dr. Kedar Baral, an epidemiologist, adds that though they can’t make a definitive statement, there are signs that lead in that direction.
“It’s been nearly a month since the lockdown was imposed, and not much has changed. Cases should normally be decreasing in two weeks, but the rate at which they are decreasing is slow, which is cause for concern,” adds Baral. “Perhaps it’s time we traveled to different communities and did the testing.”
Dr. Janak Koirala, an infectious diseases expert, agrees with Baral, claiming that 100 sick Covid-19 patients can infect up to 2,500 people. In a country like Nepal, where community testing has not been done, the number could be substantially higher.
A seroprevalence survey conducted by the World Health Organization and the government’s Epidemiology and Disease Control Division in December revealed that 13% of Nepal’s population (3.9 million) had been infected with the virus at some point. However, the government’s data showed that just 200,000 people had been infected with the virus up to that point.
As of June 6, the number of persons sick had risen to about 600,000, with over half of those affected residing in Kathmandu and the remaining 40% dispersed around the country. Because major cities with dense populations, such as Kathmandu, have a high number of infected people, the number of sick people in these cities is also relatively high.
Crisis is most likely.
However, because many people have left large cities, there is a significant likelihood that rural areas may suddenly become a hotspot, which will be damaging, according to Baral.
“The numbers may be decreasing, but the risk remains,” he says.
The rationale for the warning is that diseases in rural areas take longer to spread because these areas are sparsely inhabited. Doctors believe that this, combined with a paucity of testing in certain areas, is a disaster waiting to happen.
“People are only tested if they have symptoms or if they have recovered. However, the percentage of people who do not test despite symptoms is fairly significant, which is why we shouldn’t rely on government data,” Baral says.
According to Baral, if the government can conduct antigen testing across the country in the next two weeks, it would be able to have a solid image of where the country stands in terms of regulating Covid-19. He feels that a lack of testing in rural areas, as well as the geographic challenges these locations face, are the reasons why they haven’t been able to come up with a bigger picture.
“Cities are no exception. Lockdown isn’t the only option, according to Baral. “We must ensure that we are putting communities to the test. Only then will we be able to keep the pandemic under control.”
As the number of infections declines, so does the number of persons dying from Covid-19, but the virus’s risk remains constant, according to public health specialist Dr. Sharad Onta. People shouldn’t think Covid-19 is going away based on the data, he argues, because the data isn’t 100% correct.
“We haven’t really put villages in distant locations to the test. We can’t celebrate till we test these areas. If we do, it will be stupidity,” says Onta, who, like Baral, is emphasizing community testing in the coming weeks.
Despite the fact that doctors and health professionals are optimistic about the drop in instances, they believe the government and the general public should not get too excited if they want to eradicate Covid-19.
Rural areas have received warnings.
Dr. Sher Bhadur Pun, a communicable disease expert, says the Shukraraj Tropical and Infectious Disease Hospital has been flooded with patients from rural areas in the last week. People from the Ramechhap, Sindhuli, and Dolaka districts, which lack adequate health care, have traveled to Kathmandu to seek treatment in private hospitals.
“Those who left Kathmandu on the eve of the lockdown went back to their villages and infected locals. This has resulted in an increase in these places, but no one knows they’re infected due to a lack of testing. “By the time they do, it will be too late,” Onta warns.
The Dhulikhel Hospital in Kavre, run by Kathmandu University, has outreach centers in 18 rural locations throughout nine districts in Nepal. Almost all of these centers are overwhelmed with Covid-19 patients, according to the hospital’s Dr. Roshan Kumar Mahato.
Following a recent visit to these remote areas, Mahato estimates that the infection rate in these locations is over 50%. He claims that 18 out of 24 people in one town tested positive for the virus, and that the number will rise in the next weeks.
“Local governments are unprepared to deal with this,” Mahato argues.
Every day, about ten people from rural areas are admitted to Dhulikhel Hospital. The number of persons dying in Dhulikhel is also fairly high, as most of them only visit hospitals when their health deteriorates. Mahato claims that despite their best efforts, they have been unable to save people’s lives since some of these regions are too distant to be transported to the hospital in a timely manner.
“Community testing in rural regions is the only way we can stop this,” Mahato agrees with Baral, Koirala, and Onta.
In Karnali, there were 280 positive cases on June 4th, spread across 11 districts. For a week, several villages with Covid-19 symptoms were sealed. The situation is so serious that all health professionals from a health station in Jajarkot’s Chhedagad municipality tested positive for Covid-19. The infection rate for antigen tests was as high as 100% in some places.
According to Gaura Gharti Magar, information officer at the District Health Office, the infection rate in Jajarkot over the last week was 60%. In the district, 907 out of 2,110 people tested positive for the virus between April 20 and June 4.
During this time, only antigen testing were performed in the district because PCR tests were not possible in the region, which has experienced three deaths since April 14. The district currently has around 250 Covid-19 patients.
In Banke, things are the same. Bheri Hospital, which handles the majority of the district’s Covid-19 cases, also sees a number of patients from the district’s rural areas and neighboring districts. Dr. Rajan Pandey, the hospital’s head consultant, said that though cases in the city have decreased, the hospital is still receiving a large number of cases from villages near Bardiya, Kailali, Dang, and Surkhet.
Despite people exhibiting symptoms, there has been little to no testing in locations like Rukum, Dailekh, Kalikot, Humla, Mugu, and Dolpa, according to Madhav Chulagain, a public health official from Jumla. People are hesitant to get tested, according to Chaulagain, despite the fact that the district has enough kits. People believe that if they test positive, they will be judged differently in society, he claims.
“They believe Covid-19 is a forbidden subject. People are becoming ill, yet they refuse to be tested,” he continues.
People in other sections of the country are acting similarly, refusing to be tested.
Vaccines are the only source of hope.
Even though Nepal is only in the second wave of Covid-19, scientists warn that a third wave is on the way if people are not careful. The reason they provide is their naivety in believing the threat has passed when the virus is mutating from one place to the next.
Vaccination is the only way to ensure people’s safety against Covid-19. Doctors and public health specialists have stated that the government should vaccinate as many people as possible in order to deal with the virus if and when the third wave arrives.
“Because this variation is more hazardous than the previous one, the only way to prepare for the next wave is through vaccination and public awareness that the vaccine works,” explains Koirala.
Pun of Shukraraj Hospital said that individuals have started inquiring about immunizations recently, which he considers to be a good omen. However, according to Pun, 90% of Covid-19 patients who arrive at the hospital have not been immunized.
“Those who have received one shot are doing well, but those who have not are not. Vaccines work,” Pun says, adding that the government must do all possible to guarantee that the majority of the population gets immunized before the third wave.
According to Koirala, the vaccination should be given initially to persons who have never had Covid-19, those with chronic illnesses, and old persons. According to research, persons who have had Covid-19 in the past have a better probability of recovering than persons who have had Covid-19 for the first time.
Baral also emphasizes immunization because, according to him, no one knows when the pandemic would stop. “The vaccine will come when it comes,” he adds, adding that for the time being, “we must focus on testing.”