As neighboring India is experiencing a second COVID-19 wave, the number of cases in Nepal have also surged, raising significant concerns. Daily cases hit a high of 9,070 on Thursday, May 6 2021. This represents a massive increase over the 298 daily cases from a month ago. Cumulative deaths from the coronavirus stand at over 3,500. Hospitals are facing increasing numbers of patients and vaccine supplies are running low. Testing in the country is showing a very high national positivity rate of 47 percent. Several regions in Nepal, including the capital city of Kathmandu and the city of Nepalgunj in the country’s Banke district, have experienced serious outbreaks.
The Asia Pacific director for the Federation of Red Cross and Red Crescent Societies, Alexander Matheou, said “We need to act now and we need to act fast to have any hope of containing this human catastrophe.”
Nepal Red Cross Chair Netra Prasad Timsina said “What is happening in India right now is a horrifying preview of Nepal’s future if we cannot contain this latest Covid surge that is claiming more lives by the minute.”
Catholic Relief Services’ Nripendra Khatri said “Because of the lockdown in major cities, access to transportation and medicines is also affected. Cremation centres around the country are filling up fast, and family members are unable to properly perform last rites.” He added “Nepal is a difficult place for logistics, especially for specialised medical equipment. Our country is landlocked and supplies often come overland from India, but right now India needs all of its medical equipment.”
This coronavirus surge exposes the serious problems with Nepal’s health care system, which in turn make the implications of these outbreaks more severe. In a country of approximately 30 million, there are only 1,600 intensive care beds and less than 600 ventilators. Nepal’s government has ramped up its efforts to combat this surge. In the face of increasing oxygen demand, the country ordered 20,000 oxygen cylinders internationally.
While India has a significant shortage of doctors, at 0.9 physicians per 1,000 people, as per the World Bank data, access to physicians is an even larger problem in Nepal. There are only 0.7 physicians per 1,000 people in the country. As of May 1, amid the surge in COVID-19 cases, hospital bed shortages have become an issue in 22 of Nepal’s 77 districts.
The vaccination campaign in Nepal has also been moving at a relatively slow rate. Only 7.2 percent of the population, at the end of April, had received at least one vaccine dose. The vaccines that have been used include Sinopharm doses provided by China and AstraZeneca doses provided by India. Nepal has also approved Russia’s Sputnik V vaccine.
In a televised address, Nepal’s Prime Minister K.P. Sharma Oli, said “I would like to request our neighbours, friendly countries and international organisations to help us with vaccines and critical care medicines …to support ongoing efforts to combat the pandemic.”
Religious gatherings, including large festivals, such as the Kumbh Mela, have been implicated as COVID-19 superspreading events in India. India’s Kumbh Mela had over 50,000 pilgrims from Nepal. Nepal’s former monarchs, King Gyanendra Shah and Queen Komal Shah, were among the attendees. They were admitted to a hospital in Kathmandu upon their return to Nepal, for COVID-19. Besides this massive gathering in India, in Nepal itself, festivals including Pahan Charhe and Bisket Jatra had crowds in the thousands.
There are other religious festivals that will be occurring soon. Health Ministry spokesperson, Dr. Jageshwor Gautam, said “Some festivals are coming up during this prohibitory period as well, but the government is not in the condition to say anything.” “We are tired of telling people to follow the safety measures.”
The government’s response to the coronavirus has prompted significant criticism. The permissive attitudes towards large gatherings such as religious festivals have been highlighted.
Nepal has a shared land border with India, and there is significant movement of people between the two countries. The openness of this border has led some to raise concerns about its role in contributing to the spread of the coronavirus. Many in Nepal and many in India have businesses in the other country. Further, Nepalis do not require showing their ID or their passport when entering Nepal. As India is facing a second wave, some Indians have gone to Nepal to escape or to seek health care. Recently, stricter measures have been implemented in Nepal. Citizens of Nepal can now only enter the country through 13 out of 35 border points. Returnees also need to be tested at the border, such that those with a positive test result will need to enter quarantine. Lockdowns were enforced in Kathmandu at the end of April as daily cases doubled, from over 2,400 on April 24 to over 4,800 on April 29.
In border areas besides India, health care facilities are being expended to provide care for workers returning to Nepal from India. This includes the addition of a 200-bed isolation chamber and 2,000 additional beds, to a facility.
The increase in deaths has posed a major issue for the government in terms of managing bodies, as crematoriums are overwhelmed. The army has supported cremations and burials.
Despite the testing system in Nepal being improved since the onset of the first coronavirus wave, the test positivity rate being remarkably high is an indicator of undertesting. This issue of underreporting is a concern in the Base Camp in Nepal, where there are numerous suspected COVID-19 cases. Nepal’s tourism department has denied the existence of these cases.
Before the implementation of stricter controls and measures, a number of migrant workers returned back to the country, raising concerns about another COVID-19 spike. COVID concerns are heightened for rural areas, as they tend to have older populations and limited health care access. International flights, from May 6 onwards, were banned. In 46 of 77 districts, there are rules restricting gatherings.
It is evident that Nepal is undergoing a significant COVID-19 wave, that puts too many people in the country at risk. The poor state of the health care system underlines the importance of a multifaceted approach in addressing different aspects of the crisis. Resource issues, including medical professional staffing, oxygen, drugs, and vaccines, must be addressed to better alleviate the health issues that are arising. The national vaccine rollout needs to be bolstered and accelerated, as the proliferation of vaccines provides the most effective long-term exit strategy from the pandemic, not only for Nepal and India, but for the entire world. Meanwhile, limiting gatherings and other situations that pose significant transmission risks are also vital to flattening the sharp upward curve in cases. It appears that Nepal’s national government is taking the crisis more seriously than in the past. However, the lack of adequate action in the leadup to this health care emergency demonstrates how poor decision making and planning can worsen the situation. Coordinated action between local and national governments in Nepal, in conjunction with international assistance, is needed to navigate this moment. In the short-term, material assistance, such as vaccine doses, medical oxygen, and ventilators, are vital. In the long-term, the medical system in Nepal needs a significant overhaul. The ongoing COVID-19 pandemic and this wave further exposes the fundamental weaknesses in the health care system. The fact that so many in Nepal lack access to health care is unacceptable.