Nepal cases are skyrocketing, sparking concern that the country’s outbreak could mimic India’s

In Nepal, a situation unfolds that seems terribly familiar.

Covid-19 cases are skyrocketing, hospitals are overwhelmed and the country’s prime minister is asking other countries for help.

Nepal is currently reporting around 20 daily cases of Covid-19 per 100,000 population – roughly the same number India reported two weeks ago.

Last weekend 44% of Nepal’s Covid tests were positive, according to government figures cited by the International Federation of Red Cross and Red Crescent Societies (IFRC), as it warned against an impending crisis.

“What is happening in India now is a horrific glimpse into the future of Nepal if we cannot contain this latest wave of Covid which is claiming more lives per minute”, said the president of the Nepalese Red Cross Society, Dr. Netra Prasad Timsina, in a press release.

The rapid spread of the virus has raised fears that Nepal is on the brink of a crisis just as devastating as India’s – if not worse.

Nepal has a fragile health system, with fewer doctors per capita than India and a lower vaccination rate than its neighbor. The country’s high test positivity rate suggests it is not detecting enough cases.

Mass public events, including festivals, political rallies, and weddings, allowed cases to spread, along with general public complacency and sluggish government action.

“The situation is getting worse day by day and it could get out of hand in the future,” Dr Samir Adhikari, spokesperson for Nepal’s Ministry of Health and Population, said on Monday.

Although Nepal has tightened borders and imposed lockdowns in its worst-affected areas – including the capital – some fear it is not enough to contain the virus as it spreads in the capital, and even to at Everest base camp.

A porous border

Just a month ago, this Himalayan nation of 31 million people was reporting around 100 cases per day. Now it’s over 8,600.

Some have blamed this on India’s second unleashed wave that spilled over into Nepal, which shares a long open land border with its neighbor.

Nepalese do not need to show their passport or identity card to enter their country, and many Nepalese have businesses in India and vice versa, which means there is a lot of cross border traffic. In recent weeks, some Indians have fled the second wave of their country, hoping to access health care in Nepal or flee to a third country, Adhikari said.

“It is very difficult to stop all mobility between the two countries,” he added.

In recent days, Nepal has tightened these rules. Nepalese Foreign Minister Pradeep Kumar Gyawali said Nepalese citizens can now only cross from India at 13 of the 35 border points.

But returnees must be tested at the border, according to Shankar Bahadur Bista, deputy director of Banke district, which borders India.

Anyone who tests negative can go home – but positive cases must enter a quarantine facility or hospital, he added.

However, Dr Sameer Mani Dixit, a public health researcher based in Nepal, says these measures came too late – the virus was already spreading in the country.

Large-scale meetings

The crisis in Nepal began to develop in early April, as the country’s Prime Minister, KP Sharma Oli, touted another cure for the unproven coronavirus.

Oli said the disease could be treated by gargling with guava leaves, adding to his ridiculed comments last year that Nepalese had stronger immune systems due to their daily consumption of spices.

As April progressed, Nepalese gathered for religious festivals at home and across the border in India, where Nepalese devotees joined Hindus bathing in the Ganges for Kumbh. Mela, one of the largest religious gatherings in the world.

They included former King of Nepal Gyanendra Shah and Queen Komal Shah, who were admitted to hospital with Covid-19 upon their return to Nepal, according to a statement from Norvic International Hospital in Kathmandu.

Around the same time, thousands of Nepalese gathered in the capital to celebrate the great religious holiday Pahan Charhe. Others gathered in Bhaktapur, a nearby town to celebrate Bisket Jatra, although authorities ordered them not to do so, according to local media. A sign supporting the event read: “Our festival is dearer to us than our lives.”

On April 24, when the country reported more than 2,400 new cases, media rallied around Oli as he inaugurated a new Dharahara, to replace a tower destroyed in the deadly 2015 earthquake.

Five days later, on April 29, when daily cases had doubled to more than 4,800, the government imposed a two-week lockdown in the capital. The next day, the Ministry of Health and Population admitted it was overwhelmed.

“As the number of infections has increased beyond the control of the health system, it has become difficult to provide hospital beds for care,” the ministry said in an April 30 statement.

Oli said on Monday that the virus had taken off in Nepal despite the government’s “most intense efforts” to contain it.

“Since we live in an interconnected and interconnected world, pandemics like this spare no one and no one is safe,” he said, speaking in English.

The government’s lack of action angered people in Nepal.

Experts say it may not have been possible to prevent a second wave, but the government could have done more to control it.

Political analyst Surendra Labh said it was inappropriate to let festivals go on – and argued that such events, along with wedding ceremonies, had made the outbreak worse.

“I think the government is not managing the epidemic well… the government is more focused on its own policy,” he said.

Health expert Suresh Panthee, one of the founders of the Institute for Sustainable Studies and Research in Nepal, said Nepal became complacent after avoiding a catastrophic epidemic during the first wave.

As cases escalated across the border, Nepal could have prepared a quarantine system for returning citizens, he said. “We had enough time but we didn’t prepare.”

Health system under siege

Nepal is one of the poorest countries in the world – and this is reflected in its health system.

According to the government’s Covid-19 response plan last May, the country has only 1,595 intensive care beds and 480 ventilators for its roughly 30 million inhabitants.

There is also a shortage of doctors, with just 0.7 doctors per 100,000 population, according to World Bank data – less than 0.9 in India. Health workers on long-term leave are being recalled to help manage the crisis, while the Nepalese military on Wednesday ordered retired medical staff to stand ready to be recalled.

As of Saturday, there was a shortage of hospital beds in 22 of the country’s 77 districts, according to Nepal’s Health Emergency Operations Center (HEOC).

Dr Paras Shrestha, a senior doctor in a Covid-19 intensive care unit in the border town of Nepalgunj, says his hospital is so overrun he advises patients with mild symptoms to self-isolate at home.

The situation in the city is already “critical”, according to Dipak Shrestha, the head of the UNICEF field office in Nepalgunj, who warned that the same could happen elsewhere.

As India is battered by its brutal second wave, the Nepalese government appears to be taking action.

Last week, it ordered 20,000 oxygen cylinders overseas, as demand for medical oxygen tripled, according to health ministry spokesman Dr Jageshwor Gautam.

And on Tuesday, the Nepalese army started expanding health care facilities in an area bordering India, to cope with the large number of Nepalese workers returning home.

A 200-bed isolation center is added, along with 2,000 beds, to a facility in Sudurpashchim province, where authorities are reporting a shortage of oxygen cylinders.

But the challenges are vast.

Nepal has about double the positivity rate of India, which suggests that a large number of cases go undetected.

Testing has improved since the start of the first wave – the country initially sent tests to Hong Kong for processing, but has grown to around 20,000 tests per day.

It’s still not enough, Panthee said.

There are signs of underreporting at base camp, where two sources told CNN that there have been dozens of suspected cases of Covid-19 in recent weeks. A spokesperson for Nepal’s tourism department denied that there were any cases.

On top of that, Nepal has a low vaccination rate. By the end of last month, 7.2% of the population had received at least one dose of the vaccine – less than India, where around 10% of the population had been at least partially vaccinated.

“I can say that the government is doing its best,” said Adhikari of the health ministry. “But we have a very weak and fragile health system in the country.”

What happens next?

The next few weeks will be crucial in controlling the epidemic in Nepal.

Authorities imposed a two-week lockdown on Kathmandu last Thursday – but before that went into effect, some migrant workers returned home.

Villages often have large numbers of elderly people and limited health care, raising concerns that migrants may have spread the virus to remote areas. It is too early to say whether the pre-lockdown migration will result in another spike, Adhikari said.

“In a few weeks, our situation will be bad. But we are doing our best, ”he said.

Authorities are taking other measures to limit the spread. From May 6, all international flights will be banned, Oli said in a televised address to the nation on Monday. Rules limiting gatherings are in place in 46 of the 77 districts.

Shrestha, the Nepalgunj doctor, hopes that if people follow the rules and stay patient, the cases will end.

But Dixit says the rules change often, making it difficult for the public to follow them. A lockdown alone isn’t enough, Panthee says. The government was to test all close contacts, isolate positive cases, better manage the border and increase its oxygen supply.

And these locks come at a cost. Gita Kuchikar, a 45-year-old housekeeper and mother of three in Kathmandu, has lost her job due to the city’s lockdown and concerns about her children’s education.

“I’m afraid because in Nepal the cases are increasing like in India,” she said. “I don’t know how our government will handle the situation.”

In the coming weeks, other festivals are approaching. The Rato Macchidranath festival is slated to start later this month near Kathmandu, although organizers have said they will adopt social distancing measures and mandatory masks, according to state media.

Gautam, of the Department of Health, predicted that people might not follow curfew and lockdown orders due to the celebrations.

“Some festivals are also preparing during this blackout period, but the government is unable to say anything,” Gautam said, adding that the situation is now in the hands of the Nepalese people.

“We are tired of telling people to follow security measures.”