A day before the prohibitory order was imposed in the Kathmandu valley, the Covid-19 Crisis Management Center (CCMC) concluded that it was imperative to break the chain of the pandemic, thus, there was no alternative but to impose the prohibitory order or lockdown in the areas reporting a high number of Covid-19 cases.
However, many public health experts doubt that it is not possible to break the chain just by restricting mobility.
Dr Anup Subedee, an infectious disease specialist, stresses the prohibitory order is imposed with an aim to reduce the rate of the spread of coronavirus infection in the community. However, it can be a serious mistake to sit idly just by imposing the order.
According to him, a lot of efforts from the Ministry of Health and Population, local governments, and the general public are needed to contain the spread of the infection. Further, he adds, “During the period of the prohibitory order, the tests should be conducted massively, focusing on contact tracing.”
To do so, he suggests that the District Public Health Office and the local governments should increase the number of tests by identifying the possible infected people through contact tracing.
Corroborating Subedee’s statement, another public health expert Dr Sameer Mani Dixit also adds, “The main thing is to stop gathering of people, to maintain social distance and to use a mask and sanitiser by every citizen.”
Avoid repeating similar mistakes
Though the main roads and highways looked deserted during the previous year’s lockdown, the inner roads were crowded. Likewise, people meeting in the neighbourhood, transporting the general public in ambulances, high-ranking and government officials travelling without any necessary work, and a number of people entering the Kathmandu valley on the recommendation of leaders and government officials were common scenes during last year’s lockdown.
Dr Sher Bahadur Pun, an infectious disease specialist at Sukraraj Tropical and Infectious Disease Hospital, says if the same tendency is repeated now, even if the prohibitory order is kept on extending, the situation cannot be controlled. “Once that prohibitory order is lifted, the infection rate could explode,” says Pun.
Experiences from the last year suggest it is difficult to enforce the prohibitory order for a long time due to socio-economic problems. Therefore, instead of extending this prohibition every week, this period should be utilised to focus on everything from changing personal behaviours to increasing the number of quarantine and isolation centres, according to Pun.
Currently, there is only one 50-bed community isolation centre in Kirtipur in the whole Kathmandu valley. Chief district officers say preparations are underway to reuse the old isolation centres in Bhaktapur and Lalitpur.
Is it too late?
According to an official of the CCMC, an average of 0.6 people have been infected from one infected person even after the end of the lockdown last year when people were following safety measures. But, now, the infection is spreading from an infected person to an average of 2.3 people as people are not complying with the health standards.
The spread of the infection has skyrocketed from April 14 to 24 after the new variant was seen in Nepal. Not only the infection rate, but the death toll is also rising. As per the analysis of the CCMC, about 12.5 per cent of those who underwent PCR tests got positive results overall whereas one per cent of those testing positive died.
Valley hospitals lack oxygen, ICUs, and ventilators. The triple mutant of the coronavirus seen in different parts of India is suspected to have spread in Nepal as well. However, it has not been tested and confirmed yet.
“Serious actions should have been taken from the third week of March,” says Dr Babu Ram Marasini, a public health expert, “However, our mechanisms have warmed up just recently, therefore, it is clear that the mistakes of the past have begun to repeat themselves.”
Marasini sees the need for a collective effort to keep the situation in control. He says that the Ministry of Health and Population should focus on increasing oxygen and ICU beds. The fever had to be checked by placing health workers at various places. Also, the samples of the possible infected persons have to be tested immediately. Likewise, community testing should be conducted where the infection rate is higher, asserts Marasini.
On the other hand, Dr Krishna Prasad Paudel, Director of Epidemiology and Disease Control Division (EDCD) under the Ministry of Health, says that efforts are being made to increase the number of beds at the hospitals. Also, Bir Hospital, Kist Medical College, and Kathmandu Medical College are being considered as alternatives.
Monitoring is a must
Public health experts also view that it is equally crucial to monitor the implementation of the prohibitory order.
The three chief district officers of the Kathmandu valley have ordered to close all businesses and shops except those selling grocery and medicines for a week effective from April 29.
Following the prohibitory order, all kinds of conferences, seminars, cinema halls, party venues, swimming pools, shopping malls, entertainment venues, salons, beauty parlours, gym centres, sports venues, libraries, museums, and zoos have been closed in Kathmandu valley.
Nepal Police that executes the order of the District Administration Office says it is ready to detain those who walk unnecessarily and do not follow the health standards. However, “only the efforts from the police are insufficient”, says SSP Basanta Bahadur Kunwar, the Nepal Police spokesperson, “Citizens themselves should be equally vigilant.”