The government lifted the 120-day long lockdown from July 21. When the lockdown was imposed on March 24, only two cases of COVID-19 were recorded in Nepal. On the 120th day, the case count had crossed 17,000. Although the risk of virus infection still looms large, activities of people show that the situation has returned to normalcy. Dr. Rabindra Pandey, a public health expert, talked to Sampada Anuranjanee Khatiwada about the effect of lifting the lockdown on the public health and the risk of virus. Excerpts:
The government ended the 120-day lockdown on Tuesday. As a public health expert, how have you taken the decision? Was it appropriate time to end it?
It looks like a 'sudden' decision of the government to end the lockdown while the threat of virus infection is still high. Had the government done some homework prior to taking this decision, it would have been a lot safer. The word 'end' has also ended the fear of virus infection amongst the public. Thus, in order to be safe from the pandemic and to opt for precautions, it is important for us to know that the lockdown has not ended yet, it is still going on in phases as resumption of schools and conducting seminars, parties or any kind of group events is not allowed yet. Since July 22, the first day after the government lifted the lockdown, the flow of people and vehicles has increased massively in the Kathmandu Valley. Lifting the lockdown has further intensified the risk of virus infection. Thus, the public shouldn’t think that the lockdown has ended and we are safe from the pandemic. They should thoroughly follow all the safety protocols prescribed by the government. The government, on the other hand, must enforce strict laws with provisions of punishment or fine to those who do not abide by the safety protocols.
Public transportation on the short route has already begun. The long route transportation services will also resume soon. What are the risks posed by the resumption of transportation services to the public health?
During the lockdown, the chances of COVID-19 spread and community transfer were limited due to less human movement. Now, as the lockdown restrictions have been lifted, human mobility has definitely increased the risk of virus transmission. Maintaining physical distancing may not be possible in public vehicles like microbuses and tempos. Also, various people from various places with different travel histories travel by public vehicles. The risk thus is high while using public transport. If one needs to cover a short distance, then it is better to walk. But if one has to use public transport, then s/he must make sure that the vehicle is well sanitised and all the safety protocols are followed. Polymerase Chain Reaction (PCR) tests of drivers and conductors must be done frequently. Vehicles must be disinfected at least twice a day. If the passenger is not wearing mask, s/he should not be allowed in the vehicle. Physical distancing must be maintained while entering and getting off the vehicle. Gloves must be worn by the driver, conductor and passengers if possible. The long route transportation services must be operated only in places with less infection rate. We should learn lessons from India. The cases of virus infection skyrocketed in India after they resumed the public transportation services. If possible, one police official must be deployed in each vehicle to make sure that all the safety guidelines are followed.
The cases of virus infection are rapidly increasing in India. Will Nepal be affected from it?
In India, predictions have been made that the COVID-19 cases would reach its peak during mid-August and it would come in control by last week of October. If we look into the COVID-19 caseload of India, the cases are increasing accordingly. This will definitely affect Nepal. In India, the cases of virus infection are increasing in places like Uttar Pradesh, Bihar, West Bengal and Uttarakhand, which share open border with Nepal. Hence, the number of people returning to Nepal from India might increase in the days to come by feeling unsafe in India. Also, charges of the isolation wards and beds are increasing with the increasing cases of COVID-19 in India. People might enter Nepal for treatment of COVID-19 as the hospitals are comparatively cheaper here. Therefore, strict surveillance must be done in the border area. Regular patrolling must be done in the open border area and those crossing the border illegally must be punished. The quarantine centers set up in the border area must be managed effectively. All the entrants must be kept in holding centers for at least 5-7 days and should be sent to either home or isolation center on the basis of their PCR test results.
The festival season is approaching near. What effects will it have on COVID-19 pandemic?
With the festivities approaching, around 200,000 to 300,000 Nepalis are anticipated to return to Nepal from India and elsewhere. As Dashain falls in October, India will be in the peak of the pandemic. Also, with resumption of fight services, number of people returning to Nepal from abroad will also increase. Airport and aircrafts are considered to be one of the unsafe places to get contracted to the virus. Thus, in order to avoid community transfer, everyone entering Nepal via airways or via Nepal-India border must be sent to the community after keeping them in holding center for at least 5-7 days and conducting PCR tests.
Are the PCR tests now being conducted on daily basis enough? Or should it be expanded?
Since places with dense population are always at high risk of being affected by the virus fallout, the PCR testing should be expanded in densely populated areas like the Kathmandu Valley. Kathmandu has population of 4 million. It is vital to conduct PCR test in at least 2 per cent of the total population of the valley. 'Pooling method' of COVID-19 testing can be used in order to minimse the cost of testing during the expansion of PCR testing. In pooling method, a huge number of samples can be tested in one go. In sample pooling technique, many swab samples are mixed together to make one swab sample. The mixed swab sample is then put to PCR test. If the pooled sample test reports negative for the virus, then it will be established that all patients are COVID-19 negative. If the test reports positive, then each sample can be tested individually to find out who is infected with the virus. The USA has used pooling method to test four individuals at once. Nepal can test 10 individuals at once under similar method, especially in the densely populated areas, using only the resources needed for a single test. Moreover, over a dozen rivers and streams flow through the Kathmandu Valley. There are many settlements of landless squatters on the bank of these rivers and streams where no safety protocols are followed. The COVID-19 tests must be done in those settlements and other areas such as alleys, brick kilns, tea shops, local liquor shops, cold stores, meat shops, vegetable market and people involved in waste management among others. The COVID-19 test should be expanded in those people who are less informed about the pandemic. For an instance, in antibody survey carried out by the Health and Family Department in New Delhi, India, antibody was found in about 28 per cent of the people. This means they contracted the virus and recovered from it without showing any symptoms. Similar survey can be done herel to ascertain the status of COVID-19 fallout in the community. It will also help the government in developing COVID-19 response policies accordingly.
Currently, the infection rate is decreasing in Nepal. Are there chances of Nepal being hit by the second wave of the pandemic?
If we look the situation in other countries, for example, the UK has predicted that the second wave of the pandemic could strike it during winter, thereby claiming 50,000 to 2,45,000 lives. Likewise, Melbourne, Australia went into lockdown for six weeks after being hit by the 'second wave.' In Beijing, China, the second wave was brought under control by testing over one million samples daily. Iran and Korea among others are also facing the second wave of virus infection. It has been predicted that various places of India like UP and Bihar would observe the second wave of virus in the winter. If India is hit by the second wave, the possibility of Nepal being affected by it will be high. Since COVID-19 is a respiratory virus, it becomes more active during the winter season. The droplets that come out from our nose and mouth remain on surfaces for a longer time during the winter. Chances of virus entering the community will also be higher during the winter. Furthermore, if the virus gets mixed with seasonal flu, the risk of community transmission will be amplified. Since the symptoms of COVID-19 and seasonal flu are similar, the number of people willing to get tested for COVID-19 will also increase during the winter. The government should prepare to provide more COVID-19 testing services during winter. It is not certain whether Nepal will experience second wave of virus outbreak or not but we must be prepared for the second wave.
What should Nepal’s role be in the research going on worldwide to develop vaccine against the COVID-19?
More than 150 laboratories across the world are carrying out research to develop vaccine against the virus. Notable progress has been seen in 18 labs. To name a few, the Oxford University has already begun the third phase of vaccine trial. A company named Pfizer, which his carrying out vaccine trail in joint venture of the USA and Germany, has also reached the third phase. Likewise, Moderna, a US-based company, has reached the second stage of trial. India is also striving to develop vaccine against COVID-19. Bookings for vaccine, once they pass the trail, have already begun worldwide. Nepal should use its diplomatic channel to book vaccine with a few companies as mentioned to get hands on anti COVID-19 vaccines as soon as they’re developed.