COVID-19 is an infectious disease caused by the newly discovered coronavirus. The virus that first appeared in the last week of December 2019 in China has, over the past two and half months, spread globally, affecting the people in 185 countries. As of March 21, the COVID-19 outbreak situation data showed 267,013 confirmed cases; with 11, 201 deaths.
WHO has repeatedly warned that Nepal is at high risk of COVID-19, though luckily no case has been reported yet, and the government is actively taking stringent actions for its prevention and not to let it enter Nepal in the first place. Several strong measures have been put in place, as were announced by Prime Minister KP Sharma Oli on Friday.
The government is gearing up responses in efforts to protect the public from the outbreak of the coronavirus. The government has forwarded various steps as precautionary measures to prevent the deadly virus from entering Nepal. In this backdrop, Dr Bikash Devkota, Spokesperson at the Ministry of Health and Population, Dr. Sagar Kumar Rajbhandari, director at Shukraraaj Tropical and Infectious Disease Hospital (SDITH) and Dr. Rabindra Pandey, a public health expert, shared their views on the weekly Gorkhapatra Sambad on Sunday. Excerpts: 

Citizens have equal responsibilities to combat COVID-19 : Devkota

Government’s preparation

Without going much into the background of coronavirus, which we are all very aware of by now, since it first appeared in Wuhan, China; Nepal had started preparation, considering information and indications regarding the nature of the virus, and its transmission, as was warned since the beginning by the World Health Organization (WHO) that signaled it was bound to widespread further. So we started preparation work since then. The Prime Minister called meetings and we briefed him. At the Ministry-level, we have Secretary-level meetings; and there is a Technical group that is working; plus other committees were formed; so we have working since then.

Just around that time, a case appeared which in fact tested our level of preparedness.  We became more alert then. We sent that sample to Hong Kong and the test was positive. This made us realise the need of preparedness and started work on a more focused way. Owing to the possible outbreak and vulnerability we started working strategically.

We then started to look what needed to be done for its prevention and worked in more focused manner. Accordingly, we made its treatment possible at the government-level through the Teku-based hospital; made extra preparations at the Teku hospital. We looked into that case-which then became negative. It gave us a message of how vulnerable Nepal was, and it proved the virus could come into Nepal anytime. So our strategic preparation journey started from there.

After that, we intensified our preparation by working on several pillars- there is a certain preparation mechanism at times of possible disease outbreaks. The first pillar is planning and coordination sector; secondly, is prevention on what can be done not to let it appear inside Nepal-which is still our main focus. As we know it didn’t start in Nepal and we do not have cases yet- so our priority is not to let the virus enter Nepal at all. Accordingly other work pillars, we worked on are community participation; risk management; surveillance; hospital’s preparedness; then comes the pillars on quarantine and isolation and its management and the logistics aspects, among others. We focused on 8-10 pillars/sectors.

On the basis of this; the GoN constituted a High-level Committee led by Deputy PM and Defense Minister. Also, an Action Team, under the GoN Chief Secretary, was formed which meets daily at 4 pm.  This team coordinates the implementation of all decisions from the high-level committee to nationwide implementation up to the lower level. At another level, we prepared the hospitals.

Surveillance at border points

Let me briefly mention the journey of the virus. It first started from China, but now the cases are decreasing in China. No cases have been detected there recently; but it has spread globally and other nations are grappling with it.  The death rate is getting much higher and increasing in other countries than in China. There is higher risk its spread in other nations, including Europe.

For Nepal the concern is higher now, as coronavirus has appeared in India. Given our open border, our main focus now is to intensify our preparation and management and prevention along the open border. After India case, which means it shows higher risk for it to come to Nepal, so increasing our vulnerability; so our changed strategy will be to focus more on preparation along the border; home quarantine, and not let it spread in the community.

So our current focus of preparation journey now is to check and stop at the entry/border points; to check how prepared our hospitals are; what to do incase cases appear; how to stop person-to-person transmission and how to ensure isolation. So our whole effort is focused on prevention.

Self-quarantine

It is wrong to assume that it has not entered Nepal, just because there are no cases. At a time when it has globally become a public health emergency, we need to act; before it’s too late. This is the right time- today, now, this moment, is the right time to act and be prepared.

As you can see, the government’s actions and decisions are getting even more stringent day-by-day.    We all hear news; there are also talks of lockdown, curfew - which could be a possibility if need be. This is a threat and an opportunity.

As we know thousands of people are still coming to Nepal. If anyone comes to Nepal from other infected countries, that person is considered as potentially infected –so we need to put the person in incubation for 14 days in order to rule out or confirm. He/she should stay in isolation. Isolation means staying separately; we used two words: isolation and quarantine.

Quarantine: the potentially infected person has to stay separately in order to not transmit it to other people.  Isolation: the person has to stay home.

Public must act

The citizens should be more responsible and do their duty. Every responsible citizen should feel his/her responsibility towards the society. Anyone returning from abroad should consider that ‘once I return, I should be very cautious and follow the rules of isolation and quarantine as needed in order to not infect others in my society.’

 I request all citizens to stay in their home for these 14 days to fight against the COVID 19.

Security of health professionals

We have already opened the tender and hopefully we could get the sufficient materials soon. But we have problems as the materials are in short supply in the global market. But still we do not ask to fight the battle without the swords.  We assure to provide necessary precautionary equipment to the health workers.

Don’t panic, stay home : Pandey

People’s perception on state’s preparedness

The government’s preparedness in prevention of coronavirus outbreak in Nepal is notable. It was perceived that the virus would enter Nepal through airports and many efforts were made in the airport to prevent the virus from entering Nepal. This was effective as well as the nation has experienced only one case of COVID-19 until now.

Although Nepal has remained safe until now, the fact that the virus has been rapidly spreading in India keeps Nepal at utter risk. Therefore, it is important to close the border completely in order to prevent the outbreak of the virus in Nepal.

The hospitals do not have the capacity to combat the pandemic if it spreads here. It would be great if the government implemented complete lockdown for at least 15 days and other strong measures to ensure people’s safety. The government must implement Chinese model of combating with the virus.

Precautions to be taken by public

It is high time to mobilise the local levels. Huge number of people is entering Nepal from India through the open borders. Also the Kathmandu Valley residents have been returning to their villages and hometowns. During this time, the local levels should record people entering their areas and direct them to stay in quarantine for at least 14 days.

If the local levels are mobilised effectively, the possible spread of the virus can be controlled.

Also, it is important to differentiate between seasonal flu and coronavirus. High fever or continuous dry cough or difficulties to breathe are the three basic symptoms of COVID-19. Only those who sense these symptoms should visit the doctors.

For other illness, the doctors and patients should practice telemedicine. The citizens all over Nepal should acknowledge that hospitals are prone to spread virus infection. They should avoid unnecessary crowding in hospitals.

Public mobility must be minimised to the extent possible to prevent the spread of virus.

Also everyone must consume information only from reliable sources.

Border must be sealed :Rajbhandari

Execution of government’s policies

The Shukraraj Tropical & Infectious Disease Hospital has now completely been devoted to treat coronavirus patients. All the other services of the hospital, including general OPD have been closed since Friday. All the experts and doctors have been prepared to combat the virus if it enters Nepal.

Also, people who are suspected to be affected from the virus are being kept in isolation wards, and they are being referred to self-quarantine on the basis of their medical reports.

The number of ICUs has been increased to 20 and the hospitals have only isolation wards and not quarantine services. Only those coronavirus patients having multi-organ failure will be kept at hospital, general COVID-19 infected patients will be referred to other hospitals.

In the last one month, daily 70-90 COVID-19 tests are being done in the hospital. The hospital is well equipped. We have the capacity to conduct 500 tests a day.

We have also been planning to implement PCR and Rapid Diagnostic Test (RDT), which would help the general public in health screening.

Dealing with COVID-19

Mental health is often neglected by the society, but it is equally important to have a sound mental health to increase one’s immunity. During the time of crisis, one should stay calm and not panic. Those who have been frightening people in social media through fake news must be punished.

Everyone should use their expertise in their levels to reduce the unnecessary threat and myths about the virus that the social media have inflicted upon people.

The media houses should be mobilised to provide consultation and counselling to people through their resources.

Preventive measures

Making health services well-equipped isn’t enough to combat the virus. Every state-level hospitals should be mobilised to test and prevent the virus. Also equipment such as PCR and RDTs should be distributed in state-level hospitals.

The unnecessary storage of food and medicines should be discouraged and those involved in it must be punished.

Also, India is currently the hotspot of coronavirus. Spread of the virus in India accelerates the risk spread in Nepal as well. Therefore, the border must be sealed as soon as possible. Only testing the temperature is not enough. Awareness at utmost level must be generated at the border areas regarding their exposure to risk of the infection of COVID-19 and about isolation and self-quarantine.

Since the health workers are at utmost risk, they should opt for using preventive equipment. Since the entire globe is in crisis of med-equipment required preventing the virus infection, these equipment must be used wisely.  Resources are less, so they should be used by making its optimum use.  Everyone should contribute from their side during the time of global emergency.