After the WHO declared COVID-19 as a global pandemic, many countries globally clamped lockdown beginning around mid of March 2020. In Nepal, the government imposed official lockdown from 24 March. Some lockdown relaxation was started after three months. However, risks and fear continue as new cases of infection continue to emerge.
In this backdrop a team from The Rising Nepal, including Gopal Khanal, Bhimsen Thapaliya and Ajita Rijal had an hour-long conversation with Dr. Jos Vandelaer, WHO Representative in Nepal, focusing around the COVID-19 trends in Nepal and WHO support to the government on ongoing COVID response. Excerpts:
Could you outline the WHO’s ongoing support and collaboration with the Government of Nepal regarding the response to COVID-19 pandemic?
Nepal is a member state of WHO, as a UN agency we have a long collaboration with the government and UN has been in Nepal over 60 years. We work with the government, particularly the Ministry of Health and Population. On COVID-19, we work day to day with the government. Once the pandemic started picking up, Nepal was quick to decide on lockdown. Some of our colleagues are working in the government premises and working hand in hand with the government colleagues to tackle the COVID epidemic.
What do we do with the government is a broad range of things. We provide ’technical support.’ Technical support is in a quite a number of areas; we help out with for example, forecasting of what supplies are needed; we help out on epidemiology and all data analysis that is needed to understand what epidemic we have in front of us and where it is going. We help with writing guidelines, with training and with communication. Therefore, it is a whole range of things we do but always in support of the government.
How do you assess Nepal’s tackling of COVID, comparing to other nations?
If you look at the global scale, the numbers of cases are going up, and deaths are stabilising. We see rises in the Americas; we see rises in this region. In addition, in African region, case is picking up; Europe is more or less flat. Quite a number of countries saw rapid cases. We have seen that in Nepal too. On how Nepal is dealing with the crisis, I think Nepal is doing well. The government was very quick to announce the lockdown, and when people started crossing the border from India, it was quick to quarantine these people.
The epidemic we see in Nepal is very special and different. The figures do not say that. The curve has gone up and it’s coming down. The vast majority of cases seen in Nepal involve people returning from India. There are localised small clusters of transmission but we haven’t’ seen widespread community transmission yet.
You see the same curve, with the same people coming from India and the people testing positive. So it’s a very specific situation in Nepal. It’s very different as vast majority, over 90 per cent, returned from abroad mainly from India, have tested positive.
Also, we see another number of things happening in Nepal; most of the people who came from India are young men, young male. We know in COVID, young people are very less affected, disease-wise, either they do not have symptoms or are mild symptoms and they don’t die. That is what we see in Nepal. Most cases are asymptomatic and less deaths because people of that age group survive.
It’s important to stress that we have not seen wide spread community transmission yet, thanks to lockdown and quarantine. We know there have been issues at the quarantine. In the beginning, quarantine were overflowed, the condition was not optimal, but by and large, the quarantine has made that the people were picked up who were positive and isolated in hospitals and they did not have chance to spread in the communities.
However, the worst is not behind us. There is a huge risk that the virus will at some point can spread in the community. If you see around the city, people are not keeping physical distance. People are not doing what they are supposed to do and that’s exactly what the virus wants. If we are too close to each other, if we do not wash our hands, if we do not wear facemasks, the virus will start spreading.
I am really afraid that it will happen in Nepal. Once that takes up, experience from other countries have taught us that it will be difficult to control. Maybe, a new lockdown or a localised lockdown may be needed.
So, as a WHO Representative you mentioned the role of government, can we say you are satisfied with response of the government?
I am not saying everything is perfect. There is always scope to do better. I said, lockdown was a difficult decision and was done very quickly and seems to have worked. The quarantining of people also a difficult decision and seems to have worked. The MoHP has prepared hospitals to be better prepared and get more supplies and that must continue. I hope once the case will pick up, which is likely, I hope there will be enough people trained.
The government has done well but the job is not finished. One of the things that needs attention is contact tracing. It is very important. Contact tracing is one area where the government can do much more. The local government and provincial government must also play their role on this. I think the government is doing what it can and the local and provincial government must continue to play their part.
Do you see the proper coordination, collaboration between the three tiers of government?
What I didn’t' mention earlier was WHO has a large number of people posted and working with the provincial and local governments. For Nepal federal system is still being rolled out and it’s not yet completely ready. Everybody has to learn how to work together.
I know that there is a weekly video call by the central government with all the provincial government to coordinate who is doing what, what they need and then to follow up. That is happening in a formal setting. But at the same time, numerous discussion between the three governments is happening which may not know anything about. But it requires extra coordination between three governments. It is difficult for central government to be everywhere. The federal system allows the government to work with local authorities to have people in all 753 municipalities to help.
Talking a bit comparatively, about Nepal’s coronavirus response, Where does Nepal stand among the countries in South Asia?
In South East Asia, overall cases are going up, and its mainly driven by India. In India cases are rising, as you have seen in the press and all over the media, I think they are over a million also seeing cases rising in Bangladesh. Some countries like Thailand are doing better. East Timor had no cases for several months. In the region, picture is quite varied. Nepal probably sits somewhere in the middle there. However, I have to say this with a caveat of the cases you see of the returnees.
The national economy is hit hard by the pandemic. There are pressure to reopen public transport, business and flights. Is it right time for government to decide to reopen businesses?
The government is in a very difficult situation. If you do a lockdown and look from purely health perspective, it works. We hardly saw cases when the lockdown was there. But human beings need social interaction. So, the job of the government is to balance this set of need of people and to be protected. It has to weigh the options between risks and economic impact. The loosening of the lockdown has, I think, already done quite some positive impact on the economy. Lots of things have picked up partially, though not yet fully, and shops are open, restaurant making take out, not 100 per cent. But we are not there yet, we are not yet out of the woods. On your question on tourism and transport, it is difficult for me to say. If you open transport, you need to do that in a way that people are not infected. The government needs to weigh these things against the risk versus benefits.
There is CCMC, there is MoHP, and there is some sort of focused collaboration. Since you said Nepal has been doing, well, how could it be better?
One of the areas that comes to mind is communication. People are keen on knowing what is going on. The discussion we have here it may be small part to help people understand what the situation is like. The government should communicate a little bit more what is actually happening. I think people don’t often know what the government is doing to get prepared. It creates anxiety around what is happening. I think if the government would step up communication, people understand why certain decision is made. That has impact on their life. Therefore, I would say stepping up communication would certainly be one area that can be improved.
Nepal is not a rich country. Even in countries richer than Nepal, the preparations are not the way they could have been or should have been. In Nepal, I’m not saying things are prefect. I am only saying that lockdown seems to have a good impact, the quarantines, despite problems, but from disease control point of view, they seem to have worked. When there are more cases in the future, and more symptomatic cases, we will have to see how the hospital capacity works, as the capacities of the beds found in hospitals are limited.
As a medical doctor, how long do you think will this virus affect the world?
I don’t know. No, I don’t have a crystal ball. The big hope is finding a vaccine or finding medicine or drugs that work against the virus. Once we have a vaccine, the whole thing will be different.
WHO is coordinating with those who are developing virus vaccine. How long will the world have to wait for it? And will there be a fair rules for every country to have access to vaccine?
Usually it takes several years to develop a vaccine. Around 100 plus institution are trying to develop a vaccine. It has to be safe and it has to work. If they are not safe, it won’t be brought to the market. If they are safe, the question is how they will work. Some vaccine work against only severe cases. We do not know which vaccine candidate will be good enough to use. If you look at globally, I think there is projection and in the best-case scenario somewhere next year or at some point around second half of next but these are all projections. Following up on the vaccines is a work coordinated by Geneva. The big question is even once you have it, it needs to be produced. So with the world’s seven billion people- you need a lot of production capacity. Second thing is the cost of vaccines. Currently nobody is talking of cost. At some point, the one who is producing will need to be paid.
WHO is putting together a mechanism on how poor counties can also get the vaccine at a subsidised rate. It is not only rich country to buy it. Once it becomes available, it will be distributed and every country has equal share and equal chance to get it.
One positive thing about COVID-19 in Nepal is very low death rate. What do you think is the reason of low fatality?
The fatality is very low. When you look at data, and people start interpreting data in certain ways. People think about what could be reason. The overall picture for Nepal is a very low death number. There are several arguments floating around, including on BCG –but there is no evidence that tells us that is actually the case. I have no argument to say. What we do know is, if you break down COVID case by age group, you know that in the younger age group, you will have fewer symptoms. If the age geos up, the fatality goes up.
Do you have something more to add for our readers?
There may be some misperception about how WHO supports the MoHP and on our collaboration. We are just an advisor at global and at country level. It is not WHO’s role to do something, we work with the government. We help in thinking through around strategies, approaches that would improve the health of people.
My final message to everyone is, please keep distance.
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