Dr. Shyam P Lohani

The euphoria at defeating the coronavirus disease had been building since late last year when daily COVID-19 cases declined to two digits in Nepal. The second wave was stimulated by different factors such as people becoming careless about the preventive measures, started attending weddings and social gatherings, political rallies, and religious gatherings. Fewer people were taking the vaccines which slowed down the vaccination drive.

Lesson
The first wave took us with shock and surprise. Our health system was not prepared for the challenge of an entirely new virus. Our healthcare system fought as best as possible and the capacity to test and trace as well as treatment protocol was developed. The critical care capacity was improved. The nationwide lockdown then bought time, although it had a negative impact on the economy, hampered education along with social and psychological consequences.
The extensive mass campaigns were carried out motivating people to wear masks, practise social distancing, and avoid close and large gatherings. With the dedication of our health workforce in often limited facilities, we fared better than initially thought. Then vaccines developed surprisingly fast brought hope that the pandemic would be over soon.
Unless there are measures to reduce contact between infected and non-infected or susceptible people, it may not be possible to deal with this pandemic in an effective manner. The higher the number of susceptible people, the faster the virus would spread. As increased number of people gets infected, the number of susceptible people starts to decline and after some time, the rate of spread also begins to slow down. When the disease was first broken out, the proportion of susceptible people was much higher than it is now. Besides, there were a large number of people whose infection was never detected. The ongoing mass vaccination also reduced the number of susceptible people. And then the virus outwitted humans owing to its capacity to mutate. With higher contagiousness, new strains emerged and spread exponentially.
The second wave is mainly due to newer, more contagious variants and thus resulting in rapid transmission. The COVID-19 contagion continues to rise in many countries due to new variants of coronavirus. There could be more variants of concern, both imported and indigenous. And, surprisingly, shortness of breath is the most common clinical feature among symptomatic patients in the second wave needing supplemental oxygen.
Importantly, there are tried and tested measures that are much more effective as control measures. The way to prevent coronavirus from being transmitted from one person to the other is to not get exposed to the virus. The more we test and identify infected individuals, effectively trace their contacts, and isolate them, the more successful we will be in controlling the spread of the virus.
Testing, contact tracing, and isolating potential vectors of the disease are the key public health measures that has been used for decades to break the chain of transmission of disease. The strategy of testing, tracing and isolating aims at identifying those individuals who have come into contact with an infected person in order to prevent new pre-symptomatic viral shedding, promoting targeted isolation whenever necessary.
An equally effective control measure is the behaviour of people themselves. Again it is here imperative to advocate that the strongest immunity against the disease is the mask and the practice of physical distancing.
The most significant achievement made so far in the first wave of the pandemic was that a large number of health workers have been vaccinated both from the public and private sectors. Their clinical capabilities are better off now. But the present concern is that our intensive care units and oxygen supply might get overwhelmed with a large number of symptomatic patients than it can handle. The present number of healthcare staff providing critical care in Nepal is grossly insufficient. Therefore, urgent hiring of additional staff seems imminent. Government should take this opportunity to strengthen its healthcare system by hiring staff with the vision to make them permanent.

Clustered restrictions
The government has rightly decided to avoid total lockdown of the country and imposed clustered prohibitory restrictions from last week in Nepal. This will help our economy run uninterrupted in areas where the numbers of cases are significantly low. There have been reports of the benefits of closing schools and mass gatherings in the first wave of the pandemic. But the stay-at-home orders and closing of non-essential businesses had little effect on flattening the curves of cases and deaths.
Even in the strictest phase of lockdown, the movement of people cannot be brought to a complete halt. Healthcare staff and emergency workers are of course working. There is also a big group of people working behind the scenes to ensure that essential supplies and services remain uninterrupted. When there is a restriction of movement of the general people, the opening of government offices except vital services becomes worthless.
It is now upon the general public to act responsibly in order to break the chain of transmission. The most effective public health preventive measures such as wearing a mask, social distancing, avoiding large gatherings should continuously be communicated to the general public through massive community engagement. At the same time, mass vaccination drive should continue in order to rapidly reach herd immunity. Importantly, the second wave may not be the end of the coronavirus pandemic, as the virus mutates further.

(Professor Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)