2020 coronavirus pandemic in Nepal

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2020 coronavirus pandemic in Nepal
COVID-19 Outbreak Cases in Nepal.svg
Map of the outbreak in Nepal (as of 11 March)
  Confirmed cases reported
  Suspected cases reported
DiseaseCOVID-19
Virus strainSARS-CoV-2
Location   Nepal
First caseBagmati Pradesh
Arrival date5 January 2020
(1 month, 2 weeks and 4 days)
OriginWuhan, Hubei, China
Confirmed cases1
Suspected cases‡1
Recovered1
Deaths
0
Territories
Bagmati Pradesh
Official website
https://heoc.mohp.gov.np/
‡ Suspected cases have not been confirmed as being due to this strain by laboratory tests, although some other strains may have been ruled out.

The global COVID-19 coronavirus pandemic was confirmed to have spread to Nepal when its first and only case was confirmed on 24 January 2020. The patient only presented mild symptoms and had been discharged a week earlier with instructions to self-quarantine at home. As of 16 March, Nepal has tested 477 other people, all of whom have tested negative.[1]

The government has taken various precautions to prevent the spread of disease. It evacuated 175 individuals, mostly students, from Hubei, in February, and quarantined them in Bhaktapur. All of them tested negative and were sent home. Sukraraj Tropical and Infectious Disease Hospital in Teku, Kathmandu, commonly referred to as Teku Hospital, is the primary hospital for the treatment of the disease, handling all suspected cases. Nepal has established health-desks at the international airport as well as on border checkpoints with India. Nepal has poor health-care and a severe lack of medical infrastructure, manpower and equipment, and is therefore considered poorly prepared to handle a large scale outbreak of the disease.

Nepal cancelled its international promotional activities related to Visit Nepal Year 2020 and the Nepalese economy is expected to be severely impacted by the pandemic due its effects on tourism, manufacturing, construction and trade.

Background[edit]

COVID-19 Pandemic[edit]

The ongoing pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[2] The outbreak was first identified in Wuhan, Hubei, China, in December 2019 and recognised as a pandemic by the World Health Organization (WHO) on 11 March 2020, as the first known pandemic that may be controlled.[3] As of 16 March, over 173,000 cases of COVID-19 have been reported in more than 150 countries and territories, with major outbreaks in mainland China, Europe, Iran and South Korea, among others.[4] More than 6,600 people have died from the disease and over 77,000 have recovered.[4]

The virus primarily spreads between people in a way similar to influenza, via respiratory droplets from coughing or sneezing.[5][6][7] The time between exposure and symptom onset is typically five days, but may range from two to fourteen days.[7][8] Symptoms are most often fever, dry cough and shortness of breath.[7][8] Complications may include pneumonia and acute respiratory distress syndrome. There is no vaccine or specific antiviral treatment, but research is ongoing. Efforts are aimed at managing symptoms and supportive therapy. Recommended preventive measures include handwashing, covering the mouth when coughing, maintaining distance from other people (particularly those who are unwell), and monitoring and self-isolation for fourteen days for people who suspect they are infected.[6][7][9]

Nepal[edit]

China is one of two countries bordering Nepal; Nepal shares a 1,414 kilometres (879 mi) border with China's autonomous region of Tibet, in the Himalayas.[10] China is Nepal's second-largest trading partner.[11] Nepal lies in South Asia, one of the least developed and the most densely populated world regions, which performs poorly in education as well as health care and sanitation metrics, and is therefore considered one of the highest risk areas for the pandemic, and also one of the least prepared.[12][13]

According to The Kathmandu Post, hospitals in Nepal have few ICU beds (just three in Teku Hospital) which are almost always occupied, with people in critical condition usually having to wait for the beds to become empty. It reported doctors as saying that it would be next to impossible to admit new patients to ICU as soon as they need them.[14] Teku Hospital, the only one designated for handling infectious disease, had built an isolation ward during the avian influenza outbreak a decade ago, but had never brought it into use, as it did not have experts to evaluate or maintain the required standards.[15]

As news of a new infectious disease in China broke, concerns were raised in Nepal over the high potential risk, the need to implement preventative measures and a severe lack of necessary medical equipment and infrastructure; according to Baburam Marasini, former director of Epidemiology and Disease Control Division, Nepal does not have any double cab ambulances to transport highly infectious patients safely, isolation wards in hospitals, or biosafety level-3 or better laboratories needed to test for highly infectious disease.[16]

Timeline[edit]

January[edit]

A 31-year-old student of Wuhan University who had returned home on 5 January,[17] was admitted with mild symptoms on 13 January and discharged on 17 January with instructions to self-quarantine at home after preliminary tests showed he may not be infected.[18] Although Nepal had the laboratories and the skilled manpower to test for the disease, Nepal did not have the reagents required. The reagents cost around Rs 17,000 per test and need to be bought in bulk, sufficient for about 200 tests. As there were no other suspected cases needing testing, the officials decided to send the samples to Hong Kong instead of buying the reagents.[19] The samples were sent to Hong Kong on 21 January.[20] On 24 January, the Health ministry confirmed that the test had come back positive. The ministry said the patient was under surveillance, those who came into close contact with him were being investigated, and health information on all passengers returning from China was being sought.[21] However, The Kathmandu Post quoted officials at the Epidemiology and Disease Control Disease as saying that no one knew of the patient's activity since he was discharged and that they were looking for him.[22] Later, they said that they had only spoken to the patient on phone; he had reported being in good health and was not asked to come in for check-up or monitoring.[23] The patient was confirmed completely treated when RT-PCR throat swabs returned negative for COVID-19 in followup assessments of 29 and 31 January.[24][25] None of the people known to have come in contact with the patient showed any symptoms after three weeks of the patient's return to Nepal, and it was therefore presumed that he had not transmitted the disease to anyone else in Nepal.[15]

On 17 January, urged by the WHO, Nepal began screening passengers arriving in Tribhuvan International Airport from China, Thailand and Japan, the three countries with multiple confirmed cases.[26] Eight persons manned the health desk. The airport did not have infrared thermal scanners and was therefore using thermal scanners as preparations were being made to install the infrared ones. The passengers who showed fever were being asked to remain in contact and contact the hospitals if they showed additional symptoms.[27]

On 23 January, Dr. Bashudev Pandey, director of Teku Hospital, was quoted as saying that the hospital was on high alert, while three other hospitals — Nepal Police Hospital, Patan Hospital and Tribhuvan University Teaching Hospital — would also treat the disease.[28] Six beds in Teku Hospital had been allocated for isolation of suspected patients.[27]

On 25 January, a day after the first case was confirmed, the Health Ministry informed that two other suspected patients were in isolation at Teku Hospital.[15] The hospital discharged them in the morning of 27 January without waiting for test results even though the results were due later that same day, raising concerns over its handling of the crisis. The tests which confirmed a negative result for both patients were conducted at the biosafety level-2 labs of the National Public Health Laboratory, the first such tests to be performed in Nepal. Reagents sufficient for 100 tests were borrowed from the Centre for Molecular Dynamics and test kits were provided by the World Health Organisation.[29] A woman was in isolation awaiting test results as of 27 January.[30]

On 28 January, Nepal closed down the Rasuwagadhi border with China, bringing Nepal-China trade to a complete halt.[31] Bordering districts of India were reported to be in high alert, and medical personnel had been deployed to various entry points along the Indo-Nepal border.[32]

February[edit]

By the first week of February, Nepal reported a shortage of face masks, as people hurried to buy them following reports of the first confirmed case.[33]

The Epidemiology and Disease Control Division had devised its own treatment protocol based on the one developed by UN Health Agency and had directed all private hospitals to strictly follow the guidelines in handling any suspected new cases.[15]

On 4 February, the Minister for Health informed that three hospitals had been made capable of testing for the virus, and 43 beds had been made available for patients of the possible outbreak. He also informed that health desks had been setup in Pokhara, Chitwan and Bhairahawa.[34] On 5 February, Nepal donated 100,000 protective masks to China as a gesture of friendship.[35]

As of 13 February, Nepal had conducted tests on 19 suspected patients. A Saudi Arabian national who only spoke Arabic and appeared to object to being kept in the hospital, fled from isolation, and could not be located. The health ministry said it would start using police to guard suspected patients at the hospital.[36]

On 14 February, the government was reported to have devised contingency plans to tackle the virus. Under Plan A, the government was preparing to evacuate Nepali citizens stranded in Hubei and keep them in isolation in Bhaktapur. Plan B included educating the people and distributing protective kits. The details of Plan C which would be implemented in case the disease actually spread and started killing people were not shared.[37]

Nepal evacuated 175 Nepalis, mostly students, who had been stranded in Hubei, on 16 February 2020, and placed them in a 14-day quarantine at Kharipati in Bhaktapur. Six other Nepalis were prevented from leaving by the Chinese government, while four of the applicants who had requested rescue later changed their minds. On 20 February, the Health Ministry reported that all of the students had tested negative.[38]

On 18 February, the Chinese Embassy in Nepal criticised The Kathmandu Post for republishing a Korea Herald piece critical of China's handling of the pandemic, accusing editor-in-chief Anup Kaphle of anti-China bias. In response, 17 editors from Nepalese mainstream press released a joint statement expressing concern about the singling out of the editor, and reminding the Chinese Embassy of diplomatic norms and constitutional guaranteed freedom of the press in Nepal; The Kathmandu Post published an editorial criticising the Embassy's actions. The Chinese embassy's actions were seen as uncharacteristic and surprising given China is known for non-interference in Nepal's internal matters.[39][40]

March[edit]

On 1 March, Nepal suspended visa-on-arrival service for nationals of five countries which were badly affected by COVID-19: China, South Korea, Japan,Italy and Iran.[41]

On 10 March, 71 Chinese workers employed in the construction of Pokhara Airport who had returned from China after undergoing a 14-day quarantine were again put into quarantine by the Nepalese side for another 14 days. They were being closely monitored and everyone was reported to be in normal health. Previously, 36 Chinese workers working for the project had also gone through a similar quarantine upon return to work.[42]

On 12 March, Nepal government decided to suspend on-arrival tourist visa for all countries with an exception to diplomatic and official visas. In case of emergency, the foreign nationals are to apply for visa with a submission of health certificate indicating no infection of the novel Coronavirus. This suspension is to last from 14 March till 30 April. The government has also restricted travel to and from India via land routes and canceled all spring mountain climbing expeditions including Mount Everest until 30 April from 14 March.[43] The Province No. 1 government unveiled plans for two quarantine sites in the province, including one on a Koshi River island. It also assured plans were underway to provide additional equipment to health personnel, to set up health desks on border-crossings with India, to keep ambulances in standby and to maintain isolation wards in three major hospitals — BP Koirala Memorial Hospital in Dharan, Koshi Hospital in Biratnagar and Mechi Hospital in Jhapa.[44][45]

On 14 March, BP Koirala Institute of Health sciences in Dharan reported that a suspected patient had refused to remain in hospital and returned home. He had promised to return the following day for testing.[46] The same day, Bihar transport department suspended Patna-Nepal bus services with immediate effect, to be enforced until 31 March, in an effort to contain the virus, after many cases emerged throughout India.[47] India declared a suspension of all passenger movement through Indo-Nepal border, except a few designated checkposts with intesified health inspections, effective from 15 March.[48]

Nepalis in foreign countries[edit]

A Nepali student who had recently reached Tasmania via Singapore tested positive for COVID-19 on 8 March.[49] On 9 March, the UAE's Health Ministry confirmed that two Nepalis in the country had tested positive for the virus.[50]

Impact[edit]

Nepal had declared 2020 as the Visit Nepal Year and aimed to bring in two million foreign tourists, almost double the figure from previous year. As the pandemic spread and Nepal had to suspend air travel to and from China, the biggest source of international tourists arriving by air, Nepal suspended its promotional campaigns.[51]

Nepal's economy is expected to be negatively impacted by the pandemic. The tourism sector has been reported to be suffering due to the absence of Chinese tourists, as well as the various travel restrictions imposed on travel globally. Manufacturing sector is experiencing a shortage of raw materials, most of which used to come from China. The situation is exacerbated by spread of the pandemic to the Middle-east which is the main source of remittance which makes up more than half of Nepal's GDP. The wholesale and retail sector has also been impacted due to fall of imports from China. The construction sector which imports most of its building materials from China has slowed down. As the Chinese contractors and workers who went home for the Chinese new year could not return, the public construction projects have also been affected.[52]

The temporary blanket ban on animal markets imposed by China as a response to the pandemic is expected to curb wildlife poaching and trafficking through Nepal, as the Chinese traditional medicine which uses various body parts of endangered animals as its ingredients has been the biggest challenge to wildlife conservation in the region.[53]

The annual Holi celebrations, which fell on 9 and 10 March in 2020 saw decreased activities, low business and cancellation of organised celebrations.[54]

Essential drugs[edit]

Nepal's pharmaceutical industry has been impacted due to lack of raw materials as a number of essential ingredients were previously imported from Hubei.[52] Nepal faced the prospect of a potential shortage of essential medicines when India imposed restrictions on export of 26 types of raw materials including of essential medicine citing disruption in the supply chain from Hubei; however India later agreed to relax restrictions in case of Nepal, and asked the Nepalese government to provide a list of names and quantities of essential medicines that it needed to supply to Nepal.[55]

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