As the number of cases and fatalities rose in the central Tarai districts this week, the big debate is whether Nepal has now progressed from cluster to community spread of the disease.
The Ministry of Health maintains that we are still in the cluster stage, as per the WHO definition. However, the hospitals in the Tarai say SARS-CoV-2 is now spreading in the community, and some cities have gone back into lockdown.
Whether we are in the cluster or community spread stage is a moot point. This is an unfolding pandemic, total caseloads are still rising exponentially in neighbouring India and around the world, Southeast Asia and Europe are being hit by a second wave. The only thing we know for certain is that there is still a lot we do not know about the virus.
But we do know that this is one super-intelligent strand of RNA. It understands human behaviour and exploits it ruthlessly. Initially, after jumping the species barrier it spread human-to-human. Then it piggybacked on global mobility through asymptomatic infections, ensuring that carriers of the virus were not too sick to be bed-ridden.
The virus has now figured out a way to lie low, allow people to get complacent, so it can make a comeback. It might even have mutated into strains to take advantage of different behaviour patterns and climatic conditions. The virus takes advantage of countries whose leaders are in denial or have underestimated it. After older people started taking precautions and started staying home, it is now inflicting the youth.
From the experience of countries that have done well to keep the virus in check, we know only three things work: limited mingling, acceptance of masks, and physical separation. That message has to go out, and there has to be behaviour change in the population.
But when Finance Minister Yubaraj Khatiwada inexplicably announced on 21 July that the lockdown had been lifted, he made a boo-boo. It was not even true — long-distance buses and regular flights had not yet resumed, bars, restaurants and schools were still closed, hotels would open only at the end of the month.
But Nepalis itching to get back to business after four months of confinement only heard that ‘the lockdown is lifted’. It gave them a false sense of security, shops opened, and there was a rise in the daily number of returnees from India. The government’s announcement was premature, and it now threatens to undo the time we bought from the lockdown to put safeguards in place.
On 28 July, Nepal recorded the highest number of daily cases in nearly a month with 319 new COVID-19 positive people out of 5,032 tested. For the past weeks, the daily total has been less than 200 out of 4,000 tests.
The government announcement that the lockdown was lifted coincided with record daily cases and fatalities in India, especially in states of Bihar and Uttar Pradesh which re-imposed restrictions. India has now seen 1.5 million cases and 35,000 deaths, third highest after the US and Brazil. More worryingly, it is now affecting rural India across the Nepal border where health and hygiene conditions are poor.
In Nepal, increased crossborder mobility led directly to a surge in cases in border districts, and since long-distance buses will start operating again from 30 July it is only a question of time before the virus spreads up into the mountains. Let us not forget how the Spanish Flu spread in India in 1918, killing tens of millions — the virus travelled by train from the sea ports, carried by soldiers returning from World War I.
Because it bungled the messaging, the government now needs to act on two fronts urgently:
- Launch a massive nationwide awareness campaign: ‘The lockdown may be over, but the pandemic is not. Take these precautions.’
- Mass testing in the community, quarantining and tracing, to keep infections within clusters.
Read also: Heightened COVID-19 risks at India-Nepal border, Mukesh Pokhrel