Nepal’s leadership showed considerable audacity by declaring a national shutdown on 24 March as a circuit breaker after only the second confirmed coronavirus infection was detected.
Since the case load was so low, perhaps they thought it was only for a week or two. More likely, it was a kneejerk reaction, and the government had no idea the lockdown should only be the first step in a process leading to mass testing.
But they bungled that one, too, by trying to pull a fast one on fast-tracking test kits from China. Worse, it was getting the wrong kits – instead of ordering hundreds of thousands of PCR kits, it went for the unreliable RDT. Valuable time was wasted.
Although it should have anticipated a mass return of Nepali workers from India, we cannot really fault the government for the lack of preparedness at the border. Even the most efficient state apparatus would have been overwhelmed by the sheer numbers of returnees.
And given the sad state of infrastructure and service delivery capacity, it would have been foolish to expect a super-efficient quarantine-test-isolation protocol to be followed. Because of inequities in Nepal’s skewed state structure, as in every disaster, it is the excluded, disenfranchised, the poor and voiceless who are suffering the most – those who depended on daily wages, migrant workers who have run out of cash and food, women and children, dialysis patients, maternity cases, and those with pre-existing ailments.
Nevertheless, what seems to be working reasonably well is that provincial and municipal government are taking charge, and despite the lack of resources and proper guidelines, are doing their best to deal with the sheer numbers of returnees.
Predictably, it is in Kathmandu where turf battles, lack of coordination and a reluctance to devolve decision-making and response to local governments has cost valuable time. Because of the delay in importing test kits, and the mystifying reliance on RDT, the number of tests per day is dropping.
There are nearly 5,000 swab collections daily for PCR testing, but only 1,000 can be processed. Test machines are either broken, or have run out of RNA extraction. There are 3,000 samples in the queue to be tested, leaving people at quarantines in limbo for days. Private laboratories have the capacity to bridge the gap, but have been left out.
As we have argued in this space before, the lockdown has outlived its usefulness. Public health experts tell us there is no way to stop this virus unless there is a vaccine, we have to learn to live with it. The lockdown has unleashed mass job losses, increased suffering, and has contributed to thousands of preventable deaths from non-coronavirus diseases because of the lack of transportation and fear of infection in hospitals. Vaccination programs for children have been disrupted, and the rate of suicides, domestic violence and rape have increased.
So far, most of the confirmed cases are from people returning from India and most hotspots are districts along the border as well in villages they have gone back to without being tested and spread it to the community. Ill-equipped and crowded quarantine centres have themselves become incubators for the coronavirus and other vector-borne diseases like dengue and malaria.
Kathmandu has belatedly decided that the best option now is to get local governments to enforce home quarantine for returnees, and only refer symptomatic cases to hospital isolation wards. But this means the Ministry of Health must scale up testing so cases can be detected and isolated, especially since about 2,000 overseas Nepalis will soon start flying into Kathmandu airport every day before being taken to holding centres, tested and sent to home districts.
People are now beginning to defy the lockdown, and there is growing public opinion pressure on the government to relax rules. The Coronavirus Control and Management Committee headed by Defence Minister Ishwar Pokhrel is said to be looking at a 10-phase exit from the lockdown in the next three months.
For this the government is planning to follow the ‘Georgia Model’ allowing small businesses to open first, do 130,000 PCR tests a month, arrange for the safe return and transport of 300,000 Nepalis from overseas, and finally restarting domestic and international flights, and public transport.
The government had similarly relaxed restrictions in mid-April, but hastily clamped down again after confirmed cases spiked. This time, it is important that the new guidelines be clear, not enforced arbitrarily and make public announcements on keeping safe distance and using masks.
Nepalis have generally obeyed the government’s shelter in place rules so far, but their patience is running out.