Looking at the daily statistics from the Ministry of Health, the figures are alarming. Nepal is nearing the 100,000 Covid-19 cases mark, and this week the country overtook the total number of cases in China.
Kathmandu Valley has emerged as a major hotspot since August-September and now accounts for one-third all Covid-19 deaths and over 61% of active cases nationwide.
This is a dramatic about-turn from July, when the Valley accounted for only 4% of all active cases in Nepal. But by August it was up to 15%, and 34% in September.
On Wednesday, Nepal recorded its highest number of positive cases on a single day with 3,439, out of which 1,684 were in Kathmandu Valley alone. Fifteen people died in the past 24 hours, bringing the total fatalities to 578.
The number of active cases on Wednesday also crossed the 25,000 threshold, which the Ministry of Health had warned would overwhelm Nepal’s health infrastructure and a lockdown may need to be re-imposed.
Currently, 233 patients are being treated in ICU and 37 are on ventilator support. Bagmati province has 127 patients in ICU and 25 on ventilators.
Nepal’s health infrastructure is far from being overwhelmed by Covid-19 patients. There are an estimated 2,600 ICU beds in private and government hospitals nationwide, and of the 900 ventilators in hospitals 490 are in working order.
The problem is that there is uneven distribution of these facilities. There are not enough ICU beds where they are needed most, and beds available in private hospitals tend to be unaffordable to most Nepalis.
The government’s 25,000 threshold appears to be a deliberate strategy to convince people to adopt preventive measures to control the disease, since curative capacity is limited. In Wednesday’s press briefing, the Ministry of Health did not say anything about a re-imposition of the lockdown.
Bir, Teaching, Teku and Patan are the only government-run hospitals in Kathmandu Valley admitting seriously ill Covid-19 patients, and their limited capacity is getting saturated. All 20 ICU beds in Teku are occupied, so are 10 beds in Bir Hospital, 20 in Teaching and 22 in Patan that are set aside for Covid-19 patients.
The Armed Police Force (APF) hospital also designated for Covid-19 care has a 20-bed ICU, but only half are in operation because of the lack of trained healthcare workers.
Some private hospitals in Kathmandu Valley like Star, MediCiti, Grande, Norvic, HAMS and B&B also admit Covid-19 patients, but these are expensive and have only a part of their total beds designated as Covid-19 wards.
Because of the pandemic, many non-Covid-19 patients are not seeking treatment, and private hospitals are converting existing capacity to coronavirus wards to compensate for the loss of revenue.
For Samir Adhikari at the Ministry of Health, the limiting factor is not ICU beds but adequate supply of oxygen. He says: “Most patients do not need to be in ICU or have a ventilator, they need oxygen and it is much more critical to ensure that there are enough cylinders.”
Adding to the problem is that patients without major complications have also occupied ICU beds, there is a poor referral system, shortage of drugs, mismanagement of human resources and facilities.