The COVID-19 Crisis Management Centre (CCMC) headed by Defence Minister Ishwar Pokhrel was advised by members who are health experts to wait another two weeks before announcing the end of the lockdown, but decided to over-rule them.
The announcement caught many public health experts unawares. Said one epidemiologist who often advises the government: “It was a surprise for us, the government has taken the decision without any preparation, and this could lead to a new surge in cases especially because the spread is out of control in bordering states in India.”
On Wednesday, the Saptari district administration sealed the border city of Rajbiraj after 20 cases were confirmed that had the hallmarks of community transmission. Although the checkpoints are supposed to be sealed, there is a still a steady stream of Nepalis returning from India through the open border.
India now has the third highest total coronavirus cases after the US and Brazil with 1.2 million confirmed cases and nearly 29,000 fatalities. A new surge has forced Bihar and Uttar Pradesh, two populous states bordering Nepal, to re-impose a strict lockdown. Both states are reporting up to 2,000 new cases a day and a rise in the number of deaths from severe COVID-19 symptoms.
“With long-distance buses being allowed soon and with it a new influx of people into Kathmandu, there is a danger of a spike in cases here,” says Anup Bastola at the infectious disease hospital in Teku. He said: “Hospitals themselves can be spreaders of the disease unless proper precautions are taken.
Doctors in Birganj say that unlike previously, when COVID-19 cases were mostly asymptomatic and deaths were mainly from co-morbidities, there has now been a spike in patients with symptoms of the disease, and some of them need ICU treatment.
Most border districts are not quarantining returnees from India anymore. Their temperatures are taken, and then told to go home and isolate themselves.
“It was foolish for the government to lift the lockdown without testing if the virus is spreading the community,” said epidemiologist Prabhat Adhikari. “The EDCD had warned a week ago that there were signs of community spread. It would have been wise to confirm that first.”
The government says 97% of the over 18,000 cases so far in Nepal are people who have recently returned from India and other countries, and it has maintained that there is almost no community spread. It says it is conducting 40,000 tests for community surveillance and active case finding.
Ministry of Health spokesperson Jageswar Gautam said the decision to lift the lockdown was prompted by the falling positivity rate of those tested. While up to 15% of those tested used to be positive till last month, the proportion has now fallen to 2-3%.
Of the 5,000 random PCR tests of communities in various neighbourhoods of the Valley earlier this month, only 3 tested positive, Gautam said. “We are now trying to make sure there is no community spread by extending the tests to other parts of the country,” he added.
The government is also testing people who work in crowded environments like bank officials, health workers, police and others.
Public health expert Sameer Mani Dixit admits the lockdown had to be lifted sooner or later, but added: “There was already a lot of movement even during the lockdown. The announcement to lift it just made it official. However, it looks like there has not been proper preparation and precautions before the decision was taken.”