Over 1,300 samples have been collected over the last two days from from Jumla, Achham, Baitadi and Dadeldhura districts in western Nepal. Some 324 oral and nasopharyngeal swab samples from three different locations in Jumla were collected on 7 April: 150 at Chandanath airport, 124 from Hima Village Council and 50 from Kanaka Sundari in Sinja.
Another 232 samples were collected from Achham district, 199 from Dadeldhura and 425 from Baitadi. Recent returnees from India, their immediate family members and those in quarantine were prioritised for the rapid diagnostic tests. Samples were flown in Nepal Army helicopters to Nepalganj, from where collected samples are taken every evening by military plane to Kathmandu for testing.
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Initially, hospitals in western Nepal had collected only a handful of samples because there were not enough Viral Transport Medium (an equipment to transport the samples to the lab). Mass testing is now being carried out with 11 laboratories across the Nepal set up for Polymerase Chain Reaction (PCR).
The PCR amplifies tiny bits of genetic material in the sample, enabling the detection of the virus. But there has been significant number of false positive and negative test results since the outbreak.
Rapid diagnostic test kits have been controversial because of their reported unreliability in Europe, but health experts here say they have 86%, and those testing positive will be tested again with PCR. The Chinese kits are being used in Kailali, Kanchanpur, Baglung, Myagdi and Parbat districts for people in quarantine. The government has some 75,000 rapid test kits, and has dispatched 5,000 to each each of the seven provinces.
In Jumla, KAHS has over 47 staff and 100 nurses on call and 10 adult ICU beds have been added in anticipation of new cases. In Achham, the district hospital has been designated as a COVID-19 only hospital. Province 5 is trying to procure 20 ventilators. But despite preparedness, hospital staff say the region’s rudimentary healthcare system will be overwhelmed if there is a COVID-19 outbreak. The Health Ministry is therefore mobilising medical students on scholarship programs and retired medics to assist to fight COVID-19.
“We do not know the exact number of people who have returned from India and even less about how many of them have symptoms, and where they are. We have to continue to work in prevention and control as well as increase mass testing,” explains Bikash Gauchan of Bayalpata Hospital in Achham which has set up a fever clinic and a separate ward.
Four months into the pandemic, Nepal has been largely spared with only handful cases and only one community transmission. Public health experts are puzzled by this, and say possible theories like BCG vaccine immunity warrant further investigation.
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The main worry is the continued spread in India where there were 30 new COVID-19 deaths in the past 24 hours, taking the total to 199. The case load in India have been rising at 567 per day.
“There are sure to be more imported cases. But where are they? There is no severity, and only one community transmitted case. So something is going on,” says Sameer Dixit.
Dhiraj Gurung who was involved in the Jumla testing said a larger than expected number turned up for the test, which may mean there are hidden cases. “But when we asked people to come for quarantine, very few showed up. This could mean there are individuals with mild symptoms, but there are not coming forward for fear of being ostracised.”
The government has extended the nationwide lockdown till 15 April because it does not want families to gather for Nepal’s New Year Day on Monday. Experts say partial lockdowns will continue in areas at higher risk, and international flights may have to be suspended for another two weeks after 30 April.
Says Sher Bahadur Pun at the country’s infectious disease centre in Kathmandu: “We are already in the second stage of COVID-19 transmission and the next stage will be serious. We cannot be complacent, and our only chance of containing it is to stop hidden cases from infecting others with an even stricter lockdown.”