Like many cities around the world, Kathmandu is struggling to find ways through the ever-shifting coronavirus landscape.
Business and residents need, and want, to get back to normal. But in Nepal and across neighbouring India, COVID-19 cases are increasing, not dropping.
Nepal’s health planners may want to look to the experience of states in the United States, many of them where Nepalis also live in large numbers. Cities there show that, as much as it might seem that virus is really ‘no big deal’, there is a real danger to opening up too fast.
The virus is as deceptive and relentless as ever. Case numbers can explode in a matter of days, and set back the return to normal by months.
Joplin in the state of Missouri sits right in the middle of the USA, between California and New York and between Minnesota and Texas. Earlier this spring, in lockdown to prevent coronavirus, the small city closed businesses and schools.
After a month, thinking that the pandemic had come and gone, it reopened earlier than other cities. Life returned to normal, it seemed. Residents relaxed. Then the storm hit, this time for real.
COVID-19 is especially dangerous because it moves silently, invisibly. And without physical distancing and masks, it moves fast. In just a few weeks, cases in Joplin jumped 20 times — from 60 to 1,200. It is now one of the hottest areas in one of America’s fastest growing coronavirus ‘hot spots’. The storm is hitting hard, and despite the extra time to prepare, the city is not ready.
Kathmandu, take note.
A few coronavirus cases were detected in March in Joplin, a city of 50,000 people. The city ‘battened down the hatches’ for a big outbreak. Hospitals set up special sections for coronavirus cases. They postponed non-essential surgeries. Health workers braced for trouble. In early April, Missouri’s governor shut down schools, closed businesses, and banned events and meetings across the state. Joplin’s residents had to stay at home.
But then little happened. The number of case numbers dropped. Hospitals saw no surge. That was good news, of course. The stay-at-home orders and other preventions worked.
But people misunderstood, and reached the wrong conclusions. They began to think that all the health warnings were exaggerated — “overhyped” according to one observer. The dreaded pandemic, the Washington Post reported, seemed ‘more rumour than reality’.
“It seemed like the wave was gone. It had passed us by,” said Rob McNab director of the coronavirus centre at one of Joplin’s two hospitals. McNab started considering closing down his hospital’s special COVID-19 isolation unit.
On 4 May, after a month long shutdown, Missouri’s governor reopened the state. Residents jumped into normal life. Businesses opened. People flocked to bars and restaurants.
In June, after a few weeksof silent spread, new coronavirus cases multiplied. A factory saw a huge outbreak, almost 400 cases. A home for seniors was hit hard. Broad community transmission started.
The disease spread without people realising it, many did not develop symptoms right away. Some never do, but they can spread the disease nonetheless. That’s what makes COVID-19 so tricky, so dangerous.
Joplin’s hospitals are now close to overflowing. New cases show up faster than ever. Freeman Hospital has tripled the size of its coronavirus unit. They will soon enter uncharted waters, near capacity. “We’ve never been in a situation where we can’t meet the needs of the community.” says McNab.
Joplin shows how difficult it is, after reopening, to regain control over the virus. People grew tired. They longed for normal life. As the Post reported, Joplin’s residents ‘long ago grew weary of making sacrifices to confront an enemy that seemed to exist only in theory’.
Joplin’s health situation is now much worse than in March but residents are doing far less to fight it. Case numbers are much higher, but the city remains open. People are less vigilant, and less careful. “People are almost numb to it,” says a local leader.
People may grow tired but the virus doesn’t. Other American cities and states reopened quickly, thinking that COVID-19 was behind them and that economic problems required more attention, but now face big crises, health and economic.
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Texas reopened quickly, and now is facing a deep health crisis that has forced it to slow down and even backtrack on its reopening. Businesses that opened have closed once again. Customers afraid of the virus are staying at home. Cities like Houston, with many Nepalis living nearby, face dire threats.
As of 7 July, total number of confirmed cases in the United States had cross the 3 million mark, with 133,000 fatalities. Public health experts are expecting another surge after the July 4 weekend.
More Nepalis have died of COVID-19 around the world than in Nepal itself. Of the 130 Nepali who have died abroad from the disease, 17 are in the United States, and 67 in UK.
Although the extra time provided by the lockdowns earlier this spring should have been a chance to take extra preparations, that opportunity was wasted. A recent New York Times headline reads: As Coronavirus Slams Houston Hospitals, It’s Like New York ‘All Over Again’.
In these places, it appears that the goal to return to normal to protect businesses and jobs has backfired, actually causing deeper and longer term economic problems. Sick populations make for sick economies.
Young adults have been particularly disappointing. Many have been going to bars and beaches and parties. Few fall victim themselves to the disease, but they spread it to others who can, and do, die.
European countries that didn’t rush reopening are now able to safely restart businesses, restaurants, schools, and sporting events. They did it right, making sure the disease was really behind them before moving forward.
But in the US, infection rates are climbing, not dropping. Each day we read tragic stories of unnecessary, preventable illness and death. One 72-year-old woman in the intensive care unit in Houston, Texas got sick because she cut back physical distancing.
“I took it seriously,” she said of coronavirus. But after the state reopened, she went to her granddaughter’s birthday party. Only eight people were there. But one brought the coronavirus. Now this grandmother is in a hospital bed, fighting for her life.
Coronavirus spreads without us being able to see it. Testing and tracing can make it more visible, but few places have the resources and training to do so properly. Relentless vigilance is the need of the hour: careful physical distancing, frequent hand washing, and proper mask wearing. These measures are inexpensive, but take a commitment by individuals, communities, and political leaders.
Tom Robertson, PhD, is researching the environmental history of the Kathmandu Valley. He writes the column, History of Disease for Nepali Times.