Nepal town is model for COVID-19 preparedness

The ear-piercing siren of six ambulances crisscrossed Thimi last week carrying 17 mild to severely affected COVID-19 patients to the municipality hospital.

It had been raining all morning, very unusual for early May, and people were peeking out of their closed windows to watch the ambulances arrive at the Nepal Korea Friendship Municipality Hospital.

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As the ambulances pulled up, the hospital sprang into action at the COVID-19 triage station, directing incoming patients to newly set up isolation wards and Intensive Care Unit (ICU). The ones suspected of coronavirus infection were taken to a special counseling and sample collection section and swabbed.

The hospital had recently built its own molecular facility for COVID-19 detection. The patients were well taken care of as per the COVID-19 preparedness protocol that the hospital had put together.

Fortunately, this was only a preparedness drill. Under Mayor Madan Sundar Shrestha, this drill was put together by the hospital in collaboration with the Nepal Red Cross Society and the Center for Molecular Dynamics Nepal. The intention was to identify important gaps so these could be addressed if there was a real emergency.

Madhyapur Thimi is one of the smaller municipalities in Kathmandu Valley with a population of 100,000 in a 12 sq km area, it is strategically located between Kathmandu and Bhaktapur. The Newa town has a strong sense of community, and a can-do mayor.

As soon as the news of the first case of coronavirus started circulating, Mayor Shrestha mobilised health officials to prepare a plan of action. Political will is one of the most important components of getting a community ready in any potential disaster.

The mayor organised several meetings to brainstorm on getting the municipality ready. A close collaboration with the municipality hospital yielded a COVID-19 preparedness plan that became one of the most comprehensive in the country, and a model for other cities.

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Two scenarios were considered and evaluated: safeguarding the community with preventive measures, and preparing for possible COVID-19 in the community. Working closely with all the 9 administrative officials a thorough local intelligence-gathering mechanism was set up to trace high risk groups (residents who had recently arrived from abroad).

Using GIS mapping all of them were put into a geo-based database. It was decided that community-based COVID-9 surveillance would be carried out with a proper risk assessment survey tool and molecular testing. Such systematic testing is the only way to assess the spread and burden of the coronavirus infections in the community.

As a result Madhyapur Thimi became one of the first municipalities in the country to systematically carry out community based COVID-19 surveillance with molecular testing. To augment the preventive measures, the town also invested in enhancing its clinical wing to prepare for incoming COVID-19 cases with a 16-bed ICU unit, a separate isolation ward and a molecular testing facility.

Thimi is well known for its Bisket Jatra a year end celebration where the whole community comes together to share joy of being part of such a rich culture. A strong sense of community matters, especially during a crisis like this. The onus of making any community safe is a concerted effort between community leaders, technical experts and bureaucrats. And when all of these components come together an effective solution can be devised to address any challenges including the current COVID-19 crisis.

The ancient town of Thimi has suffered many devastating epidemics in its 3,000 year history, but it has adapted its institutional memory to prepare itself for this modern pandemic.

Dibesh Karmacharya, PhD is a researcher and Executive Director of the Center for Molecular Dynamics Nepal, and heads biotechnology and vaccine development companies in Nepal.