What does WHO recommend as the primary prevention measures against COVID-19?
COVID-19 can affect all of us. It is a virus that is in our lungs and if we cough, if we speak and we are infected, it is possible that we infect other people simply by the small droplets that we produce. There is an easy way to prevent the spread – by keeping a distance. If all of us do this all the time, we can avoid new lockdowns, we can avoid this virus’ spread, we can avoid infecting other people.
Wearing a mask helps particularly if there are people around and you cannot keep a distance. Also, there is hand-washing, cough hygiene, and medical attention when sick. So my appeal to all the people in Nepal is please keep a distance of at least one meter. If we all do this there is a good chance we can control this disease.
How do you assess the surge in COVID-19 cases in Nepal after the lockdown was lifted on 21 July?
In Nepal, it used to be that almost all cases were caused by people coming back from abroad. The number of migrants decreased in the past two months, hence the number of COVID cases has come down. In the last week or so, however, the number of cases are going up again. This is not unexpected. Many of those quarantined migrants who tested positive have been isolated but gradually, of course, the virus will start infecting other people.
And after the lockdown people no longer behave in the way they should. Many people are not keeping a distance, they do not really observe the basic measures. This makes it easy for the virus to circulate.
Do you think there is community transmission in Nepal?
What is happening is that there is some level of transmission within the community. We are not yet ready to say that there is widespread transmission. But at local levels, we have seen people who are getting infected without having a travel history. But if we dig deeper we have a number of people who have not travelled but are in contact with someone who has travelled. That is not to say that we do not have community transmission at all, but it remains localised. It is not yet widespread across Nepal, it is sometimes in clusters, for example within families.
Has contact tracing been effective?
Once we know who is infected, we need to isolate them from the rest. So that if you have the virus, you cannot infect others. That is being done. If you test positive you will be isolated from everyone else. But it is also important to do the contact tracing. That means whoever this person has been in touch with may also be infected and that is what contact tracing does, try to find these people, test these people, and then if need be also isolate them.
How much are you working with the government?
We are in constant discussions with the government. What is the situation, what do the data tell us, what are the weaknesses, what needs to be done more. The role of WHO is advising the government, we do not make the decisions. The governments make them, we help them with data analysis, what is happening, how does epidemiology change, how does the profile of cases slowly change, with the number of returnees slowing going down the number of cases has gone down. Now we must be ready for the next phase because it is really a risk that the number of cases will go up. And those discussions we do have to make with the government.
Where do you think the government, and indeed WHO could have gone wrong?
First of all it is not a matter of trying to put blame. It is very important to look for solutions, not so much the problems. So the key issue here is that we are all in the same boat. We are all facing the same problem and everybody can play a role.
It is not that civil society, the government or WHO haven’t done enough. That is not the issue. The issue is how can we all act so that things are as good as they can be. A lot of work is happening in the background that does not come out in the press or social media. We know about the lockdown, the quarantine but also work has been done in making sure that there are enough supplies. The government has done a lot to increase testing capacity, for example. But, yes, more needs to be done, certainly much more needs to be done around contact tracing.
Once more people start getting seriously sick, hospitals needs to be able to treat patients. These things need more work. Very often people look at what is the government doing and they themselves do not do things that they need to do. The important message is that we all have a role to play.
How do we ensure that things do not get worse?
Yes, the cases are slowly going up. We know what we can do: keep a distance. The virus does not come from nowhere. If somebody is infected the virus needs to jump from that person to another. That is much more difficult for the virus to do if there is enough distance between individuals. So that is the first and basic rule that we cannot insist on enough. People, please keep a distance. Mask will help in an environment with many people.
Do we need a new lockdown? That’s the government’s decision. What a lockdown does is it forces people to keep a distance. If you cannot get out of the house obviously you are not going to have large group of people too close together. If we are all disciplined enough to keep distance, maybe a lockdown can be avoided. But if we don’t do that, the government may be compelled to place a lockdown.
It may not be a nationwide lockdown that we had for three months but maybe a localised lockdown. There are also full lockdowns, partial lockdowns depending on what you allow. We have said that all along that when a government starts relaxing a lockdown, there should always be an option of bringing it back, if there is a need. It is not only a health decision, but it impacts on the economy, on social life, and so on. The government has to weigh that balance. So if we take precautions there will be less need for a strict. If we don’t behave properly the government may have to re-impose certain lockdowns.
(Sabin Dhamala for News Agency Nepal)