Trumpism in Nepal’s COVID-19 response

Two weeks ago, as Prime Minister K P Oli spoke to Parliament, his three-hour long speech was notably disparaging towards Nepalis diagnosed with the COVID-19 virus, and the general public itself. With trademark bravado, he blamed the general public and local governments for the failure of the crippling nationwide lockdown to stop the spread of the virus.

Doubling down, he falsely credited the country’s efforts for testing and treatment with preventing a much larger epidemic. He explained that the deaths of some of Nepal’s first COVID-19 related fatalities – a young mother who had just returned from hospital, and a 29-year old male who had walked 1,000 km back to his village – were only classified as such to comply with WHO protocols and not necessarily deaths due to the coronavirus.

With almost 7 million cases and 400,000 deaths worldwide, a trend is emerging: countries that prioritised public health interventions and took decisive measure early are slowly returning to normalcy. In countries with more populist leaders (Brazil, US, UK) the epidemic has raged with massive human and economic costs. There is ample evidence that the price of incompetent leadership and gross mismanagement is countless innocent lives.

Prime Minister Oli’s inclination in the past few weeks has been to serve the public a dangerous cocktail of denialism, misinformation, and nationalism at a time when Nepal’s citizens need leadership and a steady hand. Tragically, it appears like he is leading the country down the same path as other leaders who have failed despite having tremendous strengths and resources to draw upon.

The situation around testing is one distressing example of a strategy that failed even before it began. This week, the Epidemiology and Disease Control Department issued an analysis of 805 cases where patients tested positive for COVID-19. Of these, a startling 71.8% where asymptomatic. A few days before, the department issued an update on testing guidelines that mandated only providing PCR tests for symptomatic cases as defined by a fever and one more symptoms of advanced respiratory infection. The guidance also recommends not re-testing any confirmed cases that do not display symptoms after 14 days – a significant deviation from the internationally accepted protocol requiring testing two negative PCR results before confirming a patient as COVID negative.

Considering that PCR tests have a community sensitivity of around 80%, and nearly 72% of people with the virus are no longer eligible for PCR testing – this testing protocol will inevitably miss 75% of all active COVID-19 cases in Nepal. Evidence of this policy being enforced can be found with the extremely small number of test kits recently purchased by the Nepal Army (50,000), and the lack of investment in scaling up the country’s PCR testing capacity to match the need on the ground.

Today, there are over 170,000 people in quarantine centres in environments extremely conducive for a large-scale outbreak of the virus. The current state capacity of less than 4,000 tests needs to be scaled up by at least 40 times to meet the demand within the next ten days alone. Despite universal agreement on the ineffectiveness of RDT tests, the government’s push to scale this solution through the procurement of another 5,000,000 RDT kits shows an alarming misunderstanding of how the two testing paradigms work.

A Cabinet decision has pushed the management of all quarantine facilities to the rural municipality level, effectively avoiding all federal-level responsibility for supporting the hundreds of thousands of Nepali citizens returning home from India, urban areas, and overseas. Rural municipalities and their local ward governments are already pushed to the breaking point. Expecting leaders who are only in their first-ever term in office, with no additional funding or support from the federal level, to properly ensure the safety and security of returnees, local community members, and health workers in the face of a deadly virus is foolish to a point of negligence.

The quarantine facilities are overcrowded and lack even the most basic provisions for food and water, PPE for workers, and provisions for the safety of women, children and other vulnerable groups. Poorly managed facilities are, indeed, worse than nothing at all. The conditions stress the mental and physical health of the people there, while serving as a petri dish for the transmission of the disease. Some cases have already seen infection rates in quarantine centres to be almost 40%.

In a move to demonstrate some accountability for the obvious strategic failures of the government’s response to the COVID-19 crisis, Prime Minister Oli has made a few soft moves. The health secretary was transferred and a well-known UML operative was removed from the Director-General of Department of Health Services in the wake of the well publicised Omni Group procurement fiasco.

Local media reports hint that more removals are on the cards – including of the directors of the Epidemiology Department and the National Public Health Laboratory. These latter moves may be attempts to divert the blame from the actual chief strategists who are responsible for the current mess, and placing it onto the implementation agencies. Privately, these agency directors have expressed deep frustration with the inability of the Ministry of Health, and the COVID response task force in particular, to accept practical and grounded solutions to the crisis.

Taking from the playbook of populist leaders, Prime Minister Oli’s plan seems to more in line of denial, distraction, and blaming the marginalised for the failure to mount an effective response to COVID-19. Incompetence in leadership during normal times can be limiting to the growth or development of a nation.

During a crisis, this same incompetence is deadly. The world already has seen a few examples of a megalomaniac leaders whose adherence to selfish pride over practicality, and self above all else, has led to the death of untold numbers of valuable lives. In Nepal, we cannot afford to have another.