In Nepal, virus climbs from plains to mountains

The B.1.617.2 strain of SARS-CoV-2 that started entering Nepal from India in early April first affected the border cities and districts in the plains, but is now spreading rapidly into the mountains and even the remotest villages.

From a rolling seven-day average for the past week of about 8,000 daily, Thursday’s caseload showed a decrease to 6,731 nationwide. Recoveries also rose to 7,226, exceeding the daily new infections for the second time this week. 

The national infection rate has been pulled down by the decrease in the Tarai, but it is spiking dramatically in Nepal’s mountain districts, where health facilities are even more rudimentary. Most infections and fatalities in these remote areas are not even tallied, which means the official statistics are certainly an underestimate.

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Even though the national total showed a drop on Thursday, for example, Kathmandu saw an increase of 500 over the previous 24 hours to 1,139 new cases. Similar increases have been reported in Pokhara, Surkhet, Okhaldhunga and even the remotest villages. 

When the number of daily new cases in Kailali on the Indian border was 527 on 17 May, to the north in Achham there was only one new case. Now, the tables are turned. On Thursday, new cases in Kailali had dropped to 31, while Achham recorded 68 new coronavirus infections.

Similarly, while Kanchanpur in the plains saw only 45 new cases on Thursday, it had shot up to 86 in Baitadi. The daily caseload in remote Rukum West district  has nearly doubled in the past ten days from 24 to 51, and from 21 to 47 in Dailekh.

Banke, Dang and Rupandehi in Lumbini Province were all hotspots of Covid-19 till two weeks ago with hospitals overwhelmed with patients begging for beds and oxygen. This week, the infection rates are down and the virus has now moved to the province’s more northern districts. Rolpa had only 7 new cases on 17 May, but on Thursday it recorded 56. 

However, despite the drop in cases in the plains, hospitals in the Tarai cities are still full because of critical patients in need of ICU and oxygen being referred from the mountain districts to the north. 

Some of the increase in the mountains could be explained by the fact that more tests are being done there now, but public health experts say the positivity rate is also very high in west Nepal hinterland. In one village in Rolpa, 23 of the 25 people tested last week came out Covid positive.

Gandaki Province had only 293 new cases on 17 May, but ten days later the province recorded 1,159 infections. Gorkha district has seen a big spike in cases, from 23 ten days ago to 500 on Thursday.

The most dramatic example of how serious the situation has become is the village of Barpak, which was the epicentre of the 2015 earthquake that destroyed 90% of its homes and killed 72 people. In the past two weeks, 12 people, mostly elderly, have died in the densely-packed village at an elevation of 1,900m.

Locals say there are multiple funerals every day, and there is a danger that these burial processions themselves become spreader events. Most of those who have died were not tested, but had Covid-19 symptoms. The local health post in Barpak does not have oxygen or an isolation centre, and the seriously sick have no option since hospitals in Gorkha are also full. Locals are locked up in their homes, and reports say, many are refusing to be tested.

In Karnali Province, those who can afford it are borrowing money to airlift seriously ill relatives to hospitals in Jumla or Surkhet after their oxygen saturation levels fall dangerously low. None of the district hospitals in Mugu, Dolpo or Humla have ICUs or oxygen supply. As the virus spreads in those communities, families of critical patients can only hope and pray.

At the other end of Nepal, in the roadless village of Ghunsa at 3,200m in the Kangchenjunga Conservation Area, Covid-19 has infected someone in every one of the 40 households. The local health post is overwhelmed, but has managed to porter in some oxygen cylinders to treat the more serious patients. 

The trans-Himalayan districts of Manang and Mustang were the only ones with no Covid-19, and no lockdown. Manang had zero cases ten days ago, but on Thursday 76 people tested positive. 

Even though Kathmandu Valley has seen a flattening of the peak, surrounding districts are seeing a steep spike in the past week. The daily caseload in Makwanpur has gone up from 17 to 101, and from 85 to 342 in Dhading in just seven days. Most of the critical cases from these districts are being taken by ambulance to city hospitals in Kathmandu.

The second wave of the pandemic is subsiding in the Tarai, with Province 2 recording only 480 new cases, when it was averaging 600 daily cases till two weeks ago. 

Read also: At the Covid-19 frontlines in rural Nepal, Priti Thapa