<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171148/636bda139c7e80680e080247jpeg.jpg" alt="" width="1997" height="1324"/><figcaption>Maps: CCMC</figcaption></figure>Kathmandu is a <a href="https://www.nepalitimes.com/latest/as-virus-spreads-kathmandu-hospitals-strain-to-cope/" target="_blank" rel="noopener noreferrer">hotbed for Covid-19</a> with 60% of all active cases in the country. But there are hotspots within this hotbed.A map released by the government on Friday shows where the flare-ups are most pronounced, and it is not surprising that they are in the most densely packed parts of Kathmandu Valley.With the Dasain festival two weeks away, Kathmandu residents appear to be  forgoing safety measures as they crowd at markets to shop, but the mpas provide a sobering reminder of how extensive the spread is.According to the Covid-19 Crisis Management Center (CCMC), Kathmandu’s Maharajgunj, Balaju, Lanchaur, Thamel, Bagbazar, New Baneswor, Kalimati, Jadibuti, Hadigaun, Boudha, Teku and Thapagaun are the major hotspots of the virus.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171148/636bda169c7e80680e080248jpeg.jpg" alt="" width="1080" height="763"><figcaption></figcaption></figure>Maps released by the CCMC also show a higher number of infections among residents of Kalanki, Koteswor, Pulchok, Sinamangal, Chabahil, Narayan Tole, Naya Bazar and Bansatpur Dabar Square. The maps were prepared from data a week ago, and experts say the red areas would be even more extensive if the latest data was used.On Friday Nepal crossed the 100,000 Covid-19 confirmed cases with 2,051 new positives, and the 10 additional deaths in the last 24 hours have brought the total fatalities to 600.Of the total cases on Friday, Kathmandu Valley accounted for 1,409 (1,116 in Kathmandu, 163 in Lalitpur and 130 in Bhaktapur districts) cases. The numbers were alarmingly higher on Thursday, when the three districts reported a combined total of 2,540 cases.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171148/636bda189c7e80680e080249jpeg.jpg" alt="" width="1423" height="720"><figcaption></figcaption></figure>Over 60% of the 27,053 active cases across the country are now in Kathmandu Valley, where one third of total deaths have occurred despite all the resources and facilities at its disposal.Covid-19 infection is spreading at an explosive rate in the capital, making it also the <a href="https://www.nepalitimes.com/here-now/declare-a-health-emergency/" target="_blank" rel="noopener noreferrer">capital of Covid-19 in Nepal</a>.As per the data compiled by ward offices to Kathmandu metropolis, 14 people tested PCR positive in Ward 3 of Maharajganj on Thursday and 15 each in ward 11 of Tripureswor and Ward 13 of Kalimati. Another 14 cases each were reported from Kalanki, Balkhu and Ward 31 of Shantinagar and 11 from Ward 32 of Koteswor and Jadibuti areas.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171148/636bda1b9c7e80680e08024ajpeg.jpg" alt="" width="1513" height="1019"><figcaption>Photos: BIKRAM RAI</figcaption></figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171148/636bda1d9c7e80680e08024bjpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171148/636bda1e9c7e80680e08024cjpeg.jpg" alt="" width="640" height="417">Experts blame much of the recent surge of Covid-19 in the Valley to the public’s reckless behaviour. Only this week, the <a href="https://www.nepalitimes.com/banner/dasain-crowds-disregard-covid-19-warnings/" target="_blank" rel="noopener noreferrer">Dasain Bazar in Asan and different parts of the capital</a> saw huge crowds shopping in narrow alleyways, many of them without masks, and even those with masks wore them around their chins.Says chief Consultant of Shukraraj Tropical and Communicable Diseases Hospital at Teku Anup Bastola: “We are no longer able to admit even those critically ill and the situation is only likely to get worse with Dasain and the upcoming winter season. We have challenging days ahead.”

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Hotspots within Kathmandu’s Covid-19 hotbed

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171144/636bd9a69c7e80680e080225jpeg.jpg" alt=""/><figcaption>Photo: BIKRAM RAI</figcaption></figure>Looking at the daily statistics from the Ministry of Health, the figures are alarming. Nepal is nearing the 100,000 Covid-19 cases mark, and this week the country overtook the total number of cases in China. <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/coronavirus-in-nepals-corridors-of-power/" target="_blank" rel="noopener noreferrer">Kathmandu Valley has emerged as a major hotspot</a> since August-September and now accounts for one-third all Covid-19 deaths and over 61% of active cases nationwide. This is a dramatic about-turn from July, when the Valley accounted for only 4% of all active cases in Nepal. But by August it was up to 15%, and 34% in September.On Wednesday, Nepal recorded its highest number of positive cases on a single day with 3,439, out of which 1,684 were in Kathmandu Valley alone. Fifteen people died in the past 24 hours, bringing the total fatalities to 578. The number of active cases on Wednesday also crossed the 25,000 threshold, which the Ministry of Health had warned would overwhelm Nepal’s health infrastructure and a lockdown may need to be re-imposed. Currently, 233 patients are being treated in ICU and 37 are on ventilator support. Bagmati province has 127 patients in ICU and 25 on ventilators. <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/local-governments-lack-resources-to-tackle-covid-19/" target="_blank" rel="noopener noreferrer">Nepal’s health infrastructure</a> is far from being overwhelmed by Covid-19 patients. There are an estimated 2,600 ICU beds in private and government hospitals nationwide, and of the 900 ventilators in hospitals 490 are in working order. The problem is that there is uneven distribution of these facilities. There are not enough ICU beds where they are needed most, and beds available in private hospitals tend to be unaffordable to most Nepalis. The <a href="https://www.nepalitimes.com/here-now/kcs-fast-highlights-nepals-covid-19-failure/" target="_blank" rel="noopener noreferrer">government’s 25,000 threshold</a> appears to be a deliberate strategy to convince people to adopt preventive measures to control the disease, since curative capacity is limited. In Wednesday’s press briefing, the Ministry of Health did not say anything about a re-imposition of the lockdown.  Bir, Teaching, Teku and Patan are the only government-run hospitals in Kathmandu Valley admitting seriously ill Covid-19 patients, and their limited capacity is getting saturated. All 20 ICU beds in Teku are occupied, so are 10 beds in Bir Hospital, 20 in Teaching and 22 in Patan that are set aside for Covid-19 patients.The Armed Police Force (APF) hospital also designated for Covid-19 care has a 20-bed ICU, but only half are in operation because of the lack of trained healthcare workers. Some private hospitals in Kathmandu Valley like Star, MediCiti, Grande, Norvic, HAMS and B&amp;B also admit Covid-19 patients, but these are expensive and have only a part of their total beds designated as Covid-19 wards. Because of the pandemic, many non-Covid-19 patients are not seeking treatment, and private hospitals are converting existing capacity to coronavirus wards to compensate for the loss of revenue. For Samir Adhikari at the Ministry of Health, the limiting factor is not ICU beds but adequate supply of oxygen. He says: “Most patients do not need to be in ICU or have a ventilator, they need oxygen and it is much more critical to ensure that there are enough cylinders.”Adding to the problem is that patients without major complications have also occupied ICU beds, there is a poor referral system, shortage of drugs, mismanagement of human resources and facilities.  <figure><img width="2306" height="1108" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171144/636bd9a99c7e80680e080226jpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="2334" height="1084" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171144/636bd9ac9c7e80680e080227jpeg.jpg" alt=""><figcaption> </figcaption></figure>Since June, more than 350 healthcare professionals have been trained by the National Health Training Centre in critical care, and are now working in various hospitals and institutions across the country, but not in ICU wards. “We submitted the details of the trained professionals to the ministry and it is now their responsibility to deploy them where they are most needed,” says director of the Centre, Yaduchandra Ghimire. The Ministry of Health sent a budget to all government hospitals to repair ventilators, install ICU beds and oxygen generators. However, it does not look like this has been done. Director General of Health Services Dipendra Man Singh says: "We have to move fast. At the rate <a href="https://www.nepalitimes.com/latest/coronavirus-in-nepals-corridors-of-power/" target="_blank" rel="noopener noreferrer">Covid-19 infection</a> is spreading, it is becoming increasingly difficult for even Kathmandu to manage the treatment of infected patients.” This situation was not unexpected. Last month, the Nepal Society of Critical Care Medicine had suggested the Health Ministry to establish 500-bed medical college with 50-bed ICU for a possible surge in symptomatic patients.  "Infected people are now dying at home without treatment. The infrastructure needed to treat critically ill patients has not been managed due to the conflicting interest of the leadership at the health ministry," says one doctor affiliated with the group. While Kathmandu Valley’s hospital capacity is stretched, <a href="https://www.nepalitimes.com/here-now/covid-19-lessons-for-kathmandu-from-the-tarai/" target="_blank" rel="noopener noreferrer">things have more or settled down</a> in Province 2 and Sudur Paschim Province that saw multiple peaks back in June-July (see graphs, above) following the return of migrant workers from India. Hospitals there were also overwhelmed then, but now able to manage patients. Additional reporting by Ramu Sapkota.

Sonia Awale

As virus spreads, Kathmandu hospitals strain to cope

<figure><img width="1248" height="832" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171144/636bd92c9c7e80680e0801fbjpeg.jpg" alt=""/><figcaption>Photo: PMO</figcaption></figure>After lying relatively dormant since January, SARS-CoV-2 is spreading rapidly in Nepal, with <a href="https://www.nepalitimes.com/here-now/covid-19-lessons-for-kathmandu-from-the-tarai/" target="_blank" rel="noopener noreferrer">most of the cases now in Kathmandu Valley</a>, affecting even close advisers of Prime Minister K P Oli. On Saturday, four of Oli’s aides including press adviser Surya Thapa, political adviser Bishnu Rimal, foreign policy adviser Rajan Bhattarai and secretary Indra Bhandari said they had tested positive. Two other staff at the PMO in Baluwatar had also tested positive last week. Also on Saturday, 28 Nepal Army soldiers guarding the prime minister’s official residence at Baluwatar also tested positive, but none of them were said to be assigned as Prime Minister Oli’s personal body guards. The infected soldiers are in the process of being replaced. The <a href="https://www.nepalitimes.com/latest/covid-19-spreads-closer-to-nepals-ruling-circle/" target="_blank" rel="noopener noreferrer">spread of the virus within Nepal’s corridors of power</a> at Baluwatar has raised worries about the wellbeing of Prime Minister Oli who has had <a href="https://www.nepalitimes.com/latest/prime-ministers-health-condition-under-wraps/" target="_blank" rel="noopener noreferrer">two kidney transplants</a> and is said to be immuno-compromised. Then came news late on Saturday that four members of the opposition Nepali Congress had also tested positive: Gagan Thapa, Arjun Narsingh KC and two other central committee members. KC is Thapa’s father-in-law. Thapa announced that he had Covid-19 through his Twitter account, and said his condition was normal but that he was isolating at home. He also warned anyone who had been in close proximity to him to consult a doctor if they had any problems. Interestingly, NC leader KC said through a Twitter post that he was surprised to hear that he had tested positive through the mass media, and added that the party headquarters where the tests were conducted had not informed him. The other two NC central committee members who tested positive are Ganga Chaudhari and Sambhulal Shrestha. On 1 October the party had tested 240 of its secretariat staff, security guards and party members ahead of a meeting that has been called for 5 October. Meanwhile, the Prison Management Department announced on Saturday that more than 700 inmates across the country had tested positive for Covid-19, and eight of the prisoners had died. Six of the fatalities were in the Central Jail in Kathmandu and one each in Banke and Morang.  So far, 1,900 prison inmates have been tested so far, and aside from the 700 active cases 200 have recovered. The Department has only been testing those with symptoms, and it is expected that the real number of positive cases is higher. Those who have tested positive so far have been in jails in Parsa, Banke, Suyangja, Lalitpur, Sindhupalchok, Kathmandu, Jumla, Saptari, Siraha, Sunsari and Morang. The Department has cancelled all visits at prisons, and spread out the detainees. Nepal’s prisons are notoriously crowded and <a href="https://www.nepalitimes.com/latest/prisons-can-be-incubators-for-covid-19/" target="_blank" rel="noopener noreferrer">experts have warned that they could be hotbeds for the virus</a>. There have been calls to <a href="https://www.nepalitimes.com/here-now/nepals-prisons-need-to-be-depopulated/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-prisons-need-to-be-depopulated/&amp;source=gmail&amp;ust=1601862869062000&amp;usg=AFQjCNF4YWZCS0PK7CRkWiXeeVHkmwVbPw">depopulate the prisons</a> by releasing those serving time for relatively minor crimes. <figure><img width="2340" height="1008" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171144/636bd92f9c7e80680e0801fcjpeg.jpg" alt=""><figcaption>Charts: WORLDOMETER</figcaption></figure><img width="1388" height="770" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171144/636bd9329c7e80680e0801fdjpeg.jpg" alt=""><img width="1376" height="770" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109171144/636bd9359c7e80680e0801fejpeg.jpg" alt="">After being relatively unscathed since January, the coronavirus has been spreading rapidly in Kathmandu Valley. The first surge was seen after the <a href="https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/" target="_blank" rel="noopener noreferrer">first lockdown was partially lifted in July</a>, and the second since the <a href="https://www.nepalitimes.com/banner/muddling-through/" target="_blank" rel="noopener noreferrer">restrictions were lifted on 10 September</a>. Eight more deaths were reported all over Nepal on Saturday, two of them in Kathmandu Valley, taking the total to 528. Most of the dead are over 60 years old. 103 of the total fatalities are from Kathmandu, 25 from Bhaktapur and 24 from Laitpur districts. Of the nearly 13,000 tests done in the past 24 hours nationwide, SARS-CoV-2 was detected in 2,120, taking the total confirmed cases to 84,570. There were 2,044 who had recovered on Saturday, taking the total recovered to 62,740 and giving Nepal a recovery rate of 74.1%. There are now 21,302 active cases all over Nepal, of which nearly 10,000 are in hospitals and the rest in home isolation. The Ministry of Health had warned that the lockdown may need to be reimposed if the <a href="https://www.nepalitimes.com/here-now/kcs-fast-highlights-nepals-covid-19-failure/" target="_blank" rel="noopener noreferrer">number of active cases exceeded 25,000 because of the limitations on hospital beds</a>.  Unlike during the early weeks of the pandemic, many more cases now are symptomatic and the deaths are among the elderly population, indicating a rapid spread of the virus in the community.  The number of patients in ICU is now 217, and there are now a record number of 31 people in ventilators.

Coronavirus in Nepal’s corridors of power

<figure><img width="760" height="428" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151112/636bb5d09c7e80680e07bc25jpeg.jpg" alt=""/><figcaption>Nepali workers entering the border from India through Behaliya checkpoint in Rupandehi. Photo: MANORANJAN SHARMA</figcaption></figure>In July, as the government eased the first lockdown, people streamed <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener noreferrer">across the border from India into Nepal</a>, spreading the <a href="https://www.nepalitimes.com/banner/as-india-peaks-covid-19-spreads-rapidly-in-nepal/" target="_blank" rel="noopener noreferrer">coronavirus infection along cities in the Tarai</a>. The districts from Jhapa to Parsa became hotspots. Hospitals ran out of ICU beds and ventilators, municipalities had no test kits left, and there were horror stories of patients dying while going from one hospital to another that refused admission. But it did not take too long for asymptomatic carriers to bring the virus into Kathmandu Valley, where population density and high mobility <a href="https://www.nepalitimes.com/latest/covid-19-spreads-closer-to-nepals-ruling-circle/" target="_blank" rel="noopener noreferrer">made the capital an ideal breeding ground for SARS-CoV-2</a>.   With 16 additional deaths on Monday and two on Tuesday, total Covid-19 fatality in Nepal has now reached 429. Kathmandu Valley alone accounts for over one-fourth of all deaths in Nepal from the virus. On Monday, Kathmandu, Lalitpur and Bhaktapur districts recorded 647 new cases (about half the nationwide total of 1,356). The tables are now turned. Even as the Tarai has the virus largely under control, the majority of the 223 patients in ICU and 37 on ventilator support nationwide are in Kathmandu Valley. The country’s only infectious diseases hospital in Teku, despite adding isolation wards, ventilators and ICU beds, has <a href="https://www.nepalitimes.com/banner/nepals-virus-vortex/" target="_blank" rel="noopener noreferrer">run out of space for Covid-19 patients</a>. “Even with the increased capacity, we cannot admit all the patients,” hospital director Sagar Rajbhandari told Nepali Times. Three months after the government announced it would build a 300-bed hospital just for coronavirus patients, there has been no action. It has not followed the advice of its own public health experts to expand testing and tracing. In fact, the Nepal government seems to have admitted defeat. Its unspoken strategy now is now letting the virus take its course, warning citizens to adopt their own precautions and learn to live with the disease <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">until a vaccine is available</a>. This explains why even as the number of new cases and fatalities in Kathmandu Valley <a href="https://www.nepalitimes.com/latest/nepal-beats-own-record-in-covid-19-cases-and-deaths/" target="_blank" rel="noopener noreferrer">break its own record every day</a>, the lockdown is being further eased with public transport, flights, shops and restaurants allowed to open. Adding to this is the utter lack of coordination between locally elected municipality officials and the District Administration Offices which issue new and contradictory guidelines every day, and blame each other for the situation getting worse. Locally elected representatives <a href="https://www.nepalitimes.com/editorial/nepals-leaders-are-in-isolation/" target="_blank" rel="noopener noreferrer">should have been allowed to handle the outbreak</a> like in the Tarai, with the central government only ensuring that they have adequate resources, equipment and medical personnel. “Kathmandu’s response to the pandemic shows that the central government doesn’t trust local units who are close to the people and can respond fastest to their needs,” says Chandra Kishore, a Tarai-based journalist in Birganj. “The focus should be on empowering local governments and health posts to contain the spread of the virus.”Even as Kathmandu struggles to contain the virus with all the resources and facilities at its disposal, Nepal’s capital could learn a few things from the way Tarai cities and municipalities handled the spike and brought the virus under control.One example is Narainapur in Banke district, which first made it to the news as a hotspot back in May <a href="https://www.nepalitimes.com/latest/with-3rd-covid-19-fatality-nepal-issues-funeral-guideline/" target="_blank" rel="noopener noreferrer">with over 100 cases and Nepal’s second Covid-19 fatality</a>.Most of the infected were migrant worker returnees from India. Since then, the municipality has brought active cases down to zero. <figure><img width="640" height="398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151112/636bb5d29c7e80680e07bc26jpeg.jpg" alt=""><figcaption> </figcaption></figure>“In our experience what worked the best was the collaboration between the local government, CDO office and the Nepal Army,” says Naresh Shrestha, the Covid-19 focal point for Banke district. “This has helped us conduct proactive contact tracing and raise awareness about safety measures. Narainapur is also relatively isolated which helped us seal the access points and better manage the outbreak.” <figure><img width="640" height="435" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151112/636bb5d49c7e80680e07bc27jpeg.jpg" alt=""><figcaption> </figcaption></figure>After Kathmandu Valley, Banke has conducted the most PCR tests and of the total 1,662 coronavirus cases in the district, 1,264 people have already recovered. The remaining cases are in densely populated areas of Nepalganj and Kohalpur.Nepalganj mayor Dhawal Shumshere Rana says his city was among the first to be hit with the coronavirus, and had to learn quickly through trial and error.“We didn’t know what was coming. Me and my staff took PCR tests ourselves to set an example for others,” Rana said on the phone. “We now have the virus more or less under control. We still have some cases, but life is back to normal and our people are following safety measures.”In the neighbouring district of Bardia which has a 83km border with India, there has been a gradual rise in cases. In Badhaiyatal municipality, the authorities shut the quarantine centre that had become an incubator for the virus.“After we realised what was happening, we focused on containing the virus in the quarantine centre and invested in contact tracing, which helped us bring the situation under control,” explained Gokarna Giri of the Bardia District Health Office. “But containing the virus in crowded cities and marketplaces has been challenging. We can’t reach everywhere, people have to be mindful about obeying safety measures.”Udaypur in the Inner Tarai of eastern Nepal <a href="https://www.nepalitimes.com/banner/nepals-muslims-face-stigma-after-covid-19-tests/" target="_blank" rel="noopener noreferrer">was a coronavirus hot spot in April</a> when 13 men in a mosque who had returned from Delhi all tested positive. There was stringent contact tracing of people who they had been in close proximity to, and the district was sealed off for months.In fact, Udaypur’s experience is now called the ‘Bhulke Model’ after a ward of Triyuga Municipality that used PCR tests for contact tracing after false negatives  from RDTs. Infected people were immediately sent to hospital isolation wards, and health officials did repeat contact tracing of the entire community until cases came down to zero.  <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Muslim-woman-activist-Udaypur%20,3997" target="_blank" rel="noopener noreferrer">Gaighat-based activist Najbul Khan</a> used to travel every day on her motorbike during the lockdown with supplies and essential medicines for communities ostracised due to infection. Her Muldhar Mahila Kendra offered counseling for youth who were mentally stressed, prepared iftaar for the Muslim community for 18 days during Ramadan.“All of us, the community, volunteers, and the local authorities worked together to overcome the coronavirus. It is because of this that Udaypur is a model for successfully bringing Covid-19 under control,” Khan says.In the beginning, Udaypur did not even have sufficient personnel to collect swab samples, and the district hospital’s Parmendra Yadav was working overtime to conduct tests <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">without proper personal protective gear</a>. His hard work was met with stigma: fearful colleagues stopped talking, and the eatery he frequented stopped serving him.  But Yadav persisted, he trained lab personnel to bring the district’s limited health services up to speed and received PPE from non-profits in the area.“It was a difficult two months, but it paid off knowing how far we have come in terms of controlling Covid-19,” says Yadav. “Kathmandu could learn from our strategy of widespread testing, contact tracing, and strict border controls.”With additional reporting from Ramu Sapkota.

Covid-19 lessons for Kathmandu from the Tarai

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6339c7e80680e073709jpeg.jpg" alt="" width="2048" height="1365"/><figcaption>All photos: BIKRAM RAI</figcaption></figure>A total of 620 police across the country have been infected with Covid-19, two Deputy Inspector General working in the Nepal Police Hospital being the latest. Yet, police are on the frontlines along the country’s highways and at entry-points to Kathmandu to enforce traffic restrictions.Earlier this month, the Traffic Police Headquarter in Singha Darbar, Metropolitan Police Office in Ratna Park and Nepal Police Headquarters in Naxal were all sealed off following the detection of SARS-CoV-2 among police officers. Nepal Police Headquarters alone reported 155 positive cases. So far 240 police officials have recovered with 380 undergoing treatment.Although the lockdown was partially lifted on 21 July, Nepal’s health authorities have re-imposed restrictions on long-distance buses, inter-district travel, sealed off cities in the Tarai, and districts in the mid-mountains, and closed restaurants again.Kathmandu Valley has become a hotspot with 172 new cases detected on Sunday, taking the total active cases to 1894. Across Nepal, 641 new cases were reported taking the total to 26,660 with 104 fatalities form Covid-19.The total deaths from the virus has doubled in the past 15 days, and rose from 38 on 15 July to 104 on 16 August.Following this surge of coronavirus in the capital city, the government last week sealed off Kathmandu Valley — no one can drive in or out. It further restricted movement of public and private vehicles from 9PM-5AM, and enforced an odd-even rule for all vehicles in the city.Pictured here are traffic police officers checking vehicles at Koteswor and Satdobato intersections on Sunday night just before the 9PM curfew went into effect.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6369c7e80680e07370ajpeg.jpg" alt="" width="2048" height="1365"><figcaption></figcaption></figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6399c7e80680e07370bjpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba63c9c7e80680e07370cjpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba63f9c7e80680e07370djpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6429c7e80680e07370ejpeg.jpg" alt="" width="640" height="427"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6459c7e80680e07370fjpeg.jpg" alt="" width="2048" height="1365"><figcaption></figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6489c7e80680e073710jpeg.jpg" alt="" width="2048" height="1365"><figcaption></figcaption></figure>Photos by Bikram Rai.

Nepal Police at the frontlines against coronavirus

<figure><img width="1050" height="875" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5d79c7e80680e0736ebjpeg.jpg" alt=""/><figcaption></figcaption></figure>Given how unconcerned rulers in Kathmandu have historically been to the plight of underserved Nepalis in the rest of the country, it was perhaps inevitable that the current government would finally start taking the COVID-19 pandemic seriously after the case load <a href="https://www.nepalitimes.com/banner/nepals-virus-vortex/" target="_blank" rel="noopener noreferrer">increased in the capital</a>.On Thursday, the government sealed off Kathmandu Valley -- no one can come in or out. This sense of urgency after one minister, five MPs, one head of a constitutional body, a provincial attorney general and other elected officials tested positive for the virus in the past week.  Nepal Communist Party co-chair Pushpa Kamal Dahal is in self-isolation at his home in Khumaltar after a driver of his secretariat was infected. In Baluwatar, Prime Minister Oli, who has had a double kidney transplant, has also restricted visitors.  However, as we went to press on Thursday at noon, Dahal drove to Baluwatar to meet Oli -- breaking his own self-isolation. The two had not met for 10 days.   For the past week, it seemed the <a href="https://www.nepalitimes.com/editorial/you-stab-my-back-i-stab-yours/">struggle for supremacy</a> between Dahal and Oli had been put on hold, as their factions could not physically meet to <a href="https://www.nepalitimes.com/latest/nepal-ruling-party-on-verge-of-split/">plan and plot their next mo</a>ves against each other. Because of this, the media has got a respite from the blow-by-blow daily reporting of who from one faction or the other secretly met whom, and where. <figure><img width="775" height="517" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5da9c7e80680e0736ecjpeg.jpg" alt=""><figcaption> </figcaption></figure>Two justices of the Supreme Court, Ishwar Prasad Khatiwada and Hari Phuyal are in self-isolation after one of his security guards tested positive. Opposition Nepali Congress leader Mohan Basnet is in home quarantine after his father died of COVID-19, and the NCP’s Amrit Bohara and Sher Bahadur Tamang are also in self-isolation after travel.In Kathmandu, the Police Headquarters in Naxal and the Traffic Police Centre at Singha Darbar have both been sealed off after at least 200 police officers tested positive. The head of the Commission for the Control of Abuse of Authority (CIAA) Nabin Ghimire tested positive on Tuesday, and the office of the corruption watchdog has been closed.The spokesperson of the Federal Parliament Rojnath Pandey also tested positive last week. He had joined MP Pradip Yadav and a parliamentary team on a tour of the flood and virus affected districts of the Tarai. MP Yadav had tested positive, but has now recovered. Also recovered is Karnali provincial assembly member Jivan Shahi.Similarly, Province 1 lawmaker Kusum Shrestha announced on Facebook this week that she had tested positive. Province 5 member of the legislative assembly Krishna KC also took to Facebook to inform that she had tested positive, was at Bheri Hosptial and also said she was ready to donate her blood plasma once she recovered. <figure><img width="1100" height="560" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5dd9c7e80680e0736edjpeg.jpg" alt=""><figcaption> </figcaption></figure>In Province 2, which is now a hotspot for the virus because of its proximity to Bihar, Law Minister Gyanendra Yadav and assembly member Rina Yadav have tested positive. Yadav says she has no travel history and no symptoms, and is now in self-isolation at home. “I only took the test because I wanted to go to Kathmandu to meet my family,” she added. Birganj Mayor Vijay Sarawagi is in a hospital in Kathmandu after testing positive, and will be tested again this weekend, according to doctors.   As of Thursday, Kathmandu Valley had 111 new COVID-19 cases – the seventh day in a row with more than 100 new infections. There were 4 more fatalities, and 89 patients in ICU across Nepal, as the total confirmed cases hit 24,957 with 525 more infections. There are 14,769 people in isolation nationwide and coronavirus treatment centres are <a href="https://www.nepalitimes.com/banner/nepals-virus-vortex/">filling up with patients</a>, especially in Tarai cities. This week, the government instructed private hospitals to set aside 20% of their capacity for COVID-19 cases. The surge followed the <a href="https://www.nepalitimes.com/nt/latest/?page=3">partial lifting of the lockdown on 21 July</a> after which people started <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/">streaming in to the Tarai</a> from India, and many from there travelled unrestricted to Kathmandu Valley. The government has extended the ban on regular flights and long-distances buses till 31 August, and once more shut down restaurants and closed district administration offices.

COVID-19 spreads closer to Nepal’s ruling circle

<figure><img width="1700" height="1105" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5c29c7e80680e0736e2jpeg.jpg" alt=""/><figcaption>Nepal Army personnel perform final rites of a daily wage worker who passed away this week. Photo: RSS</figcaption></figure>It was 11am on Monday morning in a quiet residential side street in Patan. Suddenly there was commotion as an ambulance and a police van arrived at the cul de sac, sirens blaring.
Families were at their windows looking down, curious neighbours crowded the street. Health official in a full protective equipment held a man, escorted him to the ambulance, and quickly drove off.
The man was the friendly neighbourhood barber. He had returned to Kathmandu from Saptari after the lockdown was eased last month, and had been in the Teku COVID-19 hospital after he tested positive. He had told neighbours that he had been discharged after recovering. But no one knew for sure, and rumours were flying.
<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/nepals-virus-vortex/" target="_blank" rel="noopener noreferrer">Nepal's virus vortex</a>, Sonia Awale
“He was lurking around yesterday, he bought some stuff from my shop,” said a worried shopkeeper. “I have kids to look after, what if he transmitted corona to me?” Another bystander, his mask down at chin-level, piped in: “I heard he ran away from Teku.” The police left to guard the street were even more clueless. They had every reason to be nervous, since 350 policemen are in quarantine after the Police Headquarters and the Traffic Police Office were both sealed after more than 35 officers tested positive.
Our own investigation into this incident makes it a case study in why there is so much confusion, misinformation and public stigma surrounding the coronavirus pandemic.
It turns out the 32-year-old was living by himself in a rented room in Patan near where he had a barber shop for the past two years. After testing positive in a swab sample taken in Thankot on return from the Tarai last month, he was admitted into the Sukraraj Tropical and Infectious Disease Hospital in Teku and stayed there for 17 days.
In that time, he had four PCR tests, all of which were positive. But after spending two weeks in isolation, he tested negative and was then asked to leave hospital to make way for another patient. However, Teku forgot to give him his negative report.  
On 10 August, the barber was summoned to the Ward office where he was asked for his negative certificate. Because he did not have it, and fearing that he might lose his shop, he fled. The Ward office immediately tracked him down, and informed police and an ambulance to take him back to Teku. There, he had to take another PCR test, and now is back in isolation in his room, awaiting the result.     
“What this example shows is that a little knowledge is dangerous,” said a Ward officer, explaining that fear of ostracisation, fear of the disease, public dread, misinformation, all came together to escalate the panic.  
At Teku, hospital director Sagar Rajbhandari explained that it was impossible for a patient to be released from the COVID-19 ward without testing negative. But he immediately contradicted himself by saying that since the hospital was so overwhelmed, there might have been lapses.
The Ward officer lamented that given the residents of the neighbourhood were all well-to-do and educated, they should have known not to crowd around when the ambulance arrived. On the one hand, they were worried about their health, but on the other they were not maintaining physical separation, he added.
“We want to help protect our residents, but it is time we start from scratch to work on COVID awareness,” the officer said. 
There has been a surge in COVID-19 infections since the lockdown was <a href="https://www.nepalitimes.com/nt/latest/?page=3" target="_blank" rel="noopener noreferrer">partially lifted on 21 July</a>. People from India <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer">streamed into the Tarai</a>, and many from there travelled unrestricted to Kathmandu Valley – leading to a spike in cases. This prompted the government to put off re-opening regular flights and long-distances buses, clamped down again on restaurants and closed district administration offices for two weeks in the capital.
On Wednesday, Kathmandu Valley saw 138 new cases – the sixth day in a row with more than 100 new cases of COVID-19. There were 8 more fatalities, and 85 patients in ICU. Nationwide, the total confirmed cases hit 24,432 with 484 more infections on Wednesday. Most of the patients have recovered and there are 11,058 people in isolation nationwide.
As the designated coronavirus treatment centres nationwide <a href="https://www.nepalitimes.com/banner/nepals-virus-vortex/" target="_blank" rel="noopener noreferrer">fill up with patients</a>, especially in the Tarai cities, the government instructed private hospitals on Tuesday to set aside 20% of their capacity for COVID-19 cases. 
Public health experts like Sameer M Dixit at the Centre for Molecular Dynamics Nepal says the virus is here to stay, and the only way to deal with the pandemic before a vaccine is developed, is for every individual to uphold rules about distancing, <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">masks and hand-washing</a>.
“Nepalis lack enough knowledge on the pandemic. It is easily prevented, but once infected they can be in grave danger,” he says.  
For his part, Rajbhandari at Teku says the case of the Patan barber is emblematic of the many cases he sees at his hospital caused by the uncontrolled movement of people first from India to Nepal, and then from the Tarai to Kathmandu.
He says: “We doctors and health officials have to bear the brunt of all the policy mismanagement of the government.”  
Back at the Ward in Patan, the elected representatives say they are going to strictly enforce <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">the guidelines on movement, physical distancing, and wearing masks</a> so as to avoid the kind of panic that struck the neighbourhood this week.

The barber and the virus in Kathmandu

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5809c7e80680e0736cdjpeg.jpg" alt="" width="2000" height="1334"/><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba58a9c7e80680e0736cejpeg.jpg" alt="" width="2000" height="1333"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba58d9c7e80680e0736cfjpeg.jpg" alt="" width="2000" height="1333"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5919c7e80680e0736d0jpeg.jpg" alt="" width="2048" height="1365"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5949c7e80680e0736d1jpeg.jpg" alt="" width="2048" height="1365"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5979c7e80680e0736d2jpeg.jpg" alt="" width="2000" height="1332"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba59b9c7e80680e0736d3jpeg.jpg" alt="" width="2000" height="1334"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba59e9c7e80680e0736d4jpeg.jpg" alt="" width="2000" height="1398"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914114/636ba5a19c7e80680e0736d5jpeg.jpg" alt="" width="2000" height="1333">Photos: Bikram Rai and Monika Deupala

COVID-19 mutes Krishna festival in Kathmandu

<figure></figure> <img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba5129c7e80680e0736a1jpeg.jpg" alt=""/><figcaption>A woman with her mask down walks by Sneha Shrestha mural in Pimbahal, Patan this week. Photo: BIKRAM RAI</figcaption> Five months after the first COVID-19 case was detected in Kathmandu, and after many experts were puzzled about why the virus was not spreading as fast as elsewhere, parts of Nepal and Kathmandu city are now in the vortex of the pandemic.Hospitals in Tarai cities are fast filling up with symptomatic cases, and doctors say patients requiring ICU treatment and ventilator support are on the rise.On Thursday, Kathmandu Valley recorded its highest daily rise of 87 positive cases. All beds are occupied in hospitals with designated wards for coronavirus patients. Overwhelmed, doctors are sending asymptomatic patients to home isolation. Some were diverted to Kathmandu Medical College’s facility in Duwakot and Ayurveda Hospital in Kirtipur.<a href="https://www.nepalitimes.com/banner/experts-caution-against-extending-nepal-lockdown/" target="_blank" style="background-color: rgb(255, 255, 255); font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Experts caution against extending lockdown</a>, Sonia Awale<a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" style="background-color: rgb(255, 255, 255); font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Lockdown may be over, but pandemic is not</a>, EditorialThe government has approached private hospitals to start opening COVID-19 wards, and had set the maximum treatment charge per patient. However, private hospitals are balking, they say the fees are too low for the care needed.“Self-isolation at home has worked elsewhere but in Nepal where people don’t strictly follow safety measures, patients are ostracised, and there is a lack proper rescue mechanism, it might not be the best strategy,” cautions BaburamMarasini, former head of the Epidemiology and Disease Control Division. “It would be better to move asymptomatic cases to available government training centres, non-profit institutions, and if needed even hotels and hostels.” <figure></figure> <img width="955" height="594" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba5159c7e80680e0736a2jpeg.jpg" alt=""><figcaption> </figcaption> As of Thursday, Nepal has a total of 21,750 cases with 6,296 active. So far, 65 people have lost their lives, five of them on 6 August alone. Cases in Kathmandu Valley have reached 876, mostly in the capital city (see graphs). Eight people have been infected with coronavirus at the Ministry of Internal Affairs and Law and so has minister Gyanendra Kumar Yadav in Province 2.Says public health expert Sameer Dixit: “Local governments and security personnel should be facilitating self-isolation at homes. Admitting asymptomatic cases in hospitals depletes resources, as it exposes mildly infected patients to severe cases.”There are now 66 ICU cases across Nepal with 29 just in Bagmati Province (see map) where three patients are on ventilator support. Given the steep rise in symptomatic and severe COVID-19 cases, all 1,702 ICU beds nationwide and stock of 900 ventilators could be used up.“The rate of infection in Kathmandu is increasing, and this could lead to a shortage of hospital beds, equipment and heath workers,” warned Jageshwor Gautam of the Health Ministry, appealing to the public to remain at home and follow <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">safety measures</a>. Several hundred traffic police in Kathmandu are in quarantine after the infections spread, and the Nepal Police headquarters was sealed this week after seven staff tested positive. <figure></figure> <img width="949" height="606" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba5189c7e80680e0736a3jpeg.jpg" alt=""><figcaption> </figcaption> Special attention should also be given to the fact the virus SARS-CoV-2 is airborne, which is why <a href="https://www.nepalitimes.com/banner/masks-unmasked/" target="_blank" rel="noopener noreferrer">wearing mask</a> should be mandatory, spitting prohibited and ensuring cross ventilation in workstations at all times.Finance Minister and government spokesperson Yubaraj Khatiwada says the government does not want to re-impose a nationwide lockdown, but says some restrictions may have to be put into place.District administrations of Kathmandu, Lalitpur and Bhaktapur districts met on Thursday to draw up a joint strategy for the Valley. Among the measures being discussed are: strict protocols for government offices, banks, markets, and public transport. They are worried most people are not following guidelines for masks and physical separation, and warn that they may have to resort to punitive measures and fines to enforce the rules.Health experts fault Khatiwada’s <a href="https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/" target="_blank" rel="noopener noreferrer">announcement on 21 July</a> in which he categorically stated that the “lockdown has been lifted” even though it had only been relaxed. They said this had given people a <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">false sense of security</a>, and especially allowed Indian factory workers, vendors, barbers and drivers to stream back to Nepal <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer">across the open border</a>. This is the reason the Tarai cities were the first to be hit, and the virus is spreading to Kathmandu from there.    The COVID-19 Crisis Management Centre (CCMC) is said to be discussing modalities for a ‘smart lockdown’, including isolating areas where there are outbreaks and stricter enforcement of mask and separation rules. It is also going to decide this weekend whether or not to re-open long distance buses, as well as regular domestic and international flights which were supposed to resume on 17 August.Says Buddha Basnyat, a physician at Patan Academy of Health Sciences: “We are seeing a worrying surge in typical COVID-19 symptoms with advanced pneumonia, unlike before when most cases were asymptomatic and had co-morbidity.” <figure></figure> <img width="516" height="655" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba51a9c7e80680e0736a4jpeg.jpg" alt=""><figcaption> </figcaption> Experts say the rise of symptomatic cases is also due to co-infection such as seasonal flu, typhoid and <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/" target="_blank" rel="noopener noreferrer">dengue</a>, all infectious disease common during the monsoon. Some have pointed to high co-morbidity and delayed mass testing as  contributing factors to possible community transmission in the Tarai districts and Kathmandu.But despite the surge in symptomatic cases, health professionals have advised against re-imposing a blanket curfew, favouring a ‘<a href="https://www.nepalitimes.com/banner/experts-caution-against-extending-nepal-lockdown/" target="_blank" rel="noopener noreferrer">smart lockdown</a>’ where localities with cluster outbreaks are sealed off, and tested – while strictly enforcing masks in public places and preventing crowds.So far, shutdowns have been re-imposed in five Tarai districts, and semi-lockdowns in parts of nine others where there has been a surge in cases. <figure></figure> <img width="640" height="828" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba51d9c7e80680e0736a5jpeg.jpg" alt=""><figcaption> </figcaption> “We are already experiencing semi-lockdown of sorts because of floods and landslides. A lockdown now will cause more harm than good. The only way to fight this pandemic is <a href="https://www.nepalitimes.com/editorial/open-and-shut-case/" target="_blank" rel="noopener noreferrer">behavioural reform, surveillance and isolation</a>,” says Marasini.Indeed, most experts agree that a focus on the coronavirus should not shift attention away from more devastating conditions that can <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">affect people’s well-being</a> because of economic collapse.

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