<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d18d39c7e80680e0ac7e8jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: SAGLO SAMAJ/HIMALMEDIA</figcaption></figure>Earlier this year, as the <a href="https://www.nepalitimes.com/latest/the-pandemic-of-hunger/">sec</a><a href="https://www.nepalitimes.com/latest/the-pandemic-of-hunger/" target="_blank" rel="noopener noreferrer">ond wave</a> was subsiding in Nepal’s far-western mountains, I noticed the kind of dramatic change in the diet of families that I had earlier only seen in semi-urban settings.In Achham district’s Bayalpata Hospital, I came across a one-year-old who weighed just 5kg. She was being breastfed by a mother who was herself undernourished. “The child only eats noodles and biscuits, that is why I am still breastfeeding,” said the mother.The family has cows and a patch of land where they grow vegetables. There is enough lentil and flour at home. <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/a-tall-order/" target="_blank" rel="noopener noreferrer">So why was the child not eating a healthier diet?</a>“Noodles have all the nutrition to give her strength but my baby is still losing weight which is why I have brought her to the hospital,” the young mother tells the doctor.The traditional practice of growing and consuming locally grown lentils, soybean, millet and buckwheat is being replaced even in the remotest parts of Nepal by <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/">junk food</a> in throwaway plastic wrappings.Locals here have been misled by tv commercials that have glamourised noodles and biscuits, and convinced many parents that they contain <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/">vitamins and micronutrients that will make their babies healthy</a>. The instant food in plastic packs are also convenient for parents who are usually busy all day in the fields.Read also: <a href="https://www.nepalitimes.com/opinion/living-to-eat/" target="_blank" rel="noopener noreferrer">Living to eat</a>, Aruna UpretyChild specialist Ramesh Kant Adhikari says that, on the other hand, most urban children who grow up on junk food tend to be obese and malnourished, and certain parents are proud that they are raising well-fed children.“Parents don’t understand that such foods are harmful to the health of their children,” Adhikari told me. “They don’t believe me even when I try to explain.”As long as tv commercials and social media ads continue and the government does not regulate, the problem will persist and continue to grow. Even in the food-deficit regions in the remotest corners of Accham and Doti districts where families cannot even get basic medicines, packaged junk foods are now easily available. This is evidence enough of <a href="https://www.nepalitimes.com/editorial/hunger-for-governance/" target="_blank" rel="noopener noreferrer">the state’s misplaced priorities</a>.Children of subsistence farmers, <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">already undernourished</a>, are consuming low-nutrition junk foods. The children then suffer health consequences, which means expensive consultations with doctors who then prescribe costly bottled vitamins, further impoverishing the family, and thus completing the vicious cycle.“There is absolutely no evidence that supplemental vitamins are good for growing children,” adds Adhikari. “All they need is a proper, balanced diet found in traditional home foods.”Read also: <a style="font-weight: 600;" href="http://archive.nepalitimes.com/news.php?id=2409#.W2L-r9UzbIU" target="_blank" rel="noopener noreferrer">Junk food epidemic</a>, Aruna Uprety<a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/promoting-nutritious-local-food-for-post-quake-children,524" target="_blank" rel="noopener noreferrer">Local is best</a>, Aruna UpretyBut parents are so swayed by unethical commercials that public health experts are fighting a losing battle to convince them of the dangers of junk foods. Indeed, some health care workers share part of the blame: they prescribe vitamin supplements to young children instead of counselling parents on the nutrition available in the traditional Nepali diet.The Ministry of Agriculture has for decades been publishing booklets and posters to promote local produce such as buckwheat, millet, potato, lentils, latte, tarul, and beans. But lack of coordination between the health and agriculture ministries means that information rarely gets out into the hinterland.The Health Ministry also distributes packets of Balvita at health posts to treat children with malnutrition, but it does not have the sense to inform parents that the same calories, proteins and vitamins are found in abundance in fresh homemade food.Children everywhere are easily swayed by commercials, they demand what they see on tv, and parents often comply. There is also a status symbol associated with young students who take packets of instant noodles with them to school for snacks.Junk food commercials can be countered by attractive infomercials about a healthy diet. Following the pandemic, some television and radio stations started to broadcast programs on nutrition, but their reach is limited.When I was working in East Africa 10 years ago, an Ethiopian doctor shared his experience of combating childhood malnutrition in his country. “We made flour from dry-sprouted soya beans and chickpeas so that it had protein, vitamins, calcium and other micronutrients. It was cheap, easily available, and very easy to disseminate information about.”I keep sharing this information with health workers all over Nepal. But there is resistance because the Health Ministry in Kathmandu is not serious about promoting local food products aggressively enough.For example, sesame seeds have good fat, calcium, and mineral content, and can be given to children and pregnant mothers. Flax seeds contain omega-3 fatty acids and fibre. But we do not advertise these locally available superfoods, or use them in fighting malnutrition. Instead doctors prescribe imported capsules packaged by multinationals that contain the very same ingredients.Federal Ministries, especially Agriculture and Health, must coordinate with their provincial and municipal counterparts to fight malnutrition. It is not an exaggeration to say that the epidemic of junk food in Nepal is now emerging as a <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">public health crisis</a>.Aruna Uprety is a public health specialist and author of the 2017 book on nutrition, खाना खानुभयो?Read also: <a href="http://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">More exercise, less soft drinks …</a>, Sonia Awale

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We are what we eat

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91cc9c7e80680e06f10fjpeg.jpg" alt="" width="640" height="428"/>One thing we cannot complain about is that, for once, the world is not ignoring a humanitarian disaster in Nepal. They have even named a variant after us.Worried about the Delta strain spreading in his country, a UK official blamed the ‘Nepal variant’ for spoiling summer holiday plans for many Brits. The tabloid press, but even the BBC, dutifully headlined this, despite a WHO denial about a Nepali strain. But the damage was done. Just google ‘Nepal variant’ now.What the publicity has done is pushed the world to rush oxygen and medical supplies to Nepal. All help is useful in a crisis like this, but much of the aid being flown in contains items that Nepal is already buying in bulk in China.While there was a dire shortage of oxygen cylinders three weeks ago that led to loss of lives, the nature of the emergency has changed. Nepal’s 29 oxygen factories are now working at 100% capacity producing only medical oxygen, and soon there will be a surplus. The problem is not supply, but logistics and equitable distribution.What we really need are vaccines — most urgently for the 1.4 million Nepalis above 65 who got their first dose of Covishield AstraZeneca three months ago, and are now past the default date for their second after India banned its export.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91cf9c7e80680e06f110jpeg.jpg" alt="" width="640" height="318"><figcaption>India's total vaccine exports before it was stopped in March.</figcaption></figure>The lockdown should have bought us time for a mass vaccination drive, but once more we squandered two months shutting people in their homes. The restrictions did bring down the daily caseload, but infections are likely to spike again once mobility increases, just like last year.Instead of #NepalVariant trending on Twitter, we need #NepalVaccines to go viral. To be sure, the United States has pledged 80 million surplus doses, but only 7 million of that in the first phase is for the whole of South and Southeast Asia with a population of 1.5 billion. Supply bottlenecks mean the first shipments will not include AstraZeneca.Europe has a stockpile of AstraZeneca and more on order that are not going to be used, either because of slow uptake or because of fears of clots. In France, tens of thousands of doses have gone to waste. Norway and Denmark are not using  AstraZeneca anymore, and some of this may be channeled to Europe’s pledge to donate 100 million doses this year, sell 1.3 billion doses at cost price to low and middle-income countries, and donate another 1.3 billion doses in 2022, mostly through COVAX.The International Monetary Fund (IMF) last week announced a $50 billion plan to vaccinate 40% of the world population within 2021, and 60% by mid-2022. This is all encouraging news if it happens, but the long and short of it is that for Nepalis, neither the second doses nor vaccines for the larger population are getting here any time soon.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91d19c7e80680e06f111jpeg.jpg" alt="" width="640" height="282"><figcaption>Number of patients in ICU and ventilators in Nepal in May.</figcaption></figure>Even Andrew Pollard of Oxford University, an old Nepal hand, and one of the developers of the AstraZeneca vaccine says he feels helpless. <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNEqHFh4Fbf8IcsJ4g-XnTG5qP1SzA">He wrote in a column</a> in this paper recently: ‘I felt so proud when I saw the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNE6-2fepjLEOU19PSLjzWqAvKa05A">first doses of the Oxford vaccine being administered in Kathmandu</a>, and the hope that it brought to Nepalis, but I am now saddened to hear that further supply is delayed.’On Tuesday, the 60-65 age group in Kathmandu Valley, and 62-65 outside started being vaccinated with the 1 million extra doses of Sinopharm VeroCell donated by China. However, we need to get jabs to at least 19 million Nepali arms in the next few months to reduce the danger of a pre-Dasain surge, not to mention younger cohorts who are likely to be more vulnerable to a predicted third wave. Negotiations with Sinopharm to procure another 2 million doses are bogged down over a confidentiality clause in the contract.The only ‘Nepali variants’ we should be worried about are the country’s feckless and mutated politicians. Prime Minister Oli has replaced five Health Ministers since 2018, three of them since the pandemic began.Since vaccines are unlikely soon, <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNFBpfK-x_4CespExs5Gd3dW9_6oMA">public health experts have warned</a> us repeatedly that even after the lockdown is eased, and even if some people are vaccinated, the only way to prevent future surges is through <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNFrVgv5oLBXzAWQyNuTw7uc_DdWQA">proper masks and physical distancing</a>.A recent <a href="https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNHgAojjRlhejojvnimKSVT8uOMRbA">Yale study in Bangladesh</a> involving over 300,000 people showed that four simple actions led to a 10-time increase in mask wearing. Their <a href="https://docs.google.com/document/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://docs.google.com/document/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNGV_AM4_ATLpwI_uAwFRandfzstdA">four-fold path</a> includes: 1. Giving away free masks, 2. Spread information about how to wear them properly, 3. Get celebrities to promote mask-wearing, 4. Enforce mask-wearing through persuasion and punishment.Official figures <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNH48dysJncU5jxSSYZYwIF57tBcRw">grossly underestimate</a> the spread and fatality from Covid-19 in Nepal. A projection by the <a href="https://covid19.healthdata.org/nepal?view=daily-deaths&amp;tab=trend" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/nepal?view%3Ddaily-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1623211108062000&amp;usg=AFQjCNH24lI1y0n0i0mWO_OHRW4ckwQBxA">Institute for Health Metrics and Evaluation (IHME)</a> of the University of Washington School of Medicine in Seattle shows that on 31 May when the government reported 96 deaths from Covid-19, the actual number was closer to 363.IHME calculations also show that 1,000 fewer Nepalis will die by 1 September if 95% of people wore masks while outdoors. The government is hinting that the lockdown rules will be eased on 14 June. Since vaccines are still a long way off, our only protection is masks and minimising movement.

Nepal goes viral

<figure><img width="2038" height="1356" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86d59c7e80680e067877jpeg.jpg" alt=""/><figcaption>Universal mask wearing could save 2,211 lives in Nepal in the next three months, according to a new study. Photo: AMIT Machamasi</figcaption></figure>In its daily briefing on Saturday, the Ministry of Health announced that 4,311 people had tested positive for Covid-19, and 116 more people had died in 24 hours from the pandemic.Experts were encouraged by these figures, and took it as a sign that the<a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/"> second wave</a> had peaked. Indeed, the daily confirmed cases had dropped to half the level a week ago, and so had the positivity rate. Fatalities were also down from nearly 200 a day earlier this month.However, a new study shows that pandemic statistics the world over are fraught with inaccuracies, and the <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/">Nepal figures</a> are also a gross underestimation. The calculations show that new daily infections were probably closer to 120,000 on Saturday, and there were more than 700 deaths from Covid-19 nationwide—more than 30 times higher than official figures. The study by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine in Seattle goes beyond official confirmed figures to calculate <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’</a> and undetected Covid-19 infections.  ‘As terrible as the COVID-19 pandemic appears, this analysis shows that the actual toll is significantly worse,” said <a href="http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNE9LwJOecLypPgPl4neBePOrEG0gw">IHME Director Chris Murray</a>, revealing the results of the analysis this month. ‘Understanding the true number of Covid-19 deaths not only helps us appreciate the magnitude of this global crisis, but also provides valuable information to policymakers developing response and recovery plans.’The official figures for Nepal are frightening enough. The country has the world’s second-highest bi-weekly increase in deaths at 291%, and the highest national test positivity rate of 40%. Yet, Nepal conducts only 713 tests per million people, contact tracing is virtually non-existent, less than 2% of the 30 million population is fully vaccinated, and <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">mask-wearing</a> is at less than 65%. IHME’s graphs for Nepal show that during the early May peak when new confirmed cases were above 9,000 every day, the actual daily number was probably closer to 350,000. Nepal’s Ministry of Health’s total tally of fatalities is now 7,163, but the modelling shows that the actually total is 28,256. <figure><img width="2370" height="1010" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86da9c7e80680e067878jpeg.jpg" alt=""><figcaption> </figcaption></figure>Epidemiologists warn that if the official figures are so wrong, then the planning to meet the requirements for everything from test kits, hospital beds, ICU, <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">oxygen requirement,</a> ventilators, and even funerary planning would need to be re-evaluated and up-scaled.“We have known that under-reporting is widespread. The figures are underestimates, but the impact cannot be underestimated,” says virologist Sher Bahadur Pun at Teku Hospital. “For example, although we are just beginning to see a <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">plateauing</a> of the second wave, the increase in new cases is constant and the strain on the health system remains the same.”The IHME uses the <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’ model</a> to calculate a more accurate figure for the infection and death rate from Covid-19 by using data for previous years, and factoring in new variables to calculate how many more people are actually dying during the pandemic compared to pre-pandemic years.There are many factors affecting mortality during the pandemic: deaths directly due to Covid-19, increase in mortality because patients with pre-existing conditions are not getting the hospital care they need, or deaths due to mental disorders. However, there is also a reduction during the pandemic of deaths caused by high air pollution, fatalities from other air-borne infections like tuberculosis, measles or influenza, and even a drop in highway-traffic accidents. So, IHME modellers collected available data on excess mortality from Covid-19,  added an estimate the additional deaths that were not registered to came up with the total deaths from coronavirus. The results are shocking. The actual global death toll from Covid-19 is more than double the 3.5 million official figure. In India, the government’s figure for total fatalities till Saturday stood at 325,998, but the projections show that the actual deaths probably at more than 1 million. Although the death rate is going down, IHME says India’s cumulative deaths from Covid-19 could be 1.2 million by 1 September. In Nepal, even official data shows a steep spike during the whole of May as Nepali workers started arriving from India with the fast-spreading B.1.617 variant. But on 1 May when the confirmed daily Covid-19 deaths was showing only 32, the model shows that 117 people were already dying every day nationwide from the disease. Within two weeks, even when the official total had soared to 205, the graphs show that the excess daily mortality was already 742. The reason for the discrepancy was that mostly hospital deaths were being counted, and the death registration system is inaccurate and late.  <figure><img width="2350" height="1014" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86dc9c7e80680e067879jpeg.jpg" alt=""><figcaption> </figcaption></figure>Epidemiologist Lhamo Yangchen Sherpa says the graphs just prove what everyone knew all along: testing is inadequate and even the distribution of testing facilitates is lop-sided. For example, 29 of 42 labs with RT PCR testing capacity in Bagmati Province are clustered within Kathmandu Valley. The whole of Gandaki province is reliant on three labs in Pokhara.She adds: “People in<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/"> remote parts of Nepal like Solukhumbu</a> have to walk for days to give their swab sample, which is then sent to a lab in Biratnagar. By the time result is back, a week has passed by and many of them are already sick.” Most of the returnees from India were never tested, and went straight home without quarantine, becoming data blind spots and skewing transmission numbers beyond Nepal’s limited testing capacity. Even though the national case numbers have gone down, experts say it is raging across rural Nepal—but there is no way to quantify it because of the lack of testing.Epidemiologist Sherpa recommends rapid turnaround of antigen tests to reduce time lost waiting for PCR results in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">rural Nepal</a>. She says, “Patients show symptoms in five days but are contagious from the third day onwards. To avoid further spread in that crucial 48 hours, we must increase access to tests but also bring down the time it takes to get the result.”But targeted testing of symptomatic patients in remote districts like Rolpa and Humla have shown a staggering 90% positivity rate. Because of the lack of hospital care and the absence of medical oxygen, many die at home and the numbers never feed into the daily count announced in Kathmandu every evening.Virologist Pun at the Teku Hospital says effective contact tracing would provide the most accurate situation report, but that is not happening. He says, “The 70-80 daily new cases during the first wave were mostly asymptomatic travellers needing mandatory checks and their traced contacts. But in the more severe second wave, there is no contact tracing at all.”  <figure><img width="2350" height="952" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86df9c7e80680e06787ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Experts like Moshfiq Mobarak of Yale University say that the most effective strategy for countries with fragile health systems like Nepal to reduce fatalities is a three-pronged approach that aggressively promotes mask-wearing, responds to localised surges, as well as last-mile vaccine delivery.Mask-wearing alone has been proven in a trial in Bangladesh to show that a vigorous campaign for no-cost mask distribution, aggressive awareness drive, and punishment for non-wearers tripled the number of people using masks properly.‘This is an extremely cost-effective way to reduce transmission risk and save lives,’ Mobarak said in an op-<a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/">ed he co-wrote for Nepali Times last week. </a>Indeed, the IHME model also proves that direct impact of mask wearing in Nepal. The modelling shows that the total coronavirus death toll in Nepal by 1 September will be at 44,711 if mobility went up to pre-Covid levels. However, if 95% of Nepalis wore masks in public at all times, the number of deaths would be reduced to 42,500. This means 2,211 lives would be saved just by universal mask-wearing in the next three months.Even though Nepal’s second wave may be susbsiding, experts say the country will take longer to come out of it than neighbours India or Bangladesh despite the lockdown. This is because of the lack of vaccines, mask-wearing at less than 65%, as well as lack of mass testing. Nepal’s seven-day decrease in new caseloads post-peak is estimated to be around 7.45% compared to India's 12.8%.

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Nepal Covid-19 impact worse than official figures

<figure><img width="2038" height="1356" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceedd9c7e80680e09ae54jpeg.jpg" alt=""/><figcaption>Universal mask wearing could save 2,211 lives in Nepal in the next three months, according to a new study. Photo: AMIT Machamasi</figcaption></figure>In its daily briefing on Saturday, the Ministry of Health announced that 4,311 people had tested positive for Covid-19, and 116 more people had died in 24 hours from the pandemic.Experts were encouraged by these figures, and took it as a sign that the<a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/"> second wave</a> had peaked. Indeed, the daily confirmed cases had dropped to half the level a week ago, and so had the positivity rate. Fatalities were also down from nearly 200 a day earlier this month.However, a new study shows that pandemic statistics the world over are fraught with inaccuracies, and the <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/">Nepal figures</a> are also a gross underestimation. The calculations show that new daily infections were probably closer to 120,000 on Saturday, and there were more than 700 deaths from Covid-19 nationwide—more than 30 times higher than official figures. The study by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine in Seattle goes beyond official confirmed figures to calculate <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’</a> and undetected Covid-19 infections.  ‘As terrible as the COVID-19 pandemic appears, this analysis shows that the actual toll is significantly worse,” said <a href="http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNE9LwJOecLypPgPl4neBePOrEG0gw">IHME Director Chris Murray</a>, revealing the results of the analysis this month. ‘Understanding the true number of Covid-19 deaths not only helps us appreciate the magnitude of this global crisis, but also provides valuable information to policymakers developing response and recovery plans.’The official figures for Nepal are frightening enough. The country has the world’s second-highest bi-weekly increase in deaths at 291%, and the highest national test positivity rate of 40%. Yet, Nepal conducts only 713 tests per million people, contact tracing is virtually non-existent, less than 2% of the 30 million population is fully vaccinated, and <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">mask-wearing</a> is at less than 65%. IHME’s graphs for Nepal show that during the early May peak when new confirmed cases were above 9,000 every day, the actual daily number was probably closer to 350,000. Nepal’s Ministry of Health’s total tally of fatalities is now 7,163, but the modelling shows that the actually total is 28,256. <figure><img width="2370" height="1010" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceee09c7e80680e09ae55jpeg.jpg" alt=""><figcaption>Cumulative deaths in Nepal by 1 September under pre-Covid mobility scenario, scaled top vaccination drive by then, and if 95% of people wore masks while outdoors. Source of all graphs: IHME University of Washington / Nepal Ministry of Health and Population</figcaption></figure>Epidemiologists warn that if the official figures are so wrong, then the planning to meet the requirements for everything from test kits, hospital beds, ICU, <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">oxygen requirement,</a> ventilators, and even funerary planning would need to be re-evaluated and up-scaled.“We have known that under-reporting is widespread. The figures are underestimates, but the impact cannot be underestimated,” says virologist Sher Bahadur Pun at Teku Hospital. “For example, although we are just beginning to see a <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/">plateauing</a> of the second wave, the increase in new cases is constant and the strain on the health system remains the same.”The IHME uses the <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths&amp;source=gmail&amp;ust=1622442215950000&amp;usg=AFQjCNGW9ufUy8M70_z6NyotWDzInxyG1A">‘excess mortality’ model</a> to calculate a more accurate figure for the infection and death rate from Covid-19 by using data for previous years, and factoring in new variables to calculate how many more people are actually dying during the pandemic compared to pre-pandemic years.There are many factors affecting mortality during the pandemic: deaths directly due to Covid-19, increase in mortality because patients with pre-existing conditions are not getting the hospital care they need, or deaths due to mental disorders. However, there is also a reduction during the pandemic of deaths caused by high air pollution, fatalities from other air-borne infections like tuberculosis, measles or influenza, and even a drop in highway-traffic accidents. So, IHME modellers collected available data on excess mortality from Covid-19,  added an estimate the additional deaths that were not registered to came up with the total deaths from coronavirus. The results are shocking. The actual global death toll from Covid-19 is more than double the 3.5 million official figure. In India, the government’s figure for total fatalities till Saturday stood at 325,998, but the projections show that the actual deaths probably at more than 1 million. Although the death rate is going down, IHME says India’s cumulative deaths from Covid-19 could be 1.2 million by 1 September. In Nepal, even official data shows a steep spike during the whole of May as Nepali workers started arriving from India with the fast-spreading B.1.617 variant. But on 1 May when the confirmed daily Covid-19 deaths was showing only 32, the model shows that 117 people were already dying every day nationwide from the disease. Within two weeks, even when the official total had soared to 205, the graphs show that the excess daily mortality was already 742. The reason for the discrepancy was that mostly hospital deaths were being counted, and the death registration system is inaccurate and late.  <figure><img width="2350" height="1014" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceee39c7e80680e09ae56jpeg.jpg" alt=""><figcaption>Daily deaths is the best indicator of the progression of the pandemic. This graph shows the discrepancy between official figures and total Covid-19 daily fatalities factoring in 'excess mortality'. There is usually a 3-week lag between infection and death.</figcaption></figure>Epidemiologist Lhamo Yangchen Sherpa says the graphs just prove what everyone knew all along: testing is inadequate and even the distribution of testing facilitates is lop-sided. For example, 29 of 42 labs with RT PCR testing capacity in Bagmati Province are clustered within Kathmandu Valley. The whole of Gandaki province is reliant on three labs in Pokhara.She adds: “People in<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/"> remote parts of Nepal like Solukhumbu</a> have to walk for days to give their swab sample, which is then sent to a lab in Biratnagar. By the time result is back, a week has passed by and many of them are already sick.” Most of the returnees from India were never tested, and went straight home without quarantine, becoming data blind spots and skewing transmission numbers beyond Nepal’s limited testing capacity. Even though the national case numbers have gone down, experts say it is raging across rural Nepal—but there is no way to quantify it because of the lack of testing.Epidemiologist Sherpa recommends rapid turnaround of antigen tests to reduce time lost waiting for PCR results in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">rural Nepal</a>. She says, “Patients show symptoms in five days but are contagious from the third day onwards. To avoid further spread in that crucial 48 hours, we must increase access to tests but also bring down the time it takes to get the result.”But targeted testing of symptomatic patients in remote districts like Rolpa and Humla have shown a staggering 90% positivity rate. Because of the lack of hospital care and the absence of medical oxygen, many die at home and the numbers never feed into the daily count announced in Kathmandu every evening.Virologist Pun at the Teku Hospital says effective contact tracing would provide the most accurate situation report, but that is not happening. He says, “The 70-80 daily new cases during the first wave were mostly asymptomatic travellers needing mandatory checks and their traced contacts. But in the more severe second wave, there is no contact tracing at all.”  <figure><img width="2350" height="952" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131128/636ceee69c7e80680e09ae57jpeg.jpg" alt=""><figcaption>Estimated infections in Nepal, showing the first and second waves, and the impact of mask-wearing.</figcaption></figure>Experts like Moshfiq Mobarak of Yale University say that the most effective strategy for countries with fragile health systems like Nepal to reduce fatalities is a three-pronged approach that aggressively promotes mask-wearing, responds to localised surges, as well as last-mile vaccine delivery.Mask-wearing alone has been proven in a trial in Bangladesh to show that a vigorous campaign for no-cost mask distribution, aggressive awareness drive, and punishment for non-wearers tripled the number of people using masks properly.‘This is an extremely cost-effective way to reduce transmission risk and save lives,’ Mobarak said in an op-<a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/">ed he co-wrote for Nepali Times last week. </a>Indeed, the IHME model also proves that direct impact of mask wearing in Nepal. The modelling shows that the total coronavirus death toll in Nepal by 1 September will be at 44,711 if mobility went up to pre-Covid levels. However, if 95% of Nepalis wore masks in public at all times, the number of deaths would be reduced to 42,500. This means 2,211 lives would be saved just by universal mask-wearing in the next three months.Even though Nepal’s second wave may be susbsiding, experts say the country will take longer to come out of it than neighbours India or Bangladesh despite the lockdown. This is because of the lack of vaccines, mask-wearing at less than 65%, as well as lack of mass testing. Nepal’s seven-day decrease in new caseloads post-peak is estimated to be around 7.45% compared to India's 12.8%.

<figure><img width="933" height="622" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85d19c7e80680e067815jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The deadly COVID-19 surge that has engulfed neighbouring India appears to be spilling over into Nepal. <a href="https://covid19.healthdata.org/nepal?view=daily-deaths&amp;tab=trend" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/nepal?view%3Ddaily-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNGfuMEKH4nbyw3hcxqFK7i15jQZ4w">Daily deaths have been exploding</a>. The experience from India shows that fragile health systems can get overwhelmed quickly leading to needless suffering: <a href="https://www.nytimes.com/2021/04/23/world/asia/india-covid-oxygen-hospitals.html" data-saferedirecturl="https://www.google.com/url?q=https://www.nytimes.com/2021/04/23/world/asia/india-covid-oxygen-hospitals.html&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNENS9eia0jqVilkrcyyhhNE-jxYyw">citizens’ pleas for oxygen</a>, lack of ICU beds and medicines. Tackling this threat requires Nepal to adopt a three-pronged approach immediately: <ol><li>Promote consistent mask-wearing to contain the spread of disease, especially in rural areas where the healthcare infrastructure is even more deficient.</li><li>Prepare a healthcare response in the event of localised surges</li><li>Prepare for quick last-mile vaccination delivery, in anticipation of vaccine arrival. </li></ol>There are rigorous evidence-based strategies to implement such a response, as Nepal’s other South Asian neighbours are doing.  On mask-wearing, researchers at Yale University and Stanford University, together with the non-profits Innovations for Poverty Action and GreenVoice ran a large-scale (350,000 adults) randomised controlled trial to identify <a href="http://tinyurl.com/maskpromotion" data-saferedirecturl="https://www.google.com/url?q=http://tinyurl.com/maskpromotion&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNE53xG48uOd3u-buWDHQbA4AgkJ1Q">a precise combination of strategies</a> that are successful in changing <a href="http://tinyurl.com/maskpromotion" data-saferedirecturl="https://www.google.com/url?q=http://tinyurl.com/maskpromotion&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNE53xG48uOd3u-buWDHQbA4AgkJ1Q">mask-wearing norms</a>. Randomised controlled trials are the same techniques used to test vaccine efficacy. When the strategies were jointly implemented, they tripled mask-wearing in rural Bangladesh, and this effect was persistent over 10 weeks of observation, including after the intervention activities ended. These four strategies form the NORM model: No-Cost masks distributed at scaleOffering Information on mask-wearingReinforcement in public places by intercepting non-mask wearersModelling and endorsement by trusted leaders   <img width="1540" height="918" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85d49c7e80680e067816jpeg.jpg" alt="">The researchers tested a dozen other strategies like verbal commitments, text message reminders, social signaling, involving the village police in reinforcement, and even village-level monetary rewards, but none of these were successful in increasing mask-wearing rates any further. The basic NORM model without these unnecessary add-ons is an extremely cost-effective way to reduce transmission risk and save lives. Why do these strategies work?  Door-to-door distribution with messaging makes it public knowledge that everyone in the community was given a mask, and neighbors are aware of the public health threat of not wearing one. Public, in-person reinforcement creates some social shame from being confronted by a stranger and creates incentives for people to carry the mask to avoid the awkward confrontation. The endorsement from community leaders makes the program personal and credible. The Stanford engineers on the research team produced high-quality reusable, washable masks that can be procured very quickly and cheaply in South Asia. The research team also provides <a href="https://docs.google.com/document/u/0/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit" data-saferedirecturl="https://www.google.com/url?q=https://docs.google.com/document/u/0/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNHmPxf6BzdhtcBRIRgO3QCt-_dj8g">detailed implementation protocols</a> for all project activities, to make each step <a href="http://tinyurl.com/maskprotocol" data-saferedirecturl="https://www.google.com/url?q=http://tinyurl.com/maskprotocol&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNFdN78xGI1kCVezL4844eoi9DjiIA">easily and quickly implementable</a> for governments.    The results of this study  were so compelling that state governments and groups in India, Pakistan and Bangladesh have quickly moved to implement the NORM model, and it has drawn headlines such as ‘<a href="https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html" data-saferedirecturl="https://www.google.com/url?q=https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNFF_oND2c2C6cn24lnj8UqJQK1crQ">India draws lessons from Bangladesh’s mask study</a>’, in a leading newspaper in India. In India, SEWA (Self-Employed Women’s Association) is distributing 3-5 million masks and has implemented the model for 1 million people in Gujarat. The Mayor of Dhaka North quickly mobilised a consortium of partners within 48 hours to implement in crowded shopping malls and at transit hubs before the Eid travel rush.   <img width="640" height="634" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85d79c7e80680e067817jpeg.jpg" alt="">The commissioner of Lahore and the health minister of Khyber-Pakhtunkhwa Province in Pakistan have mobilised staff and resources to implement after Ramadan. BRAC, the world’s largest non-governmental organisation, is poised to reach 77 million people in Bangladesh with the NORM masking interventions, along with associated healthcare responses and vaccine preparation strategies. This model of community-level mask distribution, promotion, and reinforcement can serve as the anchor to cost-effectively deliver the other necessary components of an effective COVID response strategy: empowering community health workers to provide more accurate treatment options to those who fall ill, and undertaking the activities required to overcome vaccine hesitancy and facilitate vaccine registration.  In both India and Bangladesh, SEWA and BRAC are taking advantage of the economies of scale in mask delivery to also set up Covid care centres to take pressure off hospitals. Distinguishing effective from inaccurate treatment strategies requires medical expertise and clinical experience. We have partnered with the <a href="https://science.swasth.app/" data-saferedirecturl="https://www.google.com/url?q=https://science.swasth.app/&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNH_Trj1oFBrdZZoMibJpLTZTEhGVA">Swasth </a><a href="https://science.swasth.app/" data-saferedirecturl="https://www.google.com/url?q=https://science.swasth.app/&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNH_Trj1oFBrdZZoMibJpLTZTEhGVA">Alliance</a> convened by a professor at Harvard Medical School to create training manuals on effective Covid treatment plans for community health workers. We have also collected large-sample data to <a href="https://www.medrxiv.org/content/10.1101/2021.03.11.21253419v1" data-saferedirecturl="https://www.google.com/url?q=https://www.medrxiv.org/content/10.1101/2021.03.11.21253419v1&amp;source=gmail&amp;ust=1621659959142000&amp;usg=AFQjCNF7p-2nFnzjsaUPM_uK7qO3Db08rg">systematically understand the nature of vaccine hesitancy</a> in Nepal, and other low and middle-income countries, to inform the design of vaccine campaigns.   Quick implementation of the NORM model in Nepal is feasible with decisive leadership and political will, as other South Asian neighbours are doing. Our international research team stands ready to provide any necessary technical support to adapt the model, share all implementation protocols, and monitor results to aid further tinkering and any necessary course-correction, as we have done for our other partners in India, Pakistan, and Bangladesh. The team is not looking for any monetary or research rewards. The evidence is convincing that this is a cost-effective way to stem Covid transmission and save lives, and we would therefore like to facilitate implementation by the Nepali government or other local non-government actors.    Mushfiq Mobarak is Professor of Economics, Yale University, and Neela Saldanha has a PhD in marketing from the Wharton School of the University of Pennsylvania and an MBA from the Indian Institute of Management, Calcutta. To support:<a target="_blank" href="https://docs.google.com/forms/d/e/1FAIpQLSfMJkyBBtK74lqSsHZnx_8qb0_sJ0WaR7A7XA8IQHAobrBEQA/viewform" style="letter-spacing: normal; margin: 0px; padding: 0px; border: 0px; outline: 0px; font-size: 14px; font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;" rel="noopener noreferrer">https://docs.google.com/forms/d/e/1FAIpQLSfMJkyBBtK74lqSsHZnx_8qb0_sJ0WaR7A7XA8IQHAobrBEQA/viewform</a> <table style="letter-spacing: normal; margin-bottom: 0px; padding: 0px; border-top-width: 0px; border-left-width: 0px; outline: 0px; font-size: 14px; font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;"><tbody style="margin: 0px; padding: 0px; border: 0px; outline: 0px; font-style: inherit; font-size: 1em; font-family: inherit; vertical-align: baseline;"><tr style="margin: 0px; padding: 0px; border: 0px; outline: 0px; font-style: inherit; font-size: 1em; font-family: inherit; vertical-align: baseline;"><td style="margin: 0px; padding: 0px; border-right-width: 0px; border-bottom-width: 0px; outline: 0px; font-style: inherit; font-size: 1em; font-family: inherit; vertical-align: baseline;"> </td> </tr></tbody></table><img width="84" height="109" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85da9c7e80680e067818jpeg.jpg" alt=""><img width="82" height="109" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85db9c7e80680e067819jpeg.jpg" alt="">

3-pronged strategy to save Nepal from Covid-19

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131120/636ced0a9c7e80680e09ad9fjpeg.jpg" alt="" width="1024" height="658"/><figcaption></figcaption></figure>Nepal’s Covid-19 crisis has figured in a US Senate Foreign Relations Committee hearing in Washington on Wednesday, where members heard USAID officials, and urged a more urgent response.Democratic Senator Chris Murphy of Connecticut said he was concerned that the situation in Nepal was even more serious, after India stopped the export of vaccines.Meanwhile the first US legislator of Nepali-origin Harry Bhandari from Maryland has started a signature campaign calling on President Joe Biden to rush urgent medical aid to Nepal.Responding to the queries from senators at the hearing, Jeremy Konyndyk of USAID admitted the situation in Nepal was serious, that the high positivity rate meant there was an urgent need for more testing.Last week, the group <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/&amp;source=gmail&amp;ust=1621001079983000&amp;usg=AFQjCNExp09ZvwY7OX2ArKmLNmcLJlnyLw">The Covid Alliance for Nepal</a> wrote to the US Ambassador to Nepal Randy Berry to urge him to help secure the AstraZeneca vaccine from the US stockpile. Nearly 1.3 million people in Nepal who have received the first dose of the AstraZeneca Covishield vaccine are waiting for the second dose, amidst uncertainty after India banned its export.Meanwhile, US Indo-Pacific Command announced on Thursday that it is giving Nepal $2.85 million to acquire oxygen plants, cylinders and storage tanks, as well as PPE, isolation centre equipment and other gear. USAID also announced that it had given various agencies of the Nepal government nearly $51 million to fight the pandemic.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131120/636ced0e9c7e80680e09ada0jpeg.jpg" alt="" width="1176" height="1080">Also on Thursday, deputy Prime Minister Ishwar Pokhrel called US Ambassador Berry asking for urgent help with AstraZeneca vaccines. Pokhrel said Berry had assured him that he was also urging Washington about the need for vaccines, and that he would keep the Nepal government informed.In return Berry also requested Pokhrel, who heads the Covid-19 Control and Management Committee (CCMC) to restore two flights a week from Kathmandu to evacuate its nationals stuck in Nepal to return to the United States. All international and domestic flights in Nepal have been grounded till 31 May, and the lockdown in Kathmandu has been extended till 27 May.In a separate development, the European Union is also extending €2 million in humanitarian funding to Nepal that will be used to monitor home isolated cases through tele-medicine services and rapid referral to hospitals, national emergency medical teams deployment and international emergency medical teams mobilisation facilitation as well as procurement of oxygen equipment including oxygen concentrators, cylinders, home care kits, diagnostics including antigen test kits and PPE.Nepal has also activated the EU Civil Protection Mechanism, and Finland is the first member to offer more than 2 million surgical masks, 350,000 FFP2 masks, 52,500 pairs of vinyl gloves and 30,000 isolation gowns."We stand in full solidarity with Nepal in its fight against the pandemic and are quickly mobilising emergency support with initial €2 million funding, and we stand ready to provide further assistance,”  said EU Commissioner for Crisis Management, Janez Lenarčič.

International help for Nepal picks up

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84ec9c7e80680e0677c2jpeg.jpg" alt="" width="1024" height="658"/><figcaption></figcaption></figure>Nepal’s Covid-19 crisis has figured in a US Senate Foreign Relations Committee hearing in Washington on Wednesday, where members heard USAID officials, and urged a more urgent response.Democratic Senator Chris Murphy of Connecticut said he was concerned that the situation in Nepal was even more serious, after India stopped the export of vaccines.Meanwhile the first US legislator of Nepali-origin Harry Bhandari from Maryland has started a signature campaign calling on President Joe Biden to rush urgent medical aid to Nepal.Responding to the queries from senators at the hearing, Jeremy Konyndyk of USAID admitted the situation in Nepal was serious, that the high positivity rate meant there was an urgent need for more testing.Last week, the group <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/&amp;source=gmail&amp;ust=1621001079983000&amp;usg=AFQjCNExp09ZvwY7OX2ArKmLNmcLJlnyLw">The Covid Alliance for Nepal</a> wrote to the US Ambassador to Nepal Randy Berry to urge him to help secure the AstraZeneca vaccine from the US stockpile. Nearly 1.3 million people in Nepal who have received the first dose of the AstraZeneca Covishield vaccine are waiting for the second dose, amidst uncertainty after India banned its export.Meanwhile, US Indo-Pacific Command announced on Thursday that it is giving Nepal $2.85 million to acquire oxygen plants, cylinders and storage tanks, as well as PPE, isolation centre equipment and other gear. USAID also announced that it had given various agencies of the Nepal government nearly $51 million to fight the pandemic.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84ef9c7e80680e0677c3jpeg.jpg" alt="" width="1176" height="1080">Also on Thursday, deputy Prime Minister Ishwar Pokhrel called US Ambassador Berry asking for urgent help with AstraZeneca vaccines. Pokhrel said Berry had assured him that he was also urging Washington about the need for vaccines, and that he would keep the Nepal government informed.In return Berry also requested Pokhrel, who heads the Covid-19 Control and Management Committee (CCMC) to restore two flights a week from Kathmandu to evacuate its nationals stuck in Nepal to return to the United States. All international and domestic flights in Nepal have been grounded till 31 May, and the lockdown in Kathmandu has been extended till 27 May.In a separate development, the European Union is also extending €2 million in humanitarian funding to Nepal that will be used to monitor home isolated cases through tele-medicine services and rapid referral to hospitals, national emergency medical teams deployment and international emergency medical teams mobilisation facilitation as well as procurement of oxygen equipment including oxygen concentrators, cylinders, home care kits, diagnostics including antigen test kits and PPE.Nepal has also activated the EU Civil Protection Mechanism, and Finland is the first member to offer more than 2 million surgical masks, 350,000 FFP2 masks, 52,500 pairs of vinyl gloves and 30,000 isolation gowns."We stand in full solidarity with Nepal in its fight against the pandemic and are quickly mobilising emergency support with initial €2 million funding, and we stand ready to provide further assistance,”  said EU Commissioner for Crisis Management, Janez Lenarčič.

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7899c7e80680e0967ccjpeg.jpg" alt="" width="640" height="360"/>Active cases of Covid-19 in Nepal have soared to over 30,000, from approximately 600 in February. 5% of those infected have been requiring hospital admissions.Hospitals in major cities are already starting to feel the pressure. Nepal has a total of 18,917 general beds, 1,486 ICUs and 634 ventilators.Health Minister Hridayesh Tripathi in an interview with Nepali Times on Wednesday warned that our health system cannot contain the pandemic at the rate people are getting infected.Excerpts:Nepali Times: Covid-19 patients are not getting hospital beds. How often do you get calls from people asking you for help?Hridayesh Tripathi: The <a href="https://www.nepalitimes.com/latest/first-signs-of-the-second-wave/">second wave</a> is more contagious and lethal, often times symptoms appear towards the end when patients require ICU or ventilator support. As a result, there is higher demand. We have increased the number of beds but they are still not enough. This is the case also in the world’s most developed countries.We are already working on our plan to build 5-15 beds capacity hospitals in each municipality. We are the first in South Asia to adopt such an ambitious program.The decision to connect 2,000 HDUs (High Dependency Units with oxygen) across the country with 50 beds in each province have fallen by the wayside, however.The ministry has already completed all the procedures and distributed 2,000 HDU connections. It has been installed successfully in few areas but for the most part, it has not happened due to negligence and delay.You warned that cases will peak in July in Nepal. At the rate people are getting infected, will our infrastructure be enough?We might be reporting <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/">11,000 new cases a day by July</a>. But our health system is already saturated.When I made that point based on the <a href="https://www.nepalitimes.com/editorial/its-not-over-yet/">projections</a> by the ministry and WHO, I was ridiculed, some joked that I should become an astrologer, and others accused me of fear-mongering. At the time new variants had not even been identified in Nepal. This is to say that the total infections might be more than what we forecast previously.https://www.youtube.com/watch?v=O5eroEP1AG4&amp;t=5sYou pointed to the need for vigilance before New Year. District administration offices have just started to enforce restrictions. Why it was not implemented on time?Our effort has been on not to impose nationwide lockdown if possible taking into account its impact on our economy. We tried to find an alternative but the public didn’t take the latest surge seriously despite the government’s repeated appeal to follow safety measures.Both political parties and communities are responsible for the second wave. I request everyone to <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">adhere to health standards.</a>Why did the government then impose a lockdown for 15 days? If the number of active cases in hill and mountain districts exceed 200 and 500 in urban centres, the Chief District Officer may issue a restraining order in those areas on the recommendation of the District Covid-19 Crisis Management Center (DCMC).It takes at least 10 to 14 days to break the chain of the infection, which is why we have placed prohibitory order for two weeks.Will we have lockdown for an extended period like last year?Not if everyone follows the order. But if <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/">people neglect it</a>, I can’t say how long it will last.What has the government done to prevent rapid community spread as it happened last year when Nepali migrants from India returned home?We have arranged to send returnee Nepalis home after antigen tests. Foreign nationals must have a negative PCR test to enter Nepal either via road or air. Everyone must quarantine.We have received over 3 million doses of vaccines from India and China. One million doses of Covishield from Serum Institute of India that you paid for haven't arrived. What is holding things up? Only a small number of <a href="https://www.nepalitimes.com/latest/nepal-braces-for-new-wave-with-vaccine-drive/">vaccines</a> have been approved for use and we lack storage infrastructure for some of those shots. So we have limited options and the Department of Drug Administration has approved some vaccines accordingly. After the initial <a href="https://www.nepalitimes.com/latest/the-gift-of-the-jab/">donation from India</a>, we even bought 2 million doses of Covishield from the Serum Institute.We then offered to buy 5 million more. But the local agent here in Nepal of the manufacturing company asked for 10% in commission, forcing us to step back. The involvement of middlemen, who were also present when we bought the vaccine for $4 per dose complicated the procurement for 27 days. By then, infections began to soar in India and thre were restrictions on export.If so, will everyone who received the first dose also get their second within the prescribed period? People are getting a <a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/">second dose</a>. Everyone who got the first one will also receive the booster shot.We have used all the options to bring the vaccine. We even asked the private sector but no one applied. The government has decided to approve no more than 10% profit for importers, which seems to have demotivated them.We have also approved the <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/">Sputnik V</a> vaccine and the Russian government is manufacturing vaccines in Nepal with selected private companies.The British Ambassador has committed to providing additional 2 million doses to Nepal. The US ambassador gave us his word that he will also help with the vaccine.Of the 14.8 million doses we pledged under the WHO’s COVAX initiative, we have received only 348,000 doses. Vaccines may seem like a health and commercial product, but, fundamentally, we are at the mercy of vaccine politics.What about the availability of oxygen?Patients of the new variant require three times more oxygen than those infected by the original strain. But we should be more concerned about cylinders than oxygen because they are occupied as long as patients are undergoing treatment. We are planning to buy 40,000 cylinders, and are talking with the UAE and the Korean ambassadors.Who should people struggling with lack of hospital beds contact?Kathmandu has the infrastructure, treatment won’t be a problem as of now. We can’t say the same for Nepalganj. I also see challenges in Birganj.We are working tirelessly to develop the infrastructure required, which is why we are building hospitals with HDUs in all municipalities. We have already deployed skilled human resources and budget across the country.  We are evaluating the situation as the second wave spreads.

“Our health system can’t contain the pandemic”

<figure><img width="945" height="727" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce72c9c7e80680e0967aajpeg.jpg" alt=""/><figcaption>Nepali family living in Goa for the past 10 years: Amar Tiruva and his wife Radha with their daughter, Antara. Radha died this week, and Amar is in a ventilator. Antara is being cared for by a neighbourhood church.</figcaption></figure>Amar Tiruva and his wife Radha have been living in Goa for the past ten years. They have an 11-year-old daughter, Antara.The family was happy in the former Portuguese enclave, with a comfortable job in the city. Although they had been feeling the impact of the pandemic, everything changed two weeks ago.Both Amar and Radha, who are in their thirties, tested positive for Covid-19. As their condition worsened, the couple was admitted to Goa Medical College for treatment, while social workers from a neighbourhood church looked after Antara. <img width="545" height="905" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce72e9c7e80680e0967abjpeg.jpg" alt="">On 24 April, Radha succumbed to the virus, and Amar’s condition is getting worse. He is unconscious in a ventilator, unaware that his wife has died. It took three days for volunteers to cremate Radha’s body because of the long queue at the crematorium. Antara has been told that her mother did not make it, and is distraught. Amar’s 80-year-old mother in Nepal’s Kailali district is herself not in good health. She prays for her son’s recovery, and feels helpless so far away, says Amar’s nephew Kamal who lives in Mumbai but cannot go to Goa because of the travel restrictions.The Tiruva family’s struggle and tragedy is just a drop in India’s vast ocean of grief as the Subcontinent is engulfed in the <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/" target="_blank" rel="noopener noreferrer">Covid-19 second wave</a>. India is recording more than 300,000 new cases every day for the past five days (see graphs below), and the official death toll this week exceeded 200,000. However, public health experts say these figures are a gross underestimation.   <figure><img width="1432" height="793" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7309c7e80680e0967acjpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="828" height="702" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7339c7e80680e0967adjpeg.jpg" alt=""><figcaption> </figcaption></figure>There are an estimated 3 million Nepalis <a href="https://www.nepalitimes.com/latest/the-long-journey-to-nepal/" target="_blank" rel="noopener noreferrer">working all over India</a>, but the number could be higher since no records are kept of seasonal migrants. Officially, 40 Nepalis have died in the current Covid-19 surge in India, with 100 hospitalised, but that number is certainly much higher.The Nepal Embassy in New Delhi has been inundated with calls for help, but has been able to do little more than issue a statement asking Nepalis in India to observe all health precautions since the hospitals are all full. Ambassador Nilambar Acharya says he has also been lobbying with the Indian government to lift the export ban on the Covishield vaccine manufactured by Serum Institute of India.<a href="https://www.nepalitimes.com/latest/the-india-connection-in-nepals-covid-19-status/">The India connection in Nepal’s COVID-19 status</a>, Nepali TimesIndia <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">gifted Nepal 1 million doses in February</a>, and Nepal paid for 2 million more doses, but only half the consignment arrived before India diverted vaccines to address its own emergency. Ambassador Acharya said, “The Indian government has assured us that it will put Nepal on a priority for vaccines.”R B Khadka of the Akhil Bharat-Nepali Ekata Manch maintains a network of Nepalis all over India, and had been helping those in need since last year. But he says the scale of the crisis this time is too big to handle, adding that with the shortage of hospital beds, oxygen supply for Indians, there is little hope for Nepalis, particularly poorer migrant labourers.“I am getting calls day and night from desperate Nepalis asking if I can arrange an oxygen cylinder, a hospital bed or for remdesivir, I have lost hope and I cannot lie to them anymore and say I will try to help,” Khadka told Nepali Times. <figure><img width="2250" height="1600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7359c7e80680e0967aejpeg.jpg" alt=""><figcaption> </figcaption></figure>Another Nepali resident, Hari Raila, ran a small eatery in Delhi’s Paharganj neighbourhood. His condition had been getting steadily worse, and he was being transported by ambulance to the Nepal border but died on the way in Uttar Pradesh’s Muradabad as he struggled to breathe.All this week, relatives of another Nepali, Bishnu Paudyal, had been trying unsuccessfully to get him admitted to a hospital in the suburbs like Guragaon, Ghaziabad and Faridabad. But he couldn’t get a bed, and died from lack of oxygen in his blood on Tuesday.Some Nepalis like Raila are even being taken to Nepal, in the belief that things are better there. Others have been heading to hospitals as far as Rajasthan and Madhya Pradesh. But private hospitals charge as much as IRs500,000 to IRs2million to admit patients. Ambulances cost IRs15,000 to take patients to hospital, and few Nepalis can afford that. Remdisvir is selling for Rs20,000 per dose in the black market. From Mumbai, Kamal Tiruva says he would like to take his nephew back to Nepal from Goa, but knows it is impossible.<a href="https://www.nepalitimes.com/latest/indians-use-nepal-to-circumvent-travel-bans/">Indians use Nepal to circumvent travel bans</a>, Nepali Times <figure><img width="1125" height="1500" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7399c7e80680e0967afjpeg.jpg" alt=""><figcaption> </figcaption></figure>On 26 April, the New Delhi-based South Asian University issued a notice to all students to evacuate its hostel. Some Nepali students have no alternatives, and have stayed on despite having tested positive.“Although the University has issued a notice, there is nowhere to go,” says Bipin Ghimire, a PhD student of International Relations, who says hospitals this week turned back Nepali students who were sick. “We saw patients in stretchers waiting in the corridors, doctors were attending to them outdoors.”Ghimire continues to self-quarantine in the hostel itself, but Makan Tamang along with three other Nepali students decided to travel to Nepal via Gorakhpur because one way air tickets now cost Rs50,000. <figure><img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce73c9c7e80680e0967b0jpeg.jpg" alt=""><figcaption> </figcaption></figure>“I am happy that I am going home,” Tamang, who is from Melamchi, said on the phone while on the highway, “but I am worried about what will happen at the border.”Suresh Raj Neupane has been in New Delhi for the past three years as the India correspondent for Nepal's Kantipur newspaper.  He finds it unfair that even though there are more Nepali workers in India than in the Gulf and Malaysia combined, the government back home does not care much for them.“It is unfortunate that Nepalis working overseas are given more emphasis despite the Supreme Court’s ruling to assist Nepali workers in India,” says Neupane, who has been covering the plight of Nepalis here. “India is actually the biggest source of remittances for Nepal, with workers sending home Rs130 billion a year.”_________________  <h2>Nepalis caught between helpless states</h2> The Nepal Embassy in India has assured Nepalis that those with the Aadhar identity card and a permanent address in India are eligible for the vaccines, but many Nepali labourers say they have been denied vaccines due to the lack of documents. Anoo Bhuyan, health reporter of the portal India Spend who has been reporting on the Covid-19 second wave, says, “What has happened in India is a humanitarian crisis and the government of India should have been more proactive and accountable for their actions in curbing the virus.”She says that since the lockdown, all the vaccination centres have been shut and while the government has pledged to roll out vaccines for those under 45 by 1 May, it has been trying to hide the fact that there is a shortage of vaccines, as well as oxygen cylinders and other medical supplies.Despite India’s shortage, the Nepal government has asked the Indian government to also lift a ban on export of liquid oxygen which some Nepali private importers rely on to fill cylinders.“Nepal and India have a very special relationship and the border is open, we have to help each other, and we will continue to do so in a time of such a catastrophe,” Nepal's ambassador to India Nilambar Acharya (right) told Nepali Times.The Nepal Embassy has urged the Indian government to provide the same facilities as Indian citizens for Nepalis workers here for vaccines, tests and treatment. <figure><img width="200" height="294" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7409c7e80680e0967b1jpeg.jpg" alt=""><figcaption> </figcaption></figure>The former chief Minister of Jammu and Kashmir, <a href="https://twitter.com/OmarAbdullah" target="_blank" rel="noopener noreferrer">Omar Abdullah</a> told Nepali Times he will be asking around in his constituency about Nepalis in Kashmir and Ladakh who may be in difficulty. He added, “We will reach out to those who need assistance.”Read also: <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/">The Covid tsunami</a>, Editorial

India’s Covid catastrophe hits Nepalis hard

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7109c7e80680e09679fjpeg.jpg" alt="" width="960" height="641"/><figcaption>All photos: AMIT MACHAMASI</figcaption></figure>In a scene reminiscent of last year, tens of thousands of people thronged Kathmandu's main bus terminals to get out of the capital ahead of<a href="https://www.nepalitimes.com/latest/kathmandu-locks-down-again/" target="_blank" rel="noopener noreferrer"> Thursday's Covid-19 lockdown</a>.Most are leaving for their home districts in whatever trasport they can find: riding on top of buses, on the back of pickups or in taxis. The three district administrations in Kathmandu Valley announced a two week-long prohibitory order from 29 April as the country confronts a rising trajectory of Covid-19 cases and deaths. However, domestic flights will not be affected by the restrictions.A similar <a href="https://www.nepalitimes.com/banner/nepal-goes-into-lockdown-for-a-week/" target="_blank" rel="noopener noreferrer">announcement of a lockdown on 24 March 2020</a> saw an exodus of an estimated one-third of Kathmandu Valley's population. Many who could not find transport walked for weeks from Kathmandu to remote districts.Nepal recorded 4,364 new Covid-19 cases from 14,672 PCR tests on Tuesday, of which 1966 were in Kathmandu Valley--with 1,602 in Kathmandu, 240 in Lalitpur, and 124 in Bhaktapur. There were 18 additional deaths, bringing the official total to 3,194. Meanwhile, the positivity rate has risen more steeply in the second wave to more than 30%, compared to less than 4% in February, while there are more than 25,000 active cases.These photos taken at the Bus Park in Gongabu on Tuesday afternoon show people not caring about keeping physical distance to crowd around ticket counters, potentially risking a community spread of the virus. In the past month, hundreds of thousands of Nepalis have also returned from India, and tests at the border have shown that up to 10-15% of those tested were positive, or had been infected with Covid-19.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7139c7e80680e0967a0jpeg.jpg" alt="" width="912" height="610"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7159c7e80680e0967a1jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7189c7e80680e0967a2jpeg.jpg" alt="" width="721" height="481"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce71a9c7e80680e0967a3jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce71c9c7e80680e0967a4jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce71f9c7e80680e0967a5jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7219c7e80680e0967a6jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7249c7e80680e0967a7jpeg.jpg" alt="" width="720" height="480"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7279c7e80680e0967a8jpeg.jpg" alt="" width="960" height="640"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121156/636ce7299c7e80680e0967a9jpeg.jpg" alt="" width="960" height="640">Read also: <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/">The Covid tsunami</a>, Editorial

Another Kathmandu exodus

Born in Khandbari in eastern Nepal, Parashuram Pathak helped his family around the farm, sold what they grew in the market and lent a hand in the kitchen.&nbsp; After working as a chef in Dubai, San Francisco, Denmark, Australia, and on cruise ships, Pathak has now brought back what he has learnt to the Tusa Restaurant in Bhaktapur that opened on Nepali New Year on 13 April. Tusa uses fresh indigenous ingredients from various parts of Nepal, and fuses them with international methods to produce unique dishes. Pathak is a global Nepali, and is introducing global Nepali cuisine to his homeland. Pathak left an executive chef job to intern at three-Michelin-starred Noma in Denmark, named the best restaurant in the world five times. Noma runs on a philosophy of foraging to rediscover wild local ingredients, and Tusa’s mission is similarly noble: preparing dishes with Nepali ingredients using modern techniques and equipment. “We are taking Nepali food beyond dal-bhat and momo, we are taking it international,” Pathak said on the phone from Sydney. Read also: <a href="https://nepalitimes.com/here-now/nepali-baker-rises-to-the-top-in-denmark">Denmark’s best baker is a Nepali</a>, Vishad Onta  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_1312bc016cbb2fe59c6d4a78d1f8b463af4a10b3f79559a2405fd54ea5b3197a.jpg" data-media-id="editor_1" data-image-id="20240419180424_1312bc016cbb2fe59c6d4a78d1f8b463af4a10b3f79559a2405fd54ea5b3197a" data-rendition-name="original" width="801" height="802" loading="lazy" alt="The return of the natives Page 12 NT #1208"> <figcaption>Photo: PARASHURAM PATHAK/FACEBOOK</figcaption> </figure>  Pathak’s team in Nepal includes chefs Rupesh Bohara and Sagar Shrestha who have also worked extensively in Dubai and Australia, and share his vision. The three realised they shared the same dream, and over the past five years have travelled across Nepal to research their menu, collecting ingredients and ideas from homestays, food carts, and nature. The team then scouted for Nepal’s best architect, and zeroed in on Bhaktapur-based heritage conservationist Rabindra Puri who designed the Malla-era house for Tusa in the Nag Pokhari neighbourhood. Bohara and Shrestha have moved back to Nepal for good, and Pathak arrives in September. “I made dishes from all over the world, but when someone asked what Nepali food was like, I had no answer,” says Bohara, “I came back to find out.” &nbsp;“You can get citizenship, a green card, big houses and cars, but where is the self-satisfaction?” asks Shrestha, who has a red-and-blue chef’s knife with the sun and moon of the Nepali flag tattooed on his right forearm.&nbsp; Read also:<a href="https://nepalitimes.com/diaspora-diaries/the-return-of-a-master-baker"> The return of a master baker</a>, Raju Pakhrin  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_c601264463e5a28d4e71a46781f340a53619a08d00949a7aaebfef84e75a319d.jpg" data-media-id="editor_3" data-image-id="20240419180424_c601264463e5a28d4e71a46781f340a53619a08d00949a7aaebfef84e75a319d" data-rendition-name="original" width="6000" height="4000" loading="lazy" alt="The return of the natives Page 12 NT #1208"> <figcaption>Photos: TUSA</figcaption> </figure>  Bohara and Shrestha passionately recount stories of their trips across Nepal, speaking of generous lodge owners who introduced them to local ingredients. Tusa can seat 28, and dining here is a sensory experience with a live kitchen. The chefs cook and place dishes on a large granite countertop with induction sections built in. Behind the counter is a grill on an indoor fire with pulley control to adjust the fire. Everything that can be made in Nepal — chairs and tables, ceramic dishes, the grill — is locally sourced. The executive kitchen/laboratory is downstairs. It is spacious, spotless, and contains appliances rarely seen in restaurants here: a sous vide machine that cooks vacuum-sealed packets at consistent temperatures, and a dehydrator for sisnu nettles. A fresh batch of deep purple kimbu (mulberry) muffins has just come out of the oven. Fridges have dry-aged fish and marigold kombucha. Fermentation seems to be the theme at Tusa, and Pathak explained: “Fermentation takes away the natural sugars in food, leaving behind a true, umami taste.”&nbsp; Read also: <a href="https://nepalitimes.com/here-now/vikings-khukri-passion">Viking's khukri passion</a>, Alisha Sijapati  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_c59e2b4230864f646bc36108adb951e95ec85da6156740294b1ec715b86acf89.jpg" data-media-id="editor_5" data-image-id="20240419180424_c59e2b4230864f646bc36108adb951e95ec85da6156740294b1ec715b86acf89" data-rendition-name="original" width="5895" height="3930" loading="lazy" alt="The return of the natives Page 12 NT #1208"> </figure>  Tusa itself means ‘shoot’ in Nepali, and can be a dish of fermented bamboo shoots. The restaurant serves a tasting menu with six courses, plus surprises. It starts with a fermented potato and millet roti with charred green garlic and tomato chutney. The bread tastes like a mix of alu paratha and kodoko roti with a satisfying, mild flavour. The chefs do not show off, and overdo it. Dishes are tastefully simple and faithful, a theme that runs through the meal. The second course is a filet of fish charred on one side and placed in a broth. It is delicate and smokey, and does not mask the character of the fish.&nbsp; The next is Batuk Chukauni, a Magar dish with a lentil snack and a yoghurt-based potato achar. The batuk, made of lentil batter, is light and the chukauni has potatoes and peas. Read also: <a href="https://nepalitimes.com/here-now/money-is-not-everything-but-you-need-money-for-everything">"Money is not everything, but you need money for everything"</a>, Rohit Shrestha  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240419180424_e3f51228ff792e8d4297f81f8e67d138584e922ae035d131977494219e5e85c5.jpg" data-media-id="editor_7" data-image-id="20240419180424_e3f51228ff792e8d4297f81f8e67d138584e922ae035d131977494219e5e85c5" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="The return of the natives Page 12 NT #1208"> <figcaption>Batuk Chukauni. Photo: VISHAD ONTA</figcaption> </figure>  Next is a skewer of jackfruit with a tamarind and mustard glaze that has the texture of a slice of sausage and melts in the mouth. Then comes the first off-menu item: a steak of watermelon, glazed and grilled, tasting sweet, sour and smokey. After that a palate cleanser sorbet made with laligurans syrup adorned with a frozen candied rhododendron petal. Finally the main course: barbeque chicken and chyakla coarse corn grits. The chicken has been brined, marinated, cooked sous-vide and seared on the grill. The delicate consistency of the chicken stands out. Desert is a smooth, creamy cheesecake that uses the local juju-dhau yoghurt. And the last course is a moist, moss-green sisnu cake laced with mulberry jam and cream.&nbsp; There is nothing gimmicky about Tusa. It is the coming together of skilled Nepalis with international exposure who have mixed what they have learnt abroad with the flavours of home.&nbsp; The tasting menu is Rs3,500, and it may take some time before Nepalis develop a predilection for some of its items. The chefs are excited, vindicated, and relieved. Coming back to Nepal, uprooting successful careers abroad to take a chance on Nepal must not have been easy.&nbsp; Tusa had a soft launch on New Year’s day with Kathmandu-based diplomats. Australian Ambassador Felicity Volk was one of them, and wrote on a Facebook post: ‘Chefs who honed their skills in Australia and returned to Nepal to give back. We call it fine dining, they call it #cominghome.’ Read also: <a href="https://nepalitimes.com/multimedia/the-baker-of-barpak">The baker of Barpak</a>, Tara Aryal Pandey

The return of the natives

For a year or two after the 25 April 2015 earthquake, the residents of Kathmandu were too terrified to return to their high-rise apartments. None of them collapsed in the 7.8 disaster, but many sustained serious structural damage. &nbsp;
Fast forward nine years, and they have all but forgotten that frightful day. Kathmandu is back to building substandard structures, even as land prices drive developers to build taller.&nbsp;
With no more space to spread horizontally, Kathmandu is going vertical. But structural engineers say most of the high rises do not take into account seismicity, soil condition, construction methods, quality of raw materials, fire hazard, and search and rescue in collapsed concrete structures.
“Much of our focus since the 2015 earthquake has been on building and construction, but not as much on where we are building,” warns Sangeeta Singh, Professor of Urban Planning and Deputy Director of Centre for Disaster Studies at the Institute of Engineering.
Read also: <a href="https://nepalitimes.com/banner/in-a-disastrous-state">In a disastrous state</a>, Sonia Awale
She adds: “Kathmandu is not really suited for high-rises. We have to first test the condition of the soil, but building permits are being issued without this fundamental step.”
Kathmandu Valley is a former lakebed with soft topsoil prone to liquefaction and excessive shaking, as seen during the 1934 megaquake. Many ruptures tore up the surface in 2015. &nbsp;
During an earthquake, the rock layers below Kathmandu ring like a bell and the vibrations on the surface take between 0.5 to 2 seconds for one oscillation. Buildings also vibrate, but at different frequencies depending on their height, construction material, and arrangement of their structural components.
At five floors, the vibration period of a building is 0.5 seconds, which is the same as that for Kathmandu Valley, and this could cause more damage, says structural engineer Surya Narayan Shrestha at the National Society for Earthquake Technology - Nepal (NSET).
“Building anything that is five storeys or higher in Kathmandu needs special design and structural considerations,” says Shrestha.
Read also: <a href="https://nepalitimes.com/editorial/shaking-things-up">Shaking things up</a>, Editorial
Technologies exist to reduce seismic risk in high-rises, and these are used in earthquake-prone cities like Tokyo, Los Angeles, Jakarta or Mexico City.&nbsp;
Base isolation, for example, separates the vibration of the land and the building, reducing damage from soil-building resonance. Base isolators move and stretch under pressure, absorbing much of an earthquake's impact by reducing swaying and shaking. &nbsp;
Seismic dampers change the pattern of vibration altogether, dissipating energy as vibrations move across a structure. But these are all expensive technologies, and none of the high-rises in Kathmandu use them.
However, Nepali engineers who can help with technology transfer are working in the field in Nepal and overseas. Kathmandu’s high-rises are already very expensive, and making them seismic-resistant would be an incremental cost.
Read also: <a href="https://nepalitimes.com/opinion/comment/learning-from-jajarkot-what-we-didnt-after-2015-695vpzle">Learning from Jajarkot what we didn't after 2015</a>, Sushil Gyewali
The shape of high-rises also matters. Reinforced concrete buildings with asymmetric designs of the kind that are seen in newer structures in Kathmandu experience more torsion and shear during quakes. High-rises with regular geometry are stronger. &nbsp;&nbsp;
An even bigger concern is that of emergency evacuation and rescue in case of fire or earthquake. Kathmandu fire services do not have ladders that reach the higher floors of most new structures.
“High-rises mean more people and potentially higher casualties,” explains Shrestha. “We need immediate evacuation routes, fire escapes, emergency ladders, and fire trucks that can reach higher. Right now, safety features are voluntary and not mandatory.”
The street access, shelters, open spaces, and evacuation routes are integral to disaster preparedness and the safety of neighbourhoods and not just buildings. Most new high-rises in Kathmandu have narrow access roads.
Read also: <a href="https://nepalitimes.com/opinion/rebuilding-resilience-7-years-later">Rebuilding resilience 7 years later</a>, Anil Pokhrel
Since most of the buildings that survived the 2015 disaster were reinforced concrete structures, it fed the misconception that they are safer. But Himalayan seismologists say that if the intensity and duration of the shaking had been just a little higher, many substandard concrete structures would have collapsed.&nbsp;
And that is the final gap: Nepal’s limited expertise and equipment for search and rescue inside collapsed concrete structures. Kathmandu’s high-rises need to be better prepared for the next Big One.
“Structural safety and design were at the front and the centre after the 2015 earthquake, we also revised some building codes but we are back to square one with contractor-driven construction, especially in peri-urban areas,” says Sangeeta Singh, who is also with the National Planning Commission. “We need to monitor construction as much as design.”&nbsp;
Shrestha at NSET agrees there have been improvements in building practices in the past nine years, but adds, “We have both learnt and unlearnt lessons from 2015. The awareness hasn’t yet translated into action on safety.”
Read also: <a href="https://nepalitimes.com/here-now/lessons-not-learned-from-2015-o2etq6zu">Lessons not learned from 2015</a>, Sonia Awale

The rise of high-rises

Midway along the stretch of the ancient trade route between Tibet and India lies the Kel Tol neighbourhood. The name is derived from the original Koligrām, and it is believed the Koli people, who were originally from Rāmagrām in present-day southern Nepal near the Indian border, settled here. The Koli were the maternal ancestors of none other than the Buddha. Kel Tol is famous for the Buddhist monastic complex of Kanak Chaitya Mahāvihar, featuring the majestic two-tiered gilded temple of the white god Karunāmaya.&nbsp; This elaborately decorated courtyard is a bustling centre of the Vajrayāna sect of Buddhism, practised widely by the indigenous Newā people of Kathmandu Valley. Karunāmaya, also known as Ārya Avalokiteshwor, is defined in great detail in the 1st century CE Buddhist text Sadharmapundarikā where he liberates all sentient beings from suffering. He helps rid the eight external fears metaphorically equated with their equivalent internal states of mind: lions (pride), wild elephants (ignorance), fire (anger), snakes (jealousy), floods (attachment), imprisonment (miserliness), thieves (wrong views) and cannibals (doubt).  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_fe370cbee75003cd3eb5dccc7c3b2671630da193b0744db2aeac1bab3ff4a85c.jpg" data-media-id="editor_0" data-image-id="20240418130432_fe370cbee75003cd3eb5dccc7c3b2671630da193b0744db2aeac1bab3ff4a85c" data-rendition-name="original" width="1338" height="2000" loading="lazy" alt="Seto Machhindranath"> </figure>  In the Pancha Rakshyā Sutra, a Buddhist scripture from 200 CE, Ārya Avalokiteshwor was counted among the eight major deities. Followers of the Brāhminical god Shiva worship Ārya Avalokiteshwor as Seto Machhindranāth. For Shaivites, Machhindranāth is the Indian saint who founded the Nāth cult in the 10th century CE. He is the guru of saint Gorakhnāth. During the reign of Yakshya Malla (1428–1482 CE), a beautiful image of Ārya Avalokiteshwor was dug up by a farmer in present-day Jamal, which was then a cultivated area outside the city. The farmer, known as a Jamami (meaning the one from Jamal) took the image home for safekeeping. That night, Ārya Avalokiteshwor appeared in the farmer’s dream and told him that the proper place for him to reside is at the confluence of two rivers. The nearest confluence was at present-day Wongha (Indrachok) and the image was installed in the Kanak Chaitya Mahāvihar complex in Kel Tol near Wongha. This made it easier for city residents to pay homage to Ārya Avalokiteshwor and spread compassion. Soon, the deity came to be revered highly as Jamaleshwor, the one found in Jamal. Eventually, the name got corrupted, as happens often in Nepāl Bhāsā, to Janabahā Dyo. The courtyard where his temple is located is now popularly known as Janabahā.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_5c9b219530e400445ef4e7f64856b43e7cdb756be26d9ed4565c84044c178a7e.jpg" data-media-id="editor_1" data-image-id="20240418130432_5c9b219530e400445ef4e7f64856b43e7cdb756be26d9ed4565c84044c178a7e" data-rendition-name="original" width="2500" height="1668" loading="lazy" alt="Seto Machhindranath"> </figure>  The gilded temple of Janabahā Dyo, first built in the early 16th century CE, is adorned with wooden and metal artefacts that symbolise 108 forms of Ārya Avalokiteshwor. It stands out as the most decorated temple of its kind in Kathmandu. Today, Janabahā is a living heritage site where many ancient customs and rituals are widely practised as per Vajrayāna Buddhist tradition. Devotees throng the Janabahā Dyo shrine for daily worship and to receive Karunāmaya’s blessings. Being the compassionate one, Ārya Avalokiteshwor goes around town every year in his tall wooden chariot to allow sick and physically disabled devotees to pay homage to him from the comfort of their homes. One could say it is a door-to-door visit by the Compassionate One.&nbsp; For the pragmatic minded, the chariot festival is an annual renewal of communal harmony, validation of our ancient mathematical supremacy and demonstration of the need to keep practical skills alive, including the craft of building earthquake resilient houses.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_fc8b234ceca87dee4b99e897a485cef121fb953857fb61492a413fbfcc48360c.jpg" data-media-id="editor_2" data-image-id="20240418130432_fc8b234ceca87dee4b99e897a485cef121fb953857fb61492a413fbfcc48360c" data-rendition-name="original" width="2500" height="1667" loading="lazy" alt="Seto Machhindranath"> </figure>  The Janabahā Dyo chariot is pulled from Jamal, where his image was found by the farmer, through the historic heart of Kathmandu in a gala parade every year. The procession, accompanied by folk music ensembles and revellers, starts on the eighth day of the bright half of the month of Chaitra, and lasts up to a week (ending on Saturday this year). Hundreds of devotees pull the chariot along the streets as a way of expressing their gratitude to lord Karunāmaya for blessing them with compassion and well-being. Purna Ratna Vajrāchārya is an ordained priest who belongs to the clan responsible for taking care of Janabahā Dyo. He has been studying the design and architecture of the chariot for the past 40 years, and overseeing its construction for the past 15. He has learnt that the engineering principles of building the chariot are based on the mathematical system in which Buddhism is taught. For example, 365 pieces of wood are used in the chariot, each representing a day of the year. Each of the four wheels consist of 25 pieces of wood, totalling 100, representing completeness or fulfilment. The chariot is vertically divided into 13 sections, a parallel to the Buddhist concept of Trayodashi Bhuvana that describes the 13 steps that one must take to achieve the state of Nirvana.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_36d9964c9845f6d9a074786361fc5ab7d49138503ad162086998b731349b0ec0.jpg" data-media-id="editor_3" data-image-id="20240418130432_36d9964c9845f6d9a074786361fc5ab7d49138503ad162086998b731349b0ec0" data-rendition-name="original" width="2500" height="1668" loading="lazy" alt="Seto Machhindranath"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_2662753a9514a682ccdfd17bf05e2be3771183a68dc86b717ab67d9aad894563.jpg" data-media-id="editor_4" data-image-id="20240418130432_2662753a9514a682ccdfd17bf05e2be3771183a68dc86b717ab67d9aad894563" data-rendition-name="original" width="1668" height="2500" loading="lazy" alt="Seto Machhindranath"> </figure>  &nbsp;Exactly nine types of wood are used, which is the sum of the four base elements that make up the universe (earth, water, fire and air) and the five human senses. The height and length of the chariot is 32 arm’s length (hāt in Sanskrit), 14.8m. The number 32 represents the maximum number of auspicious and physical qualities one could possess to be considered an outstanding human being.&nbsp; Says Vajrācharya, “Observing how the chariot is built helps one learn the fundamental pillars of the Buddha’s teachings, and find an easier path to Nirvana.” The structural design of the nearly 15m wooden chariot is not only awe-inspiring but also gravity-defying. It leverages the pliancy of the materials used in its construction -- flexible joints tied with cane soaked in water for several days. The precise proportions of the chariot ensure great manoeuverability in the narrow streets along the route of the chariot procession that include some 90° bends, without colliding into houses.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_9f5c2943f5d6b3f0010d3d5213697549945e87a6f7d3d8cbadd69f0dea6c6e2c.jpg" data-media-id="editor_5" data-image-id="20240418130432_9f5c2943f5d6b3f0010d3d5213697549945e87a6f7d3d8cbadd69f0dea6c6e2c" data-rendition-name="original" width="2500" height="3750" loading="lazy" alt="Seto Machhindranath"> </figure>  Driving and steering the chariot with brute muscle power of the mirthful crowd is a seemingly impossible task. But this has been achieved year after year, despite the fact that the devotees who tug wildly at the ropes lassoed to the two front wheels, are most likely in high-spirits (pun intended). Sanjay Manandhar, a US-based technology entrepreneur, recounts how his high school physics teacher from Canada asked his students to go observe the locals build the chariots of Karunāmaya if they were interested in becoming engineers in the future.&nbsp; “That made no sense to me then, but, after all these decades, I now see clearly how the structural design of the chariot, adopted early on by our ancestors is full of earthquake-resilient properties that need to be applied in building houses in an earthquake-prone zone like Nepal,” says Manandhar. A highlight of the chariot festival is that human goddess Kumari makes an appearance at the final destination in Lagan, usually on the third day. This is only one of the 13 times that people get to see the Kumari outside her temple abode.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240418130432_08aa39f3f004a212b33c60a2840d6013110de15dd34a0288f699dd5fda8957ab.jpg" data-media-id="editor_6" data-image-id="20240418130432_08aa39f3f004a212b33c60a2840d6013110de15dd34a0288f699dd5fda8957ab" data-rendition-name="original" width="2500" height="1667" loading="lazy" alt="Seto Machhindranath"> </figure>  On the last day of the festival (Saturday), the image of lord Karunāmaya is carried on a palanquin by priests from Janabahā in a gala procession and brought back to his permanent residence at the temple in Kel Tol.&nbsp; The chariot festival is thought to have started during the reign of King Pratap Malla of Kantipur in the 17th century CE. For close to four centuries, the construction of the chariot and its operation has proven to be a phenomenal engineering feat, and the people’s faith in divinity means the tradition is alive.&nbsp; The essence of the colourful rituals and the religious beliefs of this ancient chariot festival is now all but lost. The logic, technology and practicality must be brought back to light, as they reflect the high civilisation and wisdom of our ancestors that we can leverage in modern times and into the future. &nbsp; Alok Tuladhar is a culture and heritage documentarian.

Kathmandu’s gravity-defying chariot festival

In the run-up to the third Nepal Investment Summit this weekend, there have been seminars, conferences and workshops where the discourse has revolved around the economy and the investment climate.
The consensus that Nepal needs foreign direct investments (FDI) to grow was repeated, and the familiar litany of reasons about why it has not been able to was discussed.&nbsp;
Policy advocates and regulators have understood that the lack of urgency is compounded by procedural inconsistencies, on top of the already deficient investment environment in the country.
It is a welcome change from what used to be flippantly accepting matters as given. There now seems to be a sense of urgency, with procedural inconsistencies and lack of harmonisation between various Acts and regulations openly discussed.&nbsp;
Government stakeholders also appear more willing to learn and attempt to be part of the solution. Whatever policy changes have been introduced in the past have been piecemeal and address the few rather than the entire industry. This left dual regulatory approaches aimed at similar players.&nbsp;
Read also: <a href="https://nepalitimes.com/opinion/killing-investment-in-nepal-in-10-easy-steps">Killing investment in Nepal in 10 easy steps</a>, Dibesh Karmacharya
This time, unlike in the past two Summits, the government seems to be committed to amending 9 Acts, a positive step towards showing commitment to change. However, the deadline to do so during the winter session of Parliament is over. The option mooted has been to have it passed through ordinance, a lesser appealing step; albeit, a positive one moving forward.&nbsp;
To attract FDI in a competitive global market means that Nepal has to demonstrate that it is serious about bringing in investments with a more consultative and collaborative approach with investors. A departure from procedural to a result-oriented focus is needed.&nbsp;
To put issues in perspective, Nepal needs US$20 billion in investments to meet the UN’s Sustainable Development Goals (SDG) targets by 2030. If net-zero decarbonisation targets are to be met by 2045, another US$7 billion will be required annually.&nbsp;
Looking at our investment history and poor government capital expenditure, the gap is long and wide. In fiscal year 2022-23 Nepal booked a lamentable ~$59 million in FDI (equity). Nepal is in fact the lowest market in South Asia for FDI with 0.3% of the regional average.&nbsp;
What is it that we can do to fill the gap?&nbsp;
First, we need to move away from the notion that Nepal only needs large investments. This has proven to be a mistake, and time series data have proven that smaller investments, in aggregate, make a larger impact on economies.&nbsp;
Read also: <a href="https://nepalitimes.com/news/poor-cash-rich-nepal">Poor cash-rich Nepal</a>, Sonia Awale
We talk about an ‘enabling environment’ but without the right tools. We place restrictions on interest on debt ceiling (SOFR +5.5), without risk premium adjustments, we do not have an active secondary market for bond trading, nor do we have a yield curve, an integral part of the bond market, which is inhibiting us from tapping into the trillion dollar green bond market.&nbsp;
In order to attract green financing, Nepal needs to develop its bond market. Sovereign risk rating has been mooted and was expected to be operationalised before the Investment Summit.&nbsp;
However, to be rated in an adverse economic environment could further deteriorate investment potential due to a lesser-than-expected rating.&nbsp;
Hedging is another instrument that needs further research on. A commercial bank last year showcased the first risk-hedging mechanism for an investment of $8 million. This can be the beginning to expand on its modality. &nbsp;
Subordinated debt instruments have been introduced, but on a special nod basis, this now needs to be institutionalised as it is the most applicable form of investment after equity in a market that has volatile forex reserves.&nbsp;
Read also: <a href="https://nepalitimes.com/editorial/invest-in-investment">Invest in investment</a>, Nepali Times
Viability Gap Funding has been introduced by multilateral development agencies implemented in solar installations. It is a tool to incentivise the private sector to invest in projects that are not financially lucrative initially, but have potential for profitability in the long run. This needs to be scaled up and replicated in sectors like infrastructure, where returns may not be immediate.
Moving forward, to attract FDI, Nepal needs to tap into the funds that are available for the growth of small and medium enterprises (SMEs) and climate change. Alternative investments such as Private Equity Venture Capital (PEVC) have been around in a structured manner in Nepal for nearly a decade now.
These funds have blended finance components and have attracted climate funding as well. PEVC is a new asset class and can address the issues of penetrating into SME financing by incorporating environment, social and governance issues into their investment process.&nbsp;
SMEs are the backbone of any economy, PEVC comes with the ability not only to scale up the enterprise with risk capital, but with the ability to bring technical knowhow to enhance not only the enterprise but also the entrepreneur.&nbsp;
Read also: <a href="https://nepalitimes.com/opinion/success-in-nepal-means-not-having-to-work">Success in Nepal means not having to work</a>, Anil Chitrakar
A differentiator from all other forms of financing available till date in Nepal. Blended finance is a way of de-risking investments, especially in frontier markets. Business Oxygen (BO2) is an example of blended finance with subordinated debt investments of IFC (World Bank Group) taking the lead and Climate Investment Funds along with FCDO as co-investors.&nbsp;
On a larger scale, the 216MW Upper Trisuli 1 is another example of blended finance with IFC, a Korean consortium and local investments. So far, we see that development finance Institutions have been taking the lead in Nepal as their risk appetite is greater than commercial investors and they are eager to help develop the financial markets.&nbsp;
In order to be sustainable, we need to step on this and attract commercial capital from all over the world. To do this there has to be political will to make that pivot.&nbsp;
Instead of being a means to an end, the two previous Investment Summits turned out to be intermittent and cosmetic, providing hardly any results. The third one’s success will depend on how the event will be implemented as a platform for continuous marketing for the country and facilitation for investors in future.&nbsp;
Nepal has outdone many countries in its macro-economic indicators, with sound forex reserves and a stellar history of debt payments to its creditors. This story needs to be propagated along with the drive for change to attract potential investors.
Read also: <a href="https://nepalitimes.com/opinion/comment/alternative-investments-to-attract-fdi">Alternative investments to attract FDI</a>, Siddhant Raj Pandey

covid-2nd-wave

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Nepal Covid-19 impact worse than official figures

3-pronged strategy to save Nepal from Covid-19

International help for Nepal picks up

International help for Nepal picks up

“Our health system can’t contain the pandemic”

India’s Covid catastrophe hits Nepalis hard

Another Kathmandu exodus

The return of the natives

The rise of high-rises

Kathmandu’s gravity-defying chariot festival

Nepal looks at alternative investments