<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20230112100136/63bfd50f9c7e80680e0d30d0jpeg.jpg" alt="" width="1024" height="576"/><figcaption>Health workers transporting Covid-19 vaccines in rural Nepal. Photo: NARENDRA SHRESTHA/ADB NEPAL</figcaption></figure>It was exactly three years ago that the novel coronavirus first emerged from Wuhan. SARS-COV-2 has now come full circle as cases soar and hospitals are overwhelmed across China.Beijing abandoned its zero-Covid policy, and has stopped registering fatalities from Covid-19. Official case load and death figures are said to be underreported. International health experts believe more than 1 million people may die from the disease this winter.Several countries now require mandatory Covid tests from passengers arriving from China, after Beijing eased travel restrictions in the new year. Countries in the region including Nepal are on high alert.The Health Ministry last week made masks once again mandatory in public places while appealing to people to resume hand washing and social distancing. On 28 December Nepal reported only 8 cases and zero Covid deaths.The Ministry has also urged the public <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">to take booster shots, and second boosters</a> for people above 55 and the immunocompromised. The Drug Advisory Committee on 27 December granted emergency use approval for the Pfizer-BioNtech bivalent vaccine of which Nepal is set to receive 1.5 million doses from the COVAX global initiative by mid-January.Read also: <a href="https://www.nepalitimes.com/here-now/three-years-of-living-dangerously/">Three Years of living dangerously,</a> Sonia Awale“What is of utmost priority now is to protect our elderly and vulnerable populations. We need to fully vaccinate them if they have not or give them a booster, bivalent would be even more effective as it can fight both the original and Omicron strains,” explains Sher Bahadur Pun at the Teku Hospital.Pun likens what is happening in China now to the Omicron surge in Hong Kong earlier this year which also saw a significant rise in hospitalisations and deaths. Nepal also suffered a spike in fatalities among the elderly towards the end of the <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/">Omicron third surge in 2022</a>. In both cases, the unvaccinated were victims.“Omicron might be less severe but in vulnerable groups who have not been vaccinated, even this strain can cause complications,” he warns.More than 80% of Nepal's eligible population (above 5) have been fully vaccinated against Covid-19. But the booster uptake is much lower at only 27%. There is also concern that it has been more than a year since most Nepalis got their last shots, and their immunity might be waning. Officials recommend a booster even though memory cells could provide some residual protection.The WHO has asked China to reveal its true Covid figures, and the nature of the prevalent strain. Experts attribute its surge to vaccination hesitancy among the elderly, stringent zero-Covid strategy which suppressed natural immunity, and Chinese vaccines like Sinovac being less effective than mRNA jabs.Read also: <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">Why is there vaccine hesitancy in Nepal?</a> Sonia Awale“China did great with lockdowns and restrictions but took it to unnecessary levels, which means the population is Covid naïve compared to other countries. When they reopened, the variants already present multiplied rapidly,” explains Buddha Basnyat, physician at Patan Academy of Health Sciences. “It also seems they did not learn from the rest of the world, did not vaccinate their elderly sufficiently and relied only on their own vaccines.”The efficacy of Chinese-made vaccines has long been debated, but there are no studies to prove their efficacy, or lack thereof. However, experts agree that all the available vaccines recommended by WHO considerably reduce the severity of the disease.Media amplification of the China surge has caused some panic in the neighbourhood. Japan, Malaysia, Taiwan and India are the latest countries to require Chinese passengers to have Covid tests. India has also introduced nasal vaccine this week, those who had taken Covishield and Covaxin can take it as a heterologous booster dose.Read also: <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/">Nepal’s uneven Covid-19 deaths</a>, Ramesh KumarHowever, the BF7 Omicron strain has already spread around the world and it is not virulent, and does not seem to adversely affect vaccinated individuals. Experts also caution that although 1 million deaths sounds like a lot, it is a tiny fraction of China’s population. The Chinese government has accused the West of ‘hypocrisy and hyping the threat’.“The BF7 is not a new variant, it has been around for a while. It has been circulating in Europe, America and parts of Asia. It has been reported in India and chances are high it is in Nepal too, we probably just haven’t detected it yet,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal.He adds: “Nepalis have developed enough resistance through reinfections and vaccinations, especially as subsequent strains have been more contagious but less virulent.”The WHO says it is concerned about further mutations and the emergence of new variants, but mutations do not necessarily mean increased severity. Just like Omicron is more contagious but less severe than Delta.Says Pun: “There are at least 17 sub-variants of Omicron in Nepal. This means we have had enough immunity gained via reinfections. We also have protection from vaccination and the proof of this is how we marked our festivals, and elections without following safety measures and without any resulting surge.”Read also: <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/">Omicron may not be risky, but take care,</a> Sonia AwaleHaving said that, the <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">pandemic is not yet over.</a> Parts of China including Hong Kong, South Korea, Hong Kong and Japan which have high mobility of Nepalis are also seeing a Covid-19 surge this winter.The health desk at Kathmandu airport is not strictly checking vaccination or PCR tests anymore, and some experts say it should increase surveillance — especially when flights from Chinese cities resume on 8 January. After being locked down for so long, many Chinese are already booking holiday travel to Asian destinations.The Rasuwa border post also reopened this week to resume the cargo transport at Kerung and the trade between the two countries. The checkpoint which has been shut due to the pandemic since early 2020.Says Buddha Basnyat: “There is no harm in continuing to follow safety measures, it is now proven that masks and hand washing saves lives. It also protects us from a host of infections including typhoid and TB and more importantly from air pollution, all non-Covid silent killers.”

Sonia Awale

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China’s surge: should Nepal be worried?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111414110/63723c339c7e80680e0c9605jpeg.jpg" alt="" width="2304" height="1536"/><figcaption>Nearly three years after the outbreak of Covid-19, every day life is mostly back to normal. Photo: SUMAN NEPALI</figcaption></figure>For the first time since it was first detected almost three years ago and ravaged Nepal, the SARS-CoV-2 virus has been overtaken by another public health emergency: <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak/" target="_blank" rel="noopener noreferrer">the dengue epidemic</a>.Covid-19 is not gone (even President Bidya Devi Bhandari just had it), and new strains are co-mingling with various serotypes of <a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay/" target="_blank" rel="noopener noreferrer">dengue that have officially claimed 39 lives</a> and infected over 30,000 people across Nepal this monsoon. But like the numbers for Covid-19, those are gross under-estimations.As we speak, a new Omicron sub-variant BF.7 which is better equipped to escape antibodies from earlier infections or vaccinations has already spread from the United States to China. Masks, bivalent boosters and avoiding crowds are the most effective prevention methods which only a few follow.Yale University researchers have found <a href="https://www.nber.org/papers/w30512" target="_blank" rel="noopener noreferrer">considerable growth in excess deaths</a> (total deaths in a population in a given period which is above what is normally expected) among anti-vaxers in Ohio and Florida.In fact, the fatality rate seems to have a direct correlation with political belief. The paper published by the National Bureau of Economic Research this month showed that excess death rates for American republicans increased from nearly 0% pre-pandemic to 35% by end-2021. The increase for Democrats was only 10%.Similarly, <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2796235#:~:text=Conclusions%20and%20Relevance%20In%20this,had%20received%20a%20booster%20dose." target="_blank" rel="noopener noreferrer">another study</a> published in The Journal of the American Medical Association last month revealed that Covid hospitalisations in 13 US states was 10.5 times higher among the unvaccinated and 2.5 times higher in vaccinated persons with no booster shots.Closer home, Hong Kong saw a disproportionate number of Omicron deaths earlier this year among the unvaccinated elderly. While highly transmissible, the strain was much less fatal among the vaccinated elsewhere.Even in Nepal, which has a full vaccination rate close to 80%, one of the highest in the world, those still being hospitalised with Covid were mostly unvaccinated.“I recently had a girl patient who had lost her parents and a brother to Covid who had not been vaccinated,” recalls Sher Bahadur Pun, a virologist at Teku Hospital in Kathmandu. “There have been one too many unvaccinated patients in my ICU who believed rumours on social media.”In Nepal, as elsewhere, the early days of the pandemic were marked by <a href="https://www.nepalitimes.com/latest/the-social-media-contagion/" target="_blank" rel="noopener noreferrer">rampant misinformation</a>, first about the novel coronavirus itself, stigmatisation of patients and <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">healthcare providers</a> alike. The general public was slow to adopt safety protocols, which contributed to over 1 million cases and 12,000 deaths in Nepal. Worldwide, there have been over 630 million cases and at least 6.5 million deaths from Covid so far.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111414110/63723c369c7e80680e0c9606jpeg.jpg" alt="" width="914" height="396"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111414110/63723c389c7e80680e0c9607jpeg.jpg" alt="" width="892" height="499"><figcaption> </figcaption></figure>The pandemic did reinforce hand washing, hygiene and mask-wearing in Nepal, which in turn also <a href="https://www.nepalitimes.com/opinion/silver-linings-in-the-covid-cloud/" target="_blank" rel="noopener noreferrer">helped reduce incidences</a> of tuberculosis, typhoid, flu and other infectious diseases.But the biggest disruption was caused by repeated lockdowns which led to an <a href="https://www.nepalitimes.com/banner/economic-cost-of-5-months-of-nepal-lockdown/" target="_blank" rel="noopener noreferrer">economic crisis</a> in Nepal, lately worsened by the <a href="https://www.nepalitimes.com/here-now/ukraine-crisis-hits-nepal-economy-hard/" target="_blank" rel="noopener noreferrer">Russian invasion of Ukraine</a>. All this has slowed improvements in nutrition levels as well as <a href="https://www.nepalitimes.com/editorial/lockdown-fallout/" target="_blank" rel="noopener noreferrer">maternal and infant health</a>.During the pandemic, Nepal had an early warning of what was to come just by following trends in neighbouring India (see book review, below). But lack of adequate preparation at the border meant ineffective quarantine and testing, and a <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener noreferrer">rapid spread of the virus to the remotest corners</a> of the country. As hospitals in India ran out of beds and oxygen, so did Nepal.The second wave in 2021 saw India register the highest daily Covid-19 deaths, but the death rate proportional to population was probably higher in Nepal. Better-equipped hospitals with trained staff and adequate <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">oxygen and ICU facilities</a> across the country would have saved many of those lives.“Countries like Nepal will have to prepare for not just new emerging diseases but also re-emerging and existing infections. And the only way to do that is by strengthening our health system,” adds Pun “We must start training our medical personnel and upgrade health infrastructure. That is the biggest takeaway from the pandemic.”Nepal was one of the first countries to volunteer for Oxford University’s <a href="https://www.recoverytrial.net" target="_blank" rel="noopener noreferrer">Recovery Trial</a> which studied the efficacy of various drugs, yet there is rampant over-prescription and over-the-counter availability of antibiotics.“We are still using antibiotics like Azithromycin to treat viral infections such as Covid and dengue which is adding to the problem of antimicrobial resistance,” says Buddha Basnyat, a physician at the Patan Academy of Health Sciences.At Teku Hospital, many of virologist Sher Bahadur Pun’s patients are also testing negative for dengue and suspects the mosquitoes that bit them could have been carrying another virus like Zika or Chikungunya which have been detected in India. "The symptoms are very similar and transmitted by the same mosquito," he adds.Covid-19 is <a href="https://www.nepalitimes.com/here-now/the-nature-of-pandemics/" target="_blank" rel="noopener noreferrer">just one of many pandemics</a>. But it won’t be the last. As humans interact with a deteriorating natural habitat and wildlife, they are exposed to zoonotic diseases — viruses that can jump from animals to humans. The growth in instantaneous international travel means infections can spread rapidly across the world.At the peak of the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">second wave with the Delta strain</a> more than 250 Nepalis were dying every day, but governments in Kathmandu and the provinces were preoccupied with a nasty power struggle. <a href="https://www.nepalitimes.com/editorial/playing-politics-in-a-pandemic/" target="_blank" rel="noopener noreferrer">Political infighting delayed response</a>, and led to many more unnecessary deaths.As Nepal and India prepare to mark the third year of the Covid-19 outbreak, the worst seems to be over. It took a global crisis and millions of deaths to remind us to be prepared for the next pandemic.Says Buddha Basnyat: “We now have to make the best use of our capacity and build on it. Let’s not be complacent, there are many other infections that afflict this part of the world.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111414110/63723c3a9c7e80680e0c9608jpeg.jpg" alt="" width="1050" height="626"><figcaption> </figcaption></figure>Pandemic unmasked the real disease: governance failureOn 24 March 2020, the Narendra Modi government in India imposed the first lockdown with just four hours of warning. WHO praised this ‘timely and tough action’ to stop Covid, and the University of Oxford at the time called it the strictest lockdown in the world. With China’s zero-Covid policy that is probably not true anymore.Still, India’s sudden lockdown unleashed the greatest movement of people in the Subcontinent after the 1947 Partition, which had a cascading effect on Nepal.‘For a country with zero social security, which did not even have an authentic count of the number of people left without an income due to the lockdown, and where fractiousness and social fault lines make the poor and the backward easy preys of the systematic corruption, a measure like this would need weeks of planning. Even then it could still go wrong. So the repercussions of such a move without any preparation were unimaginable.’In her book Billions Under LockdownIndian journalist Abantika Ghosh chronicles the impact of lockdowns on her country. In a smaller scale, the upheavals caused by the lockdowns impacted Nepali migrant workers in India and <a href="https://www.nepalitimes.com/latest/indians-stuck-in-nepal-also-trying-to-get-home/" target="_blank" rel="noopener noreferrer">Indians in Nepal who had to undertake arduous treks home</a>.In her book, Ghosh tells the story of 38-year-old Ranveer trying to make the 400km journey on foot from Delhi to his village in Madhya Pradesh. He died along the way, 100m short of reaching his destination. Nepali migrant workers, prevented from entering their own country at the border, <a href="https://www.nepalitimes.com/latest/nepalis-still-stuck-in-no-mans-land/" target="_blank" rel="noopener noreferrer">swam across the Mahakali River in Darchula</a>. Some drowned.Once quarantined, often without proper testing and contact tracing, Covid refugees were housed in <a href="https://www.nepalitimes.com/here-now/nepal-quarantines-hotspots-for-disease/" target="_blank" rel="noopener noreferrer">crowded shelters</a> which themselves became super-spreaders for the virus. The outbreak snowballed as migrants took the virus home to families, leading to community transmission.As hospitals were overwhelmed with cases, several treatment therapies were introduced. From a combination of HIV drugs and convalescent plasma therapy to malaria drug <a href="https://www.nepalitimes.com/opinion/the-truth-about-the-chloroquine-scam/" target="_blank" rel="noopener noreferrer">hydroxychloroquine</a>, a typhoid antibiotic Azithromycin and Remdesivir, all of which were later proven to be ineffective, and sometimes even harmful. What saved lives was the <a href="https://www.nepalitimes.com/here-now/pandemic-and-the-political-economy-of-oxygen-supply/" target="_blank" rel="noopener noreferrer">timely supply of oxygen</a>, and the cheap steroid Dexamethasone.Ghosh writes about India: ‘The biggest lesson of all was how politics became the most insurmountable impediment in the control of the disease.’ Ditto for Nepal.The pandemic unmasked the real disease: <a href="https://www.nepalitimes.com/banner/nepal-is-a-hotbed-of-virus-and-politics/" target="_blank" rel="noopener noreferrer">state neglect, corruption, governance failure</a> leading to ad-hoc restrictions, lack of testing and surveillance, an overwhelmed health system that left hundreds of millions of hapless citizens to fend for themselves.It also showed what worked: empowered local health institutions which responded quickly with testing, tracing and quarantining. No surprise that the Indian state with the lowest Covid fatality rate despite high exposure was <a href="https://www.nepalitimes.com/opinion/how-did-kerala-beat-covid-19-spread/" target="_blank" rel="noopener noreferrer">Kerala</a>.Abantika Ghosh’s lessons learnt could just as well be written for Nepal: ‘A matured health system is also decentralized, transparent, and, on occasion, self-sustaining … If you don’t treat diseases early, you only treat them when they are complex, and because complex interventions are more expensive, you do not have the resources left to bolster primary care. The more hospitals you build without investments in primary care, the more hospitals you will need to build.’Sonia AwaleBillions Under Lockdown: The Inside Story of India's Fight Against Covid-19 By Abantika Ghosh2021 Bloomsbury IRS699393 pages<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111414110/63723c3c9c7e80680e0c9609jpeg.jpg" alt="" width="695" height="1080">

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Three years of living dangerously

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723b9b9c7e80680e0c95d2jpeg.jpg" alt="" width="4993" height="3241"/><figcaption>Vermilion rice paste and barley shoots prepared for Tika. All photos: SUMAN NEPALI</figcaption></figure>After two years of <a href="https://www.nepalitimes.com/latest/this-years-dangerous-dasain/" target="_blank" rel="noopener noreferrer">relatively muted Dasain festivities</a> due to the Covid-19 pandemic, Nepalis were all revved up to make up for it this year. However, heavy post-monsoonal rains over most of Nepal drenched Tika on Wednesday.The rains, combined with a lingering <a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay/" target="_blank" rel="noopener noreferrer">dengue epidemic in Kathmandu</a> did put a damper on the festivities, but did not seem to dampen the Dasain spirit.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723b9f9c7e80680e0c95d3jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723ba39c7e80680e0c95d4jpeg.jpg" alt="" width="640" height="427"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723ba69c7e80680e0c95d5jpeg.jpg" alt="" width="2304" height="1536"><figcaption>People leaving for their home towns for Dasain and crowded marketplace with people shoping for the festivities.</figcaption></figure>On 5 October, families celebrating the festival across the country observed Tika, the main day of <a href="https://www.nepalitimes.com/banner/where-are-you-going-this-dasain/" target="_blank" rel="noopener noreferrer">Dasain</a> when elders bless younger ones with ceremonial vermilion-rice paste on the forehead and sacred barley shoots. The celebration continues until the full moon night of 9 October.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723ba99c7e80680e0c95d6jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bac9c7e80680e0c95d7jpeg.jpg" alt="" width="640" height="427"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bb29c7e80680e0c95d8jpeg.jpg" alt="" width="4809" height="3387"><figcaption>Various rituals performed throughout Dasain festivities.</figcaption></figure>Dasain has been marked for millennia as a symbol of good vs evil, but probably originated as a harvest festival, and evolved into family get togethers. It is also traditionally accompanied by <a href="https://www.nepalitimes.com/banner/high-on-swings/" target="_blank" rel="noopener noreferrer">playing on bamboo swings</a> and flying kites -- although this Dasain was too wet for kite fights.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bb69c7e80680e0c95d9jpeg.jpg" alt="" width="1600" height="1066"><figcaption></figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131156/63723bb99c7e80680e0c95dajpeg.jpg" alt="" width="2048" height="1312"><figcaption></figcaption></figure>Nepali Times photojournalist Suman Nepali brings these and more in this photo feature depicting this year’s <a href="https://www.nepalitimes.com/banner/top-dasain-destinations/" target="_blank" rel="noopener noreferrer">Dasain</a> festivities.

Dasain 2022

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413118/637230459c7e80680e0c255ajpeg.jpg" alt="" width="1594" height="986"/>With a new increase in the number of Covid cases in Nepal, there is now a looming threat of a fourth wave in Nepal, even as public health experts are divided about the extent and severity of the new surge.But they agree on one thing: we must continue to follow preventive measures despite our vaccination and infection status since the elderly and people with comorbidities are still at high risk.Six new Omicron variants have been detected in Nepal including BA.2, BA.5, BA.2.38, BA.2.73, BA.2.75 and BF.1, according to Rajeev Shrestha, infectious disease specialist at Dhulikhel Hospital which conducted whole-genome sequencing on 22 swab samples last week.On Sunday, Nepal reported 347 new cases while 95 patients recovered. Two fatalities were recorded in the past 24 hours. Active cases have surpassed 3,000 again, with the test positivity also climbing to 8.9%.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413118/637230489c7e80680e0c255bjpeg.jpg" alt="" width="1500" height="1000">The newer variants of Omicron are many times more contagious than the original strain leading to a spurt in new Covid cases daily. The World Health Organisation (WHO) has also termed all the new sub-strains as variants of concern because of their higher  transmissibility.So far, BA.5 is the most dominant sub-variant and has spread over 110 countries with France, the US, Italy, Germany and Brazil.Japan, Australia and China are also reporting spikes in new Covid cases while Iraq and Tunisia have emerged as new 'hotspots'. In South Asia and Southeast Asia, BA.5 is widespread in India and Indonesia.“Some 5.7 million people worldwide have been infected with this variant. Scientists say that 50% of the existing Covid-19 infection is from this variant,” says Sameer Kumar Adhikari of the Health Ministry. “And because it is spreading widely in India, we are also very much at risk, especially if we are lax about it like we were with previous variants.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413118/6372304b9c7e80680e0c255cjpeg.jpg" alt="" width="2554" height="1434">Another Omicron variant BA.2.75 which was first detected in India seems to be equally infectious and has spread to 14 countries including Japan, Germany, UK, Canada, America, Australia, New Zealand and Nepal.According to WHO chief scientist Saumya Swaminathan, BA.2.75 has mutated in such a way that it defeats the immune system's ability to fight the disease and can cause severe infections. Most recently, BA.1 has been found to be the most contagious of the bunch, more so than BA.2.75.The good news is that the new variants will largely spare previously vaccinated populations. But while the variants are yet to register complications like those caused by the Delta variant during the second wave, vulnerable populations are still at the highest risk, especially given that Nepal has a very low uptake for boosters.“What all these new variants are doing is reducing the effectiveness of Covid vaccines. How much is a matter of further investigation but they are indeed decreasing vaccine efficacy,” says Shrestha.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413118/6372304e9c7e80680e0c255djpeg.jpg" alt="" width="1221" height="814">The Nepal government last week reinforced its vaccination campaign with a special focus on the booster shots. Even as over 80% of Nepal’s eligible population have been fully vaccinated against Covid-19, less than 25% of Nepalis have taken booster shots.Meanwhile, a new study from Qatar has found that while the rate of reinfection of new variants is comparatively high, people who have been previously infected with earlier versions of SARS-CoV-2, particularly Omicron are less susceptible to the two fast-spreading lineages BA.4 and BA.5 sub-strains.Nonetheless, experts recommend keeping a close watch on symptoms to break the cycle of infection and save those at risk of contracting the disease. People who have already been previously infected should also follow preventive measures, mask up, avoid crowds and sanitise regularly.Says Rajeev Shrestha: “As soon as you have fever, cold and loss of smell, think of yourself as Covid infected and manage accordingly. Prevention and vaccination are the only ways to stop another deadly  wave.”Read more: <a href="https://www.nepalitimes.com/banner/1-mask-up-2-avoid-crowds-3-get-boosters/">1. Mask Up. 2. Avoid Crowds. 3. Get Boosters</a>, Sonia Awale

Is Nepal on the verge of a fourth wave?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f29c7e80680e0b288djpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photos: UNICEF NEPAL</figcaption></figure>Despite periods of political and economic instability, Nepal achieved dramatic progress in maternal and child health in the early 2000s becoming an international model.It took great strides in reducing childhood malnutrition, in particular, reducing stunting from 57% in 1996 to 33% in 2016. Maternal and Infant mortality rates also similarly declined, only for much of these successes <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">to stall in the recent years</a>. And this trend has been made worse by the Covid-19 pandemic, states a new UNICEF report.Titled “<a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">Nutrition in Nepal: Three decades of progress for children and women</a>”, the report brings together a set of nine original articles that examine the drivers of success and identify where greater policy and programmatic action is needed to achieve the Sustainable Development Goal (SDG) nutrition targets.“Optimal maternal and child nutrition is the basis for developing a resilient society,” says EU Ambassador to Nepal, H.E. Nona Deprez. “The decline in the number of malnourished children, improvements in health facilities and services, and the multisectoral approach used in Nepal over the past three decades are a testament to the Government of Nepal’s commitment to reducing all forms of malnutrition.”A <a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">special supplement of the Maternal and Child Nutrition Journal</a> published on Thursday lists some of Nepal’s biggest nutritional achievements. Between 1996-2016, the early initiation of breastfeeding saw an increase from 18% to 56%, and complementary feeding increased from 54% to 77%.During the same period, women taking sufficient iron and folic acid supplements during their pregnancy rose from 6% to 71%. This was combined with earlier and more frequent antenatal care visits.Consistent administering of Vitamin A has saved the lives of an estimated 45,000 Nepali children under the age of five, between 2002 and 2015. Similarly, households using adequately iodised salt doubled from 35% to 77% from 1998 to 2016.Much of this progress can be credited to improvements in household wealth, parental education, and <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">sanitation</a>. But equally important was increased coverage of health and nutrition services undertaken by successive governments.Nepal Government utilised ground-breaking research to test interventions and overcome challenges, it is also committed to enforcing mandatory legislation such as salt iodisation, writes the journal supplement.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f69c7e80680e0b288ejpeg.jpg" alt="" width="1500" height="1001"><figcaption></figcaption></figure>Mobilisation of <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a> (FCHVs) across Nepal villages and towns have improved the health of mother and children, so has an investment in sectoral programs including education and sanitation.But there are now new challenges to achieving national and global targets on nutrition, which also threatens to undermine past gains.“The learning from the past 25 years that are incorporated in the supplement will inform and contribute to future improvements. However, we must act now, given the impact that the pandemic has had on the nutritional health of mothers and their children,” says Elke Wisch, UNICEF Representative to Nepal.During the pandemic, most households experienced job losses or reduced income. With the <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> spreading across Nepal, the pandemic’s ensuing socioeconomic crisis is long from over.This means reduced dietary intake among children and mothers. School closures will deprive many children of getting one decent meal a day. All this will add to <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">childhood malnutrition</a> which continues to be a major cause of death and retarded mental and physical development among younger populationsAs such, UNICEF has recommended the government to improve the general public’s access to nutritious, safe, affordable, and sustainable diets. It also suggests integrating essential nutrition services into the existing service delivery platforms like family planning, antenatal, delivery and post-natal care and well-child and sick-child care and continuing to mobilise FCHVs to reach more women and children.To disseminate factual information, advice and counselling on infant and young child feeding, <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">healthcare workers</a> can also use multiple communication channels such as radio, TV or social media.But perhaps equally if not more important is strengthening local levels so that they can plan, implement and monitor nutrition programs and services, and maintain Nepal's commitment to generating data, information, and evidence to assess progress and inform decisions.

Covid undermines Nepal's mother-child gains

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ac9c7e80680e0b2875jpeg.jpg" alt="" width="960" height="641"/><figcaption>Crowd of people lining up for Covid vaccination outside Teku Hospital on Tuesday. Photos: AMIT MACHAMASI</figcaption></figure>During the devastating second wave last year, hundreds of people were dying every day. Hospitals had <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">run out of ICU beds and oxygen cylinders</a>.This time, hospitals are running out of medical staff.As elsewhere, <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the third wave</a> in Nepal is infecting healthcare workers, endangering not only patients with Covid pneumonia, but also those suffering from pre-existing conditions like kidney failure, diabetes, cancers or cardio-vascular diseases.This acute shortage in medical staff across Nepal due to the rapid spread of Omicron has prompted the Ministry of Health to consider shortening the isolation period for doctors, nurses and paramedics to five days. The US and India have already done so.Hundreds of <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health workers</a> are testing positive daily in hospitals all over the country, turning health facilities themselves into a hotbed of the virus.On Tuesday, there were 10,258 new cases out of 22,828 tested, bringing the positivity rate up to 45%. This is the highest ever daily new cases for Nepal and also the highest positivity rate.International airlines flying out of Kathmandu are reporting a sharp increase in the number of passengers who cannot fly because of the PCR positive test results. So far passengers on domestic flights are not required PCR tests, only vaccine cards from next week.“Omicron is spreading like wildfire through all hospitals, in ours alone we have 35 staff testing positive,” says <a href="https://www.nepalitimes.com/banner/nepals-far-sighted-eye-care/" target="_blank" rel="noopener noreferrer">Sanduk Ruit</a> of Tilganga Eye Hospital in Kathmandu.One of the bigger facilities in Kathmandu, HAMS Hospital, has 16 of its clinical staff in isolation after testing positive. On 17 January, 52 staff of the Trauma Centre Hospital tested positive in one day, affecting emergency care of accident victims.Teaching Hospital and Bir Hospital in the Valley also have a similarly high number of doctors and nurses infected and isolating.“Health workers in every ward are infected, Covid has now spread from the emergency to the general ward, the blood bank, physiotherapy, ICU and even the administration,” director of the Trauma Centre Pramod Joshi told Nepali Times.The hospital is now primarily treating patients that need emergency care and surgery. “The hospital is full of patients and the ICU is packed as it always is,” he said.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ae9c7e80680e0b2876jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The third wave has now even affected hospitals outside Kathmandu, which are struggling to cope due to a shortage of staff.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital</a> in remote Achham district has curtailed some critical services like C-sections because of sick staff. Charikot hospital in Dolakha district which had finally stopped reporting new Covid infections only last month is back to caring for an increasing number of coronavirus patients but with fewer staff.“Some of us have mild but manageable symptoms but we are still working, we had a shortage of healthcare workers even before this third wave,” Binod Dangal of Charikot Hospital said. “In fact, we have fewer people than we had during the second wave, we have equipment but no trained staff. We are no better prepared than we were before.”The only respite during the third wave is that the new strain is much milder. Because Omicron’s impact is largely confined to the upper respiratory tract, physicians say their patients do not need as much oxygen or ventilator support as was the case with the Delta variant which primarily affected the lungs.Most doctors in and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">outside Kathmandu</a> say they expect infected staff to be back at work in a week after another test. Even so, given Nepal’s largely unprepared and limited healthcare infrastructure which works on a shift basis, medical staff having to isolate just a few days can seriously disrupt medical care, especially in rural areas where hospitals and doctors were always few and far between.Indeed, this latest crisis reflects on a pre-existing chronic shortage of doctors, nurses and trained medical staff, says <a href="https://www.nepalitimes.com/opinion/diary-of-a-covid-frontline-worker-in-nepal/" target="_blank" rel="noopener noreferrer">Bikash Gauchan</a> of the Gandaki Province Infectious and Communicable Disease Hospital in Pokhara.“What we are experiencing now is both an acute and chronic shortage of healthcare workers, and this carries a lesson for our government, to strengthen and prepare its medical resources for future pandemics,” he adds.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron/" target="_blank" rel="noopener noreferrer">Booster shots for frontliners</a> including healthcare workers in Nepal  started this week, and the additional dose will provide much needed protection to doctors and nurses who work in close contact with possibly infected patients.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b29c7e80680e0b2877jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b49c7e80680e0b2878jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204b79c7e80680e0b2879jpeg.jpg" alt="" width="960" height="641"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204ba9c7e80680e0b287ajpeg.jpg" alt="" width="960" height="641">But crowded vaccination centres (pictured above) themselves risk being breeding grounds for infection. This time the queues are not just of the unvaccinated getting their first jabs, but also those waiting for boosters. Even if vaccinated, doctors say masks and physical distancing are mandatory.They warn the public <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">not to be complacent</a> because they are vaccinated and that Omicron is milder. Binod Dangal of Charikot Hospital says: “Most people are treating Omicron as a normal cold but it is very important for us to monitor the progress of the disease in the next few weeks, and prepare for adequate critical care.”At Nepal’s biggest infectious disease centre Teku Hospital, virologist Sher Bahadur Pun cites scientific studies to say that the shortage of healthcare workers will not persist, and the isolation period can be reduced. Nepal has likely passed the most infectious stage of <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">Omicron spread</a> and it is now time to keep a close watch on people isolating at homes and in hospitals.Pun adds: “We must also investigate which strain is causing Covid deaths in Nepal because if Omicron had indeed replaced Delta, our figures for mortality should not be as consistent as it was before the third wave.”

3rd Covid wave infects Nepal’s frontliners

<figure><img width="1319" height="1975" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203ae9c7e80680e0b281ejpeg.jpg" alt=""/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>For the first time in four months, Nepal recorded over 1,000 daily new Covid cases on Sunday. Of the 12,632 people tested nationwide, 9% were positive – proving that <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer">Omicron</a> has replaced Delta as the dominant strain.Reacting to the sharp rise in infections, Nepal’s Covid-19 Crisis Management Committee (CCMC) has imposed a ban on gatherings of more than 25 people in public spaces, and made it compulsory to show vaccine certificates before entering them. Schools that had just opened following winter vacation, will also be shut for another three weeks.“It will be foolhardy of us not to expect a surge now. But if the vaccination drive slows, we will pay for it dearly,” warns Buddha Basnyat, a physician at Patan Academy of Medical Sciences.But Nepal’s vaccination drive has hit a speed bump because of a shortage of syringes. Although <a href="https://www.nepalitimes.com/here-now/from-scarce-vaccines-to-storage-shortage-in-nepal/" target="_blank" rel="noopener noreferrer">there is a stockpile</a> of 12 million doses in refrigerated stores across the country, and 6 million more doses on the pipeline, there are a limited number of needles to administer them.Nepal was one of the first countries in the region to start Covid vaccinations in March 2021, and has managed to fully inoculate only 36.8% of its 30 million population. Only half the population has received the first dose. The needle shortage is holding back first jabs, second doses and booster shots for the vulnerable groups including health workers, the elderly and immuno-compromised individuals.“Two doses of vaccines against Omicron is not as effective but a booster is. So we have to provide the third dose not so much to prevent mortality, but to stop Omicron from spreading rapidly and overwhelming our healthcare system,” says epidemiologist Lhamo Yangchen Sherpa.She adds: “Yes, there is a moral dilemma to boosters. Given that a majority of Nepalis haven’t yet been fully vaccinated we have to consider the latest development as the doses are approaching their expiry date.” Nepal is planning to provide boosters only when 40% of the population has been fully inoculated. But studies have shown that the immunity afforded by vaccines wanes over time with a significant decline in the level of antibodies. And while most of the vaccines are not as effective against Omicron, they still <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">largely prevent severity</a>.Says Minister of Health and Population Birodh Khatiwada: “We are trying to sort out some final details and will make an announcement on boosters soon.”Studies have now confirmed that Omicron produces less damaging infections with impacts largely limited to the upper respiratory tract and does not multiply readily in lung tissue, leading many to believe that <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">the new variant is much milder</a> and hence likely to replace Delta.“We must provide boosters for the most vulnerable groups, I have seen many patients at my hospital who are fully inoculated but struggling with complications,” says virologist Sher Bahadur Pun at Kathmandu’s Teku Hospital. “Just because they have already received two doses we can’t leave them to die.” He adds: "In the meantime, we also have to identify groups who can’t access shots and those who are still hesitant to inoculate, and work out strategies that address them best to speed up the vaccination drive.”Most infected people are also experiencing much milder symptoms of Omicron, either because they have been vaccinated or have natural immunity due to previous infections that they were not aware of. Even so, the sheer transmissibility of the new strain will likely <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">overwhelm Nepal’s understaffed and underfinanced healthcare</a> mechanism. <figure><img width="640" height="296" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203b19c7e80680e0b281fjpeg.jpg" alt=""><figcaption>Daily case load in India and Nepal (below). Source: WORLDOMETERS</figcaption></figure><figure><img width="640" height="327" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203b49c7e80680e0b2820jpeg.jpg" alt=""><figcaption></figcaption></figure>In neighbouring India, the daily caseload is now nearing 150,000 a day, and it is doubling every 1.5 days in Bihar state across the border. During the Delta surge, Nepal’s cases peaked two weeks after it did in India, but with Omicron it may not even take that long. “We are prepared for hospitalisations if cases are milder and not as serious but we don’t know how the virus will behave. We are also better prepared than the last surge with oxygen, ICUs and other facilities,” says Sangita Kaushal Mishra at the Ministry of Health Health Coordination Division.That may be the case, but across Nepal many rural hospitals are still understaffed and <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">do not have trained personnel</a> to operate ventilators and run ICU wards. Similarly, not all newly installed oxygen plants are functional yet.Then there is virtually no contact tracing, leading experts to believe that figures for Omicron are underreported, and only individuals with symptoms are being tested. “Given how contagious Omicron is, increased testing can go a long way in controlling the surge, so can institutional isolation of active cases,” says Bikash Gauchan of the Gandaki Province Infectious and Communicable Disease Hospital in Pokhara.Children all over the country are still largely unvaccinated, and should be prioritised during the time that schools are closed. There has been a worrying rise in paediatric hospitalisation in the US and Europe among unvaccinated children. And while people below 18 years have been largely spared so far, they are nonetheless an active medium for the virus to spread rapidly to more at-risk groups.The community spread of Omicron in Nepal is blamed on large gatherings of major political parties during their conventions in the past month. Such irresponsibility from top leaders has also led general populations to flout safety measures. Maoist Centre Chair Pushpa Kamal Dahal, his family and many of his close aides have tested positive, and leaders of other political parties, including ministers are in isolation.The once-in-12-year <a href="https://www.nepalitimes.com/banner/creation-to-destruction-then-revival/" target="_blank" rel="noopener noreferrer">Makar Mela</a> is expected to draw 6 million visitors in a month to Panauti starting next week, and can be a hyper-spreader event. So can the lead-up to the local elections slated for April. “The fact that Omicron is much milder can make people more careless, so we must once again reinforce the importance of masks, ventilation and distancing,” says Pun.Besides this, the second line of defence is to vaccinate as many people as soon as possible, and start giving boosters to the rest. Adds Buddha Basnyat: “We were lucky with Omicron that it is mild but we should use it as an opportunity to vaccinate both the unvaccinated and boost the vulnerable groups simultaneously on war footing to prevent stronger variants from arising.”

Boosting booster jabs against Omicron

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/6372030d9c7e80680e0b27e9jpeg.jpg" alt="" width="1378" height="919"/><figcaption>Photos: AMIT MACHAMASI</figcaption></figure>Be it by naïveté, misplaced optimism, or a great faith in the healing powers of Himalayan air and turmeric, no one in Nepal had expected that we would be in the global epicentre of the Covid-19 surge fuelled by the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant in the spring of 2021</a>.Our miscalculation and gross lack of preparation cost thousands of lives and left so many Nepalis bereaved during this Dasain and Tihar. Shortly after <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">the Indian wave began in March</a>, Nepal recorded the highest number of Covid cases per capita, and the worst viral transmission rates on the planet. While the world focused on India, Nepal's health system was overwhelmed in a matter of days.Remember how we <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">desperately searched for oxygen cylinders</a>, when every ICU bed was occupied and ventilators were in short supply? Remember rural communities where the situation was even worse, and so many Nepalis died without any medical attention? And there was the black market that forced many to pay exorbitant rates for life-saving oxygen, masks, and even paracetamol.We cannot afford to forget these terrible and deadly months. If we do, and do not prepare for the next wave, we will be bound to repeat them. With <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">the Omicron variant </a>now spreading like wildfire across the globe, let us remind ourselves that Nepal experiences a surge in Covid cases a few months after the rest of the world. The Delta variant (which has been proven to be less transmissible than Omicron) took more lives in just a few months than the 2015 earthquakes.The current low case numbers in Nepal are not going to last. Repeating our mistakes of under-preparedness and apathy has the potential to kill thousands of more Nepalis in the coming months.While preliminary data shows that the Omicron variant is <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">less likely to hospitalise infected individuals</a> than Delta did, we need to take into account that this new variant spreads at a much faster rate. The relief we may feel from a smaller percentage of Covid patients needing life-saving care is cancelled out by there being an exponentially higher number of total infections.Our medical facilities will still be overwhelmed, leading to unnecessary loss of life on a large scale. In short, Omicron is <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer">not to be underestimated</a>, especially for densely populated communities in Nepal.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203109c7e80680e0b27eajpeg.jpg" alt="" width="1221" height="814">We still have some time to prepare. Policy makers and individuals alike have important roles to play in the critical next weeks and months. We cannot squander this opportunity to save lives. National and local governments need time to act now on these critical areas:<ol><li><a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">Vaccinate Aggressively</a>: There are varying statistics on the percentage of Nepalis vaccinated, but no more than 40% of the population have been fully vaccinated. Booster shots are now necessary to adequately protect a population, so we still have a very long way to go.</li></ol>The good news is that even if we cannot fully vaccinate and provide boosters for the entire population, clinical experience shows that <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">vaccinated individuals</a> have less need for Covid-19 hospitalisations and are much less likely to die from the Omicron variant. Decision makers can make our limited vaccine supply go further by prioritising vaccines for densely populated cities and in areas where Delta infection was low, as people in these areas are less likely to have natural immunity.<ol start="2"><li>Border Control: The devastating wave of the Delta variant in Nepal began a few weeks after it had taken hold in India. This was largely attributed to a spillage of the virus through the open southern border. We can support municipalities along the border to help contain the Omicron by strict health desks to screen individuals crossing the border. This will require increased funding and other resources.</li></ol><ol start="3"><li>Isolation and Quarantine Centres: Delta spread from India and urban areas into the countryside because we could not properly accommodate and care for infected patients in quarantine and isolation centres. There is time to re-establish these facilities before the next wave hits, and train frontline health workers and local governments based on guidelines that already exist. Again, as the variants (and our knowledge about them) evolve, we need to remain agile and empower our managers and healthcare workers to address the changing ground situation.</li></ol><ol start="4"><li>Oxygen Supply: During and after the Delta wave last year, the Ministry of Health and Population made commendable efforts to expand oxygen plant availability in the country, with support from international aid groups. These new plants need to be brought online and tested in the coming months, and MoHP must accelerate its efforts to meet its own requirement of having an oxygen plant at every 100 bed-hospital in the country.</li></ol><ol start="5"><li>Using Female Community Health Volunteers: FCHVs have been a key for many of Nepal’s remarkable gains in public health, including reducing maternal mortality rates. This network of local health workers was not fully deployed during the last Covid wave. We can use FCHVs to disseminate public health information, vaccine knowledge, and to play a frontline role in enforcing community guidelines to reduce local transmission of the virus, and to care for the infected. These volunteers and other community-based health workers need to be adequately compensated, and equipped with materials, protective equipment, and training.</li></ol>Properly mobilising and empowering FCHVs is the fastest and most efficient way to support rural communities that lack other options for advanced care. This will have a ripple effect across the national health system, and may be a key factor in avoiding another total collapse. All of these steps depend on implementation by the government and private healthcare system. We commend recent steps taken by the health department to test Nepalis returning from India, and to establish quarantine centres along the border.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203139c7e80680e0b27ebjpeg.jpg" alt="" width="856" height="571">As individuals, we must <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">continue to take responsibility</a> for protecting our loved ones by following public health guidelines for another few months at least. History shows we will not know for certain that Omicron has arrived in Nepal until after the variant is endemic in the population. These proactive measures can slow the spread, starting now:<ol><li>Mask up in all public places and when in close contact with members of at-risk populations. Doubling up on masks is a good idea, given the extremely contagious nature of Omicron.</li></ol><ol start="2"><li>Avoid touching the face with fingers, and frequently wash hands - at least 20 seconds with soap and water.</li></ol><ol start="3"><li>Avoid all public gatherings. If not, maintain social distance of at least 1m.</li></ol><ol start="4"><li>Support the local government by following protocols and encouraging elected officials to take proactive measures to protect the community. Volunteer to spread awareness or set up facilities if you can, and be ready to support your community when the next wave arrives. We Nepali are great at using ‘source-force’ to get things done - now is a great time to use your connections and networks to encourage people in positions of influence to take proactive steps to prepare for Omicron.</li></ol>In the age of Covid, it’ is every country and every community for itself. Delta taught us in Nepal not to trust promises of international aid to save us from the pandemic. We are on our own, and we only have each other to get through this.The Delta wave, like <a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/" target="_blank" rel="noopener noreferrer">the 2015 earthquakes</a>, also taught us that when the going gets tough, Nepalis come together and achieve miracles. Remember the community groups that blossomed across the country to create isolation centres, distribute food and supplies, and invented improvised oxygen concentrators.Remember the FCHVs and community members who risked their lives to travel into every corner of the country to deliver vaccines to the most vulnerable citizens.  This time, we have an opportunity to harness this grit and compassion when it is needed most - before the disaster strikes.Ramu Kharel is an emergency medicine physician at Brown University and has worked extensively in the frontlines of Covid-19. He runs a non-profit organisation HAPSA in Nepal that is working on Covid response.Ben Ayers is an American citizen based in Nepal for over 20 years.

Omicron is coming to Nepal, be prepared

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161156/636d1f8c9c7e80680e0af46fjpeg.jpg" alt="" width="1624" height="1360"/>Exactly one year ago, this newspaper restarted its hardcopy edition 10 month after going digital-only. The <a href="http://himalaya.socanth.cam.ac.uk/collections/journals/nepalitimes/pdf/Nepali_Times_1042.pdf" target="_blank" rel="noopener noreferrer">1 January 2021 #1042</a> of Nepali Times carried the bold banner: ‘Print Is Back’.There was optimism in the air. We thought the worst was over with Covid-19 pandemic, the economy was going to revive and the country would bounce back.Little did we know what 2021 had in store: the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">second wave</a> crashed onto Nepal’s shores in April from India, the Delta variant overwhelming the country’s hospitals, and exhausting oxygen supply. Complaceny has set in again, but experts warn we have been caught with our pants down too often.The WHO warned on Wednesday that the ominous Omicron variant is merging with Delta to create a Covid tsunami. Nepal has all the conditions (low vaccination rate, limited testing, crowding) for this highly transmissible strain to spread like wildfire again.Wish we had better news for 2022. But things are not looking too rosy. Sectorwise:Economy<a href="https://www.nepalitimes.com/banner/defying-predictions-nepals-remittances-still-high/" target="_blank" rel="noopener noreferrer"> Overseas remittances that had held steady</a> despite the pandemic went down by 7.6% in October-November to Rs312 billion. Meanwhile, imports rose to Rs82 billion so far this fiscal year, while exports is lagging at mere Rs6.5 billion. The trade deficit increased to Rs150 billion in October-November, while foreign currency reserves dipped by $510 million to a near record low of $10.47 billion — enough only to last six months of imports.Tourism revenue has collapsed, and government spending is stagnant. Banks are suffering a liquidity crisis, although that seems to be due to increased borrowing.Things are not looking good in agriculture: rice harvests went down by 20% due to post-monsoon floods, and there is a chronic fertiliser crisis.Janardan Sharma may have been a brilliant guerrilla commander, but he seems clueless as Finance Minister — he has no sense of urgency about the emergency. He and his boss are prone to gaffes that spook the market even more. This economic crisis is a result of populism and neglect. 2022 being an election campaign year, it is not likely to be addressed.CovidLearning from mistakes from the past two years, the Health Ministry must be prepared for an <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">Omicron surge in 2022</a> with border testing and tracing, ICU beds, ventilators and oxygen generators. A mass vaccination and booster campaign with the 12 million stockpiled doses should have started last month. What are they waiting for?ClimateNepal’s delegation said the right things at the <a href="https://www.nepalitimes.com/banner/copout-at-cop26/" target="_blank" rel="noopener noreferrer">COP26 in Glasgow</a>, but seems too distracted with immediate political crises to look at net-zero and forest cover targets it pledged. We cannot afford to wait for climate adaptation funds that may never come to start doing our bit at home to reduce petroleum consumption and switch to renewables.<a href="https://www.nepalitimes.com/here-now/all-eyes-on-2023/" target="_blank" rel="noopener noreferrer">Elections</a>2022 will be dominated by campaigning. We have got a whiff of what it is going to be like from speeches at the recent party conventions. In the absence of result-delivery while in office, leaders are falling back on religion, monarchy, ethnic politics and rolling back federalism.Given the political failure of the past four years (example: blatant fragmentation of ministries in Bagmati Province) those who want to scrap federalism and secularism are building mass support.GovernanceThen there is governance, or the lack thereof. Service delivery and development are at a standstill. There is colossal misappropriation of state funds for personal and party gain.National projects like the <a href="https://www.nepalitimes.com/here-now/china-lobbying-against-mcc/" target="_blank" rel="noopener noreferrer">MCC are weaponised in a geopolitical proxy war.</a> Tried-tested-failed figures of the past decades have been elected to senior party positions.MigrationGiven all this, the wellbeing of Nepalis in coming years will continue to depend on remittances. We hope <a href="https://www.nepalitimes.com/latest/nepals-remittances-forex-reserves-drop/" target="_blank" rel="noopener noreferrer">this year’s dip</a> is a blip. This important sector must be cleaned of corruption and abuse, new labour markets explored, and overseas Nepalis encouraged to return and invest.Given the new party leadership, we do not expect much from this or post-2023 governments. But we have hope in <a href="https://www.nepalitimes.com/review/alpine-style-in-the-himalaya/" target="_blank" rel="noopener noreferrer">Nimsdai Purja</a>, Prabal Gurung, Santosh Shah and tens of thousands of other hard-working citizens across Nepal who keep the flag flying.

Keep the flag flying in 2022

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1f0f9c7e80680e0af445jpeg.jpg" alt="" width="640" height="384"/>Although Nepal’s airlines have weathered the pandemic and remained airworthy, there are concerns about whether Covid has removed forever the magic and the romance of flight. It is hard to believe that it was only a century ago that the first heavier-than-air humans defied gravity and took to the skies.And just look at how far we have come since then. Modern airliners offer the epitome of luxury and comfort: seats equipped with Shiatsu backside massage, high speed internet, and futsal on the upper deck. Meanwhile in Economy, eco-friendly airlines now offer free fully-biodegradable family-size barf bags.Modern aviation is governed by the Vienna Convention as well as by Newton’s Second Law of Thermodynamics which states that the most garrulous gentleman from the Subcontinent, with odoriferous socks and a sneezing fit, must occupy the seat next to you on the 16-hour flight to Chicago.On a red-eye to Europe, the bulkhead bassinet will invariably have a baby who wails non-stop right across the air space of all five ex-Soviet Central Asian republics.In these troubled times, we have to find ways to re-inject awe and wonder to the experience of flying, which is why we are chuffed to hear that Nepal’s brand new Minister of Vermiculture, Marxism and Space Cadets has tried to ensure just that with some bold decisions.One of the first things he announced after swearing himself in was that once-Royal Nepal Airlines has been granted an ICAO license to carry dangerous goods. (If you don’t believe me, google him.) I am not sure a national flag carrier should necessarily be proud that its aircraft now carry hazardous cargo. But, hey, it also shows that we are not a nation of cowards. Nims Dai Was Born In Nepal.The resumption of free beer service on the Delhi shuttle is another proud accomplishment that will restore RA to the glory days of the Dakota, when passengers were allowed to board with one goat each as carry-on luggage on flights from Bharatpur to Palungtar provided it did not exceed the dimensions of the overhead rack.In the Covid era, there are other steps the Civil Aviation Authoritarians of Nepal (CAAN’T) have taken to revive the sheer thrill of flying. Passengers are not allowed to use toilets even if the 14 minute fright from Simara has to circle for one hour to land in Kathmandu due to air traffic congestion. Imagine the sheer suspense and excitement!It has also introduced monkeys into the domestic terminal to remind passengers about the primates we are all descended from.By allowing wild boars and jackals to cross the runway at Nepalganj, airport management has added another magical dimension of mystique to the miracle of flight.And we have just heard that pilots are also doing their bit to re-introduce a sense of amazement and surprise to domestic aviation. Recently, they transported unsuspecting Janakpur-bound passengers to Pokhara instead.

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