<figure><img width="1334" height="889" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14189c7e80680e0a995ejpeg.jpg" alt=""/><figcaption>Children aged 12-17 started getting inoculated with the Pfizer BioNTech Covid vaccine in Kathmandu on Monday. Photo: AMIT MACHAMASI</figcaption></figure>Not long ago, <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">to boost or not to boost </a>was the dilemma of rich countries, even as developing nations were struggling to vaccinate their frontline workers and elderly with the first dose.
The argument <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">has now reached our part of the world</a>, with some health experts even in Nepal recommending boosters shots for the immune-compromised and frontline workers. In fact, the government’s Teaching Hospital and a few others in Kathmandu this week administered a third booster shot to some patients suffering pre-existing diseases.
The recommendation has been met with some conflicting opinion at a time when only a little over 30% of Nepal’s target population has been fully inoculated against Covid-19. While over half the people in densely populated urban centres like Kathmandu have been vaccinated, parts of rural Nepal are still largely unable to access jabs.
“Our first and foremost priority must be to vaccine everyone, and if we have plenty more vaccines, which we are more than likely to have, the next step is to provide booster shots to people with co-morbidities and the elderly,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.
Infectious disease specialist at HAMS hospital Anup Subedee agrees: “If the question is what is more advantageous in terms of controlling the pandemic, vaccinating the unvaccinated or offering booster shots, the answer is to vaccinate everyone first.”
Having said that, Subedee adds that Nepal should provide the third dose of VeroCell to individuals who were inoculated with the Chinese vaccine, for higher efficacy, as recommended by the World Health Organisation (WHO).
The concern about boosters is mainly because antibody levels decline significantly after 6-9 months of being inoculated, as proven by studies around the world. And as one of the first countries in South Asia to start its Covid-19 vaccination drive, it has been six months since<a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer"> frontline workers</a> were given jabs.
Some experts, however, say that the human body provides protection also from so-called ‘memory cells’ so that even if vaccine immunity drops, the T and P cells which produce antibodies only when a pathogen attacks. There is no exact estimate of how long the memory cells provide protection, but it is most likely long-term, which means the general population may not need booster shots just yet.  
Those who recover from Covid-19 are even better placed to ward off the infection and its complications, with natural immunity being more effective than that gained by vaccination. And according to the recent seroprevalence survey, over two-third of Nepalis have SARS-CoV-2 antibodies that provide them natural immunity.
“Given that 68% of people in Nepal have some form of protection and a significant chunk of the population is fully vaccinated, we don’t have to worry about boosters yet. Our infection rate, hospitalisations and morbidities have all largely declined,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal, which conducted the seroprevalence survey.
The new surge in Europe has been associated with the Delta variant, which has already swept through every corner of Nepal and India, which means a majority of the people here have developed some immunity against it.
“So, we don’t have to panic about another major surge as of now,” Dixit adds.
This is <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">not to say Nepal is out of the woods</a> yet. With a declining number of daily cases and fatalities, schools have reopened, there are wedding parties, crowded marketplaces and indoor seminars are happening all over the country.
Safety measures must be maintained despite higher vaccination rates and declining hospitalisations. This means, continuing to mask up, avoiding crowds and maintaining distance -- especially with the onset of winter and the seasonal risk of coronavirus, influenza and pneumonia infections. There are already reports of students, parents and teachers in Kathmandu schools testing positive for Covid-19.
The government had <a href="https://www.nepalitimes.com/latest/pfizer-vaccines-arrive-in-nepal/" target="_blank" rel="noopener noreferrer">set aside Pfizer </a>vaccines for the immunocompromised, but a lack of uptake meant that students up to age 12 are now being offered the US-made vaccine that has been certified for children.
Shyam Raj Upreti, Nepal’s focal person for the Covid-19 vaccine maintains that the government will start administering booster shots only after nearly 100% of the targeted population has received its first dose, the figure currently stands at about 40%.
Nepal has so far received 25 million doses of vaccines in <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">donations or purchase</a>, 30 million more are in the pipeline. “We now have more than enough vaccines for our targeted population, and we are now starting with students,” says Upreti. “The new challenge is to increase vaccine acceptance among those who have so far refused to take it.”
Although surveys have shown that 97% of Nepalis trust vaccines, many pregnant women and those with co-morbidities are refusing to get shots, <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">fearing side-effects</a>.
Experts caution that Nepal’s response to the pandemic needs to <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">extend beyond vaccinations</a>. The country has to be prepared for a possible surge, and this means contact tracing including the testing of the children, stringent quarantine and isolation, well-equipped health infrastructure and trained medical staff to operate them.
“Another surge might not be a major one but it could still be on a scale sufficient to significantly impact our economy and lives,” adds Anup Subedee. “So we have to be prepared. But a lot of it boils down to political will, and an efficient bureaucracy that is focused on controlling the pandemic.”
Indeed, Covid-19 is here to stay which means continued vigilance and precautions like <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">masking and physical distancing</a>. Warns physician Buddha Basnyat: “Covid-19 is a wily virus, and it is still a formidable foe. We can’t let down our guards yet.”

Sonia Awale

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Do Nepalis need Covid booster shots?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d08649c7e80680e0a6014jpeg.jpg" alt="" width="1319" height="1975"/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>The <a href="https://www.nepalitimes.com/opinion/eu-will-stand-by-nepal-in-hard-times/" target="_blank" rel="noopener noreferrer">European Union</a> has renewed its committment to sharing more than 200 million doses of Covid-19 vaccines with low and middle-income nations, including Nepal, by the end of 2021.The doses will be delivered mainly through <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">the COVAX initiative</a>, which has so far provided 122 million doses to 136 countries. This is far less than the quantity originally promised because of supply chain issues and India’s ban on export of its AstraZeneca Covishield vaccine.“Team Europe takes its responsibility in helping the world fight the virus, everywhere. Vaccination is key – that's why it is essential to ensure access to Covid-19 vaccines to countries worldwide,” said EU President Ursula von der Leyen at this week’s Global Health Summit in Rome.In parallel, Europe is providing better access to vaccines, medicines and health technologies in Africa, in part by helping create the right conditions for local vaccine manufacturing in Africa.The initiative will be backed by a €1 billion grant from the EU, and European development finance institutions such as the European Investment Bank (EIB).On 9 July, Team Europe agreed to support large-scale investment in vaccine production by the Institut Pasteur in Dakar. The new plant will reduce Africa's 99% dependence on vaccine imports and strengthen future pandemic resilience in the continent.The European Union is one of the biggest donors of COVAX and has contributed at least €2.47 billion to the initiative, which had committed to providing free vaccines for 20% of Nepal’s population.It sent its first consignment to Kathmandu back in March with 348,000 doses of AstraZeneca Covishield manufactured by Serum Institute of India. But owing to a global manufacturing bottleneck and the export ban in India on vaccines, it was <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">unable to deliver any more doses</a> till recently.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d08679c7e80680e0a6015jpeg.jpg" alt="" width="448" height="537"><figcaption></figcaption></figure>Even as Nepal was in the grip of the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second wave</a> in May-June when there were close to 10,000 new cases daily and up to 250 fatalities a day, there was a complete stop to vaccinations.Nearly 1.4 million Nepalis above 65 are <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">still waiting for their second doses of Covishield</a>, which they may now get with a grant of 1.6 million doses of AstraZeneca from Japan.In early July, the Americans flew over 1.5 doses of single-shot Johnson &amp; Johnson to Kathmandu under COVAX, which is sending another 350,000 doses by August.At present VeroCell and <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">J&amp;J vaccination</a> drives are running in parallel across Nepal and the vaccine supply chain is <a href="https://www.nepalitimes.com/latest/vaccines-start-trickling-into-nepal/" target="_blank" rel="noopener noreferrer">less constrained</a>.But the decline in the number of new infections and deaths has now stalled. Public health experts have warned <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">of a third wave</a> and there are threats of newer, more virulent variants as long as a major chunk of the population remains unvaccinated.Covid mortality rose by 50% this week, and urban centres in Kathmandu, Lalitpur, Chitwan, Kaski and Jhapa have recorded the most new cases.On Friday, there were a total of 2,977 new cases across the country, taking the total active infections to 28,518. There were 18 fatalities in the last 24 hours and 1,678 recoveries. So far, 9,679 people have succumbed to Covid-19 in Nepal since the outbreak in January 2020.

EU to share 200 million vaccines by 2021

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f09c7e80680e0a5febjpeg.jpg" alt="" width="2048" height="1365"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>For the first time in weeks, Nepal recorded more than 3,000 new cases on 20 July. There were 25 deaths. The country is on the tail end of what has been a deadly second wave, but the rate of decline in infections and mortality has stalled.Public health officials blame it on <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">sudden reopening following two-months of lockdown</a> in which many mingled without masks, low vaccination rate, and minimal testing and tracing.While some experts say Nepal and India are now safe against another major surge of the Delta variant that was largely responsible for <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave</a>, others warn of a third wave if safety measures are not enforced.The Delta mutant is now ravaging Indonesia, and spreading across Europe and North America. And scientists say it has affected mostly countries and regions with low vaccination rates.“The third wave is a matter of when not if. And if we don’t vaccinate as many people as soon as possible, there will be a continued threat of more dangerous variants, and we will be repeating the whole cycle,” warns Buddha Bansyat, a physician at the Patan Academy of Health Sciences.So far, Nepal has fully vaccinated 1,158,130 people, 3.6% of its total population. Some 10% Nepalis have received the first dose of either AstraZeneca Covishield, Chinese Sinopharm VeroCell or <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">single-shot Johnson &amp; Johnson</a> jabs.Another 8 million doses of various Covid-19 vaccines are expected by September – some purchased from China, more doses from COVAX, as well as a direct grant from Japan. This should take the total fully vaccinated population near 20%, which together with antigen positive population could cushion the impact of a possible third wave.“We have now moved on from vaccinating <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">the elderly</a> and frontline workers to groups less at risk of the Covid-19, and we have more vaccines in the  pipeline,” says Shyam Raj Uprety, head of government's Covid Vaccine Strategy. “We have applied to buy 10.5 million more doses of vaccines from the COVAX at a subsidised rate.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f39c7e80680e0a5fecjpeg.jpg" alt="" width="448" height="537"><figcaption> </figcaption></figure>Indian public health experts have projected the third wave to hit that country in late August. What happens in India usually follows in Nepal within 12-13 days, and if that is true this time too, Nepal cannot be  unprepared like in March.“If the vaccination program progresses as smoothly as it is happening now compared to the first two surges, the third wave might not be as significant if it happens at all. By Dasain, a significant chunk of Nepalis should have been vaccinated,” explains Sameer Dixit of Centre for Molecular Dynamics Nepal.Apart from vaccines, in case of a sudden surge, hospitals need to be ready with sufficient beds and ICUs, oxygen, life-saving medical equipment, drugs and <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">functioning oxygen plants</a>. Hospitals must also prepare their paediatric wards since the third wave could affect a younger population.Since the peak of the <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">second wave</a> when there were close to 10,000 new cases a day and over 200 daily fatalities, international donors have been supplying essential medical equipment to Nepal.The Health Ministry received 385 ventilators and 970 oxygen concentrators in May June from various donors. District hospitals at local levels have also received direct supplies from aid agencies. These should be in running  condition and on standby instead of being stockpiled in Kathmandu, say doctors interviewed for this report.With the <a href="https://www.nepalitimes.com/latest/vaccines-start-trickling-into-nepal/" target="_blank" rel="noopener noreferrer">vaccine supply chain less constrained</a>, there is now a debate about reprioritising the doses and a more strategic distribution of supply. Some experts have suggested a ‘firewall strategy’ wherein densely populated cities are fully vaccinated to reduce transmission, and to revive  the economy that will in turn restore jobs.Equitable vaccination is ideal, but in epidemiological terms inoculating a thinly-spread population is not the best use of limited doses. Inoculating  younger adults mean they are less likely to carry the virus and transmit it to <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">children</a>, the largely unvaccinated group. Even within cities, the focus must be on the urban poor in congested areas.“Moving forward, we must now prioritise crowded cities and highly mobile groups for vaccination to help blunt the effect of another wave and save as many lives as possible,” says Sher Bahadur Pun, a virologist at Teku Hospital.However, epidemiologist Lhamo Yangchen Sherpa worries that focusing in cities may mean the underserved are neglected. “While reprioritising, our strategy should be such that the supply isn’t misused and the neediest aren’t missed out.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f59c7e80680e0a5fedjpeg.jpg" alt="" width="2048" height="1366"><figcaption> </figcaption></figure>At present VeroCell and J&amp;J vaccination drives are running in parallel across Nepal. Soon, the Japanese grant of 1.4 million <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AstraZeneca</a> will be used to inoculate the elderly who have been waiting for four months for their second doses.Social media is rife with speculation about the jabs and who should and shouldn’t get it, leading to widespread confusion and vaccine hesitancy. People are also comparing the efficacy level of one vaccine against the other.“Let’s take any vaccine available, they do what they are supposed to do, prevent deaths and hospitalisations in most cases,” says Buddha Basnyat.  “I encourage people with heart conditions, cancer and liver diseases to vaccinate, they are high-risk group, as well as pregnant women.”According to Public Health England, Covid-19 vaccines have so far  prevented 13,200 deaths and 39,700 hospitalisations in the United  Kingdom, even while the country sees a surge in Delta variant cases.As Nepalis inoculate against SARS-CoV-2, people are starting to forgo <a href="https://www.nepalitimes.com/opinion/staying-safe-in-2021-and-beyond/" target="_blank" rel="noopener noreferrer">safety measures</a> even if the majority of the population remains unvaccinated. They are back on the streets taking part in political rallies and conducting crowded indoor meetings. Jam-packed and poorly- managed vaccination centres could themselves be super spreaders.Says Sameer Dixit: “In midst of vaccines, variants and new surges, we cannot forget masks and physical distancing, it is still our first line of  defence against the coronavirus.”

Vaccines, variants and a third wave

<img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d066a9c7e80680e0a5f5fjpeg.jpg" alt=""/>Much-delayed <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">vaccine supplies to Nepal</a> appear to be picking up after another lot of Chinese Sinopharm vaccines arrived in Kathmandu on Friday, and assurances that the country will get additional doses through the COVAX facility in the coming weeks. In a government-to-government deal, Nepal ordered 4 million doses of Sinopharm’s VeroCell vaccines, which will be enough to inoculate an additional 2 million Nepalis. The first shipment of 800,000 doses was flown in by Nepal Airlines from Beijing on Friday. The United States has confirmed that it is working on the legal and logistical aspects of sending 1.5 million doses of its single-jab Johnson &amp; Johnson vaccine to Nepal under the COVAX initiative.  The British Minister of State for South Asia and the Commonwealth, Lord Tariq Ahmad in a written response to House of Commons MP Sir John Hayes on 30 June said that Britain would be sending more vaccines through COVAX by next month. ‘COVAX has allocated 2,000,000 vaccine doses to Nepal, of which 348,000 have already been delivered and we understand another tranche will arrive by August,” Lord Ahmad’s letter, which was made available to Nepali Times, states. However, it is not clear if the additional COVAX vaccines are the ones already pledged by the Americans, and if it is another lot how many doses of what kind of vaccines are involved. The Ministry of Health has said another 348,000 vaccines are coming through COVAX by August.  This fact is critical for the nearly 1.4 million Nepalis above 65 years who got their <a href="https://www.nepalitimes.com/latest/1-6-million-vaccinated-20-million-to-go/" target="_blank" rel="noopener noreferrer">first doses of AstraZeneca</a> more than 12 weeks ago, and their second doses are overdue. The elderly were inoculated first with Covishield AstraZeneca manufactured by Serum Institute India of which Nepal got 1 million doses as initial grant from India and then purchased another 2 million of which only <a href="https://www.nepalitimes.com/latest/the-gift-of-the-jab/" target="_blank" rel="noopener noreferrer">1 million were delivered </a>before New Delhi banned vaccine exports. Less than 3% of Nepalis have so far received both doses of Covishield or VeroCell, and another 2.6 million have got both shots. Nepal needs to inoculate at least 22 million of its eligible population. COVAX had originally promised 13 million doses of Covishield to inoculate 20% of Nepal’s population. The American announcement of 1.5 million J&amp;J doses are a part of the 7 million pledged by President Joe Biden to South Asian countries last month, of the 1 billion doses from the G-7 promised at a summit in the UK last month. ‘The majority of the doses will go through COVAX,” Lord Ahmad says in his letter. ‘In addition, the World Bank and the Asian Development Bank (both partially UK-funded) have made available significant funding to enable the Government of Nepal to purchase vaccines. This financing together with COVAX supplies can vaccinate 70% of the population of Nepal.’ Indeed, the World Bank has provided Nepal with a $100 million loan, and an additional $160 million from the ADB for vaccine procurement. World Bank country director Faris Hadad-Zervos told reporters in Kathmandu on Thursday that Nepal may have to wait a long time to get vaccines as grants through COVAX, and it might be a better idea to buy them. The EU had negotiated with vaccine manufacturers to provide 1.2 billion vaccines at cost to low income countries through COVAX. The EU has exported 340 million doses of vaccines, half its production, to countries around the world. Head of the EU Delegation to Nepal <a href="https://www.nepalitimes.com/opinion/eu-will-stand-by-nepal-in-hard-times/" target="_blank" rel="noopener noreferrer">Nona Deprez</a> says the EU is not sitting on a big stockpile of vaccines at the moment, and has not been blocking individual member states from having direct vaccine deals with countries like Nepal. <figure><img width="1017" height="652" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d066d9c7e80680e0a5f60jpeg.jpg" alt=""><figcaption> </figcaption></figure>A group of European, Nepali and Bhutanese personalities had written an <a href="https://www.nepalitimes.com/latest/nepal-bhutan-vaccine-appeal-to-european-commission/" target="_blank" rel="noopener noreferrer">open letter</a> to the European Commission president this week demanding that countries be allowed to send surplus vaccines directly to countries without having to go through Brussels and COVAX.“Nepal is very much on our radar, and direct vaccine supply depends very much on individual member states who are owners of the vaccines,” Deprez told Nepali Times. “In fact, we have received requests from 20 countries, including Nepal, and have tried to facilitate the bilateral donations.”The UN’s COVAX facility is mainly funded by the UK and EU, but its reliance on India’s Covishield as well as legally-binding shipments of doses to donor countries has set back its programs in Africa and Asia.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/" target="_blank" rel="noopener noreferrer">Pressure has been building in the UK</a> from Gurkha veterans, MPs, and activists for Britain to provide AstraZeneca vaccines at least for the second doses. At least 63 Gurkha veterans have died in Nepal from Covid-19 during the second wave.  <img width="640" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06709c7e80680e0a5f61jpeg.jpg" alt="">Nepal’s second wave has crested, but public health officials have warned of a second peak because of what they said was a premature relaxation of lockdown rules while the virus was still spreading in the community and not enough people had been vaccinated.On Thursday, there were 29 more deaths from Covid-19, and the number of infected people, while much lower than at the peak last month, was higher than the total recovered patients for the third day in a row. The number of active cases in Nepal has risen slightly again to 26,447, after dropping from 120,000.However, many experts have pointed out that the daily death and infections are severely undercounted.

Vaccines start trickling into Nepal

<figure><img width="1236" height="856" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a09c7e80680e067804jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure><h2>1. Oxygen</h2> To save lives, Nepal’s most urgent need now is oxygen. Not just cylinders, but oxygen generators, concentrators and liquid oxygen. Most infected people are not succumbing to Covid-19, they are <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">dying because of low oxygen saturation</a> in the blood, and lack of hospital beds -- patients who need not have died of coronavirus. Dire as the situation is in the cities, Nepal’s pandemic has now <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">infiltrated the remotest villages</a> where there is no hospital care and no oxygen. The virus is preying on people already suffering malnutrition, previous ailments, and decades of structural state neglect. In Rolpa, Humla and other remote districts, between 80-90% of PCR tests are coming back positive, and it takes a week to get results. Patients are either not isolating, or not following precautions.Kathmandu's doctor-to-patient ratio is 1:850, but in rural Nepal it is one doctor for every 15,000 people, and hospitals and medical staff there <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">are already overstretched</a>.Close to 60% of all swabs collected nationwide are from Bagmati Province, with nearly half of them in Kathmandu Valley, says epidemiologist Lhamu Yangchen Sherpa. She adds: “There just aren’t enough tests and contact tracing is minimal, official total cases and fatalities are grossly underestimated.” <figure><img width="1497" height="746" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a39c7e80680e067805jpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="984" height="519" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a69c7e80680e067806jpeg.jpg" alt=""><figcaption> </figcaption></figure>Hospitals in Kathmandu Valley with roof helipads have multiple daily rescue flights, but even these facilities are <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">at breaking point</a> with patients being turned away. Understaffed and under-equipped hospitals in the districts do not stand a chance. Even where hospitals exist, many families avoid them for fear of being infected and take wrong medication from pharmacies.Case in point are recent deaths due to misdiagnosis across the country. <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">Typhoid disease</a> simulates Covid-19 with similar symptoms, and the widespread Widal test is known to give false positives.“Covid patients are being prescribed antibiotics to fight typhoid, only to turn critically ill in a few days’ time,” says Buddha Basnyat of Patan Academy of Health Sciences. “This is the reason behind some of the latest Covid fatalities.” <figure><img width="1280" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a89c7e80680e067807jpeg.jpg" alt=""><figcaption> </figcaption></figure>As in India, Nepal is beginning to see a slight bending of the curve for new infections, but health experts expect the fatality rate to remain high for some more time.  There were 190 Covid deaths in the past 24 hours and 6,543 recoveries. Of the total 8,305 new cases on Thursday, Kathmandu Valley accounts for 3,232 infections. 7,814 people are undergoing treatment in hospitals with 1,748 in ICU and 492 in ventilator support. “After the relentless patient pressure of the past month, we have seen a decline in those requiring admissions,” says virologist at Teku hospital Sher Bahadur Pun. “The virus has now infected a majority of people in the cities, and this combined with the lockdown means we may be getting to the halfway mark of the second wave.” <h2>2. Vaccines</h2> A prolonged lockdown is not the answer. If it was, the <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/" target="_blank" rel="noopener noreferrer">reduction in the number of cases and the positivity rate</a> this week would have been steeper. Even while the government tries to increase oxygen supply to hospitals, the only long-term strategy is to vaccinate at least 70% of Nepal’s eligible population.Doctors report a marked difference between the recovery of people who are vaccinated against those who are not. Says virologist Pun at Teku Hospital: “Except for a few rare cases, all patients in critical condition and those dying are the ones who for one reason or another had not been vaccinated.”But Nepal has run out of its vaccine stock, leaving 1.4 million people still waiting for their second dose of AstraZeneca Covishield in a lurch, after India banned its export, and the COVAX Facility could not supply its remaining 1.8 million vaccines to Nepal because of the global supply bottleneck.  <figure><img width="1440" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ac9c7e80680e067808jpeg.jpg" alt=""><figcaption> </figcaption></figure>The Nepal government and pressure groups in Nepal and the United States <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">have strongly urged the Biden administration</a> to immediately rush some of its AstraZeneca doses to Nepal.Meanwhile, the UK, the US and Canada have authorised vaccines for use in children and adolescents, sparking outrage in the global public health community for prioritising an age group that is rarely critically affected by Covid-19. The World Health Organisation’s director-general Tedros Adhanom Ghebreyesus has urged rich countries to instead donate doses to the <a href="https://www.nepalitimes.com/latest/unicef-urges-g7-to-dispatch-vaccines/" target="_blank" rel="noopener noreferrer">COVAX Facility</a> for poorer states that have barely covered health workers and the most vulnerable groups. Speaking at the British Parliament last week, noted vaccinologist and the principal researcher of Oxford University’s AstraZeneca vaccine, Andrew Pollard, called the decision to inoculate children in wealthy nations ahead of high-risk groups in poorer countries “morally wrong.” Pollard has worked extensively in the region, leading research into the burden and transmission of typhoid in Nepal, Bangladesh and Malawi, and the impact of typhoid vaccine in these areas. He also runs surveillance for invasive bacterial diseases, and studies the impact of pneumococcal vaccines in children in Nepal.In Nepal, vaccination will grind to a halt this week after the current campaign to inoculate 300,000 people in the 18-59 age group with their second dose of the Chinese VeroCell ends.  <figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85af9c7e80680e067809jpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b29c7e80680e06780ajpeg.jpg" alt=""><img width="960" height="639" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b49c7e80680e06780bjpeg.jpg" alt="">Although <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">Foreign Minister Pradeep Gyawali says</a> the government is in “final negotiations” for 2 million doses of Sinopharm VeroCell vaccines by June, there is no movement at the Ministry of Health. Ongoing talks to procure 8 million doses of <a href="https://www.nepalitimes.com/opinion/vaccine-geo-politics-and-sputnik-v/" target="_blank" rel="noopener noreferrer">the Sputnik V</a> have hit a production capacity snag in Russia. “We can implement lockdowns only for so long, the only exit strategy is vaccines. Science delivered, now our politicians must do the same,” says Buddha Basnyat, a physical at the Patan Academy of Health Sciences. “The Nepal government must procure vaccines using every diplomatic channel possible, and rich countries must realise that they are not safe until countries like Nepal are also vaccinated.” Activists have been trying to convince <a href="https://www.nepalitimes.com/latest/leading-public-figures-call-on-uk-government-for-oxygen-for-nepal/" target="_blank" rel="noopener noreferrer">the US government and Europeans</a> that Nepal has a lot of experience in successful vaccination campaigns against polio, smallpox, measles. It has over 50,000 female community health volunteers (FCHVs) reaching children with vaccines every year.  <figure><img width="1024" height="768" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b79c7e80680e06780cjpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="2048" height="943" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ba9c7e80680e06780djpeg.jpg" alt=""><img width="1920" height="864" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85bd9c7e80680e06780ejpeg.jpg" alt="">Similarly, Nepal’s health system has amassed vast experience in maintaining the vaccine cold chain even in the remote mountains. It also has trained human resource overseeing DOTS (Directly Observed Therapy, Short-course) for tuberculosis management all over the country who can lend a hand in equitable distribution of vaccines in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">rural Nepal</a>.Says epidemiologist Lhamo Yangchen Sherpa: “It’s not too late, we can still use existing resources like FCHVs to better mobilise vaccination, conduct contact tracing, dispel any remaining vaccine hesitancy, and use public health professionals in prevention.”

It’s an Emergency

<figure><img width="740" height="494" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec0e9c7e80680e09ad41jpeg.jpg" alt=""/><figcaption>All photos: AMIT MACHAMASI</figcaption></figure>Nepal is very close to hitting that ominous mark of 10K new cases a day with 9,196 positive RT PCR and RDT tests on Friday, bringing the total active infections across the country to 78,629. There were additional 50 deaths in the last 24 hours.At the current rate of replication of the virus, the <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/" target="_blank" rel="noopener noreferrer">Health Ministry’s projections</a> of the second wave peaking at 15,000 new cases a day by July will fall modest, and soon. It is now evident that the second wave is sweeping Nepal <a href="https://www.nepalitimes.com/latest/microcosms-of-a-pandemic/" target="_blank" rel="noopener noreferrer">faster than most parts of India</a> and the world at 211 cases per 1 million population.Meanwhile, according to the Federation of Nepalese Journalists, 91 reporters working in 25 different media houses have rested positive for coronavirus disease, as of Thursday.Most of them are isolating at home but a few are undergoing treatment in Patan Hospital, Manmohan Memorial, Norvic, Sukraraj Tropical and Infectious Disease Centre and Nepal Police Hospital. <figure><img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec109c7e80680e09ad42jpeg.jpg" alt=""><figcaption></figcaption></figure><img width="736" height="491" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec139c7e80680e09ad43jpeg.jpg" alt=""><img width="728" height="485" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec159c7e80680e09ad44jpeg.jpg" alt=""><img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec179c7e80680e09ad45jpeg.jpg" alt=""><img width="768" height="513" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec1a9c7e80680e09ad46jpeg.jpg" alt="">Of the total new cases on Friday, nearly half of them (4,106) as have been the cases on a daily basis are from Kathmandu Valley, where doctors are overwhelmed with patients and major hospitals have exhausted their ICUs, ventilators and oxygen cylinders.The city’s only electric crematorium designed for Covid-19 deaths was <a href="https://www.nepalitimes.com/banner/kathmandu-valley-lockdown-till-12-may/" target="_blank" rel="noopener noreferrer">unable to handle the increasing number of fatalities</a>. Currently, of the 5,860 people admitted to hospitals, 728 are in ICU and 231 of them are in ventilator support.But even as the pandemic breaks across the country with <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">devastating consequences</a>, Nepalis are unlikely to get a vaccine anytime soon.In a press release on Friday, the Health Ministry spokesman Jageshwor Gautam said that Nepal wouldn’t be able to import more vaccines from India at the moment.“Serum Institute of India has informed us that would deliver the vaccines once they have recovered from the fire and have expanded their capacity, we are not in a situation to buy additional 5 million doses,” he added.After ordering two million doses of Covishield vaccines, Nepal has begun the procedure to buy additional five million shots and as such prime minister K P Oli had announced that the target population would be inoculated in three months.But Nepal is yet to receive one million doses it paid for and India is struggling to meet its own demand as it records an excess of 400,000 new cases a day. <figure><img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec1c9c7e80680e09ad47jpeg.jpg" alt=""><figcaption></figcaption></figure><figure><img width="768" height="513" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec1f9c7e80680e09ad48jpeg.jpg" alt=""><figcaption></figcaption></figure>Away from the doom and gloom, locked down <a href="https://www.nepalitimes.com/latest/kathmandu-turns-into-flower-city/" target="_blank" rel="noopener noreferrer">Kathmandu is abloom in Jacaranda</a>, with the streets leading up to Tundikhel painted in purple.Just like last year this time during the first shutdown, nature has taken over the usual hustle and bustle of the city, but there are few on the streets to admire the sight.

Nepal nears 10k daily cases

<figure><img width="740" height="494" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83ec9c7e80680e067764jpeg.jpg" alt=""/><figcaption>All photos: AMIT MACHAMASI</figcaption></figure>Nepal is very close to hitting that ominous mark of 10K new cases a day with 9,196 positive RT PCR and RDT tests on Friday, bringing the total active infections across the country to 78,629. There were additional 50 deaths in the last 24 hours.At the current rate of replication of the virus, the <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/" target="_blank" rel="noopener noreferrer">Health Ministry’s projections</a> of the second wave peaking at 15,000 new cases a day by July will fall modest, and soon. It is now evident that the second wave is sweeping Nepal <a href="https://www.nepalitimes.com/latest/microcosms-of-a-pandemic/" target="_blank" rel="noopener noreferrer">faster than most parts of India</a> and the world at 211 cases per 1 million population.Meanwhile, according to the Federation of Nepalese Journalists, 91 reporters working in 25 different media houses have rested positive for coronavirus disease, as of Thursday.Most of them are isolating at home but a few are undergoing treatment in Patan Hospital, Manmohan Memorial, Norvic, Sukraraj Tropical and Infectious Disease Centre and Nepal Police Hospital. <figure><img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83ee9c7e80680e067765jpeg.jpg" alt=""><figcaption></figcaption></figure><img width="736" height="491" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83f19c7e80680e067766jpeg.jpg" alt=""><img width="728" height="485" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83f39c7e80680e067767jpeg.jpg" alt=""><img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83f69c7e80680e067768jpeg.jpg" alt=""><img width="768" height="513" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83f89c7e80680e067769jpeg.jpg" alt="">Of the total new cases on Friday, nearly half of them (4,106) as have been the cases on a daily basis are from Kathmandu Valley, where doctors are overwhelmed with patients and major hospitals have exhausted their ICUs, ventilators and oxygen cylinders.The city’s only electric crematorium designed for Covid-19 deaths was <a href="https://www.nepalitimes.com/banner/kathmandu-valley-lockdown-till-12-may/" target="_blank" rel="noopener noreferrer">unable to handle the increasing number of fatalities</a>. Currently, of the 5,860 people admitted to hospitals, 728 are in ICU and 231 of them are in ventilator support.But even as the pandemic breaks across the country with <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">devastating consequences</a>, Nepalis are unlikely to get a vaccine anytime soon.In a press release on Friday, the Health Ministry spokesman Jageshwor Gautam said that Nepal wouldn’t be able to import more vaccines from India at the moment.“Serum Institute of India has informed us that would deliver the vaccines once they have recovered from the fire and have expanded their capacity, we are not in a situation to buy additional 5 million doses,” he added.After ordering two million doses of Covishield vaccines, Nepal has begun the procedure to buy additional five million shots and as such prime minister K P Oli had announced that the target population would be inoculated in three months.But Nepal is yet to receive one million doses it paid for and India is struggling to meet its own demand as it records an excess of 400,000 new cases a day. <figure><img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83fb9c7e80680e06776ajpeg.jpg" alt=""><figcaption></figcaption></figure><figure><img width="768" height="513" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83fe9c7e80680e06776bjpeg.jpg" alt=""><figcaption></figcaption></figure>Away from the doom and gloom, locked down <a href="https://www.nepalitimes.com/latest/kathmandu-turns-into-flower-city/" target="_blank" rel="noopener noreferrer">Kathmandu is abloom in Jacaranda</a>, with the streets leading up to Tundikhel painted in purple.Just like last year this time during the first shutdown, nature has taken over the usual hustle and bustle of the city, but there are few on the streets to admire the sight.

<figure><img width="3000" height="2001" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110121144/636ce4709c7e80680e0966adjpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Nepalis had started to heave a sigh of relief with the <a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/" target="_blank" rel="noopener noreferrer">start of the vaccine drive</a> in January, but the latest surge in infection rates show there is much to be vigilant about. On 7 April 2021, Kathmandu Valley reported 163 new Covid-19 cases, against the 298 cases across the country.At a first glance, the numbers look insignificant but this is 300% increase compared to the figures from a month ago. Many of those who have tested are school children, teachers and students going abroad, and most of them have shown positive for the UK strain B.1.1.7., which was first detected in Nepal back in January.“The UK variant among students point to the community spread of the new strain in Nepal and given that it’s more infectious as it is deadlier, we must look into this immediately,” says virologist at Teku Hospital Sher Bahadur Pun.Despite surpassing the US to become the fastest vaccinating country in the world, India is reporting an excess of 100,000 new cases per day now. On Wednesday, the country recorded over 126,000 cases with 630 deaths. India has been registering higher cases of the B.1.1.7 variant, which is 64% more lethal than SARS-CoV-2.The increasing infection rates in India has <a href="https://www.nepalitimes.com/latest/nepal-braces-for-its-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">put Nepal on high alert</a> and experts warn of a repeat of the trajectory last year, when imported cases from the southern neighbour led to rapid community spread. Nepal usually tracks India in health trends, and there are already signs of the second wave.“There are three things working in favour of a possible second surge: our own cases, those being imported from India and the rise of the more contagious UK strain,” says Pun.Nepali migrant workers are already arriving in large numbers at the 1,770km long porous border between Nepal and India, as the most affected states including Maharastra, Karnataka and New Delhi announce lockdowns and curfews.Officials have deployed tests at the Indian border, and those testing positive are recommended to self-isolate. However, returnees could easily bypass the official border checkpoints <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener noreferrer">as they did last year</a>.  Sameer Mani Dixit of the Centre for Molecular Dynamics agrees: “It is not possible to test everyone at the border so we should deploy local government to test and observe the returnees.”Health Minister Hridayesh Tripathi told the Parliament this week that Nepal was likely to see a surge in new cases by May, while he has also turned down the possibility of another lockdown.The Covid-19 Crisis Management Center (CCMC) has decided on antigen tests for everyone with symptoms entering the Kathmandu Valley. The government has meanwhile, instructed all local levels to set up isolation and quarantine centres. The Health ministry has also urged businesses to close after 9PM and for schools to increase safety measures.While the government has drawn flak in the past for not doing enough to control the spread of the virus, it is the public that seems to have flung all caution to the wind this time. People have continued to crowd malls and restaurants and participate in celebrations and even attend political rallies-- often unmasked and with no regard for physical distancing.“Nepalis have all but forgotten how a year ago, pregnant women couldn’t go to hospitals and how there was food insecurity and the crushing burden of economic fallout. Now, they are back to ignoring safety measures,” says epidemiologist Lhamo Yangchen Sherpa. Hazardous levels of air quality in the past two weeks following <a href="https://www.nepalitimes.com/banner/nepal-is-going-up-in-smoke/" target="_blank" rel="noopener noreferrer">wildfires across the country</a> has added to the challenge.For most of this week, Kathmandu has been recording an average of <a href="https://www.nepalitimes.com/banner/clearing-the-air/" target="_blank" rel="noopener noreferrer">200-300 in Air Quality Index (AQI) measurements</a>, aggravating the condition of people with chronic obstructive pulmonary disease (COPD), other respiratory illness and Covid-19.The government has started to inoculate frontline workers, teachers, hotel staff, Himalayan traders, among others in the age group 40-59, with ‘Vero Cell’ vaccines donated by the Chinese government. Nepali students leaving for China are also eligible for the jab.Nepal got an early start in the vaccination drive with <a href="https://www.nepalitimes.com/latest/1-6-million-vaccinated-20-million-to-go/" target="_blank" rel="noopener noreferrer">1.6 million inoculated in the first and second stages</a> of the campaign, with India’s support. But with only 500,000 doses of Covidshield in the stock and 100,000 more with the Nepal Army, uncertainty persists over when the second doses will happen for all those who have taken the first.With the European Medicines Agency concluding that there is indeed a link between <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AstraZeneca vaccine and a rare but lethal blood clot</a> case detected in the EU, countries including the UK and Germany have either restricted or have found alternatives to the Oxford University developed jab for younger age groups. This could mean that countries like Nepal suffering from a shortage could be supplied with more doses of the Covidshield shots sooner than later.After inoculation began in Nepal, many districts stopped testing. There are only about 3,000-4,000 tests happening in a day, mostly for people going abroad, and there is virtually no contact tracing.“Vaccination is important but so is testing and contact tracing. And we must continue to communicate about safety measures, there is no other way around wearing masks, hand washing and maintaining physical distance,” says Sherpa.

1st signs of the 2nd wave in Nepal

<figure><img width="1280" height="854" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9ef9c7e80680e092ecejpeg.jpg" alt=""/><figcaption>Thousands of revellers thronged to Kathmandu's Darbar Square on Sunday to celebrate Phau Purnima ignoring warnings of a possible second Covid-19 wave and despite hazardous smoke haze that has shrouded the country for days. Photos: MONIKA DEUPALA and AMIT MACHAMASI</figcaption></figure>After a year of living in the shadow of the Covid-19 pandemic, Nepalis were bracing themselves for a second wave from India, when they were hit by an unexpected disaster: <a href="https://www.nepalitimes.com/latest/wildfires-in-nepal-cause-air-quality-to-plummet/" target="_blank" rel="noopener noreferrer">wildfires that have shrouded the country</a> in a pall of smoke for days.The two crises have converged with the suspension of Nepal’s Covid-19 vaccination drive after India <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">banned the export of the AstraZeneca Covishield doses</a>. Two days after the Ministry of Health warned citizens about wearing masks, washing hands and avoiding crowds to defend themselves against a coronavirus surge, it issued another statement on Saturday telling people to stay indoors to avoid the <a href="https://www.nepalitimes.com/banner/nepal-is-going-up-in-smoke/" target="_blank" rel="noopener noreferrer">hazardous haze</a>, and not to venture out unless urgent.It did not look like people in Kathmandu were paying attention to either warning. Thousands of revellers thronged to Kathmandu’s Darbar Square on Sunday dancing and singing, spraying water and smearing colour on each other to celebrate the festival of colours, Phau Purnima. “It depends on us whether there will be another lockdown. Do we continue to mask up and maintain physical distance or start crowding and ignore safety measures?” warns Buddha Basnyat of the Patan Academy of Health Sciences. “Nepal usually tracks India in health trends, so we have to be prepared.” <figure><img width="1280" height="852" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9f29c7e80680e092ecfjpeg.jpg" alt=""><figcaption></figcaption></figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9f59c7e80680e092ed0jpeg.jpg" alt=""><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9f99c7e80680e092ed1jpeg.jpg" alt=""><figure><img width="1280" height="854" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9fc9c7e80680e092ed2jpeg.jpg" alt=""><figcaption>Public gatherings in light of vaccine shortage can have disastrous results.</figcaption></figure>Despite the government ban on public gatherings following the <a href="https://www.nepalitimes.com/editorial/its-not-over-yet/" target="_blank" rel="noopener noreferrer">second wave in neighbouring India</a>, there have been political rallies and public gathering with people behaving as if the pandemic is over. Kathmandu’s bars, restaurants and malls are packed to the brim. Offices and schools have reopened, and there is little physical distancing.On Saturday, with 62,714 new Covid-19 cases, India registered the highest daily rise in 2021 with Maharashtra, Chandigarh, Punjab, Goa, Puducherry, Chhattisgarh, Madhya Pradesh and Haryana recording the highest positivity rates. Bihar state neighbouring India is also seeing a surge as workers travel back.Anticipating another lockdown like last year, <a href="https://www.nepalitimes.com/latest/nepalis-still-stuck-in-no-mans-land/" target="_blank" rel="noopener noreferrer">Nepali migrants from India</a> have also started returning home. Checkpoints in Karnali, Far-West and Province 2 are overwhelmed with a steady rise in positive cases among returnees, who are being asked to self-isolate at homes.“We now have a year-long experience of managing Covid-19 and it is time to learn from our previous mistakes and limitations,” says Sher Bahadur Pun, a virologist at Teku Hospital.Sameer Dixit of Centre for Molecular Dynamics Nepal agrees. “While the second wave in India has been limited to fewer states so far and hasn’t resulted in as high a mortality rate as the first time, local governments here must take charge: monitor returnees, their tests and quarantines,” he says.Despite being <a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/" target="_blank" rel="noopener noreferrer">one of the first Asian countries to start a Covid-19 vaccination drive</a> in late January, Nepal now has only about 500,000 doses of AstraZeneca Covishield vaccine in stock, just sufficient for second doses starting 20 April for those who had inoculated in the first phase.Following the Indian ban on the export of Covishield vaccine before domestic demand is met, Nepal is yet to receive another million doses it purchased from Serum Institute of India. The ban has also delayed the next batch of Covishield shots under <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer">the COVAX initiative</a>, which is not expected until May.A Nepal Airlines plane is finally flying to Beijing on Monday to bring back 800,000 doses of the Sinopharm vaccine gifted by China, but it will not be sufficient to begin the next phase of vaccination targeted at the age group 55-64.But if it comes down to it, experts are recommending vaccinating as many individuals in the risk group as possible, even if that means bypassing the second dose for those already inoculated with the first. <figure><img width="3200" height="1970" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9ff9c7e80680e092ed3jpeg.jpg" alt=""><figcaption>Tourists take part in Phau Purnima revelry at lakeside in Pokhara despite fears of a second wave, and even though Pokhara has been shrouded in smoke for the past three days. Photo: KRISHNA MANI BARAL</figcaption></figure>So far, <a href="https://www.nepalitimes.com/latest/1-6-million-vaccinated-20-million-to-go/" target="_blank" rel="noopener noreferrer">Nepal has inoculated 1.6 million people</a> and needs to vaccinate 20 million more under its target to immunise 70% of its population. For this alone, the government needs to look into other certified vaccines in the market such as Russian Sputnik V, Bharat Biotech’s Covaxin and Chinese vaccines.With governments failing to ensure supply, it has become crucial to get the private sector involved to meet demand. The Ministry of Health earlier this month approved letting private companies import vaccines so that those with the resource and willingness can immunise themselves, this is said to involve India’s Covaxin and <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer">the Russian Sputnik</a>.

Thick haze adds to Nepal Covid-19 woes

<figure><img width="1500" height="970" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111156/636cd8d39c7e80680e092e63jpeg.jpg" alt=""/><figcaption>Photo: UNICEF</figcaption></figure>After immunising over 1.6 million Nepalis against Covid-19, the government now plans to administer the rest of the 600,000 jabs that it has in stock for second doses starting 20 April. But it needs at least another million shots to cover all those who inoculated in the first and second phases, as well as to complete the inoculation of those 55 years and above.The Health Ministry is banking on the remaining 1 million doses of the AstraZeneca Covidshield that it purchased from the Serum Institute of India. That consignment was not delivered on 15 March as promised after an Indian court banned export of vaccines before demand at home is met. The next batch of Covishield vaccine under the COVAX initiative is also not expected before May. However, the current suspension of vaccinations in Europe, Thailand and other countries may ease the worldwide shortage somewhat. “We will go ahead with second doses as planned, but the third phase aimed at the age group 55-64 will depend on vaccine availability and as of now we don’t have dates on when they are arriving,” admits Shyam Raj Upreti, head of the Government Covid Vaccine Strategy told Nepali Times.The Chinese government, on the other hand, has increased its gift of Sinopharm vaccines to Nepal from 500,000 to 800,000, but China has insisted that Nepal send a plane to collect it from Beijing.The shortfall in supply and procurement challenges forced the Health Ministry to allow private companies to import vaccines, including the Covaxin manufactured by Bharat Biotech in India. “The private sector can help bridge the gap in procurement limitation as well as allow people with the means and the interest to get vaccinated, but all this must be monitored and regulated,” says Sher Bahadur Pun, a virologist at the Teku Hospital.Average coverage was 73% of the eligible population in the first two phases, all of them with the Covishield AstraZeneca vaccine. However, media reports of the suspension of that vaccine in European countries this week due to fears of blood clot among some recipients may increase vaccine hesitancy in Nepal. The suspensions have baffled public health experts who warn that there is neither enough data to justify the decision, nor adequate evidence to blame blood clots on the vaccine. The fact that there have been no serious side effects in Nepal had increased the acceptance level of the vaccine in the public and among frontline health workers in Nepal. “The EU might have different standards from ours but it might be a good idea to monitor serious side effects,” says epidemiologist Lhamo Yangchen Sherpa. “However, the vaccine has been safe in this part of the world, so its benefits far outweigh the risk.”Some experts think the suspension of the vaccine campaigns in Europe may actually be a blessing in disguise for Nepal, which is facing delays in shipments of Covishield it ordered as well as remaining doses under the COVAX initiative from the Serum Institute. That delay and the heftier price tag was blamed on a rise in global demand. So far, the government has only administered Covidshield in Nepal and health authorities here see no reason to discontinue the vaccine without a real causal link between AstraZeneca and the blood clots.“The EU decision to suspend AstraZeneca is very random and counterproductive, it was probably influenced by politics,” says Buddha Basnyat of the Patan Academy of Medical Sciences. “There is evidence this vaccine is safe and protects us specifically from severe symptoms of Covid-19.”Meanwhile, reassured by the vaccination drive and a dramatic drop in infections, Nepalis have gone back to normal, and many have forgotten about precautions. With parts of India hit by a second wave with over 37,000 new cases and 171 additional deaths on Wednesday, experts have advised the Nepal government not to let up on communicating the need to mask up and avoid crowds. “Officials here have stopped testing and are focusing only on vaccinating but even those who have been inoculated must remember that they can still be carriers,” Lhamo Yangchen Sherpa told Nepali Times from Achham. “We have to continue to take safety precaution as if the pandemic is not over, which it is not.”

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