<figure><img width="1500" height="844" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111120/636cd12e9c7e80680e08f89djpeg.jpg" alt=""/><figcaption>Uma Kumari Sah with her grandmother.</figcaption></figure>It started with persistent skin <a href="https://archive.nepalitimes.com/article/nation/what-are-you-allergic-to,4151" target="_blank" rel="noopener noreferrer">allergy</a> for 15-year-old Uma Kumari Sah. She got a checkup at a leprosy hospital in Dhanusa, and later in India. Doctors detected a growth in her lungs. The very next day she flew to Kathmandu where she was given six cycles of chemotherapy, twice a week.Sah is from Hariban municipality of Sarlahi district where 30 people have died in the past three years, seven others are undergoing treatment for various types of <a href="https://archive.nepalitimes.com/article/nation/think-pink-breast%20cancer-diagnosis-treatment,3877" target="_blank" rel="noopener noreferrer">cancer</a>.  The three neighbourhoods of the village have a population of 1,500. Extrapolating this figure nationwide would mean a death toll from cancer of a staggering 650,000 people all over Nepal in three years.Hariban village is at the lap of the <a href="https://archive.nepalitimes.com/page/crushing-tale-of-Chure" target="_blank" rel="noopener noreferrer">Chure Range</a> adjoining the Tarai. There is well water, and the fertile fields are perfect for vegetables which are taken to Kathmandu to be sold. But what brings the farmers prosperity could also be one of the reasons for the epidemic of cancer here.Farmers are using herbicides and insecticides, some of them <a href="https://www.nepalitimes.com/from-the-nepali-press/banned-pesticides-are-widely-used-in-nepal/" target="_blank" rel="noopener noreferrer">banned in Nepal</a>. The water table is receding due to over-extraction and what comes out of the pumps is arsenic-laced. <figure><img width="1500" height="844" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111120/636cd1319c7e80680e08f89ejpeg.jpg" alt=""><figcaption>Chapini Khola with refuse strewn along the waterway.</figcaption></figure>Cancer used to be so rare in Nepal that there is no word for it in the Nepali language. But Hariban could be a microcosm of the cancer sweeping the country. Cancer is now the <a href="http://nhrc.gov.np/wp-content/uploads/2019/04/Progress-Interim-_cancer.pdf" target="_blank" rel="noopener noreferrer">fifth leading cause of death</a> in Nepal, with lung, <a href="https://www.nepalitimes.com/opinion/moving-forward-to-live-pink/" target="_blank" rel="noopener noreferrer">breast</a>, cervix, stomach and colorectal cancers being the most common. Approximately 28,000 new carcinoma cases are diagnosed every year in Nepal with mortality at 20,000, both at an increasing rate as per the Global Cancer Observatory estimates. But many more cases go undiagnosed due to lack of resources and insufficient screening. The ongoing <a href="https://www.nepalitimes.com/latest/living-with-cancer-during-the-coronavirus/" target="_blank" rel="noopener noreferrer">Covid-19 pandemic has added to the crisis</a>. There were five times more funerals at the Pashupati cremation site in December 2020 compared the previous year. While some could be people who died from the coronavirus, many others are thought to be patients with cancer or other chronic disease who could not get timely treatment.    Lockdowns and restrictions as well as fear of contracting SARS-CoV-2 had <a href="https://www.nepalitimes.com/here-now/kidney-patients-dying-due-to-covid-19-lockdown/" target="_blank" rel="noopener noreferrer">affected patients of many chronic illnesses</a> such as cancer due to reduced treatment and screening facilities. This in turn has likely resulted in more fatalities, say health experts. Back in Hariban, Sah is now doing well after treatment. She says: “I’m lucky because my family could afford the treatment. I now plan to study science, be a nurse and care for patients like me. I want to help the poor and provide them treatment without cost.” Rafi Miya also lives in the neighbourhood and can barely survive on income from farm. Now, in addition to poverty, the family is burdened with cost of cancer treatment for himself and his son. Miya was diagnosed with throat cancer after a biopsy in Bharatpur Cancer Hospital. “They operated on me and took the growth out, but my voice is hoarse now. We cannot get the medication here, and it is expensive.” His son Lipla Miya’s cancer has affected his bowel and bladder functions. His treatment has already cost Rs200,000.   Phekini Devi Mahato Sundi also lives nearby, and started getting skin rashes, and suspects the <a href="http://archive.nepalitimes.com/regular-columns/Testimony/lets-talk-about-boobs/breast-cancer-awareness,989" target="_blank" rel="noopener noreferrer">lump in her breast is cancer</a>. She cannot even afford to travel to get a checkup. Her husband Sinai has asthma, and is despondent that he does not have the money for her treatment. https://www.youtube.com/watch?v=qF5VYI-JVLI&amp;feature=youtu.be“We have no money, without it there is no treatment. Doctors only treat those with money,” he says, pointing to his damaged spectacles, which he cannot afford to replace.   At Hariban’s Namuna Community Hospital, physician Anil Kumar Chaudhari conforms that there has been a steep rise in malignancies, and patients are referred to hospitals in Kathmandu or Bharatpur.“There is a steady stream of cancer patients from the surrounding villages, most have skin, liver, lungs and throat cancer,” says Chaudhary. “Those who can afford it go to India.”The Nepal government provides Rs100,000 for cancer patients who cannot afford treatment, but this is negligible compared to the total bill. Most patients here seek treatment when the cancer is at an advanced stage, so they end up losing all their money as well as their lives.Another neighbor, Jaggilal Sah suffered minor illnesses for a few years, but when he got sick during the pandemic, the doctors diagnosed him with third stage brain tumour. Surya Bahadur Sangtang’s father was also diagnosed with last stage cancer and died within few months.Says Sangtang: “He was admitted to hospital for 2-3 months, we lost all our money, and we also lost our father.”The dramatic rise in cancer made Harban’s local government investigate possible contributing factors. Many residents depend on <a href="https://archive.nepalitimes.com/article/nation/heavy-pesticide-use-and-low-consumer-awareness-affecting-public-health,1394" target="_blank" rel="noopener noreferrer">commercial vegetable farming</a>, and there is <a href="https://archive.nepalitimes.com/article/nation/pesticide-laced-vegetables-continue-to-poison,1555" target="_blank" rel="noopener noreferrer">rampant pesticide spraying</a>.  With the <a href="http://archive.nepalitimes.com/article/Nation/water-table-of-kathmandu-valley-falling-fast-recharge-to-replenish,4100" target="_blank" rel="noopener noreferrer">depletion of groundwater</a>, villagers have turned to shallow tubewells increasing the risk of arsenic contamination. A sample survey from community tubewells here showed the amount of arsenic at 0.63mg/l , several times higher than the safe limit of 0.05mg/l. <figure><img width="1500" height="844" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111120/636cd1359c7e80680e08f89fjpeg.jpg" alt=""><figcaption>A garbage-filled well.</figcaption></figure><figure><img width="1500" height="844" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111120/636cd1389c7e80680e08f8a0jpeg.jpg" alt=""><figcaption>Drinking water that is not fit to drink because of pollutants.</figcaption></figure>Near the village is the Indushankar Sugar Mill that buys sugarcane from local farmers and turns it into sugar and alcohol, letting out toxic effluent into surrounding waterways. There are also 125 brick kilns in Sarlahi district, 16 of them in Hariban alone. <a href="https://archive.nepalitimes.com/article/nation/black-carbon-easier-to-control-than-carbon-dioxide-to-reduce-global-warming%20,2079" target="_blank" rel="noopener noreferrer">Soot particles from</a> the stacks can also be carcinogenic.Says a local Dhanbahadur Ghising: “Farmers use pesticides elsewhere too, but why aren’t other villages also getting cancer? This probably means it has something to do with polluted water and arsenic here.” <figure><img width="1500" height="844" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111120/636cd13c9c7e80680e08f8a1jpeg.jpg" alt=""><figcaption>Smoke stack of a brick kiln in Hariban.</figcaption></figure>Hariban Municipality has been forced to act. It is installing deep tubewells from up to 30m so that there is less chance of arsenic contamination of drinking water. The Indushankar Sugar Mill also dug a deep well and installed three tanks to store drinking water for villagers.Progress on the alternative sources of water is slow, and it will take time to have an impact. In the meantime, young and old in Hariban face daily exposure to whatever is causing the cancer epidemic here. This Sarlahi village also has lessons for other parts of Nepal, which may also be exposed to the same risk factors. Based on Episode 2 of <a href="https://www.facebook.com/saglosamaj" target="_blank" rel="noopener noreferrer">Saglo Samaj</a>, a tv magazine program produced by Himalmedia which is broadcast every Monday, at 8:30 pm on Dish Home Channel 130.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111124/636cd1409c7e80680e08f8a2jpeg.jpg" alt="" width="1447" height="815">

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Nepal’s other pandemic: cancer

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6a99c7e80680e073737jpeg.jpg" alt="" width="1365" height="2048"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>When Lalbahadur Shah of Birganj died last week, none of his relatives showed up for his funeral even though he tested negative for Covid-19. With no family, friends and neighbours attending, the Muslim community members took it upon themselves to perform his final rites as per the Hindu faith.Shah had hypertension and diabetes, although he had tested positive for <a href="https://www.nepalitimes.com/latest/dont-take-covid-19-lightly/" target="_blank" rel="noopener noreferrer">SARS-CoV-2</a>, he had recovered from the infection. He succumbed to other health complications.Across Nepal, people infected with the virus, even those who have recovered, have been <a href="https://www.nepalitimes.com/here-now/covid-19-sharpens-caste-discrimination-in-nepal/" target="_blank" rel="noopener noreferrer">shunned by neighbours and society</a>. Migrant returnees and their families have been singled out and humiliated. Doctors and health workers have been harassed by landlords.This is nothing new in Nepal. Tuberculosis and leprosy patients have been traditionally shunned. And the stigma associated with Covid-19 is very reminiscent of <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/stigma-ostracisation-for-HIV-patients-remain-in-western-nepal,1724" target="_blank" rel="noopener noreferrer">how people with HIV/AIDS used to be treated in Nepal</a> in the past, and may have lessons for dealing with SARS-CoV-2, since the virus (like HIV) is here to stay.“Physical distancing doesn’t mean discrimination and we should make people understand this,” says public health expert Aruna Uprety. “There is widespread panic about Covid-19 and this is turning people against those infected with it, exactly like it was with HIV/AIDS. This in turn is adding to the mental stress of the patients, undermining their recovery.”Says Anjana Rajbhandary, a counsellor and columnist: "Social stigma is attached to lack of knowledge and when people know less, they feel the need to blame someone else because they are afraid of the unknown. Fear and anxiety about death and disease can lead to gossip, which results in stereotyping and discrimination."Constant focus in the mass media on new infections and <a href="https://www.nepalitimes.com/latest/nepal-covid-19-deaths-cross-100/" target="_blank" rel="noopener noreferrer">fatalities</a> over those who have recovered has reinforced the misconception that Covid-19 is highly lethal, adding to the fear about it.On Tuesday, Nepal reported a total of 1,016 new cases, its highest daily rise with 205 in Kathmandu Valley alone, forcing the local governments in Kathmandu, Lalitpur and Bhaktapur <a href="https://www.nepalitimes.com/banner/kathmandu-valley-back-to-lockdown/" target="_blank" rel="noopener noreferrer">to reimpose lockdown for a week</a> starting Wednesday midnight. So far, 17,580 people have recovered while 114 have passed away.The number of new infections was down to 671 on Wednesday, 151 of them in Kathmandu Valley.The similarities between HIV/AIDS and Covid-19 goes beyond <a href="https://archive.nepalitimes.com/news.php?id=19019" target="_blank" rel="noopener noreferrer">stigma</a>. Just like HIV/AIDS  spread like wildfire in western Nepal among families with husbands working in India, most of the Covid-19 cases were imported from India and spread among the poorest sections of Nepal’s most underserved region. And just like with HIV, Covid-19 is felling people with compromised immune systems.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6ad9c7e80680e073738jpeg.jpg" alt="" width="300" height="400"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914118/636ba6ae9c7e80680e073739jpeg.jpg" alt="" width="300" height="400"><figcaption> </figcaption></figure>Long-time HIV/AIDS activist Rajiv Kafle also sees parallels between the current Covid-19 crisis and the HIV epidemic of the 1990s in <a href="https://archive.nepalitimes.com/article/nation/ending-AIDS-in-Nepal,2707" target="_blank" rel="noopener noreferrer">turning public awareness into behavioural change for prevention</a>  Both diseases are caused by viral infections and attack the immune-compromised – only the method of transmission is different. While HIV is spread through unprotected sex, sharing needles or blood transfusions, SARS-CoV-2 spreads human-to-human through aerosol particles.“As with HIV, I see a lot of denial about coronavirus. Back in the day, peer-pressure led people to partake in highly risky behaviour like sharing syringes. Peer-pressure today can be seen in the form of people pulling down their masks in presence of friends,” says Kafle.Mass media was a crucial tool in the battle against HIV/AIDS in the days before social media. In particular, tv serials and docudramas featuring popular faces like comedian duo Madan Krishna Shrestha and Hari Bansa Acharya were highly effective in creating awareness about preventive measures such as safe sex and clean needles as well as in lessening the stigma for some 50,000 people living with HIV in Nepal.Nearly 30 years later, Shrestha and Acharya are once more doing skits for public service announcements via social media and tv to <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">spread awareness about Covid-19 preventive measures</a>. The message is similar: while it was condoms and safe needles for HIV/AIDs, it is masks and distancing for Covid-19.“If we were able to change peoples’ behaviour in something as sensitive as sex, then we should be able to do it much more effectively for Covid-19,” says Rita Thapa of Nepal Public Health Foundation, who was formerly with the WHO. “We still have time to work together with local authorities, civil society and the government to run mass awareness campaign that reaches down to the grassroots.”Since this August, the government has started providing free TLD (once-a-day generic fixed-dose combination of tenofovir disoproxil fumarate, lamivudine, and dolutegravir), new antiretroviral drug considered the best regimen in the world for 17,000 people living with HIV in Nepal. Activists like Kafle credit this milestone to treatment literacy, community mobilisation and continued activism.“Only a similar kind of dedication will guarantee accountability and transparency in terms of testing and treating coronavirus in Nepal when the vaccine and therapies aren’t available,” he adds.Aruna Uprety recalls a recent field visit to Makwanpur district where she found Chepang nomads living without toilets or clean drinking water, who were not <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">wearing masks</a> and maintaining distance.“It is now pretty clear we will have to learn to live with Covid-19 just as we did with HIV. What would help is strengthening our immune system to fight against the infection, be it by applying traditional medicinal or by eating nutritious indigenous food,” says Uprety. “But to prevent infection for now our first line of defence are masks, distancing and hand-washing.”

Sonia Awale

Learning from HIV to fight Covid-19 in Nepal

Although smallpox is now ‘unfamiliar to the world today’ historian Elizabeth Fenn has written that it was ‘a misery commonplace in years gone by.’For centuries, the smallpox virus and the gruesome death and destruction it caused upended people's lives around the world and in Nepal. In this History of Disease series in Nepali Times in the past month I have recounted how smallpox traveled and killed in Europe and America, became a terrible test for survival for children in South Asia, and  struck down both royals and regular citizens in Nepal in the 19th century.We have seen how people devised inoculation and vaccination to fight the disease, and how vaccines and strong surveillance helped eradicate the disease around the world and in Nepal in the 1970s, but only 'by the slimmest of margins'.Several things about the history of the disease deserve special emphasis. As much as any influential king or prime minister, we sometimes forget that smallpox and other diseases shaped the course of human events.Part I: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer">Big story of smallpox in Nepal</a>Part II: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/" target="_blank" rel="noopener noreferrer">The smallpox virus in British India</a>Part III: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" target="_blank" rel="noopener noreferrer">Smallpox, politics and power in Kathmandu</a>Part IV: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" target="_blank" rel="noopener noreferrer">How Nepal eradicated the smallpox virus</a><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861ea39c7e80680e0ccdd9jpeg.jpg" alt="" width="1500" height="1001"/><figcaption>Photo: MANISH PAUDEL</figcaption></figure>Viruses such as measles, influenza, hepatitis, polio, rabies, and HIV – as well as non-viral diseases such as cholera, TB, syphilis, and malaria – remade not just individual lives, but also physical, economic, and political landscapes.The fury of smallpox reminds us of the inescapable power of nature. Despite all our efforts, humans are part of nature, and life is fragile.We are living beings made up of cells and nutrients, subject to the rules of geography and biology, death and disease. This reality held true in the past, and holds true today, as much as we hope otherwise. Smallpox may have been chased away, but COVID-19 stands at the doorstep.Each disease has its own characteristics, its own biological personality, its own way of spreading through society and attacking human bodies. <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNEvpoGS7wd8yELy9-vJ0LG1oby5kw">Malaria moved via mosquitoes</a> which liked warm weather, <a href="https://www.nepalitimes.com/latest/kathmandu-in-the-time-of-cholera/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/kathmandu-in-the-time-of-cholera/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNGDo4ZWCamW139FFTuqWLpgRZuSoQ">cholera through germs in water</a>, and syphilis through sex. Due to these differences, each disease left its own unique imprint on history.<a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNF3MVYYqp8ZY4QHWix_z0-R_ABxUA">Big story of small pox in Nepal</a>, Tom RobertsonSmallpox spread through the air, moved easily from person to person, caused searing pain, and, if it did not kill, left behind disfigured, broken human bodies. In Nepal, if it had struck older people, not children, or if it had not left its victim's faces scarred and their eyes damaged, it might have brought less terror.On the other hand, if it had had a reservoir in animals (as many viruses do) it would have been much harder to eliminate, and we might still be facing its burning fevers and excruciating rashes today. Small pox’s particular biology shaped history in a particular way.Nature is not just a passive stage on which we humans act out our dramas as we wish. Instead, it is an actor in every drama, sometimes in the background, sometimes centerstage, but often coming and going at its own will, not ours.<a href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/">The smallpox virus in Nepal</a>, Tom RobertsonLooking back, if we recount the stories just of kings and queens and their political chess matches, we overlook some of history's main drivers and its most important stories. In fact, if we overlook disease history we will not understand the stories of kings and queens as well as we think. Can we really tell the history of Rana Bahadur, Girvana, Bimsen Thapa, and Bir Shumshere -- much less the stories of ordinary people around the country -- without understanding the central role of disease?Looking forward, we would do well not to forget nature's power to completely take over the course of events. Smallpox also reminds us that, even though humans share the same biology, diseases often affect some subsets of society more than others, particularly those with less money and power. In other words, biological forces may be universal but they play out in social landscapes as complex and uneven as Nepal's dadakada.In the Americas, smallpox even more than guns, gave Europeans a huge advantage over the indigenous people who had never encountered the disease before, and thus lacked immunity. <a href="https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/the-smallpox-virus-in-british-india/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNHRE-p56xptgt9wTBUUjoc05RxNwA">In colonial India, smallpox and ideas about how to treat it divided the British from Indians</a> more than it brought them together.<a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNF3MVYYqp8ZY4QHWix_z0-R_ABxUA">In Nepal, smallpox preyed upon both rich and poor</a>, powerful and powerless alike. But as the 19th century Newar song 'Sitalamaaju Mye' reminds us, it divided Gorkha conquerors and Newar families. <a href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNFFHANLUtlK0myrUwhb4qdFGZg4Pg">Smallpox shaped power struggles between Bhimsen Thapa and his political rivals</a>, and later, in the effort at eradication, altered relations between government health workers and individuals from impoverished ethnic minorities.<a href="https://www.nepalitimes.com/opinion/smallpox-politics-and-power-in-kathmandu/">Smallpox, politics and power in Kathmandu</a>, Tom Robertson No doubt, smallpox also shaped gender relations in ways we need more historical research on. Just as differences between diseases mattered in the course of history, so, too, did social differences.<a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNGC0hhwCb-vpWbsy8-oT_gcbRcM6Q">Nepal's successful effort to eradicate smallpox in the 1960s and 1970s</a> seems particularly relevant to us today. Nepal's last case in 1975 shows what it took to banish a complex disease in challenging circumstances: sustained governmental focus and coordination, adequate long-term funding, scientific knowledge, talented and dedicated staff, careful record keeping, program flexibility and adaptation to local culture and conditions, and dogged surveillance.Yet even at this moment of seeming human control, nature's power was on display. Smallpox eradication happened only with help from nature. Compared to malaria and polio, smallpox was relatively easy to control. It was so intense that it was easy to spot, and that intensity also made it difficult for contagious victims to move around infecting others. Smallpox did not strike a person twice. And unlike other viruses, it proved very susceptible to a vaccine. This history suggests some of the special challenges that COVID-19 poses.Here, too, social difference mattered. Nepal's eradication campaign shows the enormous challenge of protecting individual rights in moments of public health crisis. In Nepal and other South Asian countries, government personnel sometimes used violence to force citizens to get vaccinated. Some health workers grew so convinced of their righteousness -- the 'purity of purpose' in one man's self-description -- that they felt comfortable steamrolling the wishes of others, often people from socially marginalised groups with little say in society to begin with.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" target="_blank" rel="noopener noreferrer">How Nepal eradicated the smallpox virus</a>, Tom RobertsonSuch coercion probably could have been avoided through more nimble policies, more extensive training, and better public education. Problems often sprouted, the historian David Arnold noted, when doctors and other health workers didn't understand how ordinary people saw the world and quickly dismissed their concerns as backward or superstitious -- when, as he put it, the medical system had grown ‘culturally and politically distant from the lives of its subjects’.In the end, the history of smallpox shows the fragility of life, but also the power of human perseverance. Smallpox struck down one of every three it infected. It stole beautiful children from their mothers and fathers. It stole sight from survivors. In some places, it wiped out entire families and laid waste to whole villages. It was deadly, ruthless, and horrific. It sometimes brought out the worst in human nature.But it also often spurred great ingenuity, compassion, togetherness, and resilience. In the face of disease, humans have found surprising ways to support each other, learn from the past, endure the suffering of the present, and find hope again in the future.This is the fifth article in the <a href="https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNHAaHCW0Y2UQjeFfh0UQoUPVtsqbA">series </a>History of Disease. The next column will deal with danger of dengue in Nepal. <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNEcTfdhSI0N9Tqo_qgoyZnrHCccug">Tom Robertson</a>, PhD, is researching the environmental history of Kathmandu Valley.Read other articles on smallpox in Tom Robertson’s History of Disease series in <a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/&amp;source=gmail&amp;ust=1590041413347000&amp;usg=AFQjCNGC0hhwCb-vpWbsy8-oT_gcbRcM6Q">Nepali Times</a>.

Tom Robertson

Viruses past, present and future

Epidemics are nothing new in Nepal. In fact, the country’s history is littered with references to frequent outbreaks of cholera, influenza, measles and other disease that killed thousands at a time Nepal.Yet, despite knowledge about prevention or the availability of vaccines, Nepalis still continue to die in large numbers. An outbreak of diarrhoea killed 200 people, mostly children, in Jajarkot in 2009. Last year’s unprecedented eruption of <a href="https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-020-0194-1" data-saferedirecturl="https://www.google.com/url?q=https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-020-0194-1&amp;source=gmail&amp;ust=1586755561427000&amp;usg=AFQjCNF2kQRkqfQlK6HcTgAWijq2RpcGaQ">dengue in Kathmandu</a> infected 15,000 and <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1586755561427000&amp;usg=AFQjCNEBf6yExopyyX2QWQrwe2mffPJ09w">killed at least a dozen people</a>.So, for Nepal the only difference between the coronavirus pandemic and previous disease outbreaks is that it is global in scope, and it has wrecked the economy. The government has been more proactive this time, compared to previous epidemics in taking strict measures to prevent the spread, like the <a href="https://www.nepalitimes.com/latest/nepal-covid-19-lockdown-extended-till-7-april/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-lockdown-extended-till-7-april/&amp;source=gmail&amp;ust=1586755561428000&amp;usg=AFQjCNHcPke1rqEHuZS0-wb1tig9mHFzYw">lockdown</a> which has now lasted nearly three weeks.Even so, experts say Nepal’s response was unnecessarily delayed. Nepal was one of the first countries outside China to report a case of COVID-19 when a Nepali student who had returned from Wuhan tested positive for the virus on 24 January. He later recovered, and right new cases have been detected since, but it was only in the second week of April that the government finally began mass testing in western Nepal and Tarai districts, where there have been returning migrant workers from India.<a href="https://www.nepalitimes.com/opinion/remembering-a-pandemic-100-years-ago/">Remembering a pandemic 100 years ago</a>, Buddha Basnyat<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8b679c7e80680e06b298jpeg.jpg" alt="" width="4096" height="2730"/><figcaption>A doctor based in Sukraraj Tropical and Infectious Disease Hospital explains on COVID-19. Photo: BIKRAM RAI</figcaption></figure>The mosquito-borne haemmorhagic fever is already being reported in all seven provinces. Cases have been arriving in hospitals which are already on high alert of COVID-19. A double epidemic would mean medical facilities will be overwhelmed.“We are not new to epidemics. Thousands of children continue to die of easily preventable diarrhoea every year and there will be another dengue outbreak this summer, but where is the preparedness?” asks Gangalal Tuladhar, a disaster expert and politburo member of the ruling Nepal Communist Party. “It is a primary duty of a responsible government to prepare for any disaster or an epidemic before it strikes.”<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/">“Nepal is a microcosm of all of the changes in world health”</a>, Nepali TimesIt is ironic that a senior member of a ruling political party that commands a near two-thirds majority in Parliament is the one complaining about the government being lax. To be sure, the government has been strict in enforcing the lockdown, and Prime Minister Oli hinted during a conference call with provincial chief ministers on Saturday that the lockdown may need to be extended because the virus was spreading in India.Also, local government have been crediting with taking effective prevention measures, including house-to-house surveillance and monitoring of high-risk individuals. Swab collection and mass testing of high risk groups has started in earnest.<a href="https://www.nepalitimes.com/here-now/confusion-persists-about-lockdown-rules/">Confusion persists about lockdown rules</a>, Alisha Sijapati<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121112/636b8b6b9c7e80680e06b299jpeg.jpg" alt="" width="640" height="427"><figcaption> </figcaption></figure>Still, Nepal’s lack of preparedness to fight public health emergencies has been similar to the apathy shown about enforcing building codes and having a rescue and relief strategy in place for future mega-earthquakes.It took the devastating 2015 earthquake to finally push the policymakers to develop the Disaster Risk and Management Act in 2017 – more than five years after it was languishing in the legislature. Unlike the Natural Calamity Act 1982 that is centred on the relief, the new Act listed 22 kinds of disasters in Nepal and it focuses on preparedness. Epidemics however have been categorised under ‘non-disaster’ in the new Act.<a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/">Rebuilding five years after 2015 quake</a>, Alisha SijapatiEpidemics has been lumped together with famine, fire, pest or micro-bacterial attack, industrial accident, toxic gas hazard, chemical radiation leakage, gas explosion, toxic food intake, environmental pollution, deforestation, physical infrastructure damage and accidents during disaster relief.“Placing snakebites and outbreaks together itself shows that we haven’t really understood what an epidemic means. There is a huge difference in how we have to deal with them,” says Baburam Marasini, former head of the Epidemiology and Disease Control Division.The emergence of COVID-19 on top of the reoccurrence of pre-existing diseases mean countries need health institutions with medical staff equipped to deal with epidemics, research wing to undertake new studies on emerging diseases, and a strong system that can take immediate steps to control spread of a contagion.<a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/">The climate connection to Covid-19</a>, Rastraraj Bhandari“We need to make laws taking infectious diseases into account, strengthen local infrastructure as well as increase capacity of the health sector,” Marasini says.  “We have to turn COVID-19 into an opportunity to build a new health structure and strengthen existing laws.”Chronic lack of coordination and turf battles between the Department of Health Services, National Public Health Laboratory, Epidemiology and Disease Control Division, Epidemiology and Epidemic Management Section, Teku Hospital and Animal Disease Investigation and Control Division have added to the problem.Says public health expert Madhav Chaulagain: “We are unprepared not just for new emerging epidemics but for the pre-existing diseases and seasonal disasters too.”<a href="https://www.nepalitimes.com/here-now/in-nepals-weather-erratic-is-the-new-normal/">In Nepal’s weather, erratic is the new normal</a>, Olivia Molden and Tyler McMahonClose to three years after Nepal adopted a decentralised federal structure, provincial governments have to fly COVID-19 samples to Kathmandu in lack of regional laboratories and hospitals specialising in infectious diseases.The root of the problem is a culture not primed for prevention, but for cure. Also a ‘ke garne’ fatalistic attitude that tends to leave solving a known problem until after the disaster hits.“We think about building modern hospitals to cure people. What developing countries like us should really be focusing on is prevention and preparedness,” says Gangalal Tuladhar. “We are lucky we still have time to prepare for COVID-19. It is time to work on prevention.”Read also:<a href="https://www.nepalitimes.com/latest/cash-flow-crisis-for-migrants-and-families/">Cash flow crisis for migrants and families</a>, Upasana Khadka<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">What is novel about the novel coronavirus?</a>, Buddha Basnyat

Ke garne attitude kills people

<img width="782" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8aae9c7e80680e06b254jpeg.jpg" alt=""/>Nepali Times spoke to Barun Mathema, professor of epidemiology at the Mailman School of Public Health at Columbia University in New York about how the COVID-19 pandemic will affect prisons. He was recently on the <a href="https://www.facebook.com/cnn/videos/vb.5550296508/226123838751517/?type=2&amp;theater" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/cnn/videos/vb.5550296508/226123838751517/?type%3D2%26theater&amp;source=gmail&amp;ust=1586343755174000&amp;usg=AFQjCNGi6UJyyN6-u3mKXwecTMbIgCwAOw">Michael Smercornish show on CNN</a> to warn that jails can incubate infections. Nepali Times: How serious is the danger of coronavirus or other infections spreading out of prisons into the general population?  Barun Mathema: For detainees under trail for longer term sentencing I would say we need to guided by two principles: 1) as a society we are obligated to protect detainees (in jails or prisons); 2) likewise, we should take actions to reduce risk to the surrounding communities. Given that COVID-19 thrives on social contact, having crowded jails with people coming in and out is likely to promote transmission into jails, transmission within jails and 'spillover' of infections out of the jails into the community. There are many bridge populations, i.e. jail staff, detainees and visiting members of the community, for example family, that can transport the virus into or out of the jails. Also a very important consideration is that there is likely a sizable population that have a variety of co-morbid conditions that predispose poor/bad COVID-19 clinical outcomes.So, in my opinion, we need to figure out way to lessen the load of inmates in jails (and prisons) that would require us to restrict or lessen numbers going into jails and prisons and release those in jails responsibly and safely. The criminal justice system should at least consider: i) dropping charges on low-level crimes, ii) relax charging low level offenses in the first place, and 3) release detainees who are the most vulnerable (aging or those with serious co-morbidity). All of this must of course be done safely, ethically and responsibly.The result will likely help lift some pressure within the jails, reducing the risk of outbreaks and potential spillover into the community ... in addition this will likely help in our general mitigation goal of flattening the curve.Read also:<a href="http://archive.nepalitimes.com/news.php?id=13002#.XoxhTsgzbIU">Unsafe in prison</a>, Himal Khabarpatrika<a href="https://www.nepalitimes.com/latest/nepalis-trapped-down-under/">Nepal trapped Down Under</a>, Upasana Khadka<a href="https://www.nepalitimes.com/latest/lockdown-and-the-surge-in-domestic-violence/">Lockdown and the surge in domestic violence</a>, Suvexa Pradhan TuladhaYour research is mainly on the spread of tuberculosis in Brazil’s jails. But what is your view on the probable immune-enhancing property of the BCG vaccine?I work primarily on tuberculosis, anti-microbial resistance in tuberculosis and in other bacterial pathogens. BCG vaccination is one of the most widely used vaccines in the world. Although role of BCG in preventing TB has been heavily debated over the decades, BCG vaccination is thought to prevent against severe forms of childhood TB. BCG induces a potent immune response (in fact reasons why it is also used for Bladder Cancer therapy). Previous studies have shown that BCG vaccination of infants reduces all-cause mortality, and a considerable amount of infant mortality is due to respiratory and enteric viral infections. Therefore, it is plausible that BCG may induce protective immune response against viral respiratory pathogens such as SARS-CoV2. If this is the case, we do not know the extent or how long this protective immune response would last. My guess is that it will be short term - which would be great at, for example, protecting health care workers. We would need a properly controlled clinical trials for example randomised clinical trials, to demonstrate benefit of BCG vaccination in protecting against SARS-CoV2 - such a trial is underway.How did you develop an interest in epidemiology and especially on anti-microbial resistance?I have always been interested in how things work in the real world. Of course, I quickly learned that the real world is quite complex to understand and certainly too simplistic using just one type of lens. Epidemiology, as a discipline, offered a framework to integrate both macro and micro level processes at play and thus was very attractive.My interest in TB stems from the history of the disease in society, arts, and science. It is one of the oldest diseases that is really part of our social and historical DNA - virtually everywhere in the world. This is the number one killer (due to an infectious agent) in the world with nearly 4,000 deaths a day. Controlling TB, including in places like Nepal, has been challenging and very humbling. Studying TB is really a study of biology, history and society. This disease has really eluded scientists since its discovery in 1882. There is so much we should know about this disease, but just do not.In my own research, I consider myself a student of evolution. Evolution, of course, is continual a process that cannot be stopped but is rarely so visible in our day to day. AMR is a case and point for evolution. Its emergence is fascinating from a biologic perspective and the consequences quite devastating from a human health perspective. This interface has drawn me to study AMR in TB as well as other bacterial pathogens.Any comments on the way Nepal has been handling the pandemic so far?I do not think I know enough to answer this question fairly. It is surprising that there are such few confirmed cases ... likely a consequence of testing.

"Prisons can be incubators for COVID-19"

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b79ac9c7e80680e064717jpeg.jpg" alt="" width="550" height="388"/><figcaption>American Red Cross volunteers carrying a Spanish Flu victim in 1919. Photo: RED CROSS</figcaption></figure>The <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNER7BK9EfiZTZ7HAcrRW7TMnI6jKg">current COVID-19 pandemic</a> has forced many to Google other historic outbreaks, and the search usually brings them to the 1918 influenza epidemic that killed between 20-40 million people – half of them in South Asia.Just over 100 years ago, as Europe was coming out of a ruinous four-year trench warfare, American soldiers brought the flu to the front lines from where it had spread like wildfire across Europe.Although it is called the ‘Spanish’ Flu, the virus first appeared in North America and crossed the Atlantic on US troopships bound for the front lines. It is called Spanish Flu because the virus was making people sick in the Pyrenees long after it had subsided elsewhere.After the war, British Army soldiers returning to India (some of them could very well have been Gurkhas) brought the virus to Bombay from where it spread along India’s vast railway network. 50 in every 1,000 Indians died of the virus.There were two waves of the influenza epidemic. It was probably transferred from returning migratory waterfowl to humans in Kansas in spring of 1918 before jumping across the Atlantic to Europe. The spread slowed over the summer, but returned with a vengeance in the autumn that year.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b79ae9c7e80680e064718jpeg.jpg" alt="" width="2400" height="1816"><figcaption> </figcaption></figure>Although there are many books about the Spanish Flu in Western literature, in South Asia there is no properly archived documentation about the tragic pandemic that took many lives.Even Mahatma Gandhi was stricken by the bug, and bodies were piled high along river banks in India as cremation sites ran out of firewood. Unlike COVID-19, the 1918 influenza virus struck people in the 20-40 age group.While it affected 28% of all Americans, killing 675,000 – of the US soldiers killed in World War I, half died of influenza. But surprisingly, the pandemic had very little effect on China.Many viruses have an animal reservoir, and the Spanish Flu was associated with ducks and pigs as is usual for influenza viruses. The <a href="https://www.cdc.gov/coronavirus/mers/index.html" data-saferedirecturl="https://www.google.com/url?q=https://www.cdc.gov/coronavirus/mers/index.html&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNE-MAzB2oWqzXngSV-qeu_vZW781w">MERS coronavirus</a> that affected the Gulf region in 2012 is associated with camels, and the <a href="http://archive.nepalitimes.com/news.php?id=2664" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D2664&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNFPL8LEypjMiL-Zq9OumVczJ63a9w">SARS coronavirus of 2003</a> transferred from civet cats. While the COVID-19 probably originated in bats like the other coronaviruses, its host is believed to be <a href="https://www.nepalitimes.com/banner/coronavirus-outbreak-may-curb-wildlife-trafficking/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/coronavirus-outbreak-may-curb-wildlife-trafficking/&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNGdAGDJ3BCYbsOftkHyaOipIJecdw">the pangolin</a>.As the ‘Spanish’ flu clearly showed, there is <a href="https://www.nepalitimes.com/opinion/covid-19-nepal-and-the-hygiene-hypothesis/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/covid-19-nepal-and-the-hygiene-hypothesis/&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNFhpeCjNw-lYwjui_QOmW3PKMnd3g">no evidence to show that we in South Asia have better immunity</a> towards the novel coronavirus COVID-19. So, what can be done?First thing is to increase tests for COVID-19 in suspected patients even without a travel history to affected areas. The more tests we do, the more we will know about the spread of  the actual disease.Read also: <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">This is a test</a>, EditorialIt is also crucial to do cross-sectional serological studies in communities to see if the virus has been introduced there. This test (unlike the RNA-based diagnostic test for a patient) can be done on asymptomatic people in the community to check for COVID-19 antibodies in the blood, and could give us an idea about the extent of the exposure to the community.Many of these antibody tests are new, and the Chinese have vast experience with them in treating COVID-19. The Nepali government would be well advised to seek Chinese help with antibody testing so that we are better prepared in the days and months ahead. Without more diagnostic and serological tests, we may continue to have a false sense of security as the virus continues to sneak up on us in South Asia.The silver lining (if there is one) in this unfolding COVID-19 pandemic is the attention that it has attracted to the importance of rapid diagnostic tests for other neglected infectious diseases in South Asia like <a href="https://www.nepalitimes.com/banner/tb/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/tb/&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNEq-c2ak8GqLj2idm1BOUPOOAk46A">tuberculosis</a>, <a href="http://archive.nepalitimes.com/news.php?id=18178#.XnhYpkAza70" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D18178%23.XnhYpkAza70&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNHZKfS0Lv_GE4wqJrQaZ6OSfqTgdg">typhoid</a>, typhus, or leptospirosis.The tests need to be accurate, simple, affordable, and quick. Rapid diagnostics will not just help find infected people, but also to decide on specific therapy so that unnecessary antibiotics and other treatment are not administered. Proper diagnosis will lead to control of antimicrobial resistance, another medical crisis affecting the world today.At present, diagnostic tests take many hours if not days, so hopefully, after the dust from COVID-19 settles, there will be more work on rapid tests for these still-rampant ‘biblical’ afflictions that plague us.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b79b19c7e80680e064719jpeg.jpg" alt="" width="1500" height="803"><figcaption> </figcaption></figure>Another positive effect of the COVID-19 pandemic may be the restoration of <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/&amp;source=gmail&amp;ust=1585031842556000&amp;usg=AFQjCNEk_tK3eXW25A_sGyzoFrJsJEBxww">people’s faith in effective tried and tested vaccines</a> in the western world.Rumours about side-effects of vaccines going viral on social media have convinced many parents not to inoculate their children, leading to outbreaks of vaccine-preventable diseases like diphtheria, polio and whooping cough in the West. If successful, the COVID-19 vaccine would set the record straight for the proliferation of ‘anti-vaxxers’.Pandemics are like earthquakes, they cannot be wished away. It is best we prepare for a potential COVID-19 outbreak as best and resourcefully as we can. This is not optional, since there will be more pandemics in future.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNE0aoyspsOeHIBjtexE2rB8xE3KOw">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

Remembering a pandemic 100 years ago

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b79709c7e80680e064703jpeg.jpg" alt="" width="2460" height="1110"/><figcaption>Silk Air flight to Kathmandu from Singapore.</figcaption></figure>All 85 passengers from a Silk Air flight from Singapore carrying a Dutch national of Nepali origin have to self-quarantine after landing in Kathmandu on Saturday night.Earlier, the Civil Aviation Authority of Nepal had threatened to send the plane back to Singapore with all its passengers after discovering that there was a person from the Netherlands on board.Nepal had banned all flights from Europe and the Gulf as well as transit passengers as of midnight Friday. On Friday, Prime Minister Oli extended the ban to all international flights from 22-31 March.The confusion appears to have been created by the two orders, and doubts about whether one superseded the other.The Boeing 737 had been refused landing in Kathmandu at first after the European national was found to be on board, but was allowed to land to refuel at 8:30pm on Saturday. Passengers were prevented from disembarking for three hours as the authorities debated what to do, and passengers inside the plane grew increasingly angry.At first they ordered the plane to fly back to Singapore, but as political pressure mounted and passengers started calling relatives, Tourism and Civil Aviation Minister Yogesh Bhattarai is learnt to have intervened. He is said to have argued that it would send the wrong message internationally if Nepal refused to allow entry to its own citizens. Most of the passengers were Nepali nationals.Similarly, 64 Nepalis who had arrived on Thai International and Air India have also been sent to the Kharipati quarantine centre on Saturday because they arrived from countries restricted after Friday midnight, which include Europe, Malaysia, South Korea, Japan, and Iran. Most of the passengers were said to be Nepalis trying to get home from Malaysia and the Gulf and using Bangkok and New Delhi for transit.Kathmandu Airport immigration chief Sagar Aryal said the transit passengers were sent to Kharipati quarantine centre because they arrived from countries that had already been banned. The Dutch national on Silk Air has been sent to Kharipati isolation centre, while the other passengers were released with orders to self-quarantine.All Singapore bound passengers on the return Silk Air flight were taken to hotels in Kathmandu and will fly out on Sunday just before the ban on all international flights goes into effect.Short-term visitors will no longer be allowed to enter or transit through Singapore from 11.59pm on Monday March 23 after two patients died from Covid-9 complications. They were the first deaths in Singapore, which has seen 430 cases, of which 140 have recovered. Most new cases are brought in by visitors, the government said.

Nepal quarantines passengers on Singapore flight

In 2013, while writing <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Flu,294">a weekly health column</a> in this paper, I explored the potential for <a href="https://www.cdc.gov/coronavirus/mers/index.html" target="_blank" rel="noopener">MERS </a>(Middle Eastern Respiratory Syndrome) to spread among Nepalis working with camels in the Gulf states. Despite all the dire predictions of how that coronavirus could be brought back to Nepal and spread in the population, it is still a mystery why there was no MERS outbreak here. Viruses do have their own predilections.This time, although <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">Nepal officially has had only one person diagnosed</a> with the novel coronavirus (COVID-19) who later recovered, it is utterly foolhardy to think that we may escape this pandemic. In Italy, there were only four cases in 20 February, but three days later it soared to 400 cases. That virulence is what is new about this novel coronavirus.Even if Nepal does not have a surge of cases now, there is every likelihood that we will have to deal with an outbreak next winter. In addition how COVID-19 will interact with a summer dengue outbreak like last year in Kathmandu is anyone’s guess. It is important to be prepared with preventive aspects.Read also: <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">This is a test</a>, Editorial<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79239c7e80680e0646e5jpeg.jpg" alt="" width="960" height="640"/><figcaption>An Army personnel demonstrates how to wear protective gear while treating possible COVID-19 patients in Nepal. All Photos: BIKRAM RAI</figcaption></figure>Masks for the general public are more for self-assurance than anything else. People who are coughing and have symptoms should wear masks. But widespread use of masks for the general public may only deplete the limited supply of masks where they are actually needed in hospitals. The most important prevention is <a href="https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/" target="_blank" rel="noopener">washing hands </a>properly with soap and water 5 to 6 times per day and avoid touching the face. Keeping a reasonable distance from one another is also important. The elderly need to be especially careful.One of the most crucially helpful decisions that the Chinese government took in December 2019 after the novel coronavirus struck Wuhan was to rapidly share the molecular structure of the virus (its genomic sequence) with the world. This made it possible for drug manufacturing companies like <a href="https://www.modernatx.com/" target="_blank" rel="noopener">Moderna</a>, a biotechnology company based in the US, to start working on a vaccine.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleThe first human trial against COVID-19 will start later on this month. This is incredibly fast because in earlier times, it would take at least six years before a vaccine was developed. Although an effective vaccine is the best defence against COVID-19, what can be done for prevention in Nepal here and now is more important.First, the good news. It is now well known that about 80% of COVID-19 victims will have mild symptoms not requiring hospital admission. Of the rest, 15% will be severe and 5% may be critical, possibly requiring ventilators in an intensive care unit. Even if only 0.5% of patients from South Asia’s population of 1.8 billion require ventilators, it is easy to imagine the tragic scale of this potential  emergency.The Wuhan data from Chinese doctors also revealed that it was the elderly (mostly male) that took the brunt of the disease and that children were not symptomatic, even though they may be infected by the virus. The findings also showed that about 1% of the patients who suffer from  COVID-19 die.This is the stark difference between COVID-19 and other causes of influenza where the death rate is only 0.1%. That is, COVID-19 kills ten times more people, and they are mostly above 60 years old. Although 1% may sound small, actual numbers will be numbing when large populations are infected.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79249c7e80680e0646e6jpeg.jpg" alt="" width="3600" height="2400"><figcaption> </figcaption></figure>Besides vaccines, there are also drug studies going on to fight COVID-19. One such medicine is called <a href="https://www.kaletra.com/" target="_blank" rel="noopener">Kaletra</a>, commonly used for HIV patients. Many other drug trials (including the antimalarial drug cholroquin) are going on.The incubation period (the time from infection to symptoms) was also studied in Wuhan and forms the basis of the quarantine period of 14 days. The average incubation period is five days but may be up to 12 days. To be on the safe side a two-week quarantine is recommended, after which it is unlikely that the symptoms will manifest.Unlike some western countries, China, Singapore, Taiwan, and South Korea practiced widespread contact tracing to control the disease. If someone was diagnosed with COVID-19, the health professionals took a detailed history of  who their contacts (including family and friends) were, and followed up to see if they developed symptoms. Contact tracing helped stem the spread of the disease in these countries.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNE0aoyspsOeHIBjtexE2rB8xE3KOw">frequent health columnist</a> for Nepali Times.

What is novel about the novel coronavirus?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79289c7e80680e0646e7jpeg.jpg" alt="" width="960" height="640"/><figcaption>A quarantine zone at Nepal Army's headquarters in Tundikhel. Photo: BIKRAM RAI</figcaption></figure>By now the novel coronavirus pandemic has affected every corner of the globe. If it has not brought disease, it has at least brought the <a style="background-color: #ffffff; font-size: 16px; letter-spacing: 0.15px;" href="https://www.nepalitimes.com/editorial/fear-goes-viral/" target="_blank" rel="noopener">fear of infection</a>. Cities, and indeed entire countries, are in lockdown. Fortress Europe has raised its walls higher. Airlines are grounded. Nepal has banned trunk international routes from Friday night. Even countries with excellent public health facilities and emergency preparedness plans are overwhelmed.Nepal is now <a href="https://www.nepalitimes.com/opinion/global-thinking-and-local-action-on-coronavirus/" target="_blank" rel="noopener">so closely intertwined with globalisation</a> through migration, tourism and trade that its <a href="https://www.nepalitimes.com/here-now/nepals-economy-already-weak-takes-direct-hit/" target="_blank" rel="noopener">already-fragile economy has been badly hit</a> even before a full-blown health emergency hits. Ironically, less-developed countries seem to have a built-in resilience that comes from being crisis-prone -- since they are lower down in the economic ladder, they have a shorter distance to fall.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/" target="_blank" rel="noopener">Poor health makes Nepalis poorer</a>, EditorialDespite Nepal’s surprisingly <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener">dramatic improvements in mother-child survival </a>over the past two decades, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">the public health system here is in crisis</a>. State-of-the-art modern hospitals in the city, while reducing the need for Nepalis to go abroad for treatment, are out of reach of a majority of the population. Government health facilities are more affordable, but for the most part medical care there is not up to mark.Nepalis are still afflicted by easily preventable water-borne diseases like <a href="https://archive.nepalitimes.com/news.php?id=16988#.XnMUhagzbSF" target="_blank" rel="noopener">typhoid and diarrhoea</a>, vector-borne infections like malaria, encephalitis or dengue, and illnesses like <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">tuberculosis </a>and acute respiratory infections that spread through breathing. Great inroads have been made in reducing the impact of communicable diseases in the past decades through awareness programs, vaccinations and safer drinking water, but children in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">remoter parts of Nepal</a> are still dying of simple infections.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleOn top of this, urbanising Nepal now also has the added burden of <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">non-communicable afflictions</a> like diabetes, cardio-vascular ailments and renal disease. As families move from the districts to the cities, changes in diet and more sedentary habits have given rise to an epidemic of lifestyle-related diseases. This is compounded by genetic susceptibility among South Asians for diabetes and heart disease.For example, a study by the BPKIHS in Dharan showed that while the national average for <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">Type 2 diabetes </a>prevalence is 8.1% of the population, the incidence in Dharan was 14%, while it was only 1% in Taplejung. The prime minister’s own second kidney transplant this month showed that <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032" target="_blank" rel="noopener">ignoring risk factors and not diagnosing non-communicable diseases</a> can lead to a huge health burden for families and the state. A small percentage of Nepalis have health insurance, so many middle income families fall below the poverty line due to medical expenses. Many Nepali migrant workers have been forced to seek jobs abroad to pay back debts incurred during hospitalisation of family members.Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">blamed on climate change</a>. But it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon. None of these factors have been addressed, so we are staring at a recurrence of dengue this year even while we cope with <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">a possible COVID-19 outbreak</a>.Public health has not been a national priority for successive governments in Nepal. Even if it has, it is only in paper and has not really been translated into <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">accessible and affordable healthcare</a> for the general public. Governance failure has contributed to this state of affairs, but there is also the virus of corruption that has afflicted the entire government healthcare system. A politico-business nexus has also infected <a href="http://archive.nepalitimes.com/news.php?id=19560" target="_blank" rel="noopener">medical education</a>, putting it out of reach of deserving poorer students.Read also: <a href="https://www.nepalitimes.com/editorial/when-panic-goes-viral/" target="_blank" rel="noopener">When panic goes viral</a>, EditorialInto this mix, we now have the coronavirus scare. Officially, Nepal has just one case in which the patient recovered and has been discharged. The government has tested about 500 people, and all have been negative. Experts have confirmed that the tests are credible, and proper protocols are in place. But not enough tests have been done to determine if there are more people out there with the virus.At $75 per test, the kits are expensive. This is where international help would be needed, and if the case rate rises the country will also need help with containment and mitigation. Nepal has been lucky so far that there is no indication of community transmission yet. But our luck could turn any day.

This is a test

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b790b9c7e80680e0646dcjpeg.jpg" alt="" width="1031" height="605"/><figcaption>Nepali students who went abroad to study in 2018.</figcaption></figure>When Pradyot Pandey took a semester off from his second year of undergraduate studies at Asia Pacific University (APU) in Japan in August 2019 to come to Nepal for an internship, he had planned to return to campus in late March.But as the COVID-19 pandemic exploded across the globe and Japan became one of the first countries outside of China to have multiple confirmed cases of the virus, Pandey has been unable to return to APU or receive clarity from APU about his situation.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b790d9c7e80680e0646ddjpeg.jpg" alt="" width="960" height="958"><figcaption> </figcaption></figure>“I was in the process of having my visa renewed when the virus spread in Japan,” Pandey told Nepali Times in Kathmandu. “Both the immigration department in Japan and the university have halted the process and I am not sure when it will be approved.”Pandey is in Nepal but other Nepali students are stranded abroad and face uncertainty about their academic future because they have been asked to return home. They also have difficulty finding accommodation if they cannot return to Nepal.But after midnight Friday, Nepali students cannot come home easily even if they wanted to as the government has banned all travel from EU and West Asia. The restriction includes tourists as well as transit passengers.The flight ban also includes all travel from Turkey, Malaysia, South Korea, Japan as well as passengers transiting those countries. This means that effective midnight 20 March, all flights to Kathmandu will be cancelled except Singapore, Thailand and Nepal's two neighbours India and China.Subuna Basnet, a Chevening Scholar at the University of Essex in the UK, was not able to come home to Nepal due to a clause in her scholarship that prevents her from leaving Britain for more than one month.“I was panicking watching the whole situation unfold and in a situation like this when anyone is vulnerable, you want to be in your own country, in the comfort of your own home,” says Basnet. "Even though the university is communicating with its students, it is difficult when we cannot get any substantial assistance from them at a time like this."<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b790f9c7e80680e0646dejpeg.jpg" alt="" width="1557" height="1367"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79129c7e80680e0646dfjpeg.jpg" alt="" width="1522" height="701"><figcaption> </figcaption></figure>Basnet is thankful that she receives a monthly stipend through her scholarship as many of her peers are on loans, and work service jobs to pay their university fees.Across the Atlantic in the United States, a national emergency has been declared and students of other nationalities packed their bags and headed home. But there are some Nepalis who cannot afford the ticket home, and also find rent expensive outside campuses which are closed.Not everyone is as lucky as Ishan Mainali, a junior at Hamilton College in New York, who was able to return to Nepal immediately as the university paid for his ticket, and allowed him to keep his belongings on campus.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79159c7e80680e0646e0jpeg.jpg" alt="" width="1536" height="2048"><figcaption> </figcaption></figure>“I am lucky that my college provided the assistance that they did at this time,” says Mainali. “I know that others are in more difficult situations so I do feel blessed.”Mainali’s Facebook post in which he details his observations of Nepali migrant workers coming in from Qatar without health inspections during his trip, has been widely circulated on social media. Like most of the Nepali students who recently flew in, Mainali is self-isolating himself for two weeks.Ang Sonam Sherpa, a first year undergraduate student at Harvard University in Massachusetts also received support from the administration even though their response was delayed."I frankly thought sending everyone home was the best course of action that the university could have done in this situation given the need of social distancing," Sherpa told Nepali Times from the US. "The stakes are just too high as it is literal life and death for so many vulnerable individuals in the society."<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79189c7e80680e0646e1jpeg.jpg" alt="" width="1065" height="1065"><figcaption> </figcaption></figure>Nirupan Karki, a third year law student at NALSAR University of Law in Hyderabad in India was in a fix when the Government of Telangana issued a directive on 14 March for all education institutions to shut down by the end of this month. NALSAR asked all Indian students to leave campus within 48 hours and made an exception for foreign nationals, allowing them to stay but under strict quarantine.Karki quickly booked an expensive flight back to Nepal to avoid being stuck at the university and arrived home last week. But for those two days, Karki was in a state of panic.“The whole situation has left me deeply uncertain as I have a lot of unanswered questions,” Karki says. “Mostly I am worried about my studies as the semester has come to an abrupt halt. Despite having online classes for the remainder of the semester, I am unaware about the mode of examination as it is a major grading criteria in our campus.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b791a9c7e80680e0646e2jpeg.jpg" alt="" width="1080" height="720"><figcaption> </figcaption></figure>Many Nepalis studying in China returned home in late January as the country sought to curb the spread of COVID-19. The Nepal government even sent <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/from-hubei-to-kharipati/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/from-hubei-to-kharipati/&amp;source=gmail&amp;ust=1584619579221000&amp;usg=AFQjCNEESKtW-75lw6bM-Eex96Medv_3WQ">a plane to evacuate 182 students</a> from Hubei Province on 16 February.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b791d9c7e80680e0646e3jpeg.jpg" alt="" width="853" height="1280"><figcaption> </figcaption></figure>Nishtha Rajbhandari, a high school senior at United World College China, along with other international students were asked to leave the country before the situation worsened as the pandemic spread rapidly around China.Rajbhandari says, “It is heartbreaking that I lost an entire semester, that too the last one of high school. There are a lot of emotions, and I don’t think anyone has been able to process it at the moment.”Rajbhandari says her class was looking forward to planning for the last semester. But she adds: “I am just grateful the situation in China is getting better and every person I know is safe, and I hope the whole situation settles soon and things get back to normal again.”<h2>A Florentine quarantine</h2><h6>A Nepali student in Italy shares what life is like under lockdown</h6><a href="https://www.nepalitimes.com/banner/ashna-comes-out-of-the-black/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/ashna-comes-out-of-the-black/&amp;source=gmail&amp;ust=1584622644848000&amp;usg=AFQjCNGRC9RHLPLi_KOkk4HTBemDxlttkA">Aashna Lama</a> was set to graduate from high school in 2015 when the earthquake hit Nepal. Now, exactly five years the COVID-19 pandemic caused her college in Florence to close down as Italy went under complete lockdown.“I’ve accepted the fact that I’m not destined for a cap and gown ceremony and my friends in Italy are fervently planning a very Italian graduation for me, laurel wreath crown and everything,” Lama told Nepali Times over email. “I don’t think graduation and I mix very well for the world.”When the Italian government announced a country-wide quarantine, Lama along with most of the residents did not have much time to react. Lama could not decide whether to stay or to go back home to Nepal.“I am quite ashamed that I took the situation so lightly in the beginning and brushed it off as a simple flu,” Lama adds. “It was shocking to see how everything was happening so quickly.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79209c7e80680e0646e4jpeg.jpg" alt="" width="3024" height="4032"><figcaption> </figcaption></figure>Luckily, most classes are online so her studies are not as badly affected. But her job as a part-time bartender is suspended since all bars and restaurants in Italy have been ordered closed.Under lockdown, Lama felt restless at first. But now that more than a week has passed, she is getting into the schedule of doing freelance work, devoting time to her art, planning photo shoots, catching up on books and tv shows and practicing her Spanish and Italian.In the evenings, Lama joins her neighbours as they play music and sing from balconies. The mass showing of solidarity has amazed the art student who says it has boosted her morale during a very trying time. She too, blasted ‘Nessun Dorma’ by Pavarotti and ‘Libiamo ne’lieti calici’ from the Italian opera La Traviata from her window one evening this week.Lama says it is a shock to see the bustling streets of this historic town as empty as it is. As someone who has lived in the city for four years she says Florence isn’t the same without the tourists throngs.She adds: “But as we’re saying here, tutto andrà bene, and I truly believe it.”

epidemic