<figure><img width="971" height="487" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204179c7e80680e0b2842jpeg.jpg" alt=""/><figcaption>Daily reported Covid-19 cases and deaths since January 2020, when the first case was detected in Nepal.</figcaption></figure>It was on 23 January 2020 that the first Covid-19 case was detected in Nepal. Two years later, the country is on the cusp of a <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">third wave</a>.The time to sound an alarm about a new surge is long over. Action should have been taken months ago. All the government can do now is to launch a massive campaign to inoculate the unvaccinated, offer boosters to frontline workers, the elderly, and people in densely populated areas.Evidence elsewhere, including in neighbouring India, show that while the <a href="https://www.nepalitimes.com/opinion/omicron-is-coming-to-nepal-be-prepared/" target="_blank" rel="noopener noreferrer">Omicron strain</a> is 12 times more transmissible than previous variants, most of those infected do not need critical care in hospitals – unless unvaccinated or immuno-compromised.    Cases are rising fast in Nepal, doubling every 2 days to 3,075 new recorded infections on Wednesday. The positivity rate has soared 10 times in a week to 23.5%. At this rate, there will be 12,000 new confirmed cases by 16 January, which will be higher than the peak of the second wave in May 2021.“With Omicron now spreading in the community, we don’t need to gene sequence anymore,” says Epidemiology and Disease Control Division director Krishna Prasad Paudel.He is hoping Omicron will show a similar trajectory to elsewhere, and those infected will have <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">milder symptoms </a>compared to Delta. The new variant mostly impacts the upper respiratory tract, with lungs largely unaffected, hence lessening the need for oxygen and ventilators.However, Nepal’s low vaccination rate (50% partially, 40% fully) means that individuals need to continue taking precautions with masks and distancing.Read also: <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/">“Nepal has all the conditions for an Omicron surge”</a>, Nepali Times <figure><img width="2048" height="1366" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637204199c7e80680e0b2843jpeg.jpg" alt=""><figcaption> </figcaption></figure>A double dose of the vaccine is not as effective against Omicron, and most Nepalis have passed six months since they were inoculated, meaning that their antibody levels have fallen considerably by now. <a href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron/" target="_blank" rel="noopener noreferrer">Boosters would provide more protection</a>, but the government is only offering those to high risk groups from next week.Although Omicron is now the dominant strain, Delta is still circulating, and causing deaths. We know from the past two years that it takes a few weeks for mortality to pick up after <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">cases start rising</a>. This has been seen in India, and Nepal closely follows health trends there.“We need to keep a close watch on our mortality figures, find out which variant is causing most deaths, and we will have to prepare hospitals and healthcare workers once again,” warns epidemiologist Lhamo Yangchen Sherpa of IPAS.Across Nepal, many <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">rural hospitals are still understaffed</a> and do not have trained personnel to operate ventilators and run ICU wards. Not all new oxygen plants are functional yet.But Sangeeta Kaushal Mishra of the Health Coordination Division assures that the government is in a better position this time: “We are prepared for hospitalisations if cases are milder, but we don’t know how the virus will behave."The sheer transmissibility of Omicron could mean severe symptoms and even deaths among the elderly and those with pre-existing conditions like diabetes.  Elsewhere in the world, even vaccinated health workers have been infected, overwhelming hospitals.Read also: <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/">“All vaccines prevent severe Covid”</a>, Nepali Times <img width="1594" height="986" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/6372041d9c7e80680e0b2844jpeg.jpg" alt="">The first line of defence against Covid is still masks and distancing. The second is <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer">mass vaccination</a>. Nepal still has a stockpile of over 10 million doses in refrigerated stores, and 6 million more doses in the pipeline. A syringe shortage reduced the vaccination rate, but Mishra expects the drive to pick up next week. More than 200,000 people were vaccinated on Wednesday.“We were lucky Omicron is mild, but we should use this  opportunity to inoculate both the unvaccinated and boost the  vulnerable on war footing,” says physician Buddha Basnyat of Patan Academy of Health Sciences.The government is starting mass inoculation of children from 12-17 years, and has shut down schools for three weeks until 29 January due to the new surge. Gatherings of more than 25 people have been banned, masks are mandatory outdoors, and people will need vaccine cards to enter public spaces from next week.“The fact that Omicron is much milder has made people even more careless, so we must once again reinforce the importance of masks, ventilation and distancing,” warns virologist Sher Bahadur Pun at Teku Hospital.Equally important is the institutional isolation of active cases and contact tracing. Experts believe official <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer">figures are under-reported</a> and total cases and fatality figures are much higher. The Economist tracks ‘excess deaths’ across countries and estimates that 2.3 million people had died from Covid-19 by May 2021 in India, compared to only 200,000 official fatalities.Its calculations show that when Nepal recorded its highest daily Covid deaths of 246 on 19 May 2021, the actual number was 425. The real infection rate was also much higher than official data.Read also: <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/">Living with Covid in 2022</a>, Sonia Awale

Sonia Awale

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3rd wave in 2 years

<figure><img width="1221" height="814" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1eaf9c7e80680e0af423jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>It has been two years since the coronavirus turned the world (and Nepal) upside down.  <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">Masks have become the norm</a>, physical distancing is a must, vaccines are mandated, and parts of the world are going back to lockdowns. The virus has infected 277,523,045 people and killed over 5.3 million, a figure that does not count ‘excess fatalities’. 
Just as everyone was waiting for business to go back to normal in 2022, countries have been hit with a <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">highly contagious new variant</a>. There are now serious worries about the efficacy of vaccines against Omicron and <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">who and when to boost</a>. 
Lab tests have shown that the AstraZeneca and VeroCell vaccines most used in Nepal may not be so effective against Omicron, and only m-RNA vaccines like Pfizer and Moderna may be effective as boosters to stop infections. However, researchers have said all vaccines, including AstraZeneca and the Chinese jabs, significantly protect against serious illness. 
Nepali Times spoke with national and international health experts to verify these initial findings and how it is likely to impact Nepal’s response to the new strain.
“The coronavirus is here to stay and it will remain with us for decades to come. To do this it will find ways to continue to infect people in communities even if they are vaccinated,” <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">Andrew Pollard</a>,  who helped develop the AstraZeneca vaccine told Nepali Times from Oxford.
He added: “The important role of the vaccines is to prevent severe disease and the evidence so far, even with Omicron, does appear to indicate that vaccines are still holding up in preventing most of the severe outcomes.”
<a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/">“All vaccines prevent severe Covid”</a>, Nepali Times 
Infectious diseases specialist at HAMS hospital in Kathmandu Anup Subedee agrees: “It is true that mRNA vaccines are more effective against the new variant but all the shots still significantly reduce severity and mortality. So our priority must be to vaccinate as many people as soon as possible and to boost the immune-compromised and frontliners.”
Researchers recommend using mRNA vaccines as booster for the vulnerable populations. Last week, Nepal received nearly 2 million doses of Moderna shots from Germany via the COVAX facility, which is sufficient to provide booster doses for the elderly. Health Minister Birodh Khatiwada announced on Wednesday that Nepal would start boosters from mid-January. 
A recent study by The Imperial College London estimated that the risk of reinfection with the Omicron variant is 5.4 times greater than that of the Delta variant. What this means is that the protection against reinfection by Omicron afforded by past infection may be as low as 19%. Early studies also suggest that Omicron is four-fold more infectious than the Alpha strain and two-fold more infectious than <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">Delta</a>.
“There is some evidence that shows that a natural immunity from past infection and or vaccine-induced immunity from prior vaccination may not be sufficient to prevent Omicron infection. But it is too early to make a concrete statement,” regional health expert Sushil Koirala told Nepali Times via email from Bangkok. 
Preliminary findings suggest that <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">Omicron may be milder than previous variants</a>, but its increased transmissibility could still result in high rates of severe disease and death particularly among vulnerable and unvaccinated groups, overwhelming ICU capacity. 
“The real question is not how many people Omicron is likely to kill but given its higher transmissibility, how Nepal’s limited health infrastructure will deal with a surge,” says Dibesh Karmacharya of the Centre for Molecular Dynamics Nepal. “We have to also see how Omicron affects vulnerable populations in Nepal that have already been vaccinated.”
The general consensus is to launch <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">mass immunisation</a> and administer booster shots for the vulnerable population simultaneously. Early evidence based on lab studies shows a booster jab with any vaccine increases protection against Omicron and reduces hospitalisations and deaths.
“Boosters do seem to increase antibodies and some early evidence from the UK shows that boosters increase protection against these mild infections,” says Pollard. “Boosters may be important for some of the frailest in our communities to keep them safe if their protection has waned. Some countries have started booster programs focusing on these risk groups first.”<a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/">“Nepal has all the conditions for an Omicron surge”</a>, Nepali Times 
The Ministry of Health has announced booster shots from mid-January 2022 provided that the World Health Organisation (WHO) permits it. The WHO has been prioritising first and second doses over boosters, especially where there is a short supply of vaccines, and recommended boosters only after 40% of the population is fully vaccinated.
“WHO might have its guidelines but we must also stick to our national priorities, we must provide boosters for frontliners so that Omicron does not shut down our health care system,” adds Subedee. “We must not miss immune-compromised and the elderly, it is more important for now to provide boosters for 80+ people than administer a single dose to 12-18 year olds.”
Nepal’s vaccine stockpile is now so big and vaccine uptake so slow that there is a danger of vials having to be destroyed because of the <a href="https://www.nepalitimes.com/here-now/from-scarce-vaccines-to-storage-shortage-in-nepal/" target="_blank" rel="noopener noreferrer">lack of refrigerated storage</a>,  and there are millions more vaccines in the pipeline. Nigeria this week destroyed 1 million vials saying the international community provided those doses close to expiry dates.
“We now need to get jabs into arms as soon as possible, we must continue inoculating those who haven’t yet been vaccinated while simultaneously also administering boosters, given the decreasing antibody levels and the rise of new variants,” says Buddha Basnyat, a physician at the Patan Academy of Medical Sciences.
So far, Nepal has confirmed three imported Omicron cases, the first in mid-November, meaning a small cluster transmission is already at play. Superspreader <a href="https://www.nepalitimes.com/latest/unconventional-party-conventions/" target="_blank" rel="noopener noreferrer">political events and large gatherings</a> have increased the risk of further transmission. 
Given relatively lower vaccination coverage, lack of booster doses, unknown efficacy of Chinese jabs used and insufficient safety measures, <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">Nepal is a breeding ground</a> for a highly contagious variant to spread. But what will happen in Nepal will largely depend on how the Omicron outbreak plays out in India. 
Says Basnyat: “We have to prepare for a new surge, we have been caught too many times with our pants down."
The way to do that, Koirala says, is to increase surveillance on the Indian border, and <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer">accelerate the vaccination drive</a>. “It is of utmost importance that Nepal start preparing critical care and for possible lockdowns for a large-scale Omicron outbreak. We can’t afford to wait.”
As we welcome 2022, the New Year’s resolution should be normalising the pandemic by increasing the global vaccine equity. Says Dibesh Karmacharya: “Some countries now have the fourth dose but unless we achieve vaccine equity and herd immunity, Omicron will just be one among a long line of variants.”

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Living with Covid in 2022

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d02a39c7e80680e0a368fjpeg.jpg" alt="" width="1360" height="680"/><figcaption>Photo via PROJECT SYNDICATE</figcaption></figure>The upsurge of Covid-19 cases, hospitalisations, and deaths in the United States serves as a bitter reminder that the pandemic is not over. The global economy will not return to normal until the disease is under control everywhere.But the US case is a true tragedy, because what’s currently happening here is so unnecessary. While those in emerging markets and developing countries are longing to get the vaccine (with many dying because they cannot get it), the US supply is ample enough to provide a double dose – and <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">now a booster shot</a> – to everyone in the country. And if almost everyone got vaccinated, Covid-19 would almost surely just “fade away,” as former President Donald Trump memorably put it.And yet not nearly enough people in the US have been vaccinated to prevent the highly contagious <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a> from driving case numbers in many areas to new highs. How do so many in a country with seemingly well-educated people act so irrationally, against their own interest, against science, and against the lessons of history?Part of the answer is that the country, for all of its wealth, is not as well-educated as one might expect – which is reflected in the country’s comparative international performance on standardised assessments. In many parts of the country – including some with the highest rates of resistance to vaccination – science education is particularly poor, owing to politicisation of fundamental issues like evolution and <a href="https://www.nepalitimes.com/banner/un-climate-report-declares-planetary-emergency/" target="_blank" rel="noopener noreferrer">climate change</a>, which in many cases have been excluded from school curricula.In this environment, misinformation can gain traction with many people. And social-media platforms, insulated from liability for what they transmit, have made a business model of maximising “user engagement” by spreading misinformation, including about Covid-19 and the vaccines.But a key part of the answer is a deep misinterpretation, especially among the right, of individual liberty. Those who refuse to <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">wear masks</a> or socially distance often argue that requirements to do so infringe on their freedom. But one person’s freedom is another person’s “unfreedom.” If their refusal to wear a mask or get vaccinated results in others getting Covid-19, their behaviour is denying others the more fundamental right to life itself.The essence of the matter is that there are large externalities: In a pandemic, one person’s actions affect the well-being of others. And whenever there are such externalities, the well-being of society requires collective action: regulations to restrict socially harmful behaviour and to promote socially beneficial behaviour.Any ordered society entails restrictions. But while prohibitions against killing, stealing, and so on restrict an individual’s freedom, we all understand that society could not function without them. In our post-Covid world, we might interpret the Ten Commandments to include: “Thou shall not kill, including by spreading infectious diseases when thou can avoid doing so.”Similarly, “Thou shall get vaccinated.” Any infringement of an individual’s liberty by requiring safe and highly effective <a href="https://www.nepalitimes.com/opinion/why-vaccination-should-be-compulsory/" target="_blank" rel="noopener noreferrer">Covid-19 vaccination</a> pales in comparison to the social benefits – and consequent economic benefits – of public health. It is a no-brainer to require all individuals, with only limited medical exemptions, to be vaccinated. While many governments appear to be too timid to impose this requirement, employers, schools, and social organisations – any organised activity that brings individuals into contact with others – should do so.As we have been learning for the last 18 months, global health is a global public good. As long as the disease rages in some parts of the world, <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">the risk of a deadlier</a>, more contagious, more vaccine-resistant mutation grows.In most of the world, however, the problem is not resistance to vaccination but a <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">severe shortage of vaccines</a>. Evidently, the private sector is unable to scale up production to ensure an adequate supply. Is that because vaccine producers lack capital? Is there a shortage of glass vials or syringes? Or is it because they hope that fewer doses will lead to higher prices and even bigger profits? Among the key barriers to greater supply is access to the requisite intellectual property, which is why the IP waiver being discussed at the World Trade Organisation is so important.Given the urgency and scale of the challenge, more is needed: Among the steps US President Joe Biden’s administration could take is to invoke the Defense Production Act and leverage the federal government’s ownership of key patents. The US has been allowing the pharmaceutical companies to use this public IP freely, while they reap billions of dollars in profits. The US must use every instrument at its disposal to increase production at home and abroad.This, too, is a no brainer. Even if the costs of global vaccination totaled tens of billions of dollars, the amount would pale in comparison to the costs of <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">persistent Covid-19 outbreaks</a> to lives, livelihoods, and the world economy.By arrangement with © <a href="https://www.project-syndicate.org/" data-saferedirecturl="https://www.google.com/url?q=https://www.project-syndicate.org/&amp;source=gmail&amp;ust=1607178503443000&amp;usg=AFQjCNHSbaaYvdpDj2FQzkDgwL7xNFnkWg">Project Syndicate</a>Joseph E. Stiglitz, a Nobel laureate in economics and University Professor at Columbia University, is a former chief economist of the World Bank (1997-2000), chair of the US President’s Council of Economic Advisers, and co-chair of the High-Level Commission on Carbon Prices. He is a member of the Independent Commission for the Reform of International Corporate Taxation and was lead author of the 1995 IPCC Climate Assessment.

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Covid-19 and Human Freedom

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d020c9c7e80680e0a365djpeg.jpg" alt="" width="1500" height="1125"/>After nearly <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">two years of disruptions,</a> Nepalis are itching to get back to normal lives. But there are signs society is returning to an old normal.As soon as the daily caseload and infection rate started falling, the <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">lockdown was lifted</a> even while more than 10% of those tested are still Covid-positive, there are still nearly 500 people in ICU and ventilators in hospitals, and the Delta variant is infecting even those vaccinated.And now schools are set to open next week. While we understand that there has been a tremendous social cost to students not attending in-person schools for nearly two years, why was there a need to reopen <a href="https://www.nepalitimes.com/latest/learning-during-the-pandemic-in-nepal/" target="_blank" rel="noopener noreferrer">just for a few weeks </a>before the holidays?Some teachers, not all, have only just got their first vaccine doses, and unvaccinated children will now be in crowded classrooms, and then going home for family and festival gatherings for Dasain-Tihar-Chhat.As our report this week warns, we have <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">been at this point before.</a> Last year this time, the government relaxed the lockdown and millions travelled to their hometowns. Cases soared as the first wave peaked during the holidays (see graph).<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d020f9c7e80680e0a365ejpeg.jpg" alt="" width="1494" height="788">Experts have told us that a <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">third wave is not likely</a>, given that 20% of the population are now vaccinated (probably rising to 30% by Dasain), as well as the presence of natural antibodies detected in nearly 70% of the population in a recent sample sero-prevalence survey.However, we <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">cannot let our guard down.</a> Delta is a sly virus, just waiting for an opportunity to pounce, and exploiting every weakness in human behaviour.Experience from Nepal and other countries have shown that fully vaccinated people can be infected, and spread the virus to others, including elderly and unvaccinated children at home. Because of Delta’s high transmissibility, experts warn that labels like ‘herd immunity’ and ‘breakthrough cases’ do not make sense anymore.By the time Nepal reaches 40% vaccinated population by December, it will also be time for the third booster shots. We also do not know how long the natural immunity will last in the 70% of the population with antibodies.Studies in India and elsewhere have shown that lockdowns and a high seropositivity rate did not protect children from being infected with Covid-19 if family members were not careful about mingling and mask-wearing.Research also shows that the risk of infection in the classroom is low if students wear masks properly at all times, and are physically separated in well-ventilated classrooms.Experts predict that there will be a slight increase in Covid-19 cases among students, teachers and family members at home when schools resume in-person classes. But as vaccination rates rise, and in areas with high sero-prevalence, it may not lead to another spike, or even a third wave.What no one can tell us is how ‘slight’ this ‘increase’ in Covid-19 cases will be in Nepal – especially since the <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/?fbclid=IwAR0IGQM5l7WOvlo7nCpubILhVAcvoXeHdI-EUnSHShNKTUlswPNRcyndBfw" target="_blank" rel="noopener noreferrer">vaccination rate is still low </a>and most classrooms, school buses, playgrounds are crowded, and children will be excited to see each other after so many months away from friends.So, while the benefits of resuming physical classes may outweigh the risks, the government <a href="https://www.nepalitimes.com/editorial/ministry-of-education-gets-an-f/" target="_blank" rel="noopener noreferrer">has been ill-advised</a> to restart in person lessons just a few weeks before schools close again for the holidays.Instead, it should have used the coming weeks to launch a saturation awareness campaign with strict criteria for school opening, citing <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">mask-wearing at all times,</a> spacing and limited mingling. Parents, teachers and students must be convinced that the risk has been minimised, and the cost of denying children education now exceeds the risks to them from Covid.Across South Asia, school closures and limited digital learning have deprived children for a prolonged period from education, widening socio-economic inequalities. In Nepal, the <a href="https://www.nepalitimes.com/here-now/digital-divide-exposes-class-divide-in-nepal-schools/">digital divide has created an education divide</a> with most of the 80% of students who attend government schools deprived of learning since March 2020.Most students have missed at least 70 weeks of school since the pandemic. Of the 29% of children in a recent survey who said they had access to distance learning via radio, television or online, only half were actually using it – mostly in cities and private schools. The pandemic has wrecked Nepal’s gains in school enrolment, especially among girl children.While keeping schools closed does not prevent the Delta variant from spreading, they should not reopen <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">without precautions in place</a> – and only after the festivities. Public awareness campaigns are needed before in-person classes resume, and compliance must be monitored. Last but not least, expedite full vaccination of teachers and school staff nationwide.

Two schools of thought

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141132/636cfe379c7e80680e0a0c29jpeg.jpg" alt="" width="1384" height="898"/><figcaption>MASKING THE TRUTH: Of the approximately 130 people in this photograph of the steps of the Nyatapola Temple during the Saparu festival on Monday, only 12 were not wearing masks properly. But experts warn that masks alone will not provide full protection from the delta variant, people must also avoid crowds like this. Photo: AMIT MACHAMASI / PHOTOSHOP BY KIRAN MAHARJAN</figcaption></figure>In January Nepal became the first country in South Asia to <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">start the Covid-19 vaccination drive</a>. Today, despite delays and a <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">devastating second wave</a>, close to 15% of the population is fully inoculated.Recent surveys show that 97% of Nepalis would take the Covid vaccines if available. Used to pollution, mask wearing is also high among urban Nepalis.With minimal vaccine and mask resistance, Nepal should have by now had the pandemic under control. And although the spike in cases after the lockdown was partially lifted in July is flattening out, the daily <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/" target="_blank" rel="noopener noreferrer">death rate</a> is still high and the risk of a <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">new Covid-19 surge</a> is greater than before.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141132/636cfe3a9c7e80680e0a0c2ajpeg.jpg" alt="" width="2770" height="1348"><a href="https://covid19.healthdata.org/global?view=cumulative-deaths&amp;tab=trend" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/global?view%3Dcumulative-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1630094210932000&amp;usg=AFQjCNGvdeV1UA0KTyh-ILmgK3DYs64LZQ">Graph from IHME for Nepal</a> showing reported total fatalities from Covid-19 (orange line) and the estimated actual deaths counting excess fatalities including unreported cases (green line). For example, on 25 August, the reported total was 10,614, but the excess deaths from Covid-19 including unreported was projected at more than 37,000. If 90% of the population started wearing masks (green dotted line), nearly 6,000 Covid-19 deaths would be prevented by 31 December (red dotted line). Go to <a href="https://covid19.healthdata.org/global?view=cumulative-deaths&amp;tab=trend" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/global?view%3Dcumulative-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1630094210932000&amp;usg=AFQjCNGvdeV1UA0KTyh-ILmgK3DYs64LZQ">IHME</a><a href="https://covid19.healthdata.org/global?view=cumulative-deaths&amp;tab=trend" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/global?view%3Dcumulative-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1630094210932000&amp;usg=AFQjCNGvdeV1UA0KTyh-ILmgK3DYs64LZQ"> site for interactive Nepal graphs.</a>Source: The <a href="http://www.healthdata.org/" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/&amp;source=gmail&amp;ust=1630094210932000&amp;usg=AFQjCNEWLI_7338oGit9sBT_Fq-Ut4iofA">Institute for Health Metrics and Evaluation (IHME)</a> an independent global health research center at the University of Washington.Experts say the vaccination drive appears to have created a false sense of security among those with jabs to believe that they are now fully immune to the coronavirus.Ironically, the government’s <a href="https://www.nepalitimes.com/editorial/no-vax-ask-for-mask/" target="_blank" rel="noopener noreferrer">promotion of masks</a> also may have been too successful – with many thinking it will protect them from the virus even if they crowd around. A case in point is the Saparu festival crowd in Bhaktapur earlier this week (pictured above).“If you are going to crowd in that way for an extended period there is no point in wearing a mask,” states epidemiologist Lhamo Yangchen Sherpa.“Many still don’t know that the virus transmission is through the airborne route, and we cannot be careless knowing how infectious the delta variant is and that the majority of the people are still unvaccinated, particularly children,” she adds.Masks and vaccines just reduce infections and serious symptoms, <a href="https://www.nepalitimes.com/opinion/dying-to-get-vaccinated/" target="_blank" rel="noopener noreferrer">they are not foolproof</a>. And epidemiologists warn that available vaccines do not stop even those who are vaccinated from transmitting the virus.New studies have also shown that even the protection vaccines provide will be wearing off, so Nepalis with jabs will be needing third booster shots even before the eligible population is fully vaccinated.Covid-19 vaccines save lives by ensuring that infected people do not have serious symptoms, and do not require hospitalisation. But vaccinated people can be carriers at the same rate as those unvaccinated if they have been infected with a <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">delta variant</a>.“What I’m seeing now is a surge of overconfidence among younger people who are vaccinated, they are risking everyone else not yet vaccinated, especially as Dasain-Tihar nears,” says virologist Sher Bahadur Pun at Teku Hospital. “We are creating an ideal condition for the next surge or the third wave to take place.”Recent studies have shown that an individual infected with delta variant even if vaccinated can have a high viral load -- as high as that of an unvaccinated person. This means they can be carriers of the virus just like unvaccinated people.The real surge in Covid cases last year took place <a href="https://www.nepalitimes.com/latest/this-years-dangerous-dasain/" target="_blank" rel="noopener noreferrer">after the festivals</a> when millions of Nepalis travelled from Kathmandu to their home villages and took the virus to the remotest corners of the country.This resulted in higher fatalities, especially in rural Nepal with <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">limited health care facilities</a>.  A recent report found that despite fewer cases, Dolpa, Mugu and Humla districts had fatality rates of 7%, 6% and 5% respectively – compared to only 0.9% in Kathmandu.The delta variant and its higher transmissibility despite vaccinations have made the situation worse this time around. <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">Covid-19 is here to stay</a>, and managing it requires behavioural change and taking safety measures such as hand washing, physical distancing and masking a necessary part of our lifestyle.Earlier this year, researchers at Yale and Stanford University ran a large-scale randomised controlled trial to identify a precise combination of strategies that are successful in changing mask-wearing habits.They found their <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">NORM strategy</a> worked well. NORM stands for:- No cost masks distributed at scale- Offering information about mask-wearing- Reinforcement in public places by intercepting non-mask wearers- Modelling and endorsement by trusted leadersAfter a successful pilot trial in Lahore with 5 million people, NORM is being scaled up to cover the whole of Pakistan. The Bangladesh Rural Advancement Committee (BRAC) is aiming to reach 81 million people with NORM methods. In India, the program is being tried out in Gujarat and other states by the Self Employed Women’s Association (SEWA).<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">Mask-wearing</a> rates have tripled where NORM methods have been implemented, helping save thousands of lives. The campaign was launched earlier this month in Nepal in the densely populated urban centre of Thimi, Sunsari’s rural areas, and Melamchi which has been battered by earthquakes and floods.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141132/636cfe3d9c7e80680e0a0c2bjpeg.jpg" alt="" width="960" height="720"><figcaption> </figcaption></figure>The plan is to distribute up to 450,000 masks through volunteers who go back to the community every 10 days to monitor progress in uptake. The pilot will be scaled up across the country with one million masks donated by Hanes, a US clothing brand arriving in Nepal shortly.The NORM pilot in South Asia is being funded by the Bill &amp; Melinda Gates Foundation and the Covid-19 Crisis Management Centre (CCMC) has endorsed the campaign in Nepal.“We hope that the NORM mask-wearing approach will enable behaviour change throughout our nation and help to curb the negative effects of Covid-19,” says Brig Gen Arun Neupane, who heads the medical division of the CCMC.Preeti Adhikary of the NORMalizing Mask Project in Nepal says the campaign has been received well, with many more local governments willing to participate.She says: “Despite the vaccine rollout there is still a lot of uncertainty. So we must educate the public that even after vaccination we must follow safety protocols, which only comes with behavioural change which is what we are trying to do.”_________________<h2>How to get QR coded vaccine certificates</h2>Vaccine certificates are now the new passports for international travel, much like in the past when passengers from certain countries were required to present the WHO-approved yellow cards at airports.This month, there were <a href="https://www.nepalitimes.com/here-now/nepalis-queueing-up-all-night-for-proof-of-jab/" target="_blank" rel="noopener noreferrer">long queues of migrant workers </a>at Teku hospital waiting for rubber-stamped papers to certify vaccination before they flew off to destination countries. The letter did not have a digitally-registered QR code, and risked being invalid.This finally prompted the Health Ministry to set up an online application with photo, ID, vaccination card and a self-declaration form for a scannable <a href="https://www.nepalitimes.com/latest/nepali-workers-queue-up-for-qr-codes/">digital vaccine certificate</a> accessible with encrypted link and QR code acceptable internationally.The QR code is linked to the officially-authorised database hosted and managed by the Health Ministry so the system is authenticated.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141136/636cfe409c7e80680e0a0c2cjpeg.jpg" alt="" width="800" height="800">WHO Nepal has been helping the Health Ministry with technical support on the digitisation of vaccination records to ensure that no one is left behind from accessing the Covid-19 vaccination and facilitating the equitable allocation of Covid-19 vaccine.The WHO support includes training, design and development of the ministry’s software system and IT equipment, and electronic vaccination registration system in seven selected municipalities in seven provinces.Vaccination digitisation can be done in three ways: pre-registration, on-site registration and post digitisation. Pre and on-site registration are used for digitisation of new vaccination records whereas post digitisation will be used for the digitisation of people who are already vaccinated and have certificate cards.“Recordkeeping is important to ensure that there is no duplication but measures must be taken so that there is no crowding at the vaccination centres, turning them into breeding grounds for the virus,” says a virologist at Teku Hospital Sher Bahadur Pun. “We need more vaccination centres and safety protocols must be implemented strictly at every booth.”Public health experts say the digitisation can help control the pandemic in the long run if properly implemented, since the documentation will assist in <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">vaccine equity</a> as the inoculation drive gains pace.Epidemiologist Lhamo Yangchen Sherpa says that online registration is important in reducing crowds at vaccination centres. But, she adds, “Since this is more applicable in areas with Internet access and for people with a smartphone, SMS with individual inoculation timing might be more effective.”To register for online vaccine certificate, visit the <a href="https://vaccine.mohp.gov.np/public-request-form">website</a>: https://vaccine.mohp.gov.np/public-request-form

Behind the masks

<img width="1513" height="1019" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc299c7e80680e0a0b72jpeg.jpg" alt=""/>In recent weeks, Nepal has resumed nationwide vaccinations against the Covid virus in earnest. While this is a crucial step towards ending the pandemic – with only 7.34% of the population fully vaccinated, <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">we are not out of the woods yet</a>, not by a long shot. 
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.washingtonpost.com/context/cdc-breakthrough-infections/94390e3a-5e45-44a5-ac40-2744e4e25f2e/" target="_blank" rel="noopener noreferrer">Leaked information from the US Center for Disease Control</a> last week has added renewed complications in this fight against Covid-19. 
The<a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer"> Delta variant</a> was the dominant strain in Nepal, and caused more than 200,000 reported infections across the country within 30 days between May and June 2020. This has now become the main strain of the virus on the planet. 
Evidence now suggests that it is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu, and smallpox. This is one of the most effective virus variants to face modern society, spreading as effectively as the ubiquitous (but mostly harmless) chickenpox. 
When the Delta variant was first isolated, the global public health community understood that it transmitted more effectively, but many questions remained about whether or not it was more deadly or likely to cause serious complications. 
One of the first sources about the severity of Delta included a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNGrOA9yy_1CCG3ZKEzLPdBkRu_zAg">study</a> from Scotland which demonstrated that it was about twice as likely to result in hospitalisation for unvaccinated individuals than the original Alpha variant. 
Another analysis of 38,805 cases in England revealed that the Delta variant posed a 2.61 times higher risk of hospitalisation than Alpha. 
One reason for this faster spread is a mutation on the spike protein, which the virus uses to enter human cells. The Delta variant has <a href="https://covariants.org/variants/21A.Delta" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://covariants.org/variants/21A.Delta&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNFeDyT6pXrRRitXys-T0BmqKODhOg">a particular mutation called ‘D614G’</a>(colloquially referred to as ‘Doug’) <a href="https://pubmed.ncbi.nlm.nih.gov/33243994/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://pubmed.ncbi.nlm.nih.gov/33243994/&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNFdbibR-uEEpwa7sjZ1qDZKgs9Xxg">that packs the surface of the virus with spike proteins</a> which, in turn, help it avoid the natural antibodies that human cells use for defenseand <a href="https://pubmed.ncbi.nlm.nih.gov/33558493/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://pubmed.ncbi.nlm.nih.gov/33558493/&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNHAjuQ_dXz0EpZ-6MCfRroVslX3gA">enter our cells more easily. </a>
As if this wasn’t enough, Delta also has<a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNEoIFGa5Um_pxXGHNQwDefBsxQ6Pg"> a spike mutation called P681R</a>, which appears to produce higher viral loads in patients, making it easy to spread to more people, more quickly. A study in China demonstrated that people infected with Delta have <a href="https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNEmgWymHmdImGh5su5H_IBjs9607A">1,000 times more viruses in their respiratory tract</a>. 
This means that there is more Covid virus per droplet that we expel. People exposed to the smaller droplets with higher concentrations of virus can be infected more quickly and when standing much further away from one another. 
This makes the virus much more likely to spread between people even with very limited contact: a review of CCTV footage from a shopping mall in Sydney, Australia proved that the virus was transmitted between two persons who were only casually passing by.
Delta has <a href="https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724&amp;source=gmail&amp;ust=1628338257264000&amp;usg=AFQjCNGIeRz4ZJuEq04MfnF6C2FmeOQZzw">an incubation period of only four days</a>, rather than six. This means that people are contagious sooner and end up infecting more people. A patient with the original Alpha variant would infect, on average, two or three other people. With Delta, this number soars to an average of eight. 
The good news is that vaccinations still offer significant protection against the Delta variant. While there is mounting evidence breakthrough infections do occur, and may result in death, the chances of ending up in the hospital or a morgue are vastly reduced once you’ve had a full dose. 
The bad news is that even if you are fully vaccinated, you can still be a major spreader of the virus. A <a href="https://khub.net/documents/135939561/390853656/Impact+of+vaccination+on+household+transmission+of+SARS-COV-2+in+England.pdf/35bf4bb1-6ade-d3eb-a39e-9c9b25a8122a" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://khub.net/documents/135939561/390853656/Impact%2Bof%2Bvaccination%2Bon%2Bhousehold%2Btransmission%2Bof%2BSARS-COV-2%2Bin%2BEngland.pdf/35bf4bb1-6ade-d3eb-a39e-9c9b25a8122a&amp;source=gmail&amp;ust=1628338257264000&amp;usg=AFQjCNHB5XqQ5B6aTBMVodh1VEJCSX1nJQ">Public Health England study</a> of more than 365,000 households found that full vaccination with either Pfizer or AstraZeneca was associated with only a 40 to 50% reduction in household transmission after a vaccinated person tested positive. 
The leaked documents from the CDC go so far as to suggest that the likelihood of further transmitting the virus is nearly the same for vaccinated and non-vaccinated individuals. This is particularly worrying for Nepal given that full vaccines for the majority of the population – including children in particular - <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">are still a long ways away</a>. 
Today, despite an increasing number of people receiving vaccinations, Delta has the upper hand. We cannot expect our government to take adequate and timely steps to avoid a third or fourth deadly wave of infections, and we can expect the virus to continue to mutate and find even more effective ways to continue to circulate through the global population. Ensuring the safety of ourselves and our communities is, once again, left in our own hands.
The standard practice of regular handwashing and wearing face masks is no longer sufficient to prevent the spread of COVID. 
With Delta, the most important prevention behaviour is to avoid crowded public spaces — particularly when there is poor air ventilation. A vaccine is not a passport to resume life as normal.
Indeed, the data shows that we all need to <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">change our behavior immediately</a> and with a renewed vigour, and to amend our public messaging accordingly. If we fail to do so, the virus will win and more loss of life and prolonged, stricter lockdowns will be the inevitable result.
Sushil Koirala is a public health expert based in Bangkok, Thailand.
Ben Ayers is an American citizen based in Nepal for over 20 years.

Delta variant’s wake-up call for Nepal

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08c39c7e80680e0a6037jpeg.jpg" alt="" width="1500" height="1000"/>When Covid-19 cases started to fall last month and the government relaxed the lockdown, most public health experts warned that it was premature because not enough people had been vaccinated.Sure enough, after falling steeply from 9,500 confirmed cases a day in mid-May to 1,500 cases, the daily caseload has now jumped to near 4,000 again. Daily fatalities dropped from 250 to 12 in mid-July, and have risen again to more than 30 a day. Active cases are once more passing 30,000. (See graph)<a href="https://www.nepalitimes.com/editorial/2am-is-too-late/">2AM is too late</a>, Editorial<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08c69c7e80680e0a6038jpeg.jpg" alt="" width="1414" height="794">The current trend is similar to October 2020 at the peak of the first wave, when there were over 5,000 daily new cases and 30 deaths. The decline in second wave infections and fatalities have now stalled, and the case positivity rate has increased to 25%.“After two months of lockdown, restrictions were suddenly lifted even though we were still reporting 2,000 cases. Everything is up and running and it is business as usual, crowding and no distancing,” says virologist Sher Bahadur Pun at Kathmandu’s Teku Hospital.He adds: “Now we have vaccination centres which risk being virus hotspots. People who have not been infected, and those not vaccinated yet are at greater risk.”The behaviour of the virus in Nepal has generally followed India’s pandemic trajectory after two weeks. After peaking at over 400,000 daily cases back in May, India has seen a decline in daily cases and fatalities. However, after registering less than 30,000 confirmed cases on 27 July, India registered 43,654 fresh cases the day after.With only 7% of its 1.3 billion people fully vaccinated, recovery from the second wave has tapered off in India, with states like Kerala are seeing a new surge.A recent survey showed that India’s seroprevalence rate is about 70% -- the proportion of the population infected in the recent past who carry antibodies. The rate is highest in the bordering states of Bihar (75%) and Uttar Pradesh (71%).The antibodies provide some immunity against the coronavirus, which is why Kerala is seeing a spike because the seroprevalence rate there is India’s lowest, at 44%.A seroprevalence survey is currently being carried out in Nepal, and experts predict that antibody rates will be similar to India, at least in the Tarai. However, they caution that this may not mean Nepal is protected by herd immunity.Nepal is administering more than 55,000 doses of Covid vaccines a day, but the government’s assurance that more vaccines are on the way may have sent the wrong message to people.“People who are vaccinated are being careless, they have stopped wearing masks and distancing themselves. I know of at least 10 acquaintances who with their families were fully vaccinated, but are now in quarantine,” says epidemiologist Lhamu Yangchen Sherpa. “Jabs protect us from hospitalisation, but we could still get infected and continue the chain of infection.”But despite projections of a new surge in late August, public health experts both in India and Nepal are cautiously optimistic that it will <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">not be as deadly as the second wave</a> unless a new variant of concern emerges before a large portion of the population is vaccinated.So far, 1.5 million Nepalis, which is 5.1% of the total population, have been fully vaccinated with either AstraZeneca Covishield, Chinese VeroCell or the single-shot J&amp;J vaccine. Over 2.3 million have been partially inoculated.But <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">vaccine doses have been distributed unequally</a> across the country with about half of it concentrated in Bagmati Province. More than 14% of people in Bagmati are fully inoculated compared to only 2.5% in Province 2, 2.8% in Far West, and 3% in Karnali. (See map)<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08c89c7e80680e0a6039jpeg.jpg" alt="" width="1500" height="1000">Some public health experts suggest focusing on high-risk, crowded cities with mobile populations, instead of trying to achieve vaccine equity at a time when vaccine doses are scarce. This will allow for reduced transmission, particularly among the vulnerable groups as well as help revive the economy and restore jobs.“Highly mobile populations and people in densely crowded places should be vaccinated next. After the second wave I am convinced that they are a much higher risk group and hence must be prioritised,” says virologist Pun.Epidemiologist Sherpa, however, recommends factoring in the access to medical services in Nepal’s vaccination strategy. A survey shows that the fatality rate among infected people is <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/" target="_blank" rel="noopener noreferrer">highest in remote areas</a>, even though the number of infected people is much less.While only 0.9% of total Covid-19 patients in Kathmandu succumbed to the disease, in the remote mountains of Mustang, Dolpo and Mugu the figures were as high as 11%, 7% and 6% respectively.Nepal’s annual Dasain-Tihar festival season is only two months away. Going by last year’s experience, millions could once more travel from Kathmandu to home districts taking the virus with them and spreading it all over the country.This is why it is important to inoculate as many people as possible before the festivals. The elderly above 65 years who have only received the first dose of AstraZeneca Covishield are at most risk, but the good news is that they will be getting their second doses from a 1.6 million COVAX consignment that Japan is sending next week.Nepal is currently rolling out VeroCell and J&amp;J vaccines from its current stock. China is giving another 1.6 million doses of VeroCell, and Nepal is negotiating to buy another 6 million.While there is talk of purchasing additional 6 million doses of Pfizer-BioNTech vaccine in the next few months for the teens between 12-18 years, these will need -70°C storage facilities. The government is urging young people to register online for vaccines, and applicants will be prioritised once enough doses arrive.The UK government on Thursday announced <a href="https://www.gov.uk/government/news/uk-begins-donating-millions-of-covid-19-vaccines-overseas" target="_blank" rel="noopener noreferrer">9 million doses of Covid-19 vaccine</a> to the global COVAX facility to be donated starting this week. The first countries to receive the consignment are Indonesia (600,000 doses), Kenya (817,000) and Jamaica (300,000). It is not yet known if Nepal is on the list.But for now, vaccine or no vaccine, <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">mask and separation</a> is the best protection.Says epidemiologist Sherpa: “Mass inoculation is our way out of this pandemic but while we chase after vaccines, let’s not forget safety measures and be prepared for a possible new wave."

Vaccines or no vaccines, mask and distance

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92f69c7e80680e06f17cjpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>This op-ed is being simultaneously published in the Indian Express (India), The Daily Star (Bangladesh), Nepali Times (Nepal) and DAWN (Pakistan).In February 2021, Covid-19 numbers started increasing again in South Asia with official daily case counts rising beyond 400,000 in India, 6,000 in Pakistan and 7,500 in Bangladesh, straining health systems.The massive surge in India soon <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">spilled over across the border into Nepal</a>, leading to ‘apocalyptic’ scenes of overwhelmed hospitals.This virus knows no borders. Containing it has necessitated global cooperation among scientists, policy makers and society. Despite a wide variation in how nations have responded to the pandemic, the most successful strategies adhere to science, and attention to local context.The <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">deadly surge in 2021</a> makes a regionally-coordinated, evidence-driven strategy even more critical. The virus continues to challenge us with its mutations and new lines of attack. If we are to move at the speed of the virus, it is necessary to construct multi-stakeholder regional coalitions to devise new solutions and frugal innovations that can be applied across South Asia.Given our shared and mostly similar social, economic and cultural contexts, local successes must find means to be amplified across the region.Is that even possible, given the troubled history South Asian countries share? The mutual mistrust appears to have hit a new low, as <a href="https://www.nepalitimes.com/editorial/shared-futures/" target="_blank" rel="noopener noreferrer">SAARC</a> has not even managed to hold its summit since 2014.But today we write a positive, hopeful story about a new consortium we are involved in, with core team members from India, Pakistan, Nepal, and Bangladesh jointly developing Covid prevention strategies. The emerging consortium provides an example of how neighbours can work together for mutual benefit, despite political differences.Every country in South Asia has struggled to ensure consistent <a href="https://www.nepalitimes.com/opinion/the-economics-of-masks/" target="_blank" rel="noopener noreferrer">mask-wearing</a> to stem the spread of Covid. Beliefs, priorities, traditions, and aversions to behaviour change are more similar across South Asia than we care to admit. These commonalities mean that interventions that are successful in changing behaviour in one place are likely applicable in other parts of the Subcontinent.We have experienced this with Community-Led Total Sanitation (CLTS) campaigns to solve the <a href="https://www.nepalitimes.com/here-now/nature-calls/" target="_blank" rel="noopener noreferrer">problem of open defecation</a> -- originally developed by Bangladeshi NGOs in partnership with an Indian consultant --- and now broadly applied across South Asia and beyond.The Grameen Bank microcredit model was an indigenous South Asian innovation that spread rapidly. BRAC’s recent ‘Graduation’ program targeting the ultra-poor in Bangladesh was replicated with success in India and Pakistan. India’s digitised social protection ecosystem with Aadhar IDs and Jan Dhan accounts serves as a model (albeit with cautionary notes) for other countries in the region. E-governance programs in Pakistan, like eVaccs and Citizen Feedback Model have been replicated and provide strong models ready to be deployed regionally and globally.The new pan-South Asian consortium in response to Covid-19 evolved out of an experiment conducted in Bangladesh, that successfully changes social norms around mask-wearing in rural communities. We observed that a combination of No-cost distribution, Offering information, Reinforcing the message in markets, mosques and other public spaces, and Modelling and endorsement by community leaders (NORM) leads to large, sustained increases in mask usage that persisted beyond the period of active intervention.This <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">four-part NORM intervention</a> was originally examined in a cohort of 350,000 individuals across 600 villages. BRAC is implementing the model to reach 81 million people across Bangladesh.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121144/636b92f99c7e80680e06f17djpeg.jpg" alt="" width="1600" height="876">The team is now partnering with several organisations across Pakistan, India, Nepal, and Bangladesh to start adapting the model to fit each country’s context, and set up partnerships to pilot, implement, tinker, and learn.The Self Employed Women’s Association (SEWA) quickly implemented the model to reach over one million members in Gujarat. An additional 1.5 million masks were shipped from Bangladesh to support SEWA’s outreach to other states. Lahore’s Commissioner worked with our research team to adapt the NORM model to an urban setting, and devised new creative ideas to improve effectiveness.For example, it has prepared to deliver <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/" target="_blank" rel="noopener noreferrer">masks</a> at doorsteps using Pakistan’s postal service, and is targeting beneficiaries on the basis of billing information from utility companies. Philanthropists and private corporations are sponsoring the masks. We are re-importing some of these innovations back to Dhaka, inspiring further scale-ups in Dhaka, Chittagong, Rajshahi and Kathmandu.Effective mask promotion requires visits to thousands of remote villages, and those same visits can be used to prepare for more effective community-based healthcare responses. To that end, a host of physicians, scientists and community based organisations created the Swasth Community Science Alliance, committing to pragmatic, science-based protocols to manage mild and moderate cases of Covid-19 in rural India, where institutional health care access is limited.These guidelines (available at https://science.swasth.app) were translated to training tools for healthcare workers by digital health innovators like Noora Health, making them widely available across the region.NORM implementation teams based in Lahore, Ahmedabad, Peshawar, Hyderabad, Dhaka, Kathmandu, and Delhi are learning from each other’s successes and failures. The process usually starts with the original research team sharing evidence-based insights with implementing agencies, as the implementers adapt the design, co-create localised implementation protocols, and are threaded together in a collaborative environment across countries where each implementing team iterates while learning from others’ prior iterations, and all our sub-teams are connected in an active learning system that allows us to course-correct in real time. This coalition is poised to change mask-wearing norms amongst hundreds of millions of people across all of South Asia.The CSA is working with partners across rural, tribal belts around India. A team of physicians from India and the Indian diaspora work with local implementing partners to support design, implementation and monitoring of home-based programs and Covid-19 centres providing rigorously protocolised treatment for moderate cases, with oxygen, proning and steroids.Combining the NORM and CSA interventions, our Masking-Treatment-Vaccine Preparation (MTV) approach offers a sensible strategy to mitigate the pandemic until universal vaccination is achieved. These are regional solutions that thoughtfully apply scientifically sound interventions to the local context.The <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">Covid-19 crisis</a> has increased policymakers’ appetite for evidence-informed policy measures that can be quickly implemented to stem transmission. This drive for quick action has created some unprecedented opportunities for enhanced cross-country collaborations that are normally hampered by politics and mistrust.We hope that the consortium that first formed around <a href="https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/" target="_blank" rel="noopener noreferrer">mask-promotion</a>, and now around science-based treatment approaches, and that developed quickly and organically without regard to national boundaries, can serve as a model for a broader and deeper collaborative ecosystem that endures.We need to come together to solve problems that affect us all. Let the lasting legacy of this pandemic be a new era of partnership in social innovations that can benefit all South Asians.https://www.youtube.com/watch?v=d0hpuXRByic&amp;t=9sMushfiq Mobarak is Professor of Economics, Yale University, and Director of the Yale Research Initiative on Innovation and Scale. Twitter: @mushfiq_econ Maha Rehman is director of policy at the Mahbub-ul-Haq Research Centre at the Lahore University of Management Sciences. Twitter @MahaRehman1Satchit Balsari is assistant professor of emergency medicine, and of global health and population, at Harvard University. Twitter: @satchit_balsari

What can we do till vaccines arrive?

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91c69c7e80680e06f10djpeg.jpg" alt="" width="1500" height="1000"/>Nepal will open its 2021 lockdown long before the country <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">has enough vaccines</a> to protect its citizens -- our aunts, uncles, and neighbours. We will not have substantial vaccine coverage for many months, if not longer.We will <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">need more oxygen,</a> more testing, and better tracking and isolation procedures. Crucially, we will also have to maintain and strengthen our only effective tools: physical distancing and masks.Unfortunately, too many Nepalis are wearing low-quality masks, taking them off too often, touching them, and not washing them or replacing them often enough. More people should be wearing three-layer surgical masks, which, for only a few more rupees, offer greater protective power.The key problem Nepal faces has not changed: infected people do not know they have the virus and spread it around. And new variants make the virus even more easily transmissible. We need to behave not as if only a small number of people could have the virus, but as if everyone we encounter already has it. That includes the friendly neighbourhood fruit seller. That includes family members. That includes you.“Vaccinations will take a long time to arrive in South Asia to create a wall of immunity. Till then, masks are most essential,” says <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/">Mushfiq Mobarak</a>, a Yale university professor who recently led a huge study of<a href="https://docs.google.com/forms/d/e/1FAIpQLSfMJkyBBtK74lqSsHZnx_8qb0_sJ0WaR7A7XA8IQHAobrBEQA/viewform"> mask-wearing in Bangladesh.</a>Many Nepalis wear cloth masks or one-layer surgical masks. These help, no question. But the 3-layer surgical masks and N95s offer more filtration efficiency and more protection, although they cost just a few rupees more. That is an investment well worth it to protect individuals, institutions, and governments.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91c99c7e80680e06f10ejpeg.jpg" alt="" width="2370" height="950"><figcaption>This projection by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine in Seattle shows that in Nepal 1,000 fewer people will die by 1 September if 95% of people wore masks while outdoors. Source of all graphs: IHME University of Washington / Nepal Ministry of Health and Population</figcaption></figure>I asked Biraj Vajracharya, an epidemiologist at Dhulikhel hospital, what kind of mask people should be buying and wearing. "Surgical mask, or if possible, N95 mask," he replied.The Yale researchers recommend high quality 3-layer masks because they filter more efficiently. They can be washed and reused without losing much efficiency. For more on the study's recommendations about masks, see this excellent <a href="https://www.youtube.com/watch?v=ifiR_5DuyfA">video</a>."We need to change mask-wearing norms amongst hundreds of millions of South Asians to mitigate the spread of COVID," Mushfiq Mobarak told me via email. "High-quality washable, reusable surgical masks are much more cost-effective, and offer a feasible path to scalability across the region."The <a href="https://www.business-standard.com/article/current-affairs/covid-19-crisis-india-draws-lessons-from-bangladesh-s-mask-study-121051401341_1.html">Yale study in Bangladesh</a>, involving over 300,000 people in 600 villages, identified simple policies that led to much greater mask wearing. They found that when <a href="https://docs.google.com/document/d/1EUhdri6CST9uzw_myffNmyUVPt8_UMsM75NOt5Q-54o/edit">authorities do four things together</a>, mask wearing more than tripled:<ol><li>Offer free masks</li> <li>Provide clear information about mask wearing in videos and brochures</li> <li>Find community leaders to speak in support of mask wearing</li> <li>Reinforce the message with gentle questioning for those not wearing</li></ol>The fourth policy was the most important: special monitors to verbally poke people who were not wearing masks. Those monitors, the Yale study explains, ‘walk around and if somebody is not wearing a mask, they intercept them and politely say, “We distributed masks here—why aren’t you wearing one?” If the person didn’t have a mask or couldn’t get one, the monitor gives them one.’What this combo of four actions does is establish a community expectation, a clear norm or standard for the community to follow. The norm shows everybody that the community expects them to wear the masks, that it takes masks seriously. That makes a big difference.The researchers call their recommended program NORM:No-Cost masksOffering InformationReinforcement in public places by intercepting non-mask wearersModelling and endorsement by trusted leadersHere's some useful mask info:<ol><li>All masks help, but 3-layer surgical masks and N95 masks offer greater protection.</li> <li>Double masking is good, especially with low-quality surgical or cloth masks.</li> <li>Masks should cover the mouth and nose. A tight fit on all four sides is good.</li> <li>If you touch the mask, you should wash your hands.</li> <li>Masks should be washed and replaced regularly.</li> <li>In general, you should wash your hands with soap several times a day.</li></ol>A historical reminder might be relevant here: when we think about the Covid-19 vaccine, we often recall the <a href="https://www.nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus/">big health breakthroughs of the past</a>, such as the discovery of the polio vaccine in the 1950s, and penicillin in the 1940s.But long before these headline-stealing medical heroes arrived to save the day, death rates had already dropped dramatically in Western Europe and North America. This health revolution came because of much less glamorous innovations: clean drinking water, efficient waste disposal, increased bathing, and expanded soap use.These basic sanitary measures saved millions and millions of lives. In Nepal in 2021, basic preventative measures such as physical<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/">l distancing and careful mask wearing </a>can save lives as well.One other reminder: last year, after we were released from Lockdown I in July, Covid-19 <a href="https://www.nepalitimes.com/latest/nepal-its-no-time-to-let-your-guard-down/">infections spiked</a>. After Lockdown II was lifted in September, infections spiked again, reaching their highest level yet. The end of Lockdown III will <a href="https://www.nepalitimes.com/latest/learning-to-live-with-covid/">likely bring new risks.</a><a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/how-chitwan-was-opened,4159">Tom Robertson</a>, PhD, is researching the environmental history of the Kathmandu Valley.

After lockdown, we will need masks more than ever

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

The return of the natives

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

The rise of high-rises

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

Kathmandu’s gravity-defying chariot festival

"I shut down my poultry farm as the villagers did not buy fresh chicken from me,” sums up a Dalit farmer from Arghakhanchi district why he had to leave for work.&nbsp;
Most people can sell fresh meat in their villages and make a good profit but Dalits still cannot because people will not buy from them due to caste stigma. Dalits have no choice but to sell their poultry to outside suppliers for lower profits.&nbsp;
“Other hoteliers found out my caste and used it to push me out of competition. They informed my customers of my caste and discouraged them from staying at my hotel,” a Dalit hotelier shares.&nbsp;
The hotel was close to a medical school and had earned a good reputation among hospital visitors, at least until they discovered his caste.
As ‘higher’ caste customers stopped coming, he moved his hotel to the East-West highway, where customers, in a rush, do not have time to worry about the caste of the owner.&nbsp;
Read also: <a href="https://nepalitimes.com/opinion/comment/nepal-looks-at-alternative-investments">Nepal looks at alternative investments</a>, Siddhant Raj Pandey
“They will knock me out of the business if they know my caste,” says a Dalit who owns a pipe manufacturing business in Western Tarai. He has been in the business for several years. Due to fear of ostracisation from non-Dalits who dominate the industry, he has erased his caste name from all his documents and uses a non-Dalit surname.&nbsp;
These three incidents illustrate deeply rooted caste barriers blocking Dalits from entering and thriving in business even as they make up 14% of Nepal’s 29 million population.
Yet, due to Nepal’s hierarchical caste system, Dalits continue to be looked down upon as ‘untouchable’ and of ‘lower’ rank, and non-Dalits, as per caste norms, do not eat food and beverage items touched by them.&nbsp;
In a 2018 Tribhuvan University study, even seven years after anti-caste discrimination laws were passed, 34% of Hill Dalits and 28% of Madhesi Dalits reported routinely facing caste-based discrimination.&nbsp;
Caste-based barriers obstruct Dalits from freely participating and thriving in business, yielding at least three distinct types of market and non-market barriers.&nbsp;
Read also: <a href="https://nepalitimes.com/opinion/success-in-nepal-means-not-having-to-work">Success in Nepal means not having to work</a>, Anil Chitrakar
First, caste bias means ‘higher’ caste groups avoid buying goods and services from Dalits, except for menial labour. In their 2019 book Good Economics for Hard Times, Nobel laureates in economics Abhijit Banerjee and Esther Duflo show that social norms such as caste and patriarchy, and not just price, shape business decisions.&nbsp;
In Nepal’s case, ‘upper’ caste customers examine not only the price and quality of what they are buying but also the social value of goods and services.&nbsp;
Second, companies use caste norms to sideline Dalits out of competition. Development economists confirm that firms often deploy caste and ethnic discrimination to remove their competitors from the playing field.&nbsp;
Third, Nepal’s Dalits do not have easy access to resources such as land, capital, and networks that are usually a precondition to enter and thrive in business. Impoverished by decades of exclusion and discrimination, Dalits do not have collateral for loans. They face social stigma and stereotypes and do not get access to idea-and-trust-based loans.&nbsp;
Read also: <a href="https://nepalitimes.com/editorial/invest-in-investment">Invest in investment</a>, Nepali Times
As a result, they are forced to get by with low capital and higher interest rates. Dalits also do not have strong business networks, nor do they have access to the social spaces where business decisions are made. They do not have a strong community support system, which could compensate for low capital and weak policy networks.&nbsp;
These caste barriers not only block the entry of Dalits into business but also create market failures. Just like the Dalit hotelier in Bhairawa who was pushed out of the market, discriminatory practices allow only a few castes to dominate, forcing customers to buy in a market not governed by price and quality but by non-market measures. Eventually, such caste-based business practices create conditions for cartels and monopolies, blocking the free market.&nbsp;
Caste-biased business practices also yield inefficient resource allocation. Caste-based preferences in recruitment mean businesses are forced to draw from smaller talent pools, and Dalits miss out on opportunities for human development. Resources such as land and capital do not move across social groups, ultimately leading to unequal income distribution and lower economic growth.&nbsp;
Despite the challenges, Nepal is committed to ending discrimination in employment and business. In 1974, Nepal ratified the ILO Convention 111–Discrimination (Employment and Occupation) Convention, 1958. In 2002, the country enacted the Bonded Labour (Prohibition) Act, formally ending forced labour such as Kamaiya, Haliya and Haruwa-Charuwa. In 2020, Nepal Rastra Bank issued a guidance note to encourage loans to Dalits of up to one million rupees on concessional interest rates.&nbsp;
While the commitments on paper have been swift, they have not led to tangible results. In 2023, the ILO Experts’ Committee called for Nepal to implement Convention 111 to address discrimination against Dalits and to promote their access to productive resources such as land and capital.
Read Also: <a href="https://www.nepalitimes.com/banner/caste-aside">Caste Aside</a>, Nepali Times
Ahead of its upcoming graduation to middle-income country status in 2026, Nepal has prioritised private sector-led development, hoping to increase investment from domestic and international investors. The Nepal Investment Summit this weekend is designed to attract investments.&nbsp;
While these are welcome moves, Nepal should not miss the opportunity to free itself from barriers holding back the Dalit community. By unlocking Dalits from discrimination, Nepal can add to its human capital, ensure fair income distribution, increase resource allocation efficiency, and augment economic growth.&nbsp;
We need research on how caste-based discrimination has reinforced market failures. The business development capacity of Dalits needs to be enhanced by creating better access to information and business networks. Nepal’s macro and micro-economic policies should combat visible and invisible caste-based business barriers.&nbsp;
Monetary policies can grant Dalits access to non-collateralised finance at concessional interest rates, and tax exemptions can create a level playing field. Finally, there could be a policy guarantee that the government, as one of the largest buyers, purchases goods and services from Dalits.
Read also: <a href="https://nepalitimes.com/here-now/dalit-lives-must-matter">Dalit lives must matter</a>, Shristi Karki

mask-wearing