Sharp rise in Covid-19 in Nepal reflects rise of India – fr

Sharp rise in Covid-19 in Nepal reflects rise of India – fr

KATHMANDU, Nepal – With six ventilators at a central Nepal hospital already being used by Covid-19 patients on Sunday, doctors asked Lal Bahadur Thakur’s son to try and find one elsewhere, while his father gasped.

As the surge of Covid-19 in India swept through Nepal, hospitals are reporting an overwhelming number of severe cases and similar shortages of beds, oxygen and ventilators. Much like what happened in India, cases have grown faster here than in any previous outbreak of the coronavirus pandemic, quickly overwhelming a health system with fewer resources than its much larger neighbor to the south.

“We have already lost two patients like him today awaiting intensive care beds or respiratory assistance. We feel totally helpless, ”said Dr Dipendra Pandey, who was treating Mr. Thakur at the Trishuli government hospital in Nuwakot district, about 80 km from the capital Kathmandu.
Mr Thakur’s 20-year-old son Chandan Thakur made a wave of calls to hospitals in the nearest towns – Kathmandu, Chitwan and Pokhara – as oxygen levels in his father’s blood plummeted below 60%. None of them had beds or fans available, he said.

On Monday morning, Mr Thakur, 50, died of acute respiratory distress syndrome due to Covid-19, despite the hospital’s efforts, Dr Pandey said.

A Covid-19 ward from a hospital in Kathmandu, Nepal, last week.

Niranjan Shrestha / Associated Press

The Covid-19 wave currently hitting India and Nepal shows the danger to many parts of the developing world that remain largely unvaccinated. Public health experts and scientists say a highly infectious coronavirus variant first identified in India appears to be fueling a precipitous increase in cases in Nepal, and are awaiting genomic sequencing of more samples to be sure.

In early March, Nepal was reporting around 100 new daily cases of Covid-19. In recent weeks, new daily cases have climbed to more than 9,000, the highest since the start of the pandemic, and around 200 people die each day, according to the Department of Health and Population.

The numbers probably do not reflect the full scale of the outbreak. The positivity rate for coronavirus tests has been around 45% in recent days. The high rate is mainly due to the country’s limited testing, said Laxman Aryal, Nepal’s health secretary.

Since November, the government has limited the availability of free testing, treatment and quarantine centers to those who need them most, saying the country with limited resources must save money to buy vaccines. Now the country is only testing people with symptoms and those who have had immediate contact with people who have tested positive, Aryal said.

A vaccination center in Kathmandu last week; by the end of April, 1.2% of the Nepalese population had been fully immunized.

Abhishek Maharjan / Zuma Press

Despite efforts to save money for vaccines, by the end of April the country had only fully vaccinated about 362,000, or 1.2%, of its 30 million people, an example the lag of developing countries compared to the United States and parts of Europe, where vaccination campaigns are already preparing the ground for an economic recovery and a steady return to normalcy.

Nepal is not the only country to see a recent increase in cases, but the outbreak here has mirrored the rapid increase in India.

Public health experts say the outbreak in India likely spread to Nepal across the countries’ common open border. Hundreds of thousands of Nepalese migrant workers, fleeing the epidemic in India, have returned home, with little or no control at border checkpoints. Nepalese Hindus have also traveled to India to participate in this spring’s Kumbh Mela festival in northern India – including the country’s former King and Queen, who tested positive shortly after returning home.

Preliminary results from a small number of samples suggest that variants circulating in India are now present in Nepal. A lab that performed genomic sequencing of a dozen samples in the Kathmandu Valley in late April and early May found that 11 of them were versions of the variant first identified in India, B.1.617, and one was the variant first identified in the UK, B.1.1.7, said Dibesh Karmacharya, executive director of the Center for Molecular Dynamics Nepal.

Nine of the 12 belonged to a particular subtype of the variant, B.1.617.2. “This is the same one that’s wreaking havoc in India right now,” Karmacharya said.

The government sent a larger sample pool to the World Health Organization for genomic sequencing, said Aryal, the health secretary.

India has suspended vaccine distribution to other countries as the country grapples with the world’s fastest growing Covid-19 surge. Delayed distribution is hampering the global immunization effort. Photo illustration: Laura Kammermann

Meanwhile, hospitals across the country are seeing more severe cases of Covid-19, including in younger patients in their 30s and 40s, which they say are due to mutations in the virus that make it more virulent, Nepalese doctors and health officials said.

“The disease has become unpredictable and we are having a hard time understanding it,” said Dr Pandey. “Compared to the first wave, the patient’s condition is deteriorating very quickly this time before we can do much.”

The crisis now gripping Nepal is a cautionary tale for other small developing countries with weak health systems and little vaccine protection.

“I’m afraid that if you don’t have a very systematic approach to this problem, we’re going to run over and over again with the second wave and the third wave and the fourth wave and so on,” Mr. Karmacharya said. . “And with each wave, you’re going to have a stronger variant. “

Nepal began its vaccination campaign in January with around 2.3 million doses of AstraZeneca PLC vaccine. About 1.5 million people have been left waiting for their second dose. Nepal ordered a million additional doses from the Indian Serum Institute with an 80% down payment, but these were delayed due to India’s suspension of vaccine exports, Jageshwor Gautam said, door -speak of the Ministry of Health.

A Covid-19 patient in the hallway of an emergency department in Kathmandu, Nepal, earlier this month.

Niranjan Shrestha / Associated Press

As of April 2020, Nepal had just 840 ventilators, around 1,600 intensive care beds and fewer than 200 hospitals with intensive care facilities, according to the health ministry. There were 23,146 doctors in the country in 2019, according to data from the World Health Organization, or eight per 10,000 people, compared to 9.2 in India and 26 in the United States.

The most immediate concern, however, was the lack of medical oxygen. Nepal has the capacity to produce 8,000-9,000 oxygen cylinders per day, but demand is almost double that amount, Aryal said. India continues to supply the country with liquid oxygen even as it struggles to meet its own domestic needs, and China has sent hundreds of oxygen cylinders, he said.

Dr Pandey, the medical superintendent at Trishuli Hospital, said he was getting calls from hospitals in Kathmandu asking if he had beds and oxygen available at his hospital. The district hospital has only 25 Covid-19 beds but is currently caring for 80 patients with the disease, all of whom need oxygen. Patients are pouring in from nearby towns, including Kathmandu, and the hospital has started to run out of its oxygen supply, he said.

On Sunday evening, as Mr. Thakur’s condition deteriorated and his family could not find a hospital bed elsewhere with a ventilator, doctors tried to use a ventilator from the hospital ambulance. But the doctors couldn’t get the machine to work properly. A nurse tried to get Mr Thakur to breathe through the night using manual bag-mask ventilation, Dr Pandey said.

“Despite our sincere wish to live, he died,” Mr. Thakur’s son said.

The bodies of Covid-19 victims were moved to prepare for cremation in Kathmandu, Nepal, last week.

Niranjan Shrestha / Associated Press

Write to Krishna Pokharel à [email protected]

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