HOW CAN NEPAL COMBAT COVID-19 CRISIS?
Rudra Dahal, BSc (Nursing), M.Ed. (Health), Calgary, Alberta, Canada
According to World Health Organization (WHO) there are 4 million 525 thousand 4 hundred and ninety-seven confirmed cases, among them 307 thousand 3 hundred and fifty-nine deaths in 215 countries as of 17 May 2020 (1). In Southeast Asia, there are 134 thousand 5 hundred and thirty-one confirmed cases of COVID -19, and deaths are 4 thousand 3 hundred and fifty-one (1). Comparing to other continents Asian regions are less affected from COVID-19 so far.
The first case of COVID-19 in Nepal was diagnosed on 24 January 2020 in Kathmandu who had just returned from China (3). The second case was confirmed on 23 March 2020 who was recently returned from France (4). Similarly, the first case of local community transmission was confirmed on 4 April 2020 in Kailali district. Nepal which is just entering in crisis mode of COVID-19; there are two deaths from COVID -19 pandemic, and confirmed cases are 295 as of 17 May 2020 (5). Nepal got a long time to learn a lesson from around the World to manage this pandemic, and now it is a real-time to fight against this devastation.
Although, Nepal has a big challenge to curb the spread of this pandemic considering overall public health circumstances and its geopolitical condition. It lacks both human resources and material resources for aggressive management to combat this pandemic. It is hard to get assistance from the international community because most of the countries are impacted by this pandemic and needing more effort to manage their own home country. However, it is receiving some international help from the neighbour countries and other nations as well as local help from soft-hearted Nepalese people to fight this enemy. There is an extreme need to maximize the testing capacities for vulnerable population. Testing facilities are located mainly in Kathmandu and other major cities only. Nepal’s government is trying to do its best to combat this situation. This needs cooperation from the general public as they are the key to minimize this menace. In this time community transmission is rapidly increasing every day which is a big challenge for Nepalese healthcare system. The following strategies may help to manage this pandemic situation and the existing healthcare system could manage the situation.

1. Internal travel ban: Nepal is experiencing caravans of inner migration as many people were returning their village feeling safe there when cases were found in Kathmandu and other major cities. Now, there are COVID-19 cases in different districts and people started to return back to Kathmandu and other cities, which is very unsafe. Kathmandu is a crowded city and there are high chances of community spread of infection to a larger number of populations. Due to this reason, it is ideal to keep people in their own place until the situation comes under control. It can be done through internal travel banning from local authorities
2. Lockdown continuity: Lockdown is the only effective measure to control the mass spread of the novel corona virus. This virus transmits through person to person contacts, so, strict lockdown is mandatory to minimize the situation. We can learn from China, Italy, Spain who used strict lockdown measures, and they were able to control the spread of the disease (7). Nepalese people need to be more sensitive to safeguard themselves and their community by staying at home, maintaining social distance, and following public health measures.
3. Increase testing volume: It is necessary to increase the number of aggressive testing volume in vulnerable areas and groups. For example, geriatric homes, disability care and rehabilitation facilities, jail, army and police barracks, slum, and marginalized residential areas. Priority should be given to seniors, low immune persons and people who have underlying chronic health conditions – they are the most vulnerable population. Mass testing in a broad population can save time and provides more extensive measures such as social distancing, isolation, quarantine and promptness contact tracing and finally accelerates the containment of the outbreak, but it needs more resources which may not fit in the context of Nepal. So, pool testing could be the right fit for our case as it is the sample testing system (6) which saves resources and provides faster results which allows prompt action in the community.
4. Isolation: It is mandatory to isolate suspected and confirmed cases to control the spread of the virus. This battle could not win by the single army; it needs cooperation and coordination between stakeholders and solidarity where all individuals have an equal responsibility to save themselves, their loved ones, their community, and the entire world. In addition to, during self isolation people should maintain their good hand hygiene, social distancing (2 meters apart), minimizing to use public transportation, wearing a mask, and avoiding crowds are advantageous.
5. Hospital capacity increment: In this time all the private hospitals and private healthcare service providers should focus on the management of this crisis. So, government and local authorities can coordinate with the private sector and arrange necessary beds and life support systems at hand to manage this pandemic such as ICU beds, ventilators, isolation/barrier care unit etc. This provides the extra set up to handle the situation if needed.
6. Border seal: Located between two big countries China and India, (China in the North and India in the East, West and South) has an open border. It is highly susceptible to incidents from its immediate neighbours due to sharing an open border that allows the free flow of people and goods from both neighbours. In this situation, there should be strict ban to crossing border from both sides by sealing the border and increasing security forces in boarder area.
7. Availability of PPE: As the COVID-19 pandemic is accelerating, the healthcare system in Nepal is overwhelmed. Preventing the spread of this virus to and from healthcare professionals and patients relies on the availability and proper use of PPE-gloves, face masks, respirators, goggles, face shields and gowns. It is mandatory to use PPE for all front-line workers and health professionals. Authorities should be aware to make an efficient supply of these items.
8. Health information sharing: It is the right of people to get the necessary information about COVID-19. So, it is beneficial to establish COVID -19 information center and disseminate all related information through different public medias 24/7 that informed the general population to know the exact situation and their responsibilities to overcome this crisis.
9. Encouragement to COVID -19 fighters:  It is necessary to encourage front line workers who are directly involved managing this crisis 24/7, especially health professionals, front line workers. They are the true militia of this battle. We can provide emotional support, provide quiet space for rest and meditation, take care of their necessities, share information among the team, and most importantly provide safer and positive workplace culture.
To conclude, there is a huge challenge for Nepal to safeguard the Nepalese population from COVID-19. Open border, limited health resources, scarcity of international assistance are some of the challenges in front of the Nepalese healthcare system. Now, situation is more dangerous than speculated by Nepalese people. So, with integrated cooperation and solidarity, Nepal will be able to combat this risk.
Resources:
1. https://www.who.int/docs/default-source/coronaviruse/situation-reports/
2. https://asiatimes.com/2020/03/nepals-vulnerability-to-covid-19/3. Bastola, Anup; Sah, Ranjit; Rodriguez-Morales, Alfonso J.; Lal, Bibek Kumar; Jha, Runa; Ojha, Hemant Chanda; Shrestha, Bikesh; Chu, Daniel K. W.; Poon, Leo L. M.; Costello, Anthony; Morita, Kouichi (1 March 2020). “The first 2019 novel coronavirus case in Nepal”. The Lancet Infectious Diseases. 20 (3): 279–280. doi:10.1016/S1473-3099(20)30067-0. ISSN 1473-3099. PMC 7130048. PMID 32057299.
3. One imported case of coronavirus confirmed in Nepal”. 23 March 2020. Archived from the original on 23 March 2020. Retrieved 23 March 2020. https://thehimalayantimes.com/kathmandu/one-imported-case-of-coronavirus-confirmed-in-nepal/
4. Ministry of Health and Population, Government of Nepal.https://covid19.mohp.gov.np/#/ accessed 2020 May 16.
5. https://theconversation.com/learning-from-disasters-nepal-copes-with-coronavirus-pandemic-5-years-after-earthquake-134009 Goethe University. (2020). Pool testing of SARS-CoV-02.  https://aktuelles.uni-frankfurt.de/englisch/pool-testing-of-sars-cov-02-samples-increases-worldwide-test-capacities-many-times-over/
6. (https://www.cbc.ca/news/world/wuhan-life-after-lockdown-1.5528144)
7. https://covid19.ndrrma.gov.np/
Appendix:
Confirmed COVID-19 Cases in Nepal by District (7)

Districts Cases Recovered Deaths Active cases