Why Nepal has so few COVID-19 cases ?

It is a pleasant surprise that Nepal has not seen many cases of COVID so far. If one is to trust the official data, it is still in single digit. Let’s hope that the situation is not going to deteriorate much further. But hope is not a strategy. I live in Seattle area and my hospital was the one to have first diagnosed case of COVID in the US. That was January 21, 2020. Now here we are, a little more than two months out, and the number of cases have exploded to almost hundred and fifty thousands with nearly three thousand deaths. It feels like Nepal and Kathmandu are currently in that same phase US was in January when things looked really under control and people were lulled into total complacency.

Like it or not, this time around, as in the much of nation’s history, our fate is tied to a great extent on what happens in India. And things are not looking pretty there. COVID 19 cases have ticked up rapidly in India. This is despite a very underwhelming number of tests. India has so far tested 6 people per million compared to 6.1 thousands per million in South Korea. I think Nepal has tested even fewer. With densely packed cities and very underfunded medical system, there is no margin for error. Large scale Lockdown is a good start but that is not going to be enough. Physical distancing is hard to implement when people live in closed quarters. It may be worrying that migration of several hundreds of thousands of people from the cities to the village may be propagating infection into the hinterlands of the country where early diagnosis and treatment is even more difficult.

What can we do:

  1. As WHO director keeps on repeating: Test, test and test. Trace the contacts. Isolate the cases.

2. Social/Physical distancing as much as possbile for as long as possible.

3. Personal Hygeine and sanitation.

4.Travel ban.

5.Participation in clinical trials e.g.WHO involved Hydroxychloroquine/Azithromycin trial.

We should not depend on summer making it better but if it happens that will be a bonus.

6. Use this as an opportunity: Time to upgrade our Public Health infrastructure. Time to upgrade our emergency care, ICU care and other acute care infrastructures. Have a strategic national emergency stockpile of essential healthcare supplies. This may help stimulate the economy as well.

I have heard first hand from healthcare workers in Nepal that many medical facilities are not even letting people with fever, cough and respiratory symptoms into their doors. This is mainly due to lack of PPEs these healthcare workers need. This is a total shame.

A University of Michigan-run study predicts India could have 915,000 coronavirus infections by mid-May, more than the case load for the whole world right now.(https://sph.umich.edu/precision-health-data-science/).There is no actual modeled data for Nepal but it is not hard to imagine that it could be in tens of thousands.