Nepal | May 28, 2020

Can Nepal’s health system handle COVID-19 sputter?

Sabitri Dhakal
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Kathmandu, March 11

What happens if a small wave of coronavirus disease sputters in Kathmandu or any part of the country? Can Nepal’s health system handle the situation?

These are some of the questions that are being raised as the COVID-19 has made its way to 113 countries, killing close to 4,300 people and infecting over 118,000.

Nepal detected its first coronavirus patient around two months ago, who has since recovered. Since then blood samples and throat swabs of 445 people suspected to have contracted the disease have been collected but none has tested positive.

The government takes pride in referring to Nepal as a country with zero active coronavirus case. And it intends to prevent the disease from entering its territory in the coming days as well. To keep the country safe, the government has been screening passengers and checking their travel history at Tribhuvan International Airport and has halted issuing on-arrival visas to visitors from coronavirus hotspots. It has also asked Nepalis not to travel abroad unless it is urgent.

Despite these preventive measures, the possibility of the virus entering the country cannot be ruled out. And even if a few cases are detected, the number of infected people can multiply rapidly within a few days as seen in Iran, Italy and South Korea.

“If the infection spreads rapidly, we’ll see what needs to be done,” said Bikash Devkota, spokesperson for the Ministry of Health and Population.

Many countries are pulling out all the stops to fight the spread of the disease. But Nepal still lacks a cohesive plan to deal with the possible threat, which can overload the health system and cause it to break apart.

Nepal has around 2,000 hospitals across the country, of which about 150 are public, and about 4,000 health centres run by the government.

But the government does not have consolidated figure on number of hospital beds that have been dedicated to isolate suspected coronavirus patients.

There are 155 beds in various hospitals in Kathmandu valley for isolation, according to the MoHP. “But provincial governments are currently working on it. A team has visited the provinces and has studied the situation,” said Mahendra Shrestha, director general of Department of Health Services.

What is also in short supply are reagents and personal protective equipment. The National Public Health Laboratory has reagents to test only 1,500 samples, according to Runa Jha, director of NPHL. And there are only 1,150 PPEs for healthcare workers, who have to deal with coronavirus cases.

“The process of procuring these equipments is very long, which needs to be revised, as we need minimum of 15 days to place the order,” said Bhogendra Dotel, director Logistics Management Division of the DoHS.

Health experts across the globe have said intensive care units and ventilators are necessary to treat patients with severe coronavirus infection. But Nepal also lacks them.

Hospitals across Nepal, both public and private, have 700 ICUs. But none of these facilities has so far been redesigned to treat coronavirus patients. Nepal’s largest public hospital, Bir Hospital, for example has 23 ICUs and 20 ventilators.

“We need ICU beds in single rooms to treat coronavirus patients, which we don’t have,” said the hospital’s Director Kedar Century.

“This means all other patients must be removed from ICUs even to treat a single coronavirus patient.”

The situation is same at Tribhuvan University Teaching Hospital, which has 11 main ICUs and Sukraraj Tropical and Infectious Disease Hospital, which the government has designated for treatment of suspected coronavirus patients where three ICU beds are available.


How to self-quarantine

On Tuesday, Health Minister Bhanubhakta Dhakal requested Nepalis to remain in self-quarantine if they feared they had contracted coronavirus disease.

Here is how one can self quarantine:

  • Use a separate room and restroom
  • Wear mask
  • Do not allow anyone else to use his/her mobiles, devices and equipment
  • Items used by the person should not be shared by others
  • Do not come outside until it is an emergency
  • Utensils and clothes used by the person should be washed and dried in the sun
  • Items used by the person during quarantine should be disinfected after 14 days
  • If the person develops any symptoms then s/he should immediately visit the hospital.

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A version of this article appears in print on March 12, 2020 of The Himalayan Times.


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