Since the beginning of 2021, Nepal has been witnessing a steady decline in the number of coronavirus cases and deaths on a daily basis. Nepal had recorded its highest number of coronavirus cases on October 21, 2020 (5,743 cases), while there are an average of 200-300 cases a day now.Multiple waves of the coronavirus are being observed in several countries, meaning subsequent waves of the coronavirus are not unlikely. Public health measures as well as testing, contact tracing and isolation are ways to prevent such repeated waves. However, many individuals have stopped following public health measures, although increasing number of shops, public transportation, offices and schools have now resumed
It seems that Nepal's first wave of the coronavirus has finally come to an end.
However, there are important questions to answer, such as "what lessons have we learnt from this pandemic?" and "if there will be a second wave".
On January 23 last year, Nepal officially announced its first coronavirus case. A nation-wide lockdown was announced on March 24 after a second COVID-19 case was confirmed on March 23. Domestic and international flights were suspended to prevent entry and spread of COVID-19 in the country. Unfortunately, infection was detected in a significant number of people returning from India.
Nepal and India share an approximately 1,800-km open border, which lacks health desks with basic infrastructure.
The newly set up quarantine centres were insufficient and could not manage the unprecedented influx of returnees from India. This corroborates that Nepal is not capable of preventing entry of any infection or outbreak, unless strict control measures are placed along the Nepal-India border.
After the lockdown was lifted on July 21, a large number of people had moved to Kathmandu from other parts of the country to resume work. Despite their request, they were unable to undergo a coronavirus test for free because they showed no symptoms.
The National Testing Guidelines for COVID-19 do not provide free testing without symptoms. Nevertheless, Nepal had witnessed 99.7% infected people without symptoms, dubbed as the "silent coronavirus", before the lockdown was lifted.
It is worth mentioning here that the "silent coronavirus" was found responsible for the spread of the virus among colleagues as well as in the community in Nepal. People were asked to stay at home in self-quarantine for 14 days.
Unfortunately, most of them did not isolate themselves.
In fact, in Kathmandu, there was no mechanism to monitor and check whether the infected people were following the protocols.
According to the Nepal Health Research Council, approximately 43% of those infected had been unable to manage separate rooms for isolation, while nearly 13% did not even maintain physical distancing during home isolation.
This, perhaps, could be the main reason for the rapid spread of the coronavirus among family members in a short period of time in Kathmandu.
There was a sharp increase in the number of deaths owing to COV- ID-19-related complications soon after the home isolation strategy was introduced.
It showed that many infected people were unaware or simply ignored the signs and symptoms of severe illness/ complications of the coronavirus. In other words, the home isolation strategy could not achieve its goal in stopping the coronavirus spread.
Several researches have shown that mutated strains of SARS-CoV-2 are responsible for the subsequent waves of the coronavirus.
Whole genome sequencing method can identify the genetic code (DNA sequencing)/ genetic variations) of the virus. Unfortunately, Nepal, so far, does not have such a facility. Actually, the author first raised concern about occurring mutations in the virus genes after asymptomatic cases suddenly shifted to symptomatic cases in Nepal.
Coronavirus mutations can occur anywhere in the world, including Nepal. In fact, some of the author's colleagues tested positive for the coronavirus with only a single gene out of three testing positive. It indicates that the coronavirus might have been mutating in Nepal.
New variant of the fast-spreading coronavirus, known as lineage "B.1.1.7" or "VOC 202012/01", circulating in the UK, was found to have mutated in the spike (S) gene, meaning a PCR test is unable to show the S-gene is positive (or missing), even if a patient is infected with the virus. Some Nepalis who recently returned from the United Kingdom tested positive for the coronavirus, and among these samples, some did not show S-gene positive, which indicates the fast-spreading UK coronavirus variant "VOC 202012/01". It took a couple of weeks to confirm this fast-spreading UK variant of the virus. Nepal, thus, needs its own such facility so that it can quickly identify the target or unusual virus and develop a future plan/ strategy accordingly.
Multiple waves of the coronavirus are being observed in several countries worldwide, meaning subsequent waves of the coronavirus are not unlikely.
Public health measures as well as testing, contact tracing and isolation are ways to prevent such repeated waves. At present, however, many individuals have stopped following public health measures, although increasing number of shops, public transportation, offices and schools have now resumed.
Moreover, the unprecedented "political twist" and upcoming elections raise a grave concern of a second wave of the coronavirus in Nepal. Because more and more people will be participating in meetings, rallies, demonstrations and protests, where the coronavirus could easily spread among the people, this may ultimately lead to community transmission.
In summary, the end of the first coronavirus wave does not mean the end of the coronavirus outbreak.
Several countries are currently experiencing repeated waves. A persistent mutation in genes, ignoring public health measures and mass gathering owing to political movements or elections or for any reason could trigger a second coronavirus wave in Nepal.
We, therefore, have to learn lessons from other countries to avoid this.
Dr Pun is Chief of the Clinical Research Unit, Sukraraj Tropical and Infectious Disease Hospital
