How the govt botched its Covid-containment strategy in Kathmandu Valley

When the government decided to reopen 44 industries in mid-May, as part of its efforts at reviving the virus-ravaged economy, the mayors of Kathmandu Valley had warned the federal government that the decision was exceedingly risky. The reopening, they said, would allow the coronavirus free rein in the densely populated capital city. They had suggested that the government strictly bar outsiders from entering the Valley and that it order the Valley’s populations to strictly follow security protocols if industries, business complexes, and shops were to be reopened.

But the officials responsible for containing the virus didn’t listen to their plea. Industries and markets were reopened without the requisite protocols in place. And menial labourers, students, and many working class people who had returned to their villages following the nation-wide lockdown in March returned to Kathmandu, owing to the lax regulations. The major entry points to Kathmandu remained open, and people from corona-affected districts like Parsa, Kapilvastu, and Banke continued to flow into Kathmandu Valley without first being screened. Many of them were desperate to get back to work because they were running out of money back home. 

This influx helped create a semblance normalcy--a false one. But as people (even those infected with the virus) gradually started to congregate, go to shops, visit their hairdressers and so on--without maintaining social distancing--more cases of the virus emerged. To make matters worse, prospective virus patients were not tracked either.  

“That was a major blunder in our efforts at controlling the virus,” said Chiri Babu Maharjan, mayor of Lalitpur Metropolitan City. “The federal government should have prevented outsiders from coming in, just as we had suggested.” 

Maharjan now feels the virus has already spread in densely populated Kathmandu and Lalitpur, and that controlling it remains a herculean task. “The virus is now spreading like wildfire,” he said. “People from the core Patan area have been informing me that they are infected with the virus. It seems the situation is getting beyond our control.”

When cases were spiking outside Kathmandu, the central government seemed to completely underestimate the magnitude of the problem facing the capital, and was unprepared to tackle the looming worst-case scenario. It did not come up with the proper protocols even months after the first lockdown. The federal government, according to local leaders, didn’t coordinate with its province and local governments on developing strategies to fight the pandemic--especially if Kathmandu were to get to the community-transmission stage. 

Elected people’s representatives in Kathmandu say top officials in the Covid-19 Crisis Management Committee (CCMC) continued to ignore requests by local representatives to discuss the issue when they approached the committee to chart out the future strategy. According to them, the federal government started to take the coronavirus seriously only after more than 200 cases began to get detected each day in Kathmandu, and after high-profile people got infected with the virus.

Last week, the mayors of Kathmandu Valley’s districts were summoned at the CCMC to discuss measures to be taken for controlling the virus. They were told to set up at least 10,000 isolation centres in each district of Kathmandu Valley--Kathmandu, Bhaktapur, and Lalitpur. 

But owing to the lack of adequate public places, and hamstrung by budgetary constraints, these local bodies are now in a fix about how to tackle the crisis that has been ravaging the capital. It was only very recently that they finally started to explore possible areas to set up isolation centres. 

Dr Samir Kumar Adhikari, deputy spokesperson at the Ministry of Health and Population, echoes Mayor Maharjan. “The inflow of people from outside Kathmandu is the main reason for the spread of the virus,” he says. “After the lockdown was lifted, people started sneaking into Kathmandu from the badly affected places.” 

Post-lockdown, localities in Kathmandu with a high population density and mobility were the first to see spikes in cases--for instance, in Koteshwor, Naxal, Satdobato, Maharajgunj, and Kalanki, which are the city’s major traffic nodes. Because of the unchecked entry of people from Covid-19 hotbeds, infection rates started spiking among security personnel--who, owing to their job, need to be out in the field. And the capital also started seeing more positive cases among bank staffers and other workers who continued to go to work. 

“We cannot say for sure if this is the peak or not. It all depends on how well the current phase is handled. But we do know cases are on the rise,” said Adhikari. 

With coronavirus case numbers continuing to spike, people in Kathmandu, a city of about 5 million inhabitants, are panicked.  

On Sunday, 429 coronavirus cases--the highest tally for a 24-hour period--were detected in Kathmandu Valley. Of them, 372 were detected in Kathmandu, 12 in Lalitpur, and 45 in Bhaktapur.

The caseloads are increasing outside Kathmandu as well. On Sunday, 1,221 cases were detected across the country, taking the total confirmed infection cases to 38,561. Till now, 221 people have lost their life to the coronavirus, of whom 14 died on Sunday alone.

And thousands of people suspected of infection are in isolation. According to the MoHP, 10,612 people are confined to institutional isolation and 6,906 are in home isolation. 

The government has so far conducted RT-PCR tests on 682,343 persons, which represents just 2 percent of the country’s population. Experts warn more positive cases could come to light if contact tracing is expedited and potential carriers are tested.  

But because the government let the problem get out of hand right from the early stages, it now finds itself in a deeper bind. According to Adhikari, the government has not demarcated  highly affected places in the Valley yet because it is afraid of sending out the wrong message. “People in the least affected areas may become reckless and defy the prescribed code of behaviour, especially in places where there are no cases, while people in the highly affected places may panic,” he said. 

Another public health expert, Dr Rabindra Pandey, however, thinks the current problem  has its roots in that period when Nepali migrant workers in India started to come home. Nepal underestimated the number of people that would come over from India. Many of them stayed in quarantines, but their numbers were so high, the government could not even conduct RT-PCR tests on them. “For one, we did not have proper quarantines,” said Pandey. “The death rate among returning migrants was low because they mostly comprised people in the working age demographic--from youths to people in their 50s. So the government did not feel the need to prepare for hospital beds and ventilators.”

The sudden surge in people coming into the country spread the virus--initially in the border cities, and then to Kathmandu. Now, it is spreading at the community level in the capital. Pandey says the number of positive cases will go up as the country has thus far tested only a negligible population. “We are now seeing consistent growth in the number of cases and in the death rate too. The recovery rate is also dropping constantly.”

According to Pandey, Nepal used to have a recovery rate of above 90 percent in the early days of the pandemic; that rate has come down to 54 now. “If we continue with our current testing regimes, we should expect to see positive cases among Nepalis for another year and a half to two years,” he estimates. “Just 12,000 tests conducted a day makes for miniscule numbers in a country with a population of 29 million. We have to increase the number of tests by the hundreds of thousands.”

Pandey warns the situation in Kathmandu could turn far worse if the government just continues to conduct individual RT-PCR tests, instead of switching to pooling testing.  In pooling testing, 10-15 samples can be tested at a time. This efficient method is also the cheapest.

“The government must change the method and ramp up testing at the mass level. And it must stop focusing on testing only suspected cases. The government is still in denial that the virus has spread at the community level,” he said. “It must first understand that community-level spread is not an insurmountable problem, if we tackle it in the right way. If we identify the cases, the virus can be controlled, but continuing to live in denial will only help spread the virus. The sooner the government realizes this, the better.”