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In the face of an unprecedented rise in the number of daily Covid-19 cases, the three districts of the Kathmandu Valley have decided to institute a lockdown beginning Thursday. All vehicular movement, both private and public, will be prohibited while shops selling daily essentials will be allowed to operate for a few hours each day, decided a Monday morning meeting of the chief district officers of Kathmandu, Lalitpur, and Bhaktapur.
The restrictions, although late, were necessary, given how quickly numbers were rising. On Sunday, April 25, epidemiologist Dr Biraj Karmacharya, during the Health Ministry’s daily press briefing, had outlined how daily Covid-19 cases had increased by a mind-boggling 241 percent, compared to last week. Even the rate of increase for India, which is currently in the grip of a severe second wave that has crippled the health system and killed thousands, was just 60 percent.
Dr Karmacharya’s presence at the daily press briefing was significant, as it showed that the Health Ministry is taking the second pandemic wave seriously. But with over 3,442 new cases on Monday alone, time is quickly running out before India’s experience becomes Nepal’s. The lockdown in the Kathmandu Valley, which has so far reported nearly half of all cases in the country, is likely to help restrict the spread, but additional measures need to be adopted if Nepal is to emerge from the second wave with minimal casualties. The lockdown will buy the authorities some time, which they will need to use to test, isolate, and contact trace those infected while also shoring up the country’s health care system with personnel, equipment, medicine, and vaccinations.
In India, the massive rise in daily cases — above 300,000 a day — has strained hospitals to the point of breaking. People have died in parking lots awaiting a free bed and oxygen supplies. In light of India’s travails, The Record surveyed a number of public and private hospitals in the Kathmandu Valley to learn how they are faring as daily cases rise and more people seek hospitalization.
All of the seven hospitals surveyed — Bir Hospital, Tribhuvan University Teaching Hospital, Grande International Hospital, People’s General Hospital, Patan Hospital, Star Hospital, and KIST Medical College and Teaching Hospital — reported that almost all of their beds designated for Covid-19 patients had filled up over the past week and that more people were seeking admission every day.
Dr Chakra Raj Pandey, medical director of Tokha’s Grande Hospital, had already sounded the alarm on Saturday on social media.
“Telephone is ringing. Covid cases are skyrocketting [sic]. Hospitals seem overwhelmed. Time to lockdown to give a breathing chance to the medical world. My prayers to our colleagues who are working day and night in India helping covid cases. Similar situation is coming to Nepal too,” Dr Pandey had tweeted.
Dr Pandey’s hospital itself is currently full.
“We have a Covid-19 ward with a capacity of 25 patients, which is currently full. There are also a total of 30 beds in the ICU with ventilator support, out of which, 19 have been designated for Covid-19 patients. Almost all are occupied,” said Sushma Basnet of the patient care service department at Grande Hospital. “We receive over 10-15 calls every day from Covid-19 patients both inside and outside the valley. But due to our limited capacity, we have not been able to take in more patients.”
The situation was similar at two of Kathmandu’s biggest public hospitals — Tribhuvan University Teaching Hospital and Bir Hospital. According to Dr Achyut Raj Karki, Covid-19 focal person at Bir Hospital, they have a total of 21 ICU beds for non-Covid patients and 10 for Covid patients, out of which eight are occupied.
“Today’s Covid-infected count alone, both suspected and those who tested positive, are about 70,” said Dr Karki.
Similarly, at Teaching Hospital, all of the 12 ICU beds designated for Covid-19 patients are occupied and there are currently 61 Covid patients at the hospital, said Ram Bikram Adhikari, spokesperson for the hospital.
“I don’t think we can say that the beds that we have are enough as the numbers have been doubling every week. We are expanding wards and making room for more Covid-19 patients,” he said.
According to Dr Sabin Thapaliya, a member of Teaching Hospital’s Covid-19 committee, the hospital will be adding 25-30 beds and will also convert some of the existing wards into Covid wards.
Many hospitals that had downsized their Covid-19 wards in light of decreasing numbers are now having to scramble to keep up with the increasing number of patients. At Patan Hospital, Covid-19 patients had fallen to just around 10, but has since increased to a few hundred.
“There are a total of 650 beds in Patan Hospital, out of which 21 ICU beds have been separated for Covid-19 patients. All 21 ICU beds are currently occupied and just today, we admitted 132 Covid-19 patients,” said Dr Rabi Shakya, director-general of the hospital.
KIST Medical College and Teaching Hospital had downsized its 60-65 bed Covid ward to just four-five beds, according to Amish Pathak, the hospital’s chief operating officer.
“We’ve signed an MoU with the government for the Covid ward, so in seven-10 days, we will ensure 100 beds with 25-30 high dependency units,” said Pathak. “In the meantime, we are using nine beds for Covid-19 patients but haven’t separated ICUs or high dependency units because of packed general ward patients. Four of the nine beds are occupied while three are in the emergency room, awaiting their PCR test results.”
Like KIST, other hospitals too are scrambling to meet demands now that cases are rising. According to medical director Sharfaraz Alam Khan, all 12 ICU beds and 10 high dependency beds at the People’s General Hospital are out of service.
“We have designated five beds for Covid-19 patients and currently, we have three patients,” said Khan.
With a lockdown in place and the federal government coordinating with various hospitals in order to ensure adequate beds, it appears that all is not lost yet and Kathmandu could still avoid New Delhi's fate. Perhaps learning from the Indian experience, Kathmandu Valley hospitals have also begun to stockpile oxygen supplies and ensure that their supply chains are intact. India is currently suffering from an acute shortage of bottled pure oxygen.
All of the hospitals that The Record spoke to said that they have adequate oxygen supplies.
“We have a total of 300 cylinders available in stock, which is adequate for 100-220 patients, so there’s no immediate problem. Our suppliers have also assured us that there will be no disruption in supply,” said Dr Karki of Bir Hospital.
On Sunday, the Health Ministry held a meeting with the Nepal Oxygen Industry Association, an umbrella organization of bottled oxygen producers. According to the association, its members have around 70-80,000 cylinders in stock with a capacity to produce 4,500-5,000 cylinders a day, reported the Kathmandu Post. Many large hospitals like Teaching Hospital and Patan Hospital also have their own oxygen plants, although not all of them are functional.
“We’ve been buying cylinders from the Patan Industrial Estate because our plants are dysfunctional,” said Dr Shakya of Patan Hospital. “We have not faced any shortages until now, but there is a possibility if our suppliers stop sending us oxygen cylinders.”
One of TU Teaching Hospital’s oxygen plants has the capacity to produce 1,000 liters of oxygen a minute but the plant requires maintenance and its parts haven’t arrived from France yet, said Adhikari, Teaching Hospital’s spokesperson.
“We have two other plants that produce 500 liters per minute but their production is not adequate so we buy oxygen cylinders from suppliers as well,” said Adhikari.
Hospitals appear to be rising to the challenge and if the spike in daily cases can be reduced by targeted lockdowns and restrictions on movement, there is hope that the second wave might be tamed. But much still relies on citizens and how well they adhere to restrictions and abide by precautionary measures like strictly wearing masks and washing hands.
“Citizens need to understand why a lockdown was imposed and follow health protocols throughout, even if they have been vaccinated,” said Dr Sher Bahadur Pun, a virologist at the Sukraraj Tropical and Infectious Disease Hospital.
Vaccinations need to be continued with, perhaps with more urgency than before. So far, nearly 2 million Nepalis have been vaccinated either with the Indian Covishield or the Chinese VeroCell vaccine. At least 20 million need to be vaccinated if Nepal is to achieve herd immunity. But Nepal doesn’t have enough vaccines in stock and given the crisis in India, it is unlikely to receive any more from the southern neighbor. The Department of Drug Administration, on April 20, gave emergency authorization to the Russian Sputnik V vaccine but it is unclear when and how many doses of this vaccine are incoming.
“Now that the government has imposed a lockdown, it should learn from its past mistakes. Most importantly, the government needs to understand that it is buying time and that the lockdown should only be held for a minimum time period,” said Dr Pun. “Planning should be data-driven and implementation of those plans should be done as soon as possible. If we have learnt from our past, we need to act.”
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