By Krishna Pokharel
KATHMANDU, Nepal -- With all six ventilators at a hospital in
central Nepal already being used by Covid-19 patients on Sunday,
doctors asked the son of Lal Bahadur Thakur to try to find one
somewhere else, as his father gasped for breath.
As India's Covid-19 surge has swept into Nepal, hospitals are
reporting an overwhelming number of severe cases and similar
shortages of beds, oxygen and ventilators. Much like what happened
in India, cases have risen faster here than during any previous
outbreak of the coronavirus pandemic, quickly overwhelming a
healthcare system with fewer resources than its much larger
neighbor to the south.
"We have already lost two patients like him today waiting for
ICU beds or ventilator support. We feel utterly helpless," said Dr.
Dipendra Pandey, who was treating Mr. Thakur at the government-run
Trishuli Hospital in Nuwakot district, about 50 miles outside
Kathmandu, the capital city.
Mr. Thakur's 20-year-old son, Chandan Thakur, made a flurry of
calls to hospitals in the nearest cities -- Kathmandu, Chitwan and
Pokhara -- as his father's blood oxygen levels dropped below 60%.
None of them had available beds or ventilators, he said.
On Monday morning, Mr. Thakur, 50, died of acute respiratory
distress syndrome due to Covid-19, despite the hospital's efforts,
Dr. Pandey said.
The Covid-19 wave now battering India and Nepal shows the danger
for many regions of the developing world that remain largely
unvaccinated. Public-health experts and scientists say a highly
infectious coronavirus variant first identified in India appears to
be fueling a precipitous rise in cases in Nepal, and await the
genomic sequencing of more samples to be certain.
In early March, Nepal was reporting around 100 new daily
Covid-19 cases. In recent weeks, new daily cases have shot up to
more than 9,000, the highest since the pandemic began, and about
200 people are dying a day, according to the Ministry of Health and
Population.
The numbers don't likely reflect the full extent of the surge.
The positivity rate for coronavirus testing has been about 45% in
recent days. The high rate is mainly due to the country's limited
testing, said Laxman Aryal, Nepal's health secretary.
Since November, the government has been limiting the
availability of free testing, treatment and quarantine centers to
those most in need, saying the resource-constrained country needed
to save money to buy vaccines. Now the country tests only people
with symptoms and those who have been in immediate contact with
people who have tested positive, said Mr. Aryal.
Despite the efforts to save money for vaccines, by the end of
April the country had fully vaccinated only about 362,000, or 1.2%,
of its 30 million people, an example of how far developing
countries lag behind the U.S. and parts of Europe, where
vaccination campaigns are already setting the stage for economic
recoveries and a steady return to normalcy.
Nepal isn't the only country to see a recent increase in cases,
but the surge here has mirrored the rapid rise in India.
Public-health experts say the surge in India has likely spread
to Nepal through the countries' shared open border. Hundreds of
thousands of Nepali migrant workers, fleeing India's outbreak have
returned home, with little to no screening at border checkpoints.
Nepali Hindus also traveled to India to participate in this
spring's Kumbh Mela festival in northern India -- including the
country's former king and queen, who tested positive soon after
returning.
Preliminary results from a small number of samples suggest
variants circulating in India are now present in Nepal. A lab that
did genomic sequencing of a dozen samples in the Kathmandu Valley
in late April and early May found that 11 of them were versions of
the variant first identified in India, B.1.617, and one was the
variant first identified in the U.K., B.1.1.7, said Dibesh
Karmacharya, executive director of the Center for Molecular
Dynamics Nepal.
Nine of the 12 were of one particular subtype of the variant,
B.1.617.2. "It is the same one creating havoc in India right now,"
said Mr. Karmacharya.
The government has sent a wider pool of samples to the World
Health Organization for genomic sequencing, said Mr. Aryal, the
health secretary.
The country's hospitals meanwhile are seeing more severe cases
of Covid-19, including among younger patients in their 30s and 40s,
which they are guessing is due to mutations in the virus that are
making it more virulent, Nepal doctors and health officials
said.
"The disease has become unpredictable, and we are struggling to
understand it," Dr. Pandey said. "Compared to the first wave, the
patient's condition this time is deteriorating very fast before we
can do much."
The crisis now gripping Nepal is a cautionary tale for other
small developing countries with weak healthcare systems and little
vaccine protection.
"I am afraid that if you don't have a very systematic approach
to this problem, we are going to run again and again with the
second wave and third wave and the fourth wave, and so on," said
Mr. Karmacharya. "And each wave, you are going to have a stronger
variant."
Nepal started its vaccination campaign in January with about 2.3
million doses of vaccine from AstraZeneca PLC. About 1.5 million
people have been left waiting for their second dose. Nepal has
ordered an additional one million doses from the Serum Institute of
India with an 80% advance payment, but those have been held up
because of India's suspension of vaccine exports, said Jageshwor
Gautam, a spokesman for the health ministry.
As of April 2020, Nepal had only 840 ventilators, about 1,600
ICU beds and fewer than 200 hospitals with intensive-care
facilities, according to the health ministry. There were 23,146
medical doctors in the country in 2019, according to the World
Health Organization data, amounting to eight for every 10,000
people, compared with 9.2 in India and 26 in the U.S.
The most immediate concern, though, has been the lack of medical
oxygen. Nepal has the capacity to produce 8,000 to 9,000 oxygen
cylinders a day, but the demand is nearly twice that amount, said
Mr. Aryal. India is continuing to supply the country with liquid
oxygen even as it struggles to fill its own domestic need, and
China has sent hundreds of oxygen cylinders, he said.
Dr. Pandey, the medical superintendent of the Trishuli Hospital,
said he has been getting calls from Kathmandu hospitals asking if
he has beds and oxygen available at his hospital. The district
hospital has only 25 Covid-19 beds but is currently caring for 80
patients with the disease, all of them needing oxygen support.
Patients have been streaming in from nearby cities, including
Kathmandu, and the hospital has started running out of its stock of
oxygen, he said.
On Sunday evening, as Mr. Thakur's condition deteriorated and
his family couldn't find a hospital bed elsewhere with a
ventilator, the doctors tried to use a ventilator from the
hospital's ambulance. But the doctors couldn't get the machine to
work properly. A nurse tried to keep Mr. Thakur breathing through
the night using manual bag-mask ventilation, Dr. Pandey said.
"Despite our utmost wish that he live, he died," said Mr.
Thakur's son.
Write to Krishna Pokharel at krishna.pokharel@wsj.com
(END) Dow Jones Newswires
May 18, 2021 11:24 ET (15:24 GMT)
Copyright (c) 2021 Dow Jones & Company, Inc.
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