Fears of COVID-19 catastrophe as Nepal reports death from new Coronavirus

Corona Virus Disease 2019 (COVID-19) which originated in China spread progressively all over the world. Till the February, 2020 China was the only country mainly affected by Covid-19, but from the beginning of March it started to spread rapidly to South Korea, at the second week of March cases increased rapidly to Italy and Spain including other European countries and at the third week of March to United States and other countries too [1]. On 11th March, 2020 WHO declares COVID-19 outbreaks of a pandemic [2]. As of 22nd May, 2020, there have been more than 5.2 million confirmed cases COVID-19, with more than 335 thousands deaths and more than 2.1 million recovered [3]. Latest data show that COVID-19 cases are increasing rapidly in poor and developing countries compared to develop and western countries. Slowly, Nepal is also entering the ranks of COVID-19 affected countries. To date, Nepal has more than 500 people infected from COVID-19 [4]. 

Nepal registered first COVID-19 death on 16th of May as a 29-year-old female [4] who gave birth on 6th of May at Tribhuvan University Teaching Hospital. She discharged on 7th May, as the health condition of both the baby and the mother was normal. She died on 14th May with respiratory difficulties [5]. Several laboratory tests had confirmed that death was from COVID-19. Similarly, Nepal reports second COVID-19 death on 17th of May as a 25 years old man from western parts of Nepal who was kept in quarantine since his arrival in Nepal from India on 12th May [4]. Similarly, Nepal reported its third Covid-19 death on 21st May, 41-years-old man who had tested positive for the virus and was getting treatment in hospital [4]. In the case of earlier two deaths, COVID-19 was confirmed only after their death. This is the first case of death of patients with confirmed COVID-19 and was under treatment. He is suspected to be infected during the social work for the management of people living in quarantine in his village. 

Nepal confirmed its first case of COVID-19 in a Nepali student who had recently returned from China on 23^rd January [1,4]. Initially, most of the confirmed cases were imported from other countries [1,6]. The first locally transmitted case was confirmed on 4th of April among relatives of the victims, marking the second stage of transmission [1,4]. Recently, reports of outbreaks in different parts of Nepal show that the country has entered the third stage of the corona virus outbreak with community transmission [6]. 

There was total 507 infected persons age ranged from two month infant to 81 years old woman in Nepal as of 22nd May. Among them 84% were male and 16% were woman. Further age specific infection shows majority (61%) were from age group 21-40 years, followed by up to twenty years (22%), 13.7% in 41-60 years and sixty years and older accounts less than four percent. If we look the trend of other countries, majority of people who infected from COVID-19 are older adults. This trend is found just opposite in Nepal. This may be due to as COVID-19 infected persons were mostly youth returning from other countries. Most of the infected persons are said in good health in Nepal. Further, death of young people in Nepal is quite contrary to existing trend that older people are more vulnerable. So far, 70 people are recovered from Covid-19. Strict lockdown and young population may be one reason for low mortality in Nepal [7]. 

Nepal is braced for a “major outbreak” after some of the thousands of migrants returning from India tested positive for the COVID-19 recently. So far the majority of COVID-19 cases in Nepal have been either Indian nationals or Nepali workers who have recently returned from India due to open and porous borders between India and Nepal. Future COVID-19 cases in Nepal will depend on the situation in India [1,4]. There have been more than 120,000 cases and more than 3600 deaths in India [3]. 

The Nepali government has prioritized awareness-raising activities and prevention activities to control the spread of COVID-19 cases [4]. Land borders with India as well as China are completely sealed off, and all international flights are now suspended. Quarantine centers and temporary hospitals are being setup across the country. Laboratory facilities are upgraded and expanded. Hospitals have been setting up ICU units and isolation beds [1]. A country-wide lockdown came into effect on 24 March and has been extended until the 2nd June. 

COVID-19 has created so many mental and psychological health issues [7,8]. With the recent increase, COVID-19 cases along with three deaths have also increased the fear among Nepalese who are already in lockdown since last two month. One study found the long prevalence of this pandemic has created different types of psychological disorders and chaos among Nepalese people [9]. The psychological issues due to pandemic in Nepal may hit in several ways due to considerably low socio-economic status and fragile health care system. Recently, thousands of Nepalese stranded in different parts of India due to lockdown are returning to Nepal. When they return to Nepal, people are afraid that there is a possibility that many of them could carry COVID-19 into the country [1,6]. Additionally, many people who were working in the Middle East as unskilled labor work lost their job and are waiting for the proper time to return to Nepal. Nepalese people are also in fear that the Nepal government may not have enough places for quarantine for this large mass and it will also pandemic. Some people are already in stress as they are facing the problem of hands to mouth as there is no any regular work. More than 90% cases of COVID-19 in Nepal are said to be asymptomatic, it has also made difficult to identify the people with COVID-19 symptoms and created the fear of that it may easily transfer to each other. 

Despite the limited resources, as the Nepal government has increased the number of COVID-19 tests in all the affected areas, the numbers of confirmed COVID-19 cases are also increasing rapidly. As the health care system of Nepal is fragile and lacks the necessary infrastructure to cope with an increasing number of infections, the country is not prepared for a full epidemic. Nepal still needs to focus on strengthening the health care system countrywide to control the present and future epidemics. Furthermore, the Government needs to be more vigilant by restricting immigrants from open borders. Further, people should be encouraged to talk each other and with neighbors which may work as social therapy and may help to some extent to get rid from the psychological fear of COVID-19 and other issues resulting from it.

The authors declare that they have no competing interests.

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Dr. Chalise conceptualized and drafted the manuscript; Mr. Dhungana helped to refine the report. Finally both worked together to give the final shape.