Kathmandu: The first outbreak of COVID-19 in Nepal was reported in January 2013, but the government started fighting after the second outbreak in Chaitra. It has been almost two months since the lockdown started for the first time in 7 days. The ongoing lockdown continues till May 4. Three people have died in the first four months of the first infection.
As of the writing of this article, the number of corona infections in Nepal has reached 487 and 49 people have been cured. Most of the people who have seen the infection have not seen any symptoms and their health condition is reported to be normal. In Nepal, its infection, symptoms and even death are spreading in a different way from the common issues seen globally and it can even establish new facts. This issue will be researched by health experts.
All international ports are formally closed. However, due to the open border and the increasing transition to India, the process of secretly entering Nepal from the Indian border has not been stopped since the beginning of the lockdown. It is estimated that the corona virus has spread to the community in Nepal. Services other than essential services are closed during this period. Except for urgent work, they are not even allowed to go out of the house. The work is done from the minimum among the employees of public and organized organizations working in health care, supply management, policy making, security arrangements and essential services. The rest are contributing from home. Due to the rate and trend of Nepal's recent transition, preparations for the lockdown period have not been adequate and effective as expected.
Nepal had adopted the lockdown measure which is considered effective in the world to 'chainbreak' the virus in time. More and more PCR tests and strategies to maintain social and physical distance have been adopted by countries like China, Denmark, Norway, Germany, Taiwan and South Korea to control this epidemic in the world. In our country, where health infrastructure and resources are weak, the most effective way to control the corona epidemic is to crack down. The government and most experts and the general public are convinced of this. However, the identification, quarantine and isolation of potentially infected people during that period, as well as the investment in PCR testing and treatment, will determine the effectiveness of the lockdown.
In order to increase the scope of testing, the government had to face the limitation of essential health care materials including adequate quantity of test kits due to procurement process and transportation problems. Despite this, in all states, corona testing is performed by rapid diagnostic kit (RDT) and polymerase chain reaction (PCR) method, keeping the information other than the address, age and gender of the infected confidential. And quarantine. It is necessary to identify as many people as possible who have come in direct or indirect contact with the infected and test them with the PCR method and keep only those who are infected in isolation.
Despite the fact that millions of people have died from this epidemic in the world, only 487 people have been infected in Nepal so far, so it is a good thing that we have the opportunity to prepare for its prevention and control. Although the scope of testing is less than the rapid rate of infection, the reliability of the RDT method is in question.
So far, the supply of essential daily necessities has been running smoothly during the two-month lockdown period and the health workers working in the health sector, including the emergency service related bodies, policy making staff, political leadership and security personnel, media personnel have been at the forefront. National and international experts involved in the field, including the World Health Organization, are warning that vaccines and drugs have not been discovered and will take a long time. There is a need to do something strategically in this last period of lockdown to limit the impact of the epidemic to a small number of people and control it with minimal damage.
As health workers and security personnel at the forefront of the service delivery have an important role to play in controlling the epidemic, it is important to protect and encourage them. It seems necessary to change the modalities of Corona Epidemic Control and Lockdown by enacting a separate Act or amending the Disaster Risk Reduction and Management Act, 2074 BS. The current strategy should focus on testing, isolation and change of modalities of lockdown, production, distribution, management of Nepalis who are forced to return from foreign employment, education and banking and industry sector management and staff management. Identification of corona infections,
Regarding the identification, testing and isolation of corona infections
First, the identity of the infected so far, the address (current) should be made public and from now on the identity of all the infected should be made public. So that the people who come in contact with them become aware of themselves and help the government in identifying the possible infected people. It is also conceivable that the National Information Commission has directed the Ministry of Health and Population to disclose the address of the infected person saying that the risk of infection has increased due to non-disclosure of permanent address.
Second, since the results of the RDT test cannot be considered final, all people who come in contact with the infected person identified by the above method should be isolated at their own place of residence as soon as possible and tested by PCR method as soon as possible. Resources, means and manpower to be tested by RDT method should be focused on PCR method. Because, even those who came positive from RDT were found to be negative in PCR and those who were negative in RDT were also found to be positive in PCR. It seems reasonable that India has also decided to stop the RDT test saying that it is not credible and the Supreme Court of Nepal has directed to test it through PCR method.
Third, among the positive cases, only those who do not have the necessary infrastructure, adequate space and resources to live in isolation at their place of residence or cannot afford it or are unable to meet the criteria of isolation should be admitted to the hospital. Others should be kept in regular contact with health workers and health institutions in isolation in their own homes with the necessary awareness and a policy of hospitalization only if there is a problem in health.
Fourth, in places where there are two or more health institutions (hospitals), separate hospitals for Corona Dedicated Hospital and other patients should be designated and necessary resources and manpower should be provided accordingly. Corona-infected people may need to be kept in places where there is only one health facility (hospital). Therefore, arrangements should be made for separate entrances and exits. Referral to another Corona Dedicated Hospital should be arranged as soon as possible.
Fifth, it is necessary to keep the security and morale of the leadership, security personnel, health workers, civil servants and others in the forefront. Therefore, resources and encouragement and respect should be provided. Also, corona testing and quarantine, isolation should be arranged from their PCR method at regular intervals.
Sixth, test kits needed for maximum testing and treatment should be procured and adequate procurement of health care materials should be provided and support should be mobilized as far as possible.
Seventh, arrangements should be made to use private health institutions and hospitals across the country or even resources and manpower. Arrangements should be made to use their expertise through regular interactions with private hospitals through electronic means.
Regarding public and organized sector services and staff management
The Government of Nepal is making efforts to increase the supply and production of essential goods and services. This issue will also be addressed through the implementation of policies and programs and budget for the coming fiscal year. In addition to this, the symptoms of Kovid-19 have been increasing in Nepal but the scope of testing has been reduced. Therefore, it has become imperative to focus our resources, manpower and programs accordingly. For this, the current efforts of the government and the private sector should be continued to ensure the supply of essential services and goods within the limits of the available resources.
Until the epidemic becomes normal, it is appropriate to take the following additional measures through special arrangements for the management of staff of public and organized organizations (except those currently employed at the local level):
First, out of the staff (except health workers and security personnel) working in the Government of Nepal, public institutions and other organized organizations, only the most essential services of such organizations should be operated from the lowest possible staff.
Second, the total workforce should be divided into three categories (excluding staff currently working at the local level, health workers and security personnel) and the minimum number of staff required in each category should be projected. For this, firstly, the employees who are physically present in the office or have to work in the field, secondly, the employees who are not physically present in the office or field, work from home by calling or online or even in the office or field as required and thirdly, more than the required number .
Thirdly, by projecting the required number of employees in the above three categories, the Ministry of Federal Affairs and General Administration in the case of civil servants, the Ministry of Finance in the case of public enterprises and other organizations have voluntarily joined one of the above three categories. Or collect online applications by inviting them to contribute to the product.
Thus, before calling for online application, special arrangements can be made through special law for the facility for such a difficult period on the basis of the security risk of all the three categories and the expenses required for livelihood (including family). If the required number of applications for the first and second class is received or if the number of applications is less or more, the concerned central body should coordinate with the concerned organization and make arrangements for deployment in the appropriate class and the necessary health security vigilance and circulation should be arranged by the concerned office.
Fourthly, in case of up to 50 percent of the total employees working in the third category, the concerned District Administration Office should make arrangements to deploy them in the service of the state or local level as per the need. In other cases, according to their condition, they will be involved in local production or any other creative work by testing the corona from their PCR method and sending the negative report to their respective districts in coordination with the transport professionals by maintaining necessary health security vigilance and physical distance. And arrangements for transportation management within the district should be made by the District Administration Office.
They may be willing to work in the service of the state or their organization as needed, or to engage in local agricultural and industrial production, depending on their circumstances. Instead of spending time unproductively during the epidemic, they may be in the mindset of engaging in productive work and helping to control epidemics and ease the supply of essential goods and services by reducing congestion in urban areas.
Fifthly, the names, posts, code numbers, mobile numbers, landline phone numbers and email addresses of the employees in all the three categories should be sent to the concerned organization, its central body, district administration office and local level as required and the district administration office in coordination with the state and local level. Arrangements should be made to deploy them even at work.
Thus, all the employees in the first, third and second of the three categories should be tested for corona by PCR method and the report negative should be managed accordingly and in case of positive, isolation and treatment should be arranged at the place of residence or hospital.
In this process, if the general public who are out of their homes want to return to their homes, the Ministry of Labor and Employment can collect their details, test their corona by PCR method and send the negative report to the concerned district at their own expense. For this, the district administration office should make arrangements for the transportation management within the district.
Lockdown is considered to be the most effective way to chainbreak and control the virus. At the same time, the scope of PCR testing must be extended within this period of lockdown by providing the necessary resources. The focus should be on hospitalization only in case of emergency, quarantine with isolation and raising awareness for social tolerance.
The corona epidemic is becoming frightening even in major importing countries of Nepal including India. It is necessary to focus on domestic agriculture and agro-industrial production keeping in view the situation of import and production problems due to lockdown. It is necessary to take the above measures to reduce the food insecurity situation and the catastrophic effects of the epidemic in the coming days. We should not delay to create an environment for changing the modality of lockdown by June 6. Otherwise, the epidemic could cause more irreparable damage than we imagined.
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