3rd Covid wave infects Nepal’s frontliners

During the devastating second wave last year, hundreds of people were dying every day. Hospitals had run out of ICU beds and oxygen cylinders.

This time, hospitals are running out of medical staff.

As elsewhere, the third wave in Nepal is infecting healthcare workers, endangering not only patients with Covid pneumonia, but also those suffering from pre-existing conditions like kidney failure, diabetes, cancers or cardio-vascular diseases.

This acute shortage in medical staff across Nepal due to the rapid spread of Omicron has prompted the Ministry of Health to consider shortening the isolation period for doctors, nurses and paramedics to five days. The US and India have already done so.

Hundreds of health workers are testing positive daily in hospitals all over the country, turning health facilities themselves into a hotbed of the virus.

On Tuesday, there were 10,258 new cases out of 22,828 tested, bringing the positivity rate up to 45%. This is the highest ever daily new cases for Nepal and also the highest positivity rate.

International airlines flying out of Kathmandu are reporting a sharp increase in the number of passengers who cannot fly because of the PCR positive test results. So far passengers on domestic flights are not required PCR tests, only vaccine cards from next week.

“Omicron is spreading like wildfire through all hospitals, in ours alone we have 35 staff testing positive,” says Sanduk Ruit of Tilganga Eye Hospital in Kathmandu.

One of the bigger facilities in Kathmandu, HAMS Hospital, has 16 of its clinical staff in isolation after testing positive. On 17 January, 52 staff of the Trauma Centre Hospital tested positive in one day, affecting emergency care of accident victims.

Teaching Hospital and Bir Hospital in the Valley also have a similarly high number of doctors and nurses infected and isolating.

“Health workers in every ward are infected, Covid has now spread from the emergency to the general ward, the blood bank, physiotherapy, ICU and even the administration,” director of the Trauma Centre Pramod Joshi told Nepali Times.

The hospital is now primarily treating patients that need emergency care and surgery. “The hospital is full of patients and the ICU is packed as it always is,” he said.

The third wave has now even affected hospitals outside Kathmandu, which are struggling to cope due to a shortage of staff.

Bayalpata Hospital in remote Achham district has curtailed some critical services like C-sections because of sick staff. Charikot hospital in Dolakha district which had finally stopped reporting new Covid infections only last month is back to caring for an increasing number of coronavirus patients but with fewer staff.

“Some of us have mild but manageable symptoms but we are still working, we had a shortage of healthcare workers even before this third wave,” Binod Dangal of Charikot Hospital said. “In fact, we have fewer people than we had during the second wave, we have equipment but no trained staff. We are no better prepared than we were before.”

The only respite during the third wave is that the new strain is much milder. Because Omicron’s impact is largely confined to the upper respiratory tract, physicians say their patients do not need as much oxygen or ventilator support as was the case with the Delta variant which primarily affected the lungs.

Most doctors in and outside Kathmandu say they expect infected staff to be back at work in a week after another test. Even so, given Nepal’s largely unprepared and limited healthcare infrastructure which works on a shift basis, medical staff having to isolate just a few days can seriously disrupt medical care, especially in rural areas where hospitals and doctors were always few and far between.

Indeed, this latest crisis reflects on a pre-existing chronic shortage of doctors, nurses and trained medical staff, says Bikash Gauchan of the Gandaki Province Infectious and Communicable Disease Hospital in Pokhara.

“What we are experiencing now is both an acute and chronic shortage of healthcare workers, and this carries a lesson for our government, to strengthen and prepare its medical resources for future pandemics,” he adds.

Booster shots for frontliners including healthcare workers in Nepal  started this week, and the additional dose will provide much needed protection to doctors and nurses who work in close contact with possibly infected patients.

But crowded vaccination centres (pictured above) themselves risk being breeding grounds for infection. This time the queues are not just of the unvaccinated getting their first jabs, but also those waiting for boosters. Even if vaccinated, doctors say masks and physical distancing are mandatory.

They warn the public not to be complacent because they are vaccinated and that Omicron is milder. Binod Dangal of Charikot Hospital says: “Most people are treating Omicron as a normal cold but it is very important for us to monitor the progress of the disease in the next few weeks, and prepare for adequate critical care.”

At Nepal’s biggest infectious disease centre Teku Hospital, virologist Sher Bahadur Pun cites scientific studies to say that the shortage of healthcare workers will not persist, and the isolation period can be reduced. Nepal has likely passed the most infectious stage of Omicron spread and it is now time to keep a close watch on people isolating at homes and in hospitals.

Pun adds: “We must also investigate which strain is causing Covid deaths in Nepal because if Omicron had indeed replaced Delta, our figures for mortality should not be as consistent as it was before the third wave.”