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With a steady increase in daily Covid-19 cases, its patients occupy almost all beds and Intensive Care Units of hospitals across the country. Against this backdrop, management of asymptomatic, mild, and moderate cases of Covid-19 at home or non-healthcare settings is important for both patients and authorities in order to relieve pressure on the healthcare system.  

Moreover, the WHO says 80 percent Covid-19 are asymptomatic, mild or moderate cases, 15 percent have severe infections, and the remaining 5 percent are critically infected patients. The apex global health organization says asymptomatic cases including patients with mild and moderate symptoms can be treated at home by following preventive measures.

Mild cases of Covid-19 are the ones diagnosed positive in PCR test but without any evidence of viral pneumonia or hypoxia while the Moderate cases have mild pneumonia. Fever (<102.38°F), dry cough, smell blindness, and sore throat are the most common symptoms in mild to moderate cases. Severe and critical cases have trouble breathing, persistent pain in the chest, bluish lips, serious to severe pneumonia, or acute respiratory distress syndrome (ARDS). Both severe and critical cases require emergency treatment or hospitalization.

Irrespective of the level of severity of the coronavirus infection, pregnant women or those above 60 or individuals with underlying medical conditions like diabetes, asthma, hypertension, kidney problems, cancer, and obesity must seek hospital treatment. Home-based care is recommended for adults or children when the hospital setting is unsafe, health facilities limited in numbers or unable to meet demand. 

Covid-19 Cases Isolation Management Guidelines issued by the Government of Nepal also say asymptomatic and mild cases can be managed through home isolation by following set preventive measures to avoid cross-transmission. The below-mentioned measures are as helpful for home-quarantined patients as well:

Physical exercise: Activities like walking within the room, for 15-20 minutes at least three times a day, help maintain proper blood circulation and prevents blood clots in lower limbs from prolonged bed rest. Deep breathing through the nose, spirometer or balloon blowing exercise 8-10 times a day helps restore lung function and improve oxygenation in mild cases. (But lung exercises are not recommended soon after food consumption.)

Gargling: Coughing, the second most common symptom after fever, causes sore throat. Gargling, an ancient therapeutic measure, four times a day, at an interval of four hours, helps reduce viral load in the oropharynx and remove throat irritation. Betadine diluted with lukewarm water in the ratio of 1:3 can be used to gargle on throat made sore by corona infection. You should not eat at least 15-20 minutes after the gargle with betadine.

Balanced diet: The person in isolation needs to eat low-carb but protein-rich foods with spices like ginger, turmeric, and garlic that generally boost physical immunity. Combination of food rich in Vitamin C, Vitamin D, and zinc that produce a synergistic role in boosting immunity is recommended. Alcohol drinking during isolation can result in anxiety disorders or depression, with greater risk of suicide. In addition, alcohol harms the immune system. Smoking by individuals with mild or moderate symptoms further weakens their respiratory system and elevates the risk of severe pneumonia. Avoiding both alcohol and smoking is important during the infection.

Medical Evaluation through Measurement of Vitals and Observation: The health condition of mild or moderate coronavirus patients must be monitored at least thrice a day and their health status updated. The patients too must immediately contact concerned authorities if their health condition worsens or they experience any difficulty. Patients can take their vitals like body temperature with thermometer and blood oxygen saturation with pulse oximeter.  If body temperature steadily increases above 102.38°F and oxygen saturation (SPO2) gradually drops below 90-92 percent, help must be immediately sought. Besides these, if there are threatening medical conditions like troubled breathing, persistent chest pain/pressure, dehydration, mental confusion, and bluish lips, immediate medical attention must be sought at government-assigned Covid-19 dedicated hospitals.   

Regular communication: The government’s isolation guidelines say at least one health worker should be assigned to monitor 50 patients under self-isolation. As per the guidelines, the designated health worker must monitor health condition of the patients, especially vital measurements at least two times a day through a phone call or message. The health worker can prescribe antipyretics drugs like paracetamol and ibuprofen for management of fever and pain during isolation. Patients also must immediately contact their health worker if they experience further symptoms or if their caretaker observes deteriorating health conditions.

Patients should disassociate themselves from rumors and misinformation about coronavirus and maintain regular communication with their friends, family, and relatives via phone or video chatting to keep themselves in good spirits—all vital to beat the infection.  

Precaution by caretakers: Children and pregnant women without underlying medical conditions but with mild and moderate symptoms can be treated at home. However, they require a caretaker at home during their isolation period. Caretakers must maintain personal hygiene and sanitation and put on a medical mask, plastic apron, and gloves while providing care or disinfecting the frequently touched surfaces, clothes, and bed items.

The WHO estimates that people with mild to moderate symptoms generally recover within two weeks. But there are some instances of the symptoms extending by a week. Hence it is advisable not to overlook the cases as mild or moderate and seek immediate medical attention if symptoms prevail for over three weeks.

Asymptomatic patients in home isolation can discontinue their self-isolation 10 days after the date of their first positive RT-PCR test on mild or moderate cases; for those with symptoms, self- isolation can end after at least 10 days from the onset of symptoms and three more days without any symptoms. More importantly, if the patients with mild or moderate symptoms have a fever, it must recede without the use of any antipyretic drugs 24 hours before discontinuing self-isolation.

The author is a graduate in Epidemiology and Biostatistics from SRM University, India

Riverine issues and concerns are inextricable aspects of Nepal-India relations that stir up fervor and sentiments in both countries. With the onset of monsoon each year through June to September and the ensuing flood-related damages, governments at both local and federal levels are faced with the perennial challenge of responding to long-standing knotty issues. Major rivers like the Koshi, Gandaki, Karnali and Mahakali and tributaries experience annual flooding, affecting both countries. With more than 6,000 rivers and rivulets from Nepal flowing into India, the transboundary flood impacts are complex, significant, and on the rise. 

Yet, what remains underexplored is the critical role that communities living in the transboundary river basins in both countries can play, as in the case of Mahakali basin on flood preparedness, mitigation, and response. Better outcomes in river and flood management can be achieved by proper coordination among water-related institutions and bringing local people into the mix. When local riverine communities are given increased access to and control over water resources, their resilience to natural hazards can improve.

The 2017-18 floods claimed 183 lives and affected 16,196 families in Nepal with a loss of Rs 60 million. Corresponding damages in India included loss of 1,808 lives and an estimated Rs. 957 billion ($13 billion) in damages according to data presented in the Rajya Sabha. The World Resources Institute (WRI)’s Aqueduct Global Flood Analyzer (2015) reports that on an average, 97,500 and 100 million population are affected every year in Nepal and India due to riverine floods, a majority of them women. Earlier floods like the one in Mahakali (2013) flood swept away 12 government offices, 156 private houses, embankments, a covered hall, and a playground in Nepal. Approximately, 42,800 Nepali (7,572 households) were affected by the Koshi floods in Sunsari District on 18 August 2008, in addition to an estimated 11,000 Indian nationals (2,328 homes), according to the government of Nepal. Rehabilitation and compensation from these events have been pending in both the countries to date.

The Mahakali river basin (also called Sharda in India) provides a unique example of how community-led actions make a difference in relaying flood-warning information between the upper and lower riparian neighbors. Communities living along the two sides of the river have strong cultural and socio-economic ties that have helped in easy and timely flow of flood-related information. During the 2013 Mahakali floods, the communities on the Indian side relayed vital and timely information about the opening of the Dauliganga dam following a heavy rainfall that saved many lives on the Nepali side. 

Learning from these examples, a transboundary early flood warning taskforce has been formed to share flood-related information between upstream and downstream communities in the Mahakali basin through apps like Whatsapp and Facebook messaging. Community-level simulation exercises between Nepal and India have been held since 2018.

In both the countries, community engagement in citizen science activities like monitoring river pollution levels has started, which is expected to mobilize riverine communities on both the sides to generate data and build evidence vital to inform local policies.

Likewise, civil society organizations are playing vital roles in transboundary water cooperation by engaging communities and local governments from both the countries. To this end, institutions like the International Centre for Integrated Mountain Development (ICIMOD) and the Indo Nepal Joint Action Forum (INJAF) convene regular Mahakali Sambad (River dialogues) between communities of Nepal and India, and local political bodies and local governments representatives (CDO from Nepal and District Magistrate from India) are invited to discuss ways to minimize transboundary flood impacts, among other cross-border issues. This equity approach uses local people’s participation and their opinions as cornerstones in effective flood management.

A successful policy outcome of such citizen action is the Dhangadi Declaration (March 2018)—a six-points commitment secured at the sub-national level in Nepal that provides a potential segue into transboundary and basin level commitments for inclusive water governance initiatives in the region. 

When tensions between the two countries are high due to the Kalapani, Lipulekh, Limpiadhura disputes, collaboration among the riverine communities of the two countries must be given continuity. Such community and CSOs-led initiatives will demonstrate the scope for more South-South Cooperation (SSC) among riparian countries in South Asia to collectively address shared waters issues, including natural hazards like floods and droughts in these basins. 

Subedi and Singh work for the Transboundary Rivers of South Asia (TROSA) Program, Oxfam. Views are personal

Shaking with rage, a BJP-affiliated TV anchor openly challenges the writ of the (non-BJP) government of his host state. Modi puts Jammu and Kashmir under a lockdown for over a year. But there is not a squeak about the plight of the Kashmiris in mainstream Indian media, even as Indian Muslims are being systematically persecuted. The number of daily Covid-19 deaths in India is now highest in the world, and yet misogynistic plots spun around the death three months ago of a popular Bollywood actor continue to dominate daily headlines.

In Nepal, the voice of Nepali Congress, the main opposition, is supposedly at its weakest in the country’s democratic history. By the same standards, the voice of its Indian counterpart, the Indian National Congress, is non-existent. This is partly because of the INC’s leadership crisis. Partly, it’s a result of the BJP controlling the mainstream Indian media and virtually shutting the INC out of it. 

Given its unmatched political sway across the country and steady silencing of opposition voices, perhaps it won’t be wrong to call India under Modi a one-party state. And just as Trump’s approval ratings remain unshakable among his hard-right supporters, Modi can do no wrong for his Hindu adherents. Whether or not Nepal returns to being a Hindu state, the nominally secular India is now all but one. 

I have warned in this space about the creeping dangers China poses to Nepal. But a supposedly democratic BJP-led India confronts us with similar challenges. What we have traditionally admired about India—its vibrant democracy supported by a raucously independent press, its long tradition of religious tolerance, its syncretic culture—are applicable no more. What we have instead in India is a pro-Hindu government intent on hanging to power by shutting out its political opposition, demonizing religious minorities, and displaying blatant jingoism. 

What moral right does New Delhi then have to ask Kathmandu to maintain a safe distance from Beijing? The way anti-China fervor in India has picked up after the emergence of disastrous economic numbers for the country has been intriguing. Initially, Modi did not want to pick a fight with a more powerful adversary. But then evidence began to emerge of the decimation of the Indian economy under Modi’s watch and his government’s abject failure to contain the Covid-19 crisis. Anti-China posturing then became the only tool to keep his public opinion intact—with the prolonged investigation into the death of Sushant Singh Rajput, much fanned by Modi-worshipping media houses, offering another useful distraction for the public.

Indians cannot expect such excesses of their government to go unnoticed in the neighborhood. There has been a steady slide of South Asian countries towards China—that authoritarian, one-party state that has become a scapegoat for most big dysfunctional democracies. But forget China for a bit. The problem is that India’s democratic neighbors no longer believe India under Modi believes in democracy, in or outside the country. (Nepalis certainly have not forgotten the inhumane 2015-16 blockade.) 

India’s secular fabric has been torn asunder. Its public debate has coarsened and picked up xenophobic overtones. It seems to have no clear strategy on Covid-control. Its economy has been hemorrhaging ever since the suicidal 2016 demonetization. It treats its neighbors with utter disdain. Seriously, what is there to like or emulate about Modi’s India?    

A few days ago, I was walking in my neighborhood when I saw an elderly woman I knew coming down the road. She was walking in an upright posture, without the help of a crutch or a stick. Her face was bright and she had a smile on her face. “You’re looking good!” I said to her. She smiled, obviously pleased.

About two years ago, I’d seen the same elderly lady, with one palm on the wall to support her frail gait. We’d gotten into a conversation. “Yestai ho, janay bela ma yestai huncha!” (‘When we’re about to die, we get frail’). I suggested she take mungrelo (nigella sativa) seeds, which help with joint health. She embraced my advice with enthusiasm. She told me she bought a bottle of the seeds, roasted them, and put them by her bedside. She popped them whenever she felt the urge to snack during the day, and ate them with her morning tea. Unlike my elderly relatives who will try an ayurvedic remedy for a few days before jumping to antibiotics and Big Pharma and surgery, this lady seemed to have no other option. Slowly I saw her get better as the months progressed. Then I saw her cured. 

This case pleases me a lot because it was the progression of Ayurvedic healing as it was meant to unfold, at its own slow time and pace. No need for joint replacements, surgeries that cost 12 lakhs, elderly people laid up in hospital with invasive surgical interventions. This old lady become fit and healthy through the simple remedy of some tiny seeds.

We have a healing tradition in South Asia that goes back thousands of years. Yet we have been taught to ignore, ridicule and dismiss it as a body of knowledge without value or scientific proof. On Twitter, the scorn against “Besarays”—people who advocate the theory that turmeric helps ward off the coronavirus—is vituperative. Where are the clinical trials, people will demand? They are seemingly blind to the evidence that the Besar Belt (including Asia and Africa) has very few coronavirus deaths. They also ignore existing scientific studies on healing properties of turmeric, including its anti-inflammatory and blood-thinning properties.

Anti-Besaray people then go on to demand Remdesivir, a drug made by a company known for its extraordinary inflated prices, including a liver drug that costs over $74,000 for a course. This is an extraordinary denial of healthcare to the masses by elites whose rip-off goes beyond ordinary fraud or swindle. We need new words to describe this kind of commercial transaction with genocidal intent, one that our current vocabulary lacks. Yet this is precisely the company the WHO is promoting, at the expense of local, easily available remedies that are already saving lives in the Third World.

I shared my mungrelo story with my great aunt. She, obviously, knows a lot more about Ayurveda than I do. She was born half a century before me. Like all modern people with pride in knowledge gleaned from the web, I assumed I was the only one to “discover” the healing properties of this seed. She demolished my ignorance in short order. “I raised my children with Ayurvedic remedies, but during my grandchildren’s time, we forgot about those. We went to the doctors and kept using antibiotics. They were constantly sick and we raised them with difficulty,” she said.

She’d used this remedy on her own children: the mother put a few jwano (ajwain) and mungrelo seeds in her mouth and chewed it, spit this mixture at the tip of the linen sari, filtered two drops of the juice, then mixed that in breastmilk and fed it to the two- month-old. Only a few of the powerful seeds are needed! The same ajwain and nigella sativa can be ground into paste, then applied to infant’s head to stop a cold. She’d put it on her nephew after a vaidya told her about it, and he’d been cured. Now imagine the money we could save from hospitalizing infants if this remedy was followed everywhere in the “poor” (but knowledge-rich) Third World. We wouldn’t need to spend lakhs on hospitalizing infants, pumping them full of antibiotics, and in general exposing a fragile infant to the possibility of an latrogenic death.

But for a modern doctor, this remedy will bring shivers because saliva contains bacteria, which must be instantly killed! Preferably with bleach. Never mind if the mother’s saliva is a key ingredient in introducing healing macrophages into the infant body. “Nowadays you can use a handkerchief,” my great aunt said. “I don’t know, maybe there was something healing about a mother’s sari.” I have no doubt there was something healing about a mother’s sari: her biome, the body, is teeming with a rich jungle of microflora and fauna which help an infant fight off disease, and what better way to introduce it into the infant than through her sari’s sapko!

Creating a microbe-free environment can be lethal, as no benefic bacteria can survive in the desert. High coronavirus death rates in the West may be caused by this overkill with hygiene.

We need to return to our roots—through the mouth and eating, through traditional food, and through the herbs we have always known and which have cured our ancestors and ensured our own existence.