Nepal is not as panicky about Covid-19 as the rest of the world. The reason? Nobody in the country has tested positive for the virus bar one person, who has now been cured.

But there were jitters across social media when Dr. Sundar Mani Dixit, a prominent physician and human rights activist, organized a press meet on March 17 to give voice to his frustration with existing anti-corona measures: “They claim there is no case of novel coronavirus in Nepal. But how can there be any when they don’t test?”

“We don’t have specialized test kits. Even the few available kits are for VIPs. From my hospital, we had sent three patients for coronavirus testing. But none of them could be tested,” Dixit added. 

Worried retweets and Facebook shares followed. Yet a section of people also dismissed Dixit’s claims and said he was only trying to sensationalize things.

The central government lab at Teku—the only place in the country to test for Covid-19—acknowledges that the number of tests carried out is not enough to give an accurate picture. Till we went to press on March 19, the lab had tested just 529 persons. Only one person returning from China tested positive on January 13. He has completely recovered, but those he came in contact with have not been tested.

So does Nepal now have active Covid-19 cases? No one can say for sure. But as the World Health Organization Director General Tedros Adhanom Ghebreyesus put it in late February: “No country should assume it won’t get cases. That would be a fatal mistake, quite literally.”

Lack of knowledge about Covid-19’s status in Nepal has helped maintain social calm to an extent. “From what I hear, we still have enough in vital supplies,” says Roshan Mishra, director of Taragoan Museum and a keen social observer. “Everything seems to be within limits till now. But you can never be too complacent.”

Rumor has it

The government’s poor public information system creates plenty of doubt. And given a general lack of trust in the government, rumors spread and soon become ‘facts’.

On March 18, the government announced closure of schools and asked people to stay indoors, to mixed reaction. On social media, some said it was a good precautionary step, while others dismissed it as scare-mongering.

Nonetheless, people in general still seem optimistic as they continue to hold parties and shake hands in public. That doesn’t mean people are not worried though.

Over the phone, an insurance agent asked APEX if the government was hiding information about dozens of identified coronavirus patients kept in isolation. Another query was if the Chinese Embassy was putting pressure on authorities not to test its nationals in Nepal. Such rumors abound.

Caught between all sorts of social media rumors and lack of credible information, a large section of the people seems to have taken the attitude of ‘ignorance is bliss’. Many take it for granted that Nepalis have strong immunity as they are used to living in ‘less than hygienic’ conditions. Some resort to popular sarcasm: The country is, as always, under the benevolent gaze of Lord Pashupatinath, so no need to worry. A doctor even posted a joke on Twitter: Coronavirus cannot survive the dust and smoke of Kathmandu.

But the level of anxiety is slowly creeping up.

“Yes, there is anxiety among the people, and that is natural in such cases. We don’t know much about the new virus. And you know how it has dominated news and social media,” says Dr Kapil Dev Upadhyaya, a senior physiatrist and counselor. “People know that we don’t have enough hospitals. If there are cases that need hospital care, it would be complete chaos given the country’s medical capacity.”

Although no one has visited Dr Upadhyaya with corona-related anxiety yet, he foresees social anxiety increasing manifold if a few positive Covid-19 cases are identified.

Officials at the Sukraraj Tropical & Infectious Disease Hospital, the country’s sole hospital dealing with infectious diseases, are also aware of rising public anxiety. “There is anxiety in every house. Everywhere, people are talking about masks and buying kitchen rations,” says Dr. Anup Bastola, the hospital spokesperson. “Even medical professionals and government officials keep asking us what is the real situation as if we are hiding facts. That clearly shows how anxious they are.”

Perhaps some anxiety is justified too. A single lab in the country caters to 30 million people. We don’t know if we have standard kits or if the tests are reliable; Dr Dixit’s claim about absent kits cannot be brushed aside. Nepalis travelled to and from China, South Korea, and other countries—unrestricted—for over two months after the outbreak in Wuhan. Few of these travelers have been tested.

 

Corona vs common flu 

Covid-19 is killing people around the world. But other ailments such as common flu kill just as many—if not more.  

According to the US Centers for Disease Control and Prevention (CDC), since 2010 influenza has resulted in between 9 million-45 million illnesses, between 140,000-810,000 hospitalizations, and 12,000-61,000 deaths annually in the US. In 2018/19, an estimated 34,000 people died from it.

A research published in the International Journal of Infectious Diseases estimated that an average of 5,290,000 influenza-related illnesses occurred in Italy each winter between 2013/14 and 2016/17. That led to over 68,000 deaths during the four years. Italy’s National Health Institute said there were about 3,883,000 cases of viral infections in the country from September 2017 to January 2018.

Alarming statistics. But why aren’t people so anxious about them? Maybe because while a lot is known about seasonal influenza, we know far less about the novel coronavirus.

“First we have poor understanding of the new virus. Next, it has a high transmission rate,” says Dr. Tista Prasai Joshi, a microbiologist with the Nepal Academy of Science and Technology. “Then there is the initial period where an asymptomatic infected person may transmit the virus on to many people. That makes it unpredictable, and therefore worrisome.”

As per different studies, a person infected with seasonal flu spreads the disease to 1-3 persons on average. In the case of Covid-19, the number ranges from 2 to 4. Likewise, for the flu, the incubation period, when symptoms are not seen in the virus carrier, ranges from 1 to 4 days. It may go up to 14 days for Covid-19, during which time an unsuspecting person can infect others. And the fatality rate for flu is 0.1 percent or less, whereas that of Covid-19 is between 1 to 3.4 percent, or even higher.

In Nepal, as people wait in fear of an imminent outbreak, not the least because of the country’s open border with India, celebrated writer Nayan Raj Pandey tweets: “We are in a dilemma, what should be the level of our fear and what should be the level of precaution. There are excuses not to be too scared. But there are plenty of reasons and facts to make you nervous as well”.