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Steep Covid-19 Rise in Nepal Mirrors India’s Surge


KATHMANDU, Nepal—With all six ventilators at a hospital in central Nepal already being used by Covid-19 patients on Sunday, doctors asked the son of Lal Bahadur Thakur to try to find one somewhere else, as his father gasped for breath.

As India’s Covid-19 surge has swept into Nepal, hospitals are reporting an overwhelming number of severe cases and similar shortages of beds, oxygen and ventilators. Much like what happened in India, cases have risen faster here than during any previous outbreak of the coronavirus pandemic, quickly overwhelming a healthcare system with fewer resources than its much larger neighbor to the south.

“We have already lost two patients like him today waiting for ICU beds or ventilator support. We feel utterly helpless,” said Dr. Dipendra Pandey, who was treating Mr. Thakur at the government-run Trishuli Hospital in Nuwakot district, about 50 miles outside Kathmandu, the capital city.

Mr. Thakur’s 20-year-old son, Chandan Thakur, made a flurry of calls to hospitals in the nearest cities—Kathmandu, Chitwan and Pokhara—as his father’s blood oxygen levels dropped below 60%. None of them had available beds or ventilators, he said.

On Monday morning, Mr. Thakur, 50, died of acute respiratory distress syndrome due to Covid-19, despite the hospital’s efforts, Dr. Pandey said.

Steep Covid-19 Rise in Nepal Mirrors India’s Surge 2

A Covid-19 ward of a hospital in Kathmandu, Nepal, last week.


Niranjan Shrestha/Associated Press

The Covid-19 wave now battering India and Nepal shows the danger for many regions of the developing world that remain largely unvaccinated. Public-health experts and scientists say a highly infectious coronavirus variant first identified in India appears to be fueling a precipitous rise in cases in Nepal, and await the genomic sequencing of more samples to be certain.

In early March, Nepal was reporting around 100 new daily Covid-19 cases. In recent weeks, new daily cases have shot up to more than 9,000, the highest since the pandemic began, and about 200 people are dying a day, according to the Ministry of Health and Population.

The numbers don’t likely reflect the full extent of the surge. The positivity rate for coronavirus testing has been about 45% in recent days. The high rate is mainly due to the country’s limited testing, said Laxman Aryal, Nepal’s health secretary.

Since November, the government has been limiting the availability of free testing, treatment and quarantine centers to those most in need, saying the resource-constrained country needed to save money to buy vaccines. Now the country tests only people with symptoms and those who have been in immediate contact with people who have tested positive, said Mr. Aryal.

Steep Covid-19 Rise in Nepal Mirrors India’s Surge 3

A vaccination center in Kathmandu last week; as of the end of April, 1.2% of Nepal’s population had been fully vaccinated.


Abhishek Maharjan/Pacific Press/Zuma Press

Despite the efforts to save money for vaccines, by the end of April the country had fully vaccinated only about 362,000, or 1.2%, of its 30 million people, an example of how far developing countries lag behind the U.S. and parts of Europe, where vaccination campaigns are already setting the stage for economic recoveries and a steady return to normalcy.

Nepal isn’t the only country to see a recent increase in cases, but the surge here has mirrored the rapid rise in India.

Public-health experts say the surge in India has likely spread to Nepal through the countries’ shared open border. Hundreds of thousands of Nepali migrant workers, fleeing India’s outbreak have returned home, with little to no screening at border checkpoints. Nepali Hindus also traveled to India to participate in this spring’s Kumbh Mela festival in northern India—including the country’s former king and queen, who tested positive soon after returning.

Preliminary results from a small number of samples suggest variants circulating in India are now present in Nepal. A lab that did genomic sequencing of a dozen samples in the Kathmandu Valley in late April and early May found that 11 of them were versions of the variant first identified in India, B.1.617, and one was the variant first identified in the U.K., B.1.1.7, said Dibesh Karmacharya, executive director of the Center for Molecular Dynamics Nepal.

Nine of the 12 were of one particular subtype of the variant, B.1.617.2. “It is the same one creating havoc in India right now,” said Mr. Karmacharya.

The government has sent a wider pool of samples to the World Health Organization for genomic sequencing, said Mr. Aryal, the health secretary.

India has put vaccine distribution to other countries on hold as the country battles the world’s fastest-growing Covid-19 surge. The delay in distribution is hampering the global vaccination effort. Photo illustration: Laura Kammermann

The country’s hospitals meanwhile are seeing more severe cases of Covid-19, including among younger patients in their 30s and 40s, which they are guessing is due to mutations in the virus that are making it more virulent, Nepal doctors and health officials said.

“The disease has become unpredictable, and we are struggling to understand it,” Dr. Pandey said. “Compared to the first wave, the patient’s condition this time is deteriorating very fast before we can do much.”

The crisis now gripping Nepal is a cautionary tale for other small developing countries with weak healthcare systems and little vaccine protection.

“I am afraid that if you don’t have a very systematic approach to this problem, we are going to run again and again with the second wave and third wave and the fourth wave, and so on,” said Mr. Karmacharya. “And each wave, you are going to have a stronger variant.”

Nepal started its vaccination campaign in January with about 2.3 million doses of vaccine from


PLC. About 1.5 million people have been left waiting for their second dose. Nepal has ordered an additional one million doses from the Serum Institute of India with an 80% advance payment, but those have been held up because of India’s suspension of vaccine exports, said Jageshwor Gautam, a spokesman for the health ministry.

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A Covid-19 patient in the corridor of a Kathmandu, Nepal, emergency ward earlier this month.


Niranjan Shrestha/Associated Press

As of April 2020, Nepal had only 840 ventilators, about 1,600 ICU beds and fewer than 200 hospitals with intensive-care facilities, according to the health ministry. There were 23,146 medical doctors in the country in 2019, according to the World Health Organization data, amounting to eight for every 10,000 people, compared with 9.2 in India and 26 in the U.S.

The most immediate concern, though, has been the lack of medical oxygen. Nepal has the capacity to produce 8,000 to 9,000 oxygen cylinders a day, but the demand is nearly twice that amount, said Mr. Aryal. India is continuing to supply the country with liquid oxygen even as it struggles to fill its own domestic need, and China has sent hundreds of oxygen cylinders, he said.

Dr. Pandey, the medical superintendent of the Trishuli Hospital, said he has been getting calls from Kathmandu hospitals asking if he has beds and oxygen available at his hospital. The district hospital has only 25 Covid-19 beds but is currently caring for 80 patients with the disease, all of them needing oxygen support. Patients have been streaming in from nearby cities, including Kathmandu, and the hospital has started running out of its stock of oxygen, he said.

On Sunday evening, as Mr. Thakur’s condition deteriorated and his family couldn’t find a hospital bed elsewhere with a ventilator, the doctors tried to use a ventilator from the hospital’s ambulance. But the doctors couldn’t get the machine to work properly. A nurse tried to keep Mr. Thakur breathing through the night using manual bag-mask ventilation, Dr. Pandey said.

“Despite our utmost wish that he live, he died,” said Mr. Thakur’s son.

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The bodies of Covid-19 victims were moved to prepare for cremation in Kathmandu, Nepal, last week.


Niranjan Shrestha/Associated Press

Write to Krishna Pokharel at [email protected]

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