Dr Suresh Tamang
The recent novel coronavirus [COVID-19] pandemic has spread all over the world. It has become the most significant public health crisis in decades. It has disrupted the lives, economies, and societies of developed countries such as the USA, Italy, France, Spain, Iran, China, the UK, and Germany as well as lower and middle-income countries (LMICs). As of today, 3,584,174 cases of coronavirus have been registered, of which a total death count of 251,575 and a total recovery count of 1,167,991 has been recorded. Coronavirus cases and deaths in the SAARC vary and Nepal, Maldives, and Bhutan seem to be impacted less than other countries. However, the viral threat has led to a worldwide quarantine for over a month now and will definitely have multi-faceted impacts on Nepal’s economy, trade, travel industries, daily life, and especially the healthcare system.
Initially, the Government health care system is solely responsible for taking care of people’s health. However, they remain stagnant in severe situations requiring immediate action. While there are a few studies conducted regarding COVID-19’s impact on health, social life, and finances, there are no studies about the multidimensional impacts on government hospitals in Nepal. It is also a critical but undiscovered issue as the healthcare system has been pushed to the breaking point.
The impact of COVID-19 on government hospitals is a very crucial issue that we have to study in the near future. In order to measure the impacts of the COVID-19, there is limited data available. We should also talk about the post-pandemic recovery and longer-term plans.
Nepal’s Situation:
It has been 43 days of the lockdown. The general lives of people have been impacted. Most economic activities are reduced, except for those considered essentials. The public transportation system and both domestic and international airlines are completely closed. In such a harsh time, Nepal will face a huge health crisis, economic challenge, and also other aspects of burden. The World Bank has estimated that the economic growth of Southeast Asian nations will fall down and remain between 1.5 – 2.8% due to the COVID-19. The Central Bureau of Statistics also has forecasted the economic growth of Nepal will shrink down to 2.27% for the current FY 2076/77.
According to the Ministry of Health and Population (MoHP), in Nepal, out of over 13,000 people who have been tested, 82 cases were identified as infected, 16 persons have recovered. However, no death has been reported yet. Since we have entered the third stage of virus transmission by identifying community transmission, the MoHP has now begun rapid diagnostic testing in all provinces. Many hospitals have upgraded their capacity to provide testing, isolation, and treatment for suspected cases of COVID-19 cases.
Numerous government hospitals were suffering from a limited supply of basic personal protection equipment [PPE]. These include the gowns, masks, eye goggles, gloves, shoe covers, or boots, which are essential for test labs and frontline healthcare workers. Most hospitals do not have the real-time reverse transcription-polymerase chain reaction (RT-PCR) for testing due to the lockdown imposed by the government. There are a limited number of ventilators, RT-PCR machines, and hardly around 105 GeneXpert machines in government hospitals across Nepal. In order to conduct rigorous lab tests, we need to have biosafety chambers, micropipettes, incubators, centrifuges, and reagents. Besides central government hospitals (including the Sukraraaj [Tropical and Infectious Disease] hospital, Armed Force and Nepal Army hospital), all provincial and major hospitals, and also Karnali Academy of Health Science, and BP Koirala Institute of Health Science have been designated for COVID-19 responses and testing labs. Altogether, Nepal now has 17 labs to test COVID-19 with RT-PCR. Few private hospitals have started the RT-PCR testing recently to complement the Government efforts.
The Government of Nepal has already developed and implemented various strategies such as lockdown, awareness programs through social media, and temporary hospitals to keep suspected people in isolation. 19 standard protocols and guidelines to prevent, track, and treat coronavirus have also been developed and implemented. The country’s borders are sealed in both India and China. A high-level Coronavirus Coordination and Management Committee (CCMC) has been formed and provides active leadership to fight against COVID-19.
Likewise, the tracking, contact tracing, isolation, and testing capacity has been increased. More than 49,000 quarantine beds have served for over 22,000 people and over 3,000 isolation beds are managed. There are 2 call centers [1115 and 1133] and a COVID-19 tracking/reporting application has been developed and implemented.
Economic and Healthcare Burden
A global pandemic like this will have an unfolding and devastating economic impact, which most counties have started facing. It also has impacted Government hospitals from its preparedness to tracking, isolating, and treating the identified and managing suspected cases. Hospitals across the country are impacted by the financial burden of managing isolation beds and quarantines to collecting throat swabs and setting up fever clinics or contact tracing and arranging biomedical equipment such as GeneXpert, PCR machines. Infection prevention and safety-related PPE, reagents, and other supplies, mobilizing and boosting staff morale remain as other prevalent logistical issues. Selected central, provincial, and regional hospitals were forced to set up testing labs, as it is difficult and costly to transport the throat swabs [sample] to major hospitals or labs with testing services. The coronavirus has added a huge economic burden and logistic challenges to hospitals, on top of the preexisting panic and stress citizens, are facing. This has also disrupted the essential regular services of hospitals such as ER, OPD, MCH, and FP, which has altered people’s access to services.
External Support to respond COVID-19
The Government's Central COVID-19 Relief Fund is growing every day. Some private charities, industrialists, and entrepreneurs have donated a big chunk of funds to support the government. Many external development partners are supporting Nepal. The World Bank has approved USD 29 million under the fast track facility to Nepal as part of the COVID-19 emergency response and health system preparedness project. This has supported Nepal to manage provincial testing labs, PPE, ICU extension, contact tracing, and isolation wards. China has also committed to providing subsidized support of critical supplies and PPE for Nepal. Nick Simons Institute (NSI) has donated 10 portable ventilators and over 2,000 PPEs to the Nepal Government. Similarly, UNDP, UNICEF, Save the Children, Lions International, World Vision International, KOIKA, Mission East Nepal have also supported PPE and other essential supplies, some of them being specifically donated to the Karnali province. Recently, the EU has also committed Euro 75 million in funding support to Nepal to fight the virus threat. A Chinese NGO called China Foundation for Poverty Alleviation (CFPA) is active in the Dhanusha district with the collaboration of its partner in Nepal.
Social Impacts of COVID-19
Recent publications have indicated that there were issues of inequitable distribution of resources in tracing/tracking and treating suspected cases. In other cases, conflicts arose due to the unfair distribution of relief and supports. A strong health system is inseparable from broader social/political systems because health protection only functions when the health system considers social inclusion, social justice, and social equity. The COVID-19 responses have to be free of discrimination and racism. There are still thousands of Nepalese stranded in the borders of India due to lockdown.
Moreover, the COVID-19 has caused disruption to the daily lives of people, but most importantly, a huge burden to regular services in hospitals. However, it has also offered hope and a sense of admiration for those seeking careers in the healthcare field. It has given our health system the lesson to be prepared for the worst situations and remain proactive with available resources in such pandemics. Preparedness is an integral part of the health system, and it is essential for health emergency disaster management.
Many frontline healthcare workers are forced to work additional hours and long shifts. They have less time to spend with their families. In addition, the lack of PPE has taken the lives of some health workers in the world. The pandemic has also impacted the health workers with possible fear, anxiety, uncertainty, safety, and illness, as well as unpredicted work hours and new knowledge. Thus, the study is equally important to understand how the COVID-19 has affected the frontline health workers as well. Among common citizens, some studies have shown that the prolonged lockdown and its economic impact could exacerbate Nepal’s hidden mental health crisis. Due to job cuts and economic downturn, a lot of families and individuals will suffer poverty, even leading to homelessness. The UNFPA has estimated an increase of unwanted pregnancies during and after the Corona crisis due to a lack of access to family planning devices and services.
Conclusion:
In summary, the detailed impacts of COVID-19 have to be studied further soon or after this pandemic. However, we can already foresee some impacts and have to be prepared for more severe effects of the threat in the future. Only then will we be able to determine the impact of this situation on our healthcare system, economy, trade, and the lives of millions of common people. Let us not forget that health is not only a medical but also a psychosocial and spiritual phenomenon; we have to look at it holistically and through an ecological perspective.
In addition, the citizens are also responsible for self-care, protection, and physical/social distancing in order to protect themselves, their families, and the community. This will not only prevent disease transmission, but will also reduce the financial, logistical, and economic burden faced by the country, frontline healthcare workers, and the entire nation.
-Suresh Tamang, PhD
Researcher and Social Justice Advocate
