Nepal does not have enough kits to test so those who do not have symptoms but likely to have contact are not tested.

Reshma Tuladhar, PhD
Microbiologist & Assistant Professor at Central Department of Microbiology, Tribhuvan University.

Reshma Tuladhar, PhD is a Microbiologist and works as Assistant Professor at Central Department of Microbiology, Tribhuvan University. Her research focus is on Dengue (vector borne disease) and the dynamics of bacterial resistance. She is a Fulbright alumnus. In this edition of B360, Dr Tuladhar helps us debunk coronavirus myths and its implications for Nepal. Excerpts:

How should we understand the Coronavirus? What do we know about it and what are we yet to know?

The Novel Coronavirus also known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a newly emerged strain of Coronavirus not identified in humans earlier. This strain is closely related to SARS virus that emerged in 2003. Disease associated with SARS-CoV-2 is COVID-19 and has been assumed to have high transmission rate compared to SARS. This virus has a unique mutation capability by virtue of which they evolve strategically to replicate in human and attribute to the severity of disease. The source of this virus has been assumed to be the bat but it has not been proven.

This virus spreads mainly through droplets of saliva or nasal discharges the infected person sneezes or coughs. Infected person shows symptoms within 5-6 days or even after 14 days of infection. Not only does the person exhibiting symptoms spread the virus but pre-symptomatic person (who has been infected but symptoms not shown) can be contagious too. The virus can persist in environment for certain period of time but the exact time period they persist is still not concluded. So protecting ourselves by wearing protective gear such as mask and using gloves when required, avoid touching surfaces unless mandatory, hand washing and sanitising, avoiding crowds and contact with people, etc will be the best to avoid potential infection.

Till date there is no specific treatment or vaccine for COVID-19. Scientists are working to develop a vaccine and explore antiviral compounds against COVID-19. Clinical trials of antibody based therapeutics have been conducted.

We hear reports of hospitals in Nepal rejecting patients who show even the slightest symptom of the Coronavirus infection. Do you think this is ethical?
I am not sure how valid this claim is. Without knowing the reason why the hospitals rejected the patients, I cannot give my opinion. Is maybe because the hospital does not have enough facility or space which compelled them to reject the patient? When hospitals even in developed countries are facing inadequate numbers of ventilators, we can imagine what the situation here in Nepal will be if cases increase. On what grounds have the hospitals rejected should be considered rather than blaming them. Hospitals may already have admitted vulnerable patients who have contacted other diseases than COVID-19.

What are the advantages of lockdown in this situation?

The 2003 SARS outbreak in Singapore made them aware of the infrastructure to be built in case of an outbreak so they have already built well equipped isolation hospitals which make them prepared. When the first outbreak of Coronvirus was reported in Wuhan, China, Singapore started massive testing for virus. Anyone tested positive were kept in isolation in hospital. Those who had no symptoms but had contacts were kept under home quarantine with tracing team periodically identifying where the person is. They maintained strict social distancing. Not all countries will have infrastructure similar to that prepared by Singapore or neither efficient tracing teams can be deployed. Thus the best option is lockdown where people will stay isolated. This will help people prevent contracting virus as well as an infected person transmitting it to another.

There are a lot of speculations on the low cases of coronavirus in Nepal as of date. What could be the reason? 

Nepal does not have enough kits to test so those who do not have symptoms but likely to have contact are not tested. If you have not tested, then you are not going to find the cases. This leads to high chances of unreported cases. Till date six cases have been reported. The number might increase once the incubation period is over and the symptoms will surface. We don’t know if it is yet to spread in the community but we cannot stay complacent about low cases being reported. Every individual needs to be alert and take preventive measures seriously.

What can the government do along with continuing the lockdown to contain the Coronavirus? 

Increase efficiency in testing and easy access to the test. Suspected people and those possibly in contact should be mandatorily tested. Priority should be given to increase hospital facility to prepare should more cases surface. To prevent community spread, people who have recently travelled need to be tracked and observed but this is not easy to implement in our country. Facilitate purchase of daily supplies maintaining distance. In the meantime, it is also the duty of every citizen to be aware, maintain social distance and abide with the lockdown.

Is Nepal even ready to face an increase in number of Coronavirus cases?
I don’t think so. It will be devastating if the number of cases increase. We do not have enough well equipped hospitals and facilities.

What are we not getting right?

Research is still ongoing to unravel numerous things about the Coronavirus. In the meantime, there has been a lot of misinformation and misinterpretation about the disease. Unless any valid conclusion has been drawn after scientific evidence from research, the claims cannot accepted.
Despite the fact that COVID-19 was first reported in Wuhan in December 2019 with fish/animal market suspected to be the source, the true source is yet to be delineated. It is also very likely that there still might be unreported cases of COVID-19 which most of the time happens in case of other diseases too.

A lot of people are using their own preventive measures to fight against the Coronavirus. Is there anything that can be done to ready the body to fight such harmful microorganisms?

Drinking warm water or eating ginger will not fight against Coronavirus, it’s a myth though warm water may soothe the throat temporarily. First thing is that this virus attacks the respiratory tract and lungs. When drinking warm water or eating ginger, it goes to digestive tract so there is no way virus can be flushed or ginger can act against it. Second, ginger does not possess antiviral effect. The only way virus is thwarted is by our immune system. Since there is no vaccine, it’s our body immune system that helps eliminate the virus. Boosting our immune system can alleviate to some extent but again it is essential to prevent from getting infected in the first place.

What can we learn from how this virus was handled in countries like Italy and Spain or in India?

The main reason Italy and Spain were hard hit was their delay in response to the outbreak. They were complacent at the beginning. Lockdown was implemented late. Besides testing was not enough. Testing was done only on those showing symptoms unlike in countries in Asia like South Korea and Singapore. Claim has been made on the high number of old age citizens since they are immune compromised group. However, this is not the major factor (although it can have some effect). Take for instant Japan has the highest number of old aged people in the world but the death rate and cases were low.

On the other hand, the cases in the most populated country like India is relatively very low. But the numbers of cases reported from different states in India is on the rise but this rise is very low compared to what we are observing in the US currently. After observing Italy and Spain, India immediately implemented lockdown, shut borders and quarantined all incoming travelers. However, again there is still chance of it spreading in the community.

What are the things China did right and wrong in dealing with Covid-19?

In order to deal with COVID-19 China implemented strict lockdown which was proven to be effective since it dramatically reduced the cases, and is now being emulated by other nations too. They suspended transportation in and out of Wuhan and other epidemic cities.

Dr. Howard Markel, a physician at University of Michigan has said that China delayed in reporting when cases of infection were detected initially in Wuhan. Had it been reported earlier, control measures could have been implemented ahead containing the spread to this extent.