The COVID-19 pandemic in Nepal was part of the worldwide pandemic of coronavirus disease 2019 () caused by severe acute respiratory syndrome coronavirus 2 (). The first case in Nepal was confirmed on 23 January 2020 when a 31-year-old student, who had returned to Kathmandu from Wuhan on 9 January, tested positive. It was also the first recorded case of COVID-19 in South Asia. Nepal's first case of local transmission was confirmed on 4 April in Kailali District. The first death occurred on 14 May. A country-wide lockdown came into effect on 24 March 2020, and ended on 21 July 2020. As of 26 July 2022, the Ministry of Health and Population (MoHP) has confirmed a total of 984,475 cases, 968,802 recoveries, and 11,959 deaths in the country. In the meantime, 5,804,358 real-time RT-PCR (RT-qPCR) tests have been performed in 40 laboratories across the country. The viral disease has been detected in all provinces and districts of the country, with Bagmati Province and Kathmandu being the worst hit province and district respectively. As for Nepalese abroad, as of 26 July 2020, the Non-Resident Nepali Association has reported a total of 12,667 confirmed cases, 16,190 recoveries, and 161 deaths across 35 countries.
From January to March, Nepal took steps to prevent a widespread outbreak of the disease while preparing for it by procuring essential supplies, equipment and medicine, upgrading health infrastructure, training medical personnel, and spreading public awareness. Starting in mid-January, Nepal established health-desks at Tribhuvan International Airport as well as at border checkpoints with India. Land borders with India as well as China were later completely sealed off, and all international flights were suspended. All academic examinations were cancelled, and schools and colleges were closed. Quarantine centres and temporary hospitals are being set up across the country. Laboratory facilities are being upgraded and expanded. Hospitals have been setting up ICU units and isolation beds. The SAARC countries have pledged to cooperate in controlling the disease in the region. India, the United States and Germany increased their support to Nepali health sectors.
The pandemic forced Nepal to cancel the then ongoing Visit Nepal Year 2020 tourism campaign. The country's economy is expected to be severely affected due to the pandemic's impact on tourism, remittance, manufacturing, construction, and trade. The World Bank has warned that the pandemic could push about one-third of the country's population below the International Poverty Line (i.e., $1.90 per day).
Vaccination for COVID-19 began in Nepal on 27 January 2021.
Background
COVID-19 pandemic
The ongoing pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak was first identified in Wuhan city, Hubei, China, in December 2019 and recognised as a pandemic by the World Health Organization (WHO) on 11 March 2020. As of , cases of COVID-19 have been reported, resulting in reported deaths. Many people have recovered, although there may be a possibility of reinfection. The case fatality rate was estimated to be 4per cent in China, but varies significantly between countries.
Common symptoms include fever, cough and shortness of breath. Complications may include pneumonia and acute respiratory distress syndrome. The time from exposure to onset of symptoms is typically around five days, but may range from two to fourteen days. There is no known vaccine or specific antiviral treatment. Primary treatment is symptomatic and supportive therapy.
Recommended preventive measures include hand washing, covering one's mouth when coughing, maintaining distance from other people, and monitoring and self-isolation for people who suspect they are infected. Authorities worldwide have responded by implementing travel restrictions, quarantines, curfews, workplace hazard controls, and facility closures.
The pandemic has led to severe global economic disruption, the postponement or cancellation of sporting, religious, political and cultural events, and widespread shortages of supplies exacerbated by panic buying. Schools, universities and colleges have closed either on a nationwide or local basis in countries, affecting approximately per cent of the world's student population. Misinformation about the virus has spread online. Due to reduced travel and closures of heavy industry, there has been a decrease in air pollution and carbon emissions.
Nepal
Nepal is a landlocked country with China in the northern side and India in the east, west and south. Nepal shares a border with Tibet Autonomous Region, in the Himalayas. China is Nepal's second-largest trading partner. Nepal has an 1,800-km open border with India in the east, west and south. Nepal lies in South Asia, one of the least developed and most densely populated world regions, that performs poorly in education as well as health care and sanitation metrics. As such, Nepal was considered one of the highest risk areas for the pandemic, and also one of the least prepared. However, WHO later re-classified Nepal to less at risk from its initial classification as "Very Vulnerable".
According to The Kathmandu Post, before the pandemic, hospitals in Nepal had few ICU beds (just three in Teku Hospital) which were almost always occupied, with people in critical condition usually having to wait for the beds to become empty. It reported doctors as saying that it would be next to impossible to admit new patients to ICU as soon as they need them. Teku Hospital, the only one designated for handling infectious diseases, had built an isolation ward during the avian influenza outbreak a decade ago, but had never brought it into use, as it did not have experts to evaluate or maintain the required standards.
As news of a new infectious disease in China broke, concerns were raised in Nepal over the high potential risk, the need to implement preventive measures and a severe lack of necessary medical equipment and infrastructure. According to Baburam Marasini, former director of Epidemiology and Disease Control Division, Nepal lacked double-cab ambulances to transport highly infectious patients safely, isolation wards in hospitals, or biosafety level-3 or better laboratories needed to test for highly infectious diseases.
Timeline
The first COVID-19 case in Nepal was confirmed on 23 January in a 32-year-old man who had returned from China on 9 January. The patient had shown mild symptoms, and was confirmed recovered when he tested negative on 29 and 31 January. Though a few suspected patients were treated in the makeshift isolation ward of Teku Hospital, no new cases were reported until the last week of March. Nepal focused its efforts on planning, prevention and preparation.
In the third week of March, Nepal began to see a significant influx of people from India as India saw increase in new cases throughout the country. A noticeable outflux of people from the Kathmandu Valley was reported. The second case was confirmed on 23 March in a young woman who had recently flown to Kathmandu from France via Qatar. A nationwide lockdown was implemented on 24 March. By 4 April, six additional cases had been recorded in people who had recently returned from abroad. The same day, the first case of local transmission was confirmed; a relative of one of the patients confirmed that day also tested positive.
The figures nearly doubled on a single day on 17 April, when 12 Indian nationals from Delhi, quarantined in a mosque in Bhulke of Udayapur, tested positive for the disease. Increased testing in the Bhulke area discovered 16 new cases within a week. Only four new patients were found in Bhulke in the following weeks; the first case outside Bhulke was confirmed on 14 May in a journalist from Gaighat Bazaar who had reported from Bhulke and attended other coronavirus-related events, bringing the total in Udayapur to 33.
On 30 April, the total number of confirmed cases stood at 57; 16 of them had been discharged from hospitals after recovery. Banke district recorded its first case on 1 May. Contact-tracing in the district discovered 22 new patients by 5 May. Parsa district, which had found seven cases of the disease in the preceding months, recorded 17 new cases on a single day on 5 May. Two youths who had been quarantined in Kapilvastu, having returned from Mumbai, tested positive for the disease on 6 May. By 11 May, Kapilvastu had a total of 15 cases; the district was sealed off for a week. The neighbouring district of Rupandehi which had recorded its first case on 30 April, also emerged as a hotspot. With Jhapa and Rautahat also recording more than 20 cases each, and isolated cases throughout the country, Nepal's coronavirus tally doubled almost every week in May – it was at 59 on 1 May, but had reached 1042 on 28 May.
The first COVID-19 death in Nepal was that of a 29-year-old postnatal woman from Sindhupalchok on 14 May.
Response Sukraraj Tropical and Infectious Disease Hospital is the designated primary hospital for the treatment of COVID-19; isolation wards, makeshift hospitals and quarantine centres have been established throughout the country. Nepal Public Health Laboratory in Kathmandu was the only laboratory capable of testing for the disease as of 15 March; laboratory capabilities were later expanded to other major cities. The Epidemiology and Disease Control Division devised its own treatment protocol in early February, based on the one developed by UN Health Agency, and directed all private hospitals to strictly follow the guidelines.
On 29 February, the government formed a high level committee to prevent and control the spread of COVID-19 under the leadership of Deputy Prime Minister Ishwar Pokhrel. On 20 March, the Health Ministry instructed public employees to report on weekends as well, and not leave the Kathmandu Valley. The government declared a Rs 500 million fund with contributions of a month's salary from government ministers. It also increased the allowances for health workers working at the front desks of hospitals by 50–100%.
The Minister of Health declared that all patients of COVID-19 would be rescued as necessary and provided free treatment.
Hospitals On 23 January, Dr. Bashudev Pandey, director of Teku Hospital, was quoted as saying that the hospital was on high alert, while three other hospitals – Nepal Police Hospital, Patan Hospital and Tribhuvan University Teaching Hospital – would also treat the disease. Six beds in Teku Hospital had been allocated for isolation of suspected patients. By 4 February, national capacity for treating coronavirus was at 43 beds. By 21 March, Gandaki Province had set up 111 isolation beds.
A meeting of the high-level coordination committee for prevention and control of COVID-19 on 17 March decided to add 115 ICU and 1,000 isolation beds in the Kathmandu Valley. It also instructed the provincial governments to set up a total of 120 ICU beds. On 20 March, the Health Ministry decided to halt non-urgent health check-ups and surgeries until 12 April in hospitals in the Kathmandu Valley with 50 or more beds. On 21 March, the Health Ministry informed that private hospitals with more than 100 beds would not be allowed to refer patients to other hospitals; they were required to treat suspected patients, wait for test results and provide free treatment if the disease were confirmed.
Quarantines The passengers and crew of the flight that evacuated the stranded from Hubei in mid-February were quarantined for two weeks at Kharipati in Bhaktapur. On 21 March, around sixty passengers from COVID-19 affected countries that landed on Tribhuvan International Airport were sent to quarantine at Kharipati, Bhaktapur; they had not presented any symptoms.
Testing