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When She still has Time, Nepal can avoid what Italy, or the United States Suffered From!

By: Dr. Sanjeeb Sapkota
Of the two ways the infection rate increases in Nepal, one is the exposure to the existing infected person. Tracking the exposed persons, isolating them, testing them and tracing them for at least 21 days (not 14 days but 21 days, to add an extra layer of caution) are the only ways not to let the exposed person spread the virus to the other.
(Nepalese returning home from Trinagar Customs in Kailali on Thursday. More than 2,500 Nepalese have returned home through the border on Wednesday and Thursday, Attaria, 8 June, 2020. Photo: Meen Thakuri-RSS)

Sitting between the mega-countries, India and China, each of who has tens of thousands of infected individuals, Nepal still has far smaller number of individuals infected with Corona Virus so far, 444, as of May 20. This is but not counting those who are yet to be tested but has the virus inside them.

The rate of spread could potentially accelerate as Nepal faces hurdles in keeping its infected number low.

On January 30, both Italy and the United States had zero reported infected individuals. But in the span of 12 weeks, by April 30, each country had hundreds of thousands of infected individuals and thousands of tragic.

There are two major ways Nepal’s rate of infections could go up: spreading the virus by the currently infected individuals and by importing the infections from outside. fatalities.

The transmission from an infected person to a healthy person depends on the dose of viruses i.e. amount of virus that gets inside the body. The dosage itself depend on two inevitable factors: the distance between the persons, and the length of time they are close. Closer the two persons the higher the probability of the infection, the longer the two persons are closer, even higher the probability of the virus getting inside the body.

The spread of any infection occurs in a triad of these components: agent, host and environment.

Corona virus is the agent, humans are the host and the medium the agents get inside host is the environment. Hands, closed or open spaces are examples of environment. Analogous to tap water in our kitchen sink where the water stops when the tap is turned off, the virus stops going from one person to another when they are rid of hands via washing with soap and water.

The chances of a healthy person getting infected is reduced astronomically if both the persons, infected and the healthy, cover their nose and mouth with any (100 percent-cotton) clothes and if the health person washes hands thoroughly with soap and water for no less than 20 seconds before his touching nose, mouth and eyes.

Corona is the respiratory virus and it enters inside us not by eating, like in hepatitis, or via blood like in HIV, but via nose, mouth, and seldom via eyes, to our nasal and oral cavity and through to our lungs. Hands play critical role in transmitting the virus. “Hands has a big hand in infecting a person”. Even if the hands are full of viruses, if they are thoroughly washed with soap, they become virus-free.

Of the two ways the infection rate increases in Nepal, one is the exposure to the existing infected person. Tracking the exposed persons, isolating them, testing them and tracing them for at least 21 days (not 14 days but 21 days, to add an extra layer of caution) are the only ways not to let the exposed person spread the virus to the other.

Contact Tracing is the age-old proven public health method used in any outbreak to keep the uninfected persons from the infected person or from those who are exposed to the unexposed persons. Ebola outbreak in western Africa in 2014, measles outbreak in California or food-related outbreak that happens often in different countries, experts use Contact Tracing to identify who are exposed to the infection and follow them over time to ensure they do not infect other.

The aim of Contact Tracing is to separate the two groups, those exposed to the infected person and the healthy, until it is confirmed the exposed group does not have infection. But if they do then keep them isolated until they are treated and become fully virus-free. This breaks the chain of the virus transmission, slows the outbreak and eventually stops it.
How to find the exposed people? The close contacts are the exposed people.

Close contacts of the infected persons are the exposed people. They are household members, co-traveler in the car or an elevator, and those in a bus or train who are within 2 meters from the infected persons.

If a nation is to sincerely track the exposed people so that they do not infect other, be it the United States, Italy, Qatar or Nepal, a massively large number of volunteers are needed. They could be skilled and semi-skilled. Students of medicine, pharmacy, nursing, university, colleges, scouts, boys and girls, female community health volunteers (FCHV) and other could be recruited and trained.

In the United State where there were 30,000 new infection a day this past month, hundreds of thousands of Contact Tracers would be needed, or may be millions, if the chain of infection is to be contained. In Nepal where there are 444 with confirmed infection so far, few thousand contact tracers could suffice.

Calling out and recruiting Contact Tracing volunteers and training them are crucial initials steps. Once they are identified and trained, they need to be kept engaged and in standby mode.

Every exposed person needs to self-isolate in home or in shelter provided by the government or non-government agencies. What does self-isolate mean? It means staying, sleeping and eating alone in a room, not coming within 6 feet of any other family member, washing own clothes, disinfecting utensils and clothes used and covering nose and mouth except while sleeping—for at least 21 days.

Each exposed person needs to be paired with a contact tracer. If volunteers are insufficient for one-to-one tracing, then one to several person tracing could be done. The contact tracer would follow up daily with the isolated person, talk about his or her symptoms, keep him/her motivated and socially engaged keep the safe distance.

All the exposed person could not be found and located. Contact-tracers task include locating them, making connections with them, arrange social support, answer their questions and help them stay engaged.

If government or non-government created shelters are available for the exposed, those are preferred over home self-isolation.

Digital applications, phones, internet as well as paper back up are tools for tracking and tracing exposed people.
The second way the infection would increases in Nepal is via the importations of the virus brought inside her border either by the foreign nationals or by the repatriating citizens.

What Nepal has done hardly any other nation has done: closed her border not only to other nationals but to her own citizens. This is by far the best measure to ensure the infected person is kept from entering inside the country. This is akin to closing the tap in the sink so tightly the water would not flow.

Though best for public health, sealing the border for long comes with heavy price. It could not remain closed for longer, and once it re-opens, Nepal need to allow only those who are free from infection. To make this happen, anyone entering Nepal need to be tested and receive a negative test 7 days prior to on-boarding the plane bound to Nepal or entering via land border. Once in Nepal they need to go in mandatory 21 days quarantine.

Hotels, gymnasiums, schools, community houses in Kathmandu or outside in provinces should be used as places of quarantine.

In Italy or the United States, contact tracing of the exposed did not happen in the initial stage of the epidemic. This allowed an unrestrained insidious spread of the infection across the country. Nepal facing quandary should rigorously track, isolate and trace those who are exposed. This helps tremendously in breaking the chain of virus transmission, slowing the outbreak and preventing her from suffering what Italy, Spain, United Kingdom or the United States are suffering.

(Dr. Sapkota is a medical epidemiologist, works at a federal health agency in the United States, is the chair of Health Committee of non-Resident Nepali Association, and the vice-president of Public Health of STAR Scholars Network.)

Published Date: Thursday, May 21st, 2020 | 11:54 AM

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