Citizen held in disarray at the border and allowed to cross as the numbers infected increased only RDT commenced before setting back home
Unmanaged quarantine, ending lockdown without proper plan and evaluation of the situation, questionable home quarantine
Kathmandu – Fast to death demanding the wide scope of PCR and need for publicizing the expenses in the name of controlling Corona has reached the 11th day. Iih and Samaira Shrestha has once again continued their hunger strike questioning false hope and lack of commitment towards the prior agreement by the government. Activists affiliated to ‘Enough is Enough’ campaign filed a complaint in Commission of Investigation of Abuse of Authority CIAA, against Finance Minister Yuwa Raj Khatiwada and Secretary Shishir Dhungana alleging the duo for lack of transparency.
Prior to this, parliament’s Audit Committee’s demand to provide detailed breakdown of Nrs. 10 billion spend under the heading of Corona prevention, control and treatment, has turned to deaf ears. Meeting held on Asar 8th concluded with guidance towards the then PM’ office’s Secretary Narayan Bidari to present the figure details. He promised the committee to provide required information within two working days but he took a leave from his post. The expenditure information is yet to be delivered.
CIAA and Audit Committee are in constant investigation on procurement of medical equipment tussle. According to Nabinkumar Ghimire, Chief at CIAA, the commission is compiling evidences against Omni Group. Audit Committee on the other hand, has recently completed dialogues with personnel from the Secretary level to the officer levels regarding the faults in the procurement process. Both, Ishwar Pokhrel, Deputy Prime Minister and Minister of Defense, Coordinator for Covid-19 Crisis Management Centre (CCMC) and Bhanubhakta Dhakal, Minister for Health and Population have been dragged in the medical equipment purchase.
The government initially approved to purchase medical equipment and materials to prevent, control and treatment of Covid 19 through Omni Group. Later the decision was turned to Nepal Army based on GtoG process. However, the government faced criticism on the both. And the controversy is yet to be resolved. Demand for increasing PCR scope is getting louder and yet the state has yet to respond it effectively.
Quarantine criteria for people moving with the country were set by the government. Several quarantine locations were set up, and with less consideration to the criteria. At times of infected cases were spotted, the patients were sent straight to isolation ward for further treatment. Contact tracing was followed through. In recent days home isolation is incorporated in the criteria. Sadly, home isolation has not been followed sincerely either. Lack of proper monitoring people under home isolation or infected is another concern.
“Persons said to be under home isolations are seen at hospitals or roaming around places like normal”, says an officer at Epidemiology and Disease Control Division. “This has further dire consequences within the valley.”
Government has placed a price on PCR for the general people interested in getting the result, which has agitated the people more. In the capital, Patan, Bir and TU Teaching hospitals prove PCR at NRs. 5500. The infected are also required to pay the cost. “The test done at those three hospitals are all paid ones”, says a lab technician at Bir Hospital. “PCR conducted at the private hospitals also send sample to us.” PCR has become mandatory for any treatment in all the hospitals be it the private or the public. Private are also found out hacking 1500 rupees from the people stating to perform even the government rejected RDTs.
The loopholes
– Untimely arrangements of medical equipments
– Narrow PCR scope
– Delayed test reports
– Irregularities in Medical Equipment procurement
– Citizens stranded at borders and only allowed in once the infected hit high numbers
– Unmanaged and inadequate quarantines
– Eased lock down without proper plan and evaluation
– Home quarantine and isolation remained unchecked and unmonitored
An amendment was made not to record the death due to other diseases despite being infected by Corona as death by Covid-19. However, the action, facing criticism from all sides, was later discarded.
Irregularities in procurement
It was only after long four months after the first case of Corona was seen in China that Nepal also recorded its second infected on Chait 9th. Two days later, the whole nation went into a lock down. The government records prove that there were zero preparations four months prior to the lockdown.“Over 1 thousand and 5 medical staffs working at the front line came to the Ministry to give their resignation citing the unavailability of essential equipments for the medics such as PPE, N-95 masks, gowns etc.”, says Health Secretary Yadav Koirala in a meeting of Audit Committee held on Asar 8.”The vital items such as N-95 masks, face masks and goggles were non-existence.” Government had not even arranged a penny for medical supplies. Although, on Chait 12th, Health and Population Minister signed an agreement with Omni Group, the budget for so, was yet not decided. “No one had any idea such a pandemic can hit the world. We planned to seek for budget as we go ahead with the procedure.”
Few days afore deciding to agree in terms with the Omni Group, government was put to sword for canceling the tender for medical supplies. Tender call published on Chait 2 was canceled on 10th by the Department of Health Services. Later, under special circumstances, Omni Group with no past experience on the same field was selected for the job, which was controversial. Public Procurement Monitoring Office under Prime Minister also pointed out the shortcoming of the process in approving the Omni group. The Office said, “The reason for cancellation for the first process, and necessity of undertaking the second getaway was not clear based on the paper works made available.”
Surya Pathak, Nepal Communist party, Member of Parliament said that the country was yet to prepare as the disease was claiming lives and draining other countries worldwide. “Tender was cancelled and the contacts were made with certain company to undertake the procurement.” He said, “The reasons behind these actions are yet unclear.”
Council of Ministers on Baishakh 16 decided to hand over the responsibilities to acquire medical equipments to Nepal Army via G to G. Army was able to bring in 2 billion 26 crore worth equipments however, the PCR quality differed. Health Ministry directed to meet the criteria set by WHO and FDA for the equipments to be purchased, Army however purchased the materials that did not even pass the national standard. Moreover, the Army took ages to bring in the equipments which were even more expensive.
PCR for all provinces
At the initial phase of lockdown, PCR was only conducted by valley based National Public Health Laboratory (NPHL). Swab collected in any part of the country were forced sent to capital city for the test. The first infected person’s swab had to travel even further to Hong Kong. According to Runa Jha, Director at NPHL, on present day 28 labs at different location provide PCR tests. These labs have capacity to conduct over 15 thousand PCR tests, she shares. “PCR test results are submitted within 24 hours.
Stranded in border added more risks
Right after the announcement of lockdown, Nepali citizens who tried to enter the country were stranded at the borders. An agreement was reached for the people from both sides to be managed within the respective boundaries by either government. The infected score in India was minimal at the time of mutual understanding. As the numbers of infected soared up, people stranded in the borders were allowed to enter Nepal. The trend of entering the country continued via different routes; be it swimming through the river, crossing during night times. Local governments were assigned to manage the foreign returnees. Province government also sanctioned budget for quarantine management to the local level governments.
A compulsory quarantine for those coming back from India was managed. “Government was successful to restrict chances of spreading the disease with its approach of the quarantine, limiting their movement regardless of whether they are infected or not, no one is allowed to enter any community. It is an appreciable act by the government.” says Dr. Baburam Marasini, Former Director Epidemiology and Disease Control Division. “However, the management within quarantine was found lacking.”
‘No intention to reduce PCR tests” says Health Minister
Dr. Marasini noted that it was a shortcoming from the government’s side not being able to manage people in the quarantines after allowing people at the border to enter the country shortly after the lockdown. “At that time, it would have been effective if the people at the borders were kept in the quarantines”, he says, “People got infected since they were kept in unmanaged quarantines in India, who later came in contact with the people at the quarantine in Nepal.” People at quarantines were also sent home after a quick RDT tests – this was a fatal error by the government.
Government had developed criteria of operating and managing quarantine. The criteria were set to protect suspected person sent into quarantine for 14 to 17 days. Minimum facilities for the quarantine includes a room with attached bathroom, if available otherwise a toilet for six people and a bath room with basic facilities of electricity, water, telephone service, medical support (MD/MPH in Community medicine, Medical Officer, Nurse, Lab Technician, Pharmacist each). Three times meals should be served. However, not all the quarantines consist of all the facilities. Some people fell ill and died in quarantines. Cases of quarantined people escaping the location just for defecation were recorded in Province 2. Similarly, there were reports that the quarantines were left empty at night as people would stay in the spots in the day time and later head back home for the nights. Holding centers are in operation at the check points to collect information from the arrivals via India or other countries, and then sent at respective local government level quarantines and home isolations.
Quarantine hotspot for suicide and rape
A 49 year male had committed suicide in a quarantine located at Rishing rural municipality, Tanahu. Similarly, a 23 year old also took own life. Dev Bahadur BK from Shit Ganga municipality, Arghakhanchi received positive in RDT test before committing suicide. A person at Dailekh who recently returned from India ended own life. He was tested positive in a PCR test. Badmalika-2, Bajura police reported a man commenced suicide in a quarantine at Satyavaadi High School at Bhaura.
Raju Sadaa, 16 year old from Prasahi, Hansapur Municipality, Dhanusha suffered a severe diarrhea whilst at the quarantine. He did not receive any treatment for such a common disease. Later he was taken to an isolation ward at a hospital; where he took his last breathe.
A 31 years old womanwas raped in quarantine at Lamki, Kailali. She has returned from India on Jeth 20th and stayed in the quarantine before being raped by the volunteers at the location.
An unplanned ease of lockdown
City areas and markets were empty as the government imposed nationwide lockdown. As the ordeal elaborated with third announcement of its extension, people started to come out. At first the hordes began to flow from cities to village areas. It escalated to such extent that even the local government and the political parties were involved in reserving vehicles to take their cadres and voters back to the desired locations. As lockdown elongated for more than three months, now the opposite flow of the people began. Lockdown was eased from Shrawan 7 with everything else except long route transportations, academic institutions and movie theaters were announced open for all.
As the result, number of infected with visible symptoms have increased in an alarming rate. Although it was said border entries will be sealed to discourage movement, to and fro is still in practice without any restrictions. Most of the people coming from India have PCR positive reports. “At the beginning, lockdown was quite effective. However, following the decision to ease the lockdown, no proper planning are put into consideration in managing and monitoring the future situation”, says Dr. Marasini, “The effect is the infected people with characteristics of the diseased person with Covid. Tarai region including Birgunj, Biratnagar are now showing the effects of clueless lift of lockdown.”
Limited scope of PCR
An application was placed addressed to Supreme Court of Nepal stating the mandatory PCR procedure test before sending the patients from quarantine and isolations to home and not to implement National Testing Guidelines issued by the government. On Asar 8, the court issued an interim order addressing the application, to compulsorily conduct PCR test for those returning home. Lakshman Aryal, Secretary at Health Ministry submitted an application to dismiss the decision stating that government in no position to conduct as per order from the court.
The Health ministry issued a guideline on Jeth 20 that approved anyone completing certain period at the isolation to be sent home without any test for the disease. The government has cited that it cannot afford the required. On the other hand, the court issued the order to send the patients home only after the mandatory PCR test and assurance of recovery from the disease. Health Ministry registered an application Asar 14 requesting to scraping the decision.
It is an obvious desperate attempt by the government to cover its short comings and irregularities by forcing the demand via application to the court, claiming that asymptomatic patients and those recovering from the disease do not require any PCR test. “We have limited resources that are only adequate to test the suspicious persons or the people that has come in contact with the infected.” It is written in the application sent to the court demanding the discard of the order, “This leads to minimize any unnecessary burden to the laboratories and assures timely submission of the results, although PCR for all is not possible.”
“Following the guidelines, it would be far easier to admit the infected to the isolation and carry on the treatment as well as assure people’s right to health. PCR tests on asymptomatic patients if shown positive will put pressure on availability of bed, people with symptoms and those getting treatment will have bed to continue their medical treatment.” It added that PCR tests following the 14 days isolation stay would only delay the discharge of the patient further leading to shortage of bed for those in dire need, thus the numbers of PCR tests were narrowed down. The ministry claims that recent study revealed that the PCR test positive on those infected above 10 days have not caused wide spread of the disease. The guidelines instruct no further tests required on the cured patients and asymptomatic patients, informs the Ministry.
Leading party in leaders tussle
The announcement of Prime Minister KP Sharma Oli over 10 billion expenditure in Corona prevention led to a mass question over the details from all sides. Youth went on hunger strike against the government demanding the complete halt of RDT tests and a 100 percent PCR procedure Corona tests. Streets were agitated. Government declared on Asar 15 to conduct over 10 thousands PCR test. That declaration has yet to be accomplished.Voices raised from quarantines as well over the snail paced submission of PCR test reports. Even the court forced writ to increase the range of PCR test.
According to Health and Population Ministry, by Tuesday numbers of Corona infected has reached 19 thousand 63. Epidemiology and Disease Control Division says within this two weeks span, infected people with symptoms are also coming in record. However, government and leading part Nepal Communist Party are absorbed in the course of survival within the power. The party leaders are more focused into strengthening their stronghold over their opponents with the party rather than showing solidarity to fight against the disease that has crippled several states globally. Since the Parliamentary Convention is over, the government need not face questioning from opposition parties.
Source: Kantipur National Daily
Pub: Shrawan 14, 2077 07:46
