[The Himalayan country is
considering declaring a health emergency to help contain a second wave that
experts say migrant laborers brought back from India.]
By Bhadra Sharma and Mujib Mashal
Then India was swept by a second
wave, and Mr. Karki wasn’t as lucky.
He was infected last month.
Hospitals in New Delhi were overwhelmed. When his oxygen level dropped, his
manager arranged for an ambulance to take him back to the border. He crossed
into Nepal, carrying with him just the clothes on his back — and the virus.
Nepal is now considering declaring
a health emergency as the virus rampages virtually unchecked across the
impoverished nation of 30 million people. Carried by returning migrant workers
and others, a vicious second wave has stretched the country’s medical system
beyond its meager limits.
Nepal has recorded half a million
Covid cases and 6,000 deaths, numbers that experts believe deeply undercount
the toll. Testing remains limited. One figure could indicate the true severity:
For weeks now, about 40 percent of the tests conducted have been positive.
A government
in disarray has compounded the trouble. K.P. Sharma Oli, Nepal’s
embattled prime minister, has been pushing for an election in November after
the country’s Parliament was dissolved this month, an event that could worsen
the spread.
This past week Hridyesh Tripathi,
Nepal’s minister for health and population, said the government was considering
declaring a health emergency as infections rise.
But such a declaration could be
caught up in politics. The move would allow officials to limit people’s
movements — a level of control that opposition groups worry could be used to
quell dissent.
In the meantime, officials in
Kathmandu, the capital, have urged people to store food for at least a week and
stay home.
The impact is rippling beyond those
infected. Remittances from migrant workers have slowed. Tourism and the economy
have been damaged.
“Millions of people continue to
feel the increasing pressure not just with the direct health impact of
Covid-19, but also with food, jobs, medical bills, kids out of school, payback
loans, mental pressure, and much more,” said Ayshanie Medagangoda Labe, the
resident representative of the United Nations Development Program in Nepal.
Nepal’s close relationship with
India helped make it vulnerable. India has long been its most important trade
and transit partner. The two nations share a deep cultural bond across a porous
1,100-mile border. Nepal’s devastation mirrors that of its big neighbor — from
patients spilling out into hospital corridors and onto lawns, to long lines at
oxygen refilling facilities, to a government
unprepared for crisis.
Officials say laborers like Mr.
Karki who were forced to come home by the second wave brought the virus with
them. Villages along the border are some of the worst hit. Nepal’s health
ministry said about 97 percent of the cases sent for genome sequencing show the
B.1.617.2 variant found in India, which the World Health Organization has
classified as a “variant of global concern.”
Nepal’s leaders were unprepared.
During India’s first wave last year, when about one million Nepali migrant
workers returned home, Nepal instituted testing and quarantine measures at
border crossings.
But during this spring’s second
wave, those measures were too little too late. By the time Nepal shut
two-thirds of its border crossings in early May, hundreds of thousands of
laborers had made it back, trickling into their villages without proper testing
or quarantine. Thousands continue to return daily.
The government’s attention had
shifted elsewhere. In February, when the virus seemed to be in retreat, Mr.
Oli held rallies of thousands of supporters in Kathmandu
and other cities. Opposition parties held their own rallies. Last year, Mr. Oli
said the health of the Nepali people would deter the disease.
The government’s defenders say that
the pandemic is a global problem and that officials are doing the best they can
with few resources or vaccines.
Mr. Oli has called for
international aid, though it won’t be enough to meet Nepal’s needs. China has
donated 800,000 vaccine doses, 20,000 oxygen cylinders and 100
ventilators. The United States and Spain have sent planeloads of medical
equipment, including oxygen concentrators, antigen tests, face masks and
surgical gloves. The United States provided $15 million this month to scale up Nepal’s Covid
testing. Nepali migrant workers in Persian Gulf nations have arranged for oxygen
cylinders to be sent home.
But Nepal can’t fight the pandemic
without help from India. Already, an Indian vaccine manufacturer has told
Nepal it can’t deliver a promised one million doses.
Nepal is also dependent on India
for half of its medical equipment needs, according to the Chemical and Medical
Suppliers Association of Nepal, but the latter country is keeping just about
everything for its own urgent domestic needs. Equipment from China, already
costly, has become more difficult to obtain because of Chinese pandemic restrictions.
“For a month now, India has stopped
the supply of medical equipment and medicine also, not just vaccines,” said
Suresh Ghimirey, the association’s president.
In some provinces that experienced
the return of many migrant laborers in India, hospitals have run out of beds.
In Surkhet district, the main provincial hospital said that it couldn’t admit
more patients. Small outlying villages are quietly mourning their dead. Testing
has been slow.
“Except a few villagers, many are
unable to come out and do daily agricultural work,” said Jhupa Ram Lamsal, ward
chief of the village of Gauri, where nine people died of Covid over 10 days
earlier this month. “The worrying thing is that even symptomatic people aren’t
ready for Covid tests.”
Mr. Lamsal said he had recently
reached Gauri, which is remote and lacks health facilities, along with a team
of doctors to conduct antigen tests. Locals turned down health professionals’
plea for Covid tests, he said, arguing they would be dispirited if they found
out they were positive.
“The situation is out of control,”
Mr. Lamsal said. “We are hopeless, helpless.”
Mr. Kakri, the printing press
worker, hailed from a village in the Bhimdatta Municipality, in Nepal’s western
corner. The area of 110,000 people has officially recorded 3,600 infections,
according to the health chief there, Narendra Joshi. But lack of measures at
the border means that the data may not fully measure the severity.
“More than 38,000 people have
returned from one of the two border points in the district since the second
wave started in India,” said Mr. Joshi. “It’s hard to manage them.”
Mr. Karki was a high school dropout
who went to India to work as a laborer when he was still a teenager, his wife,
Harena Devi Karki, said. On his visits home twice a year, he was the life of
gatherings — cracking jokes, making fun. The $350 a month he sent home covered
his family’s household costs as well as the private school fees of their two
teenage daughters and a 12-year-old son.
Even when the lockdown last year
meant Mr. Karki was stuck at home for months with no earnings, he insisted the
children continue with private school. He would repay the debts once the
printing press opened again. He dreamed of seeing his eldest daughter — “she’s
the most talented” — grow up to be a doctor.
“I couldn’t complete my studies,”
Ms. Karki remembers her husband saying. “Let me eat less, but we should send
them to a better school for their education.”
When Mr. Karki received her husband
at the border around 2:30 a.m. on April 29, she said, he was frail and lacked
the energy to even stand up. He was taken to a nearby hospital, where he died.
“‘Everything is OK. Go home,’” her
husband told her, Ms. Karki said. “But he never came home.”