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Challenges Faced by Local Governments in Controlling COVID-19 Spread

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Challenges Faced by Local Governments in Controlling COVID-19 Spread Update-4 Challenges Faced by Local Governments in Controlling COVID-19 Spread June 2, 2020 June 30, 2020 Democracy Resource Center Nepal Challenges Faced by Local Governments 1 in Controlling COVID-19 Spread Update-4 Challenges Faced by Local of the Rapid Diagnostic Test (RDT), asserting that the tests are not trustworthy and that it produced too Governments in Controlling many false results. But, due to the limited coverage COVID-19 Spread of PCR tests, RDT is still being used as an alternative of last resort. A lack of necessary equipment, the limited number of tests being carried out, lack of access to laboratories, lack of technical expertise, problems in quarantine management and difficulties Introduction in coordination and communication between the The Government of Nepal announced a nationwide three levels of governments have created additional lockdown on March 24, 2020, to control the spread of challenges in the prevention and control of COVID-19. COVID-19. At that time, only two COVID-19 cases This update focuses on local governments’ efforts to had been identified in the country. As the number of prevent COVID-19 spread, along with challenges in Nepalis returning from abroad –especially from India– quarantine management, testing, isolation treatment of increased, the number of infections also increased. patients and coordination. COVID-19 infections have been identified in all 77 districts. According to data from the Ministry of Health and Population released on June 28, a total of 215,839 Polymerase Chain Reaction (PCR) tests Challenges in the management of confirmed infections in 12,779 individuals. Of that quarantine and holding centers number, 9,731 individuals are in isolation facilities; In its preceding update, DRCN pointed out that 3,013 have recovered; and 28 have died.1 The decision quarantine facilities managed by local governments to ease the three-month long lockdown restrictions on did not meet safety standards provided by the federal June 12 has increased the possibility of the infection government and highlighted that there was a possibility spreading through the population. of the infection spreading from quarantine facilities.4 The risk of spreading infection from quarantine and Since the beginning of the pandemic, physicians isolation facilities still remains. and infectious diseases experts have been stressing the need to expand testing for the virus in order to According to statistics from Ministry of Health identify the true extent that COVID-19 has spread. and Population published on June 12, 2020, a total of Yet, testing has not been expanded to the extent 158,050 individuals were in quarantine facilities across expected. About three months ago, Kathmandu was the country. Sudurpashchim Province had the biggest the only location where PCR tests were being carried number of them, at 63,921. Province 5 had more out, but at present 22 laboratories across all seven than 34,000 individuals in quarantine facilities while provinces are carrying out approximately 7,000 tests Karnali Province had more than 27,000. In Province 2, each day.2 However, reported data also indicates that more than 18,000 people were in quarantine facilities.5 more than 30,000 swabs have not been tested and Local governments faced enormous challenges in are languishing in laboratories across the country.3 managing the quarantine stay for large numbers of Many local governments have discontinued the use citizens returning home from India.6 1 https://covid19.mohp.gov.np/#/ 2 Intermittent lack of test kits and equipment have meant that 4 https://www.democracyresource.org/reports/measures- testing is not happening at full-capacity. https://www.bbc.com/ takenby-local-government-to-prevent-transmission-of-covid-19- nepali/news-52544636 andquarantine-management-may-2020/ 3 https://myrepublica.nagariknetwork.com/news/26-000-plus- 5 Government of Nepal, Situation Report # 124 swab-samples-have-piled-up-across-nepal-more-than-10-days-to- 6 https://www.democracyresource.org/wp-content/ get-results/ uploads/2020/06/COVID-19_Update-3_3062020-1.pdf Update-4 Challenges Faced by Local Governments in Controlling COVID-19 Spread 2 Figure 1: Number of people in quarantine facilities across the country. 200000 180000 160000 140000 120000 100000 80000 60000 40000 20000 0 2-Jun 3-Jun 4-Jun 5-Jun 6-Jun 7-Jun 8-Jun 9-Jun 10-Jun 11-Jun 12-Jun 13-Jun 14-Jun 15-Jun 16-Jun 17-Jun 18-Jun 19-Jun 20-Jun 21-Jun 22-Jun 23-Jun 24-Jun 25-Jun 26-Jun 27-Jun 28-Jun Source: Ministry of Health and Population Recently, as the number of Nepali citizens returning governments across various provinces to solve issues from India decreased, the pressure on quarantine in quarantine management, carry out necessary repair facilities has decreased. By 28 June, 2020, the total and upgrading of quarantine facilities, and ensure number of individuals in quarantine facilities across that quarantine facilities meet the standards set by the the country had decreased to 61,731.7 Local units in federal government.9 Kanchanpur had been managing quarantine stays for 14,000 people at its peak, this number had decreased Around the second week of June, between 3,000 and 4,000 individuals were entering Nepal through to about 4,000 by mid-June.8 Yet, challenges associated with quarantine management persist. Officials and the Gaddachauki Check Post in Kanchanpur and the elected representatives at the district and local levels Gauriphanta Check Post of Dhangadi, which are the reported difficulties in managing waste and maintaining two main entry-points into Nepal in Sudurpashchim hygienic sanitary facilities after operating long-term Province. That daily number has now decreased to quarantines out of local schools and other public between 400 and 500 only, according to an employee buildings. The federal government has distributed at the District Administration Office of Kanchanpur. a total of NPR 130 million to nearly 176 local Similarly, nearly 2,000 Nepalis were entering the country daily through the Kakarbhitta Check Post in Mechi Municipality of Jhapa in Province 1, by the 10 7 Until June 12, the Ministry of Health and Population used to last week of June this has declined to about 200. publish data on the number of all individuals under quarantine in each province. Updates after that indicate only the total number. There is no province-level statistics. 9 https://mofaga.gov.np/news-notice/1897 8 Conversation with Chief District Officer of Kanchanpur on 10 23 June, 2020, conversation with Mechi Municipality 23 June, 2020. COVID-19 contact person. Challenges Faced by Local Governments 3 in Controlling COVID-19 Spread Update-4 Along with the decline in the number of Nepalis people from Karnali Province and Sudurpashchim returning from India, another factor that has decreased Province are being held in Lalitpur.14 Individuals are the pressure upon quarantine facilities is the federal administered a preliminary health check-up before government’s decision to send home those who do not being sent on to their respective province. However, show any visible symptoms after they have spent 14 if individuals in these holding centers continue to be days in a quarantine facility.11 Before this, some people sent to their respective districts and local units without had spent more than 14 days in quarantine facilities first administering PCR tests, there is a possibility that because their PCR test results took longer. At present, infections will be identified too late and consequently, some local governments are sending individuals home spread widely. This has increased the challenges without tests if they have already spent 14 days under already faced by local governments. quarantine, while other local governments are sending them home only after ascertaining that they do not carry the infection. KI Singh Rural Municipality in Doti had kept some individuals under quarantine for Challenges in testing and access to as long as 30 days, until their test results were made available.12 The decision by the federal government laboratories to send individuals home from quarantine facilities Local governments do not have easy access to even if they have not been tested has made elected laboratories that can identify COVID-19 infections. It representatives at the local level very uncomfortable, is necessary for all individuals staying under quarantine and the decision has also increased the chance of the to be given PCR tests in order to decrease the risks of infection spreading widely. transmission. Lately, as laboratories and their testing- abilities have expanded, more and more infections are When large numbers of Nepalis returning from India being identified every day. However, the expansion of entered Nepal, overwhelming local governments and laboratories and their testing-abilities varies between district administrations along the border, a decision was provinces. According to current statistics, even though made to operate temporary holding centers. The federal Bagmati Province has identified only a few infections, government has already released funds to relevant local the number of laboratories and their testing-capacity governments along the border to establish holding in this province is comparatively higher. Province 2 centers to provide a day’s worth of meals, overnight and Province 5 have a lot more identified cases of stay and health check-up to individuals entering infections, but their laboratories are limited in number overland through the designated 20 entry-points along and their ability to carry out tests is also limited. An the Nepal-India border.13 Since June 5, 2020, the average of 181 tests in Bagmati Province returned one COVID-19 Crisis Management Center (CCMC) has positive result while in Province 2 a mere four tests also been operating holding centers at various locations returned one positive result.15 If the number of tests in the Kathmandu Valley, with the capacity to host up carried out remains low, it will be difficult to identify to 2,900 individuals per day, in order to manage the all cases of infection.
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