2020 PROVINCIAL PROFILES GANDAKI PROVINCE Surveillance, Point of Entry Risk Communication and and Rapid Response Community Engagement Operations Support Laboratory Capacity and Logistics Infection Prevention and Control & Partner Clinical Management Coordination Government of Nepal Ministry of Health and Population Contents Surveillance, Point of Entry 3 and Rapid Response Laboratory Capacity 11 Infection Prevention and 19 Control & Clinical Management Risk Communication and Community Engagement 25 Operations Support 29 and Logistics Partner Coordination 35 PROVINCIAL PROFILES: BAGMATI PROVINCE 3 1 SURVEILLANCE, POINT OF ENTRY AND RAPID RESPONSE 4 PROVINCIAL PROFILES: GANDAKI PROVINCE SURVEILLANCE, POINT OF ENTRY AND RAPID RESPONSE COVID-19: How things stand in Nepal’s provinces and the epidemiological significance 1 of the coronavirus disease 1.1 BACKGROUND incidence/prevalence of the cases, both as aggregate reported numbers The provincial epidemiological profile and population denominations. In is meant to provide a snapshot of the addition, some insights over evolving COVID-19 situation in Nepal. The major patterns—such as changes in age at parameters in this profile narrative are risk and proportion of females in total depicted in accompanying graphics, cases—were also captured, as were which consist of panels of posters the trends of Test Positivity Rates and that highlight the case burden, trend, distribution of symptom production, as geographic distribution and person- well as cases with comorbidity. related risk factors. 1.4 MAJOR Information 1.2 METHODOLOGY OBSERVATIONS AND was The major data sets for the COVID-19 TRENDS supplemented situation updates have been Nepal had very few cases of by active CICT obtained from laboratories that laboratory-confirmed COVID-19 till teams and conduct PCR tests. The information about the middle of April, which call centres covers individuals who approached is when the Nepali New Year is engaged in the laboratories for tests, those celebrated. Over a period of four following recommended through medical advice, months—ending in the middle of up on cases and those referred by ward and July—cases increased, peaked and and contacts. municipality public health personnel went down to make up the first wave These data are as part of the Case Investigation and of the pandemic. These cases consisted uploaded or Contact Tracing (CICT) or active case of expats returning home by air or endorsed by search. Information was supplemented through land crossings; during this the Province- by active CICT teams and call centres time, PCR tests were undertaken at level Health engaged in following up on cases and less than 20 laboratories across the Emergency contacts. These data are uploaded or country. Operations endorsed by the Province-level Health Centre Emergency Operations Centre (PHEOC). (PHEOC). The middle of July witnessed the next wave. This time, cases were much higher than projected; the health care 1.3 FINDINGS infrastructure was overwhelmed, with The cases and deaths attributed to a huge burden being placed on the COVID-19 in the different provinces public health system. The total number have been captured by time, place of laboratories in the country had and person characteristics. They are reached 70 by then, a large chunk of comprised of cases and their time it in the private sector, mostly located trends; geographic location and spatial in and around Kathmandu. There were movement; affected age groups; and more symptomatic cases in the second PROVINCIAL PROFILES: GANDAKI PROVINCE 5 wave. Hospital case load increased; 11 percent from Karnali, and 11427 distinctions between normal and or 5.1 percent from Sudurpaschim. designated COVID hospitals were The following pages have a detailed removed, and there was major analysis of these cases. dependency on intensive care infrastructure and ventilator support. 1.6 WAY FORWARD This epidemiological extract has 1.5 SITUATION been prepared to help understand SUMMARY the COVID-19 situation better and in The number of COVID-19 cases in a contextual manner for each of the Nepal by PCR positivity stood at provinces. It can be used by public 2,22,287 as of 23 November 2020. A health personnel and decision-makers total of 25421 cases, or 11.4 percent, as a ready reference to support public came from Province 1; 19715 or 8.8 health and social measures at the percent from Province 2; 121861 or municipality, district and provincial 54.8 percent from Bagmati; 13306 or levels. 5.9 percent from Gandaki; 24559 or Map 1: PCR Positive Case and Deaths 6 PROVINCIAL PROFILES: GANDAKI PROVINCE Figure 1: Changing Age-Sex pattern of cases – (April – November) Sex: Female Male PROVINCIAL PROFILES: GANDAKI PROVINCE 7 Map 2: Cumulative Case Incidence by Month – April 2020 Map 3: Cumulative Case Incidence by Month – May 2020 Map 4: Cumulative Case Incidence by Month – June 2020 Map 5: Cumulative Case Incidence by Month – July 2020 Map 6: Cumulative Case Incidence by Month – August 2020 Map 7: Cumulative Case Incidence by Month – September 2020 Map 8: Cumulative Case Incidence by Month – October 2020 Map 9: Cumulative Case Incidence by Month – November 2020 8 PROVINCIAL PROFILES: GANDAKI PROVINCE Figure 2: Weekly Test Positivity Rate – (12 weeks) 35.0 30.0 25.0 20.0 % R P 7 . T 5 15.0 0 . 1 3 7 8 . 2 6 5 2 4 2 9 . 1 10.0 0 6 2 . 2 7 3 1 . 6 . 3 0 . 1 5.0 1 0 6 1 . 3 1 . 7 6 0.0 Wk 38 Wk 39 Wk 40 Wk 41 Wk 42 Wk 43 Wk 44 Wk 45 Wk 46 Wk 47 Wk 48 Wk 49 Week of reporting Figure 3: District Deaths Weekly (12 weeks) 16 14 12 s h t 10 a e d f o 8 r e 15 b 14 m u 6 12 N 10 10 4 7 5 5 2 4 3 0 1 Wk 38 Wk 39 Wk 41 Wk 42 Wk 43 Wk 44 Wk 45 Wk 46 Wk 47 Wk 48 Wk 49 Week of reporting n Gandaki province now has an 1.7 SUMMARY incidence of 573 per lakh population Gandaki province detected its first and the range of district level COVID-19 case in Baglung district back in incidence varied between the March 2020. The case load was 23 as of lows of 0.2 per lakh in Manang to May affecting 3 districts. The number of the highs of 110 and 212 per lakh cases jumped to 1005 in the next month in Nawalparasi east and Kaski of June affecting all the 11 districts. The districts. The monthly incidence monthly number of cases decreased per lakh population did not during the following months. By constantly increase in the province. September, the monthly case incidence The incidence of cases in Kaski had doubled to 2076. There was a and Nawalparasi east had been surge in the monthly reported cases to constantly rising whereas Lamjung 5533 cases in November. Kaski district witnessed monthly ups and downs reported the highest number of cases in along with Manang and Mustang. the province with a total of 5310 cases. PROVINCIAL PROFILES: GANDAKI PROVINCE 9 n The age-sex pattern of the case n Gandaki province has 3 laboratories incidence has changed radically from located in the district of Kaski in almost an absence of the females and around Pokhara. Possibly this to a substantive 30 % in most age explains, why so much polarity is groups. Almost all the age-groups seen in the reported cases from started getting affected since April Kaski and nearby Nawalparasi east. and females represented in most The test positivity rates calculated of those age groups by May. Since as overall rate of test positives by August, there is a homogeneous PCR from amongst the total samples pattern affecting all age groups tested were between a low of 6% representing both sexes. Gradually and a high of 30% in the province. the proportion of females increased The rates were consistently over though little slower than the males. 20% from Week 43 till the recent n Gandaki province had 2 cases weeks with a dip to a low of 11% reported as of April from Baglung in Week 47 during the festivals. district. By June, when almost all Between July and November, the the districts started reporting cases, test positivity rates and adjusted the spread was through the length test positivity rates, indicate that the and breadth of the province. Most efficiency of testing strategy was of the cases are concentrated in the never fully consistent and predictive. districts of Kaski and Nawalparasi In September it was efficient except east. Together these 2 districts a dip in middle, probably due to accounted for 56% of all cases in shortage of consumables. But the the province. Kaski alone reported consistency ended in mid-October 37% of the cases at 5310; followed and the curves have gone completely by Nawalparasi east with 19% of haywire. the total at 2758; and the district n The total number of deaths in the of Tanahu accounted for 10% with province is 111 with an overall 1510 cases. case fatality of 0.8% and has huge n Gandaki province is largely hills differentials. Kaski had a fatality and one terai district. The two high rate of 0.9% with 50 deaths of mountainous districts of Mustang 5310 cases, Tanahu had 1.0% with and Manang had been reporting 15 deaths of 1510 cases, Gorkha occasional and very few numbers. had 0.9% 11 deaths of 1288 cases, Largely the cases are reported closely followed by Syangja at 0.9% from Kaski, the district that locate with 9 deaths of 988 cases while its capital Pokhara and from Nawalparasi east had only 0.5% Nawalparasi east, a southern border with 14 deaths of 2758 cases.