2020 PROVINCIAL PROFILES SUDURPASCHIM 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 21 Control & Clinical Management Risk Communication and Community Engagement 27 Operations Support 31 and Logistics Partner Coordination 37 PROVINCIAL PROFILES: BAGMATI PROVINCE 3 1 SURVEILLANCE, POINT OF ENTRY AND RAPID RESPONSE 4 PROVINCIAL PROFILES: SUDURPASCHIM 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: SUDURPASCHIM 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: SUDURPASCHIM PROVINCE Figure 1: Changing Age-Sex pattern of cases – (April – November) Sex: Female Male PROVINCIAL PROFILES: SUDURPASCHIM 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: SUDURPASCHIM PROVINCE Figure 2: Weekly Test Positivity Rate – (12 weeks) 18.0 16.0 14.0 12.0 10.0 % R P 5 5 . 8.0 . T 5 5 7 . 1 1 8 8 . 3 2 2 5 1 6.0 . 1 1 1 7 1 4 . 9 2 2 9 4.0 . 8 8 5 . 2.0 6 6 . 0.0 1 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) 10 9 8 7 s h t a e 6 d f o r 5 e b 9 m u 4 N 3 6 5 2 1 2 2 1 1 1 1 0 Wk 38 Wk 39 Wk 40 Wk 43 Wk 44 Wk 45 Wk 46 Wk 47 Wk 49 Week of reporting n Sudurpaschim now has an 1.7 SUMMARY incidence of 414 per lakh In Sudurpaschim province, Covid-19 population and the range of district cases started being detected in March. By level incidence varied between the May, there were 27 cases detected and lows of 13 per lakh in Darchula distributed across 8 out of 9 districts in the to the highs of 48 per lakh in Doti province. The number of cases jumped to and Kanchanpur and 169 per 2457 in the next month of June affecting lakh in Kailali districts. There was all 9 districts. The cases came down the an upswing in the monthly case following months with 1417 cases in incidence per lakh population in August and rose in October with 2438 the province. The incidence of cases. The number of cases took a dip cases fell in all the districts in July in November with 2041 cases. The total more likely due to unavailability number of cases in the province is 11869. of tests. Since August, it had been PROVINCIAL PROFILES: SUDURPASCHIM PROVINCE 9 constantly rising in all the districts state of Uttarakhand in a long land except for Bajhang. November border and major points of entry witnessed a fall in incidence in for goods and passengers. Kailali most districts. and Kanchanpur being the major n The age-sex pattern of the case thoroughfare and trade hub also detected most of the cases June attracted most of the case burden. onwards and the age-sex pattern Doti and Achham being closely was overwhelmingly male and in road linked to Kailali had a sizeable the productive age group of 20 to case load. Darchula though on the 54 years. This began changing from India border attracted much lesser the month of July itself and grew cases mainly because of it’s civilian up to represent more female cases population being low. detected as well as representation n Sudurpaschim province has 6 of all major age groups in the laboratories located in the districts pyramid. The cumulative age of Kailali, Dadeldhura, Doti, pattern gives a roughly 1:3 female Acham, Baitadi and Bajhang. The to male ratio, little lower than last 3 being new additions. The other provinces. test positivity rates calculated as n The province had 5 cases reported overall rate of test positives by PCR in the month of April. By June, from amongst the total samples when almost all the districts started tested were between a low of 6.5% reporting cases, the spread was in week 38 and a high of 15.5% in through the length and breadth week 45 in the province. The test of the province. Most of the cases positivity rates and adjusted test are concentrated in the districts positivity rates indicate that the of Kailali, Doti and Kanchanpur. efficiency of testing strategy had Together these 3 districts been consistent and predictive, accounted for 64% of all cases in but this consonance was lost the province. Kailali alone reported in September to return to usual 41% of the cases with 4843 cases. in October-November. This is probably an indicator of supply side n Sudurpaschim province has it’s challenges in providing laboratory districts distributed across all the consumables. ecological zones. There are 2 Terai districts of Kailali and Kanchanpur; n The total number of deaths in the 4 hill districts of Baitadi, province is 37 with an overall Dadeldhura, Doti and Achham case fatality of 0.3% and has huge and 3 mountainous districts of differentials. Kailali had a fatality Darchula, Bajhang and Bajura. rate of 0.5% with 22 deaths of The province has its international 4843 cases and Kanchanpur had border connected to the Indian 0.4% with 5 deaths of 1364 cases.