2020 PROVINCIAL PROFILES KARNALI 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: KARNALI PROVINCE SURVEILLANCE, POINT OF ENTRY AND RAPID RESPONSE COVID-19: How things stand in Nepal’s provinces and the epidemiological 1 significance of the coronavirus disease 1.1 BACKGROUND it’s time trend, geographic location and spatial movement, affected age The provincial EPI profile is meant to groups and there change over time and give a thumbnail impression of the incidence/prevalence of the cases both Covid-19 situation in the province. as aggregate numbers reported and The major parameters captured and population denominations. In addition updated in this profile narrative are some insights over the changing depicted in the accompanying graphics patterns like change in age at risk and over 4 panels of Posters arranged proportion of female in total cases to highlight the case burden, trend, are also captured, as are the trend of geographic distribution and person Test Positivity Rates and distribution related risk factors in a series of of symptom producing and also those updates. cases with comorbidity. The major parameters in this profile 1.2 METHODOLOGY narrative are 1.4 MAJOR OBSERVATIONS depicted in The major data set available for the AND TRENDS accompanying situation update on Covid 19 come Most of Nepal had very few cases of graphics, from the laboratories conducting PCR laboratory confirmed Covid -19 till which consist test for Covid 19 cases for people about the middle of April or Nepali of panels of approaching the laboratory for a new year. Cases then increased to a posters that test, those recommended by medical peak and scaled down to make the first highlight advice and also in some cases those wave over a period of about 4 months the case referred by the public health personnel ending at the middle of July 2020. burden, trend, from wards and Palikas as part of These were the cases when most of geographic the Case Investigation and Contact them came as ex pats returning home distribution and Tracing (CICT) or active case search. fully screened at airports and land person-related Some additional information is also crossings at less than 20 laboratories risk factors. supplemented by the active CICT across the country that had the teams and call centres engaged in capacity to undertake PCR. The middle active follow up of cases and contacts of July saw the next wave that rose over a period of time. These data are to high much beyond the projected generally uploaded or endorsed by estimates and overwhelmed the health the Province level Health Emergency care infrastructure and put a huge Operations Centre (PHEOC). burden on the public health system in the country The total number of laboratories in the country had 1.3 FINDINGS reached 70 by then, a large chunk of it In this EPI profile we captured the in the private sector mostly located in Cases and Deaths attributed to Covid and around Kathmandu. In this second 19 in the province by time, place and wave there were more symptomatic person characteristics. The case and cases, load on the hospitals were PROVINCIAL PROFILES: KARNALI PROVINCE 5 higher taking away the distinction 5.1% came from Sudur Paschim. A between isolated designated Covid detailed analysis of these cases had hospitals from other usual ones and been done in the following pages. heavily weighing on the 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 total number of Covid-19 cases a contextual manner for each of the in Nepal by PCR positivity stood at provinces and also to be used as a 222287 as of 23 November 2020. A ready reference for the public health total of 25421 cases or 11.4% came personnel and decision makers to from Province 1; 19715 or 8.8% came support Public Health and Social from Province 2; 121861 or 54.8% Measures at Palika, District and came from Bagmati province; 13306 Province level to have better control. or 5.9% came from Gandaki; 24559 or 11% from Karnali and 11427 or Map 1: PCR Positive Case and Deaths 6 PROVINCIAL PROFILES: KARNALI PROVINCE Figure 1: Changing Age-Sex pattern of cases – (April – November) Sex: Female Male PROVINCIAL PROFILES: KARNALI 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: KARNALI PROVINCE Figure 2: Weekly Test Positivity Rate – (12 weeks) 40.0 35.0 30.0 25.0 % 20.0 R 8 . P 6 T 3 15.0 9 . 2 10.0 2 2 . 3 9 . 1 7 1 8 . 7 . 5.0 1 0 9 0 5 . 1 . 1 9 8 8 8 5 . 6 . 4 0 0.0 3 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) 9 8 7 6 s h t a 5 e d f o r e 4 8 b m u N 3 2 1 2 1 1 1 1 1 1 1 0 Wk 40 Wk 41 Wk 42 Wk 43 Wk 44 Wk 45 Wk 46 Wk 47 Wk 48 Week of reporting 1.7 SUMMARY n Karnali province now has an incidence of 345 per lakh population In Karnali province, Covid-19 cases and the range of district level started being detected in May. A incidence varied between the lows total of 120 cases were detected in of 2 per lakh in Dolpa, humla and May distributed across the districts of Mugu to the highs of 91 and 156 Dailekh, Surkhet, Salyan and Kalikot. per lakh in Dailekh and Surkhet The number of cases jumped to 1463 districts. There was an upswing in the next month of June affecting all in the monthly case incidence per the 10 districts. The cases came down lakh population in the province. the following months with a rise in The incidence of cases fell in all September with 1017 cases and October the districts in July probably due with 2095 cases. The number of cases to unavailability of tests and since took a slump in November with only 494 September it had been constantly cases. The total number of cases in the rising in all the districts except province is 6105. PROVINCIAL PROFILES: KARNALI PROVINCE 9 for Mugu and Dolpa. November Dailekh, Kalikot and Jumla connected witnessed a fall in incidence in all the by the Karnali highway keep a high districts. burden of cases in this order. On the other side of Surkhet, Salyan and n The age-sex pattern of the case incidence has been changing in the Rukum west are connected by the province. Almost all the age-groups Rapti highway coming from Dang started getting affected since May in Lumbini Province which resulted and in the initial days comprised of in an increased case load in Salyan overwhelmingly male and mostly and Rukum (West). Jajarkot, which covering the young adults. Females is divided by Bheri river from Rukum started getting represented in the and Kalikot, and is more isolated age pyramid only in September and experienced a lesser number of cases. October. But this took a skew in n Karnali province has 4 laboratories November, something peculiar to this located in the districts of Surkhet, province. Dailekh, Jumla and Rukum west. These are also the districts with n Karnali province had no cases reported in the month of April. By higher case load except for Rukum June, when almost all the districts west which has a low case load started reporting cases, the spread possibly due to the recent laboratory was through the length and breadth set up. The test positivity rates of the province. Most of the cases calculated as overall rate of test are concentrated in the districts of positives by PCR from amongst the Surkhet and Dailekh. Together these total samples tested were between a 2 districts accounted for 72% of all low of 0.5% in week 47 and a high of cases in Karnali. Surkhet reported 22.9% in week 44. The test positivity 45% of cases with 2765 cases and rates and adjusted test positivity the district of Dailekh accounted for rates indicate that the efficiency of 26% with 1606 cases. testing strategy had been consistent since September. n This province does not have any Terai region as it has only hills and n The total number of deaths in mountains. Of the 10 districts, 5 the province is 22 with an overall are in the hill region and 5 are in case fatality of 0.4% and has huge the mountains.