KATMANDU, Nepal – Ram Singh Karki escaped the first wave of the pandemic in India by boarding a crowded bus and crossing the border into Nepal. Months later, as the rate of new infections declined, he resumed his job at a printing company in New Delhi, which had supported his family for two decades and helped pay for school fees for his three children.
Then India was swept away by a second wave, and Mr. Karki was not so lucky.
He was infected last month. New Delhi hospitals were overwhelmed. When his oxygen level dropped, his manager organized an ambulance to take him back to the border. He entered Nepal, taking with him only the clothes on his back – and the virus.
Nepal is now considering declaring a health emergency as the virus unleashes virtually unchecked in the impoverished nation of 30 million people. Carried away 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 cases of Covid and 6,000 deaths, figures which experts say seriously underestimate the toll. Testing remains limited. One number could indicate the true severity: For weeks now, around 40% of tests have been positive.
A government in disarray has compounded the problems. Ailing Nepalese Prime Minister KP Sharma Oli pushed for elections in November after the country’s parliament was dissolved last week, an event that could worsen the spread.
Earlier this week, Hridyesh Tripathi, Nepal’s Minister of Health and Population, said the government is considering declaring a health emergency as infections rise.
But such a statement could be overtaken by politics. The move would allow authorities to limit the movement of people – a level of control that opposition groups say could be used to quell dissent.
Meanwhile, officials in the capital Kathmandu have urged residents to store food for at least a week and stay in their homes.
The impact is felt 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 only with the direct health impact of Covid-19, but also with food, jobs, medical bills, out-of-school children, repayment loans, mental pressure and much more, ”said Ayshanie Medagangoda Labe, United Nations Development Program Resident Representative in Nepal.
Nepal’s close relations with India have helped make it vulnerable. India has long been its most important trading 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 pouring into hospital corridors and lawns, to long lines at oxygen filling facilities, to a government unprepared for the crisis.
Officials say workers like Mr. Karki who were forced to return home by the second wave brought the virus with them. The villages along the border are among the most affected. The Nepalese Ministry of Health said about 97% of cases sent for genome sequencing had the B.1.617.2 variant found in India, which the World Health Organization classified as a “variant of global concern. “.
Nepalese leaders were not prepared. In India’s first wave last year, when around one million Nepalese migrant workers returned home, Nepal instituted tests and quarantine measures at border crossings.
But in the second wave of this spring, these measures were too little too late. By the time Nepal closed two-thirds of its border posts in early May, hundreds of thousands of workers had returned, flocking to their villages without proper testing and quarantine. Thousands continue to return daily.
The government’s attention had shifted elsewhere. In February, as the virus appeared to be receding, Mr Oli organized rallies of thousands of supporters in Kathmandu and other cities. Opposition parties have organized their own rallies. Last year, Mr Oli said the health of the Nepalese people would deter the disease.
Government advocates say the pandemic is a global problem and officials are doing their best with few resources or vaccines.
Mr. Oli called for international assistance, although it will not be enough to meet Nepal’s needs. China has donated 800,000 doses of vaccine, 20,000 bottles of oxygen and 100 ventilators. The United States and Spain have sent planes loaded with medical equipment, including oxygen concentrators, antigen tests, face masks and surgical gloves. The United States provided $ 15 million this month to step up Covid testing in Nepal. Nepalese migrant workers in the Gulf countries have arranged for oxygen cylinders to be returned home.
But Nepal cannot fight the pandemic without India’s help. Already, an Indian vaccine maker has told Nepal it cannot deliver the promised million doses.
Nepal also depends on India for half of its medical equipment needs, according to the Nepal Chemical and Medical Suppliers Association, but the latter country is keeping pretty much everything for its own urgent domestic needs. Equipment from China, already expensive, has become more difficult to obtain due to Chinese pandemic restrictions.
“For a month now, India has stopped the supply of medical equipment and drugs as well, not just vaccines,” said Suresh Ghimirey, president of the association.
In some provinces that have seen large numbers of migrant workers returning to India, hospitals are running out of beds. In Surkhet district, the main provincial hospital said it could not admit more patients. Small outlying villages quietly mourn their dead. The tests were slow.
“With the exception of a few villagers, many are unable to go out and do daily farm work,” said Jhupa Ram Lamsal, head of the village of Gauri, where nine people died from Covid more than 10 days earlier. this month. “What is worrying is that even symptomatic people are not ready for Covid testing.”
Mr Lamsal said he had recently reached Gauri, which is remote and lacks health facilities, with a team of medics to perform antigen tests. Residents have rejected medical professionals’ call for Covid testing, he said, arguing that they would be discouraged if they found out they were positive.
“The situation is out of control,” Lamsal said. “We are desperate, helpless.”
Mr. Kakri, the print shop worker, was from a village in Bhimdatta Municipality in the western corner of Nepal. The area of 110,000 people has officially registered 3,600 infections, according to health chief Narendra Joshi. But the lack of metrics at the border means 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 start of the second wave in India,” said Mr. Joshi, “It is difficult 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. When he visited the house twice a year, he was the life of the rallies – making jokes, making fun. The $ 350 a month he sent home covered his family’s household expenses as well as the private school fees of their two teenage daughters and a 12-year-old son.
Even when last year’s lockdown meant Mr Karki was stuck at home for months with no income, he insisted the children continue to private school. He would pay off the debts once the printing press reopened. He dreamed of seeing his eldest daughter – “she’s the most talented” – become a doctor.
“I couldn’t finish my studies,” recalls Ms. Karki, having said her husband. “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 didn’t even have the energy to get up. He was taken to a nearby hospital, where he died.
“’Everything is fine. Go home,” her husband told her, Ms. Karki said. “But he never came home.”