As Covid-19 rampages across Nepal, workers pay the price

KATHMANDU (NYTIMES) - Mr Ram Singh Karki escaped the first wave of India's coronavirus pandemic by boarding a crowded bus and crossing the border home to Nepal.

Months later, as the rate of new infections fell, he returned to his job at a printing press in New Delhi, which had sustained his family for two decades and helped pay the school fees of his three children.

Then India was swept by a second wave, and Mr Karki was not as lucky.

He was infected last month. Hospitals in New Delhi were overwhelmed. When his oxygen level dropped, his manager arranged for an ambulance to take him back to the border. He crossed into Nepal, carrying with him just the clothes on his back - and the virus.

Nepal is now considering declaring a health emergency as the virus rampages virtually unchecked across the impoverished nation of 30 million people. Carried by returning migrant workers and others, a vicious second wave has stretched the country's medical system beyond its meagre limits.

Nepal has recorded 500,000 Covid-19 cases and 6,000 deaths, numbers that experts believe deeply undercount the toll. Testing remains limited. One figure could indicate the true severity: For weeks now, about 40 per cent of the tests conducted have been positive.

A government in disarray has compounded the trouble. Nepal's embattled prime minister K. P. Sharma Oli has been pushing for an election in November after the country's Parliament was dissolved this month, an event that could worsen the spread.

This past week, Nepal's minister for health and population Hridyesh Tripathi said the government was considering declaring a health emergency as infections rise.

But such a declaration could be caught up in politics. The move would allow officials to limit people's movements - a level of control that opposition groups worry could be used to quell dissent.

In the meantime, officials in Kathmandu, the capital, have urged people to store food for at least a week and stay home.

The impact is rippling beyond those infected. Remittances from migrant workers have slowed. Tourism and the economy have been damaged.

The United Nations' Development Program in Nepal resident representative Ayshanie Medagangoda Labe said: "Millions of people continue to feel the increasing pressure not just with the direct health impact of Covid-19, but also with food, jobs, medical bills, kids out of school, payback loans, mental pressure, and much more.

Nepal's close relationship with India helped make it vulnerable. India has long been its most important trade and transit partner, and the two nations share a deep cultural bond across a porous 1,770km border. Nepal's devastation mirrors that of its big neighbour - from patients spilling out into hospital corridors and onto lawns, to long lines at oxygen refilling facilities, to a government unprepared for crisis.

Officials say labourers like Mr Karki, who were forced to come home by the second wave, brought the virus with them. Villages along the border are some of the worst hit. Nepal's Health Ministry said about 97 per cent of the cases sent for genome sequencing show the B16172 variant found in India, which the World Health Organisation has classified as a "variant of global concern".

Nepal's leaders were unprepared. During India's first wave last year, when about one million Nepalese migrant workers returned home, Nepal instituted testing and quarantine measures at border crossings.

But during this spring's second wave, those measures were too little, too late. By the time Nepal shut two-thirds of its border crossings early this month, hundreds of thousands of laborers had made it back, trickling into their villages without proper testing or quarantine. Thousands continue to return daily.

The government's attention had shifted elsewhere. In February, when the virus seemed to be in retreat, Mr Oli held rallies of thousands of supporters in Kathmandu and other cities. Opposition parties held their own rallies. Last year, Mr Oli said the health of the Nepalese people would deter the disease.

The government's defenders say that the pandemic is a global problem and that officials are doing the best they can with few resources or vaccines.

Mr Oli has called for international aid, although it will not be enough to meet Nepal's needs. China has donated 800,000 vaccine doses, 20,000 oxygen cylinders and 100 ventilators. The United States and Spain have sent planeloads of medical equipment, including oxygen concentrators, antigen tests, face masks and surgical gloves. The United States provided US $15 million (S$19.8 million) this month to scale up Nepal's Covid-19 testing. Nepalese migrant workers in Persian Gulf nations have arranged for oxygen cylinders to be sent home.

But Nepal cannot fight the pandemic without help from India. Already, an Indian vaccine manufacturer has told Nepal it cannot deliver a promised one million doses.

Nepal is also dependent on India for half of its medical equipment needs, according to the Chemical and Medical Suppliers Association of Nepal, but the latter country is keeping just about everything for its own urgent domestic needs. Equipment from China, already costly, has become more difficult to obtain because of Chinese pandemic restrictions.