Situation Update on Effectiveness of Quarantine/Isolation in Nepal

Background

On July 21 the Government of Nepal announced an end to the nationwide lockdown which had been imposed since March 24.[1] The government, however, allowed only limited businesses and services to operate.

Although the government ended coronavirus lockdown after four months, some local levels of province-2 and other provinces imposed further lockdown or curfew to contain the COVID-19.[2] The COVID-19 cases continue to rise in the country with the largest number of infections being reported from province-2.

Rajbiraj, Janakpurdham, Jaleshwor, Gaur, Kalaiya, Birgunj, Nepalgunj and Biratnagar urban centres of the Terai have imposed lockdown and curfew due to spike in COVID-19 positive cases.

Meanwhile, the Ministry of Health and Population (MoHP) changed the modality of quarantine on July 17 allowing people returning from abroad to stay in home quarantine.[3]

On July 30, the government issued directives to concerned authorities telling them not to use schools as quarantine or isolation facilities and ordered them to sanitize the schools that had been used as quarantines facilities but are now empty.[4]

For the better and coordinated management of quarantine centers, GoN issued Quarantine Operations and Management Standard for COVID-19. All three tiers of the government shared their responsibility for managing necessary infrastructure at quarantine and isolation centres and providing food and diet to those staying in those centres.

However, THRD Alliance’s physical monitoring of quarantines and isolations and media reports showed that the state authorities failed to provide basic health facilities to those staying in quarantine and isolations centres, causing inconveniences and even deaths. Lack of security at quarantine centres exposed people to risk of physical and sexual abuses. Quarantined people also complained of lack of access to health facilities and food.[5]

The Federal Government data shows that as of August 4 as many as 47,791 persons were quarantined, while 5,732 were active COVID-19 cases and were isolated. So far, the government recorded 57 COVID-19 deaths.[6]

As per the government data, a total of 15,829 people are in quarantine centres in Sudurpashchim province, 14, 457 people in Province-5, 9,127 people in Province-2, 2,897 people in Karnali Province, 2,197 in Gandaki Province, 1,649 people in Bagmati Province and 1,635 people in Province-1.[7]

There has been a sharp rise in the numbers of COVID-19 positive cases after the lockdown was lifted.[8]

During the lockdown, THRD Alliance monitored more than 100 quarantines, including some of the isolations, and also followed media reports regarding the issue. THRD Alliance found that majority of the quarantine centres lacked sanitization, healthy food and there was also delay in PCR tests and lack of security.[9]

And the government’s recent decision to prohibit schools from being used as quarantine and isolation centres could be challenging. THRD Alliance has prepared this update based on the physical and media monitoring as well as reports and data prepared by the government and non-governmental organizations.

Overview of Province-2

As per the data of Social Development Ministry of Province-2 (As of August 4), there were a total of 253 quarantine centres with 15,773 bed capacities. Similarly, there were 15,880 people in the quarantine facilities. (Although, the federal government’s data showed that only 9,127 persons of Province-2 were in quarantine). Similarly, Province-2 had 2,449 isolation beds and there were 626 people in isolation wards. Likewise, 2,274 people were in home quarantines. Nineteen people have died of COVID-19. A total of 5,009 people have tested positive for COVID-19.[10] In the initial months of the outbreak, there were 445 quarantine centres across the province.

Quarantines and isolation centers proved to be Covid-19 death traps at some places.[11] Raju Sada, a 16-year-old boy from Dhanusha district, who was undergoing treatment in isolation ward of Janakpur Provincial Hospital, died due to lack of timely medical treatment.

Strategies to mitigate the quarantine related challenge and community surveillance fall short as complete data base of returnees has hardly been maintained at even border entry points.

THRD Alliance’s Key Observation

Security Measures: Most of the schools and other public places were used for quarantine and isolation centres to contain the spread of the COVID-19 and in-charges as well as security personnel were deployed to maintain the security and required facilities for the people staying in the quarantines and isolations but THRD Alliance’s field monitoring reports and media reports showed that such centres lacked security measures.

On June 10, three people allegedly gang-raped a woman staying at a Kailali based quarantine centre. The 31-year-old woman alleged that three quarantine volunteers gang-raped her at the quarantine centre at Lamkichuha Municipality-1 in the district. Later they were arrested.[12]

Although, police personnel were deployed to maintain physical distance and security at quarantine and isolation centres, they were found to be flouting the social distancing rules and using force against the people living in such centres on the pretext of breach of quarantine rules.

On May 26, Sanjay Singh, a Nepal Police assistant sub-inspector allegedly abused people staying in a quarantine facility at Tilathi Koiladi, Saptari. ASI Singh beat people in quarantine centre and also harassed female members. The victims blamed that ASI Singh and other police personnel entered the quarantine building while they were asleep and misbehaved with them.[13]

On July 30, a youth quarantined in Kailali district died of snake-bite. Ganesh Shahi, 22, who was staying in a quarantine centre at Siddhartha Bidya Niketan in Gauriganga Municipality-4, was bitten by the reptile on July 27. He died while undergoing treatment at Bheri Hospital in Nepalgunj.[14]

Access to timely and hygienic food: Most of the state authorities, mostly local bodies which maintained quarantine and isolation centres, failed to provide timely and hygienic food to those who stayed in quarantine and isolation centres. Their failure to provide timely and hygienic food violated the standards set by the federal government and orders passed by the Supreme Court.

People living in quarantine and isolation centres complained that they were treated like domestic cattle and were not provide with basic facilities such as food and sanitization. People living in the isolation ward of Gajendra Narayan Singh Hospital in Rajbiraj, Saptari district complained that they were not provided food and their ward was not sanitized timely.[15]

On May 24, Chaurjahari Municipality in West Rukum stopped providing food to people living in 14 quarantine facilities and decided to provide cash instead. The municipality said that the number of people kept rising in quarantine centres and it did not have enough money to provide food to them. The local body decided to provide NPR 178 (1.47 USD/per-day) to everyone in quarantine, instead of food.[16]

Even pregnant women, from Melauli Municipality-5 in Baitadi district, who was staying in quarantine of a health post, did not get food. The Gorkhapatra, state-owned national daily, quoted Kalpana Pujaral as saying that she stayed in the quarantine for 20 days and she was yet to receive PCR test result. She also said that she did not get enough food in time. She added that the local government asked her to collect firewood to cook food for herself.[17]

Access to health facilities: THRD Alliance’s monitoring also found lack of access to medical facilities for those staying in quarantine and isolation centres.

On Jun 23, a 16-year-old Raju Sada, who hailed from Parsahi village in Hanshapur Municipality-7, Dhanusha district, died in the Isolation Ward of Provincial Hospital in Janakpurdham. The isolation was designed to treat coronavirus related patients. THRD Alliance’s monitoring found that Sada’s PCR test report did not came out even after 10 days but the hospital had kept him in isolation ward suspecting him to be a COVID-19 patient and the hospital staff did not provide adequate medical care to the patient. A video which has gone viral on social media and news-portals showed that Raju was fretting and falling down on floor from the bed on June 19. On July 13, an FIR was lodged at the District Police Office in Dhanusha against medical staff accusing them of negligence in the patient’s care.[18] The boy’s PCR test results came out negative.

Earlier, on May 17, a youth who was staying in a quarantine of Nairanapur rural municipality of Banke, died. The 25-year-old had been staying in the quarantine after returning from Mumbai, India on May 13.[19] THRDA documented the death of the youth. It is reported that the youth was not provided proper health care and an ambulance was not available to transport him to hospital when his health condition suddenly worsened in the quarantine centre.[20]

Likewise, on July 26, a 38-year-old man from Sahidnagar in Dhanusha died of coronavirus. The man was taken to the Janakpur-based Provincial Hospital after he suffered from high fever, common cold and difficulty in breathing. Doctors collected his swab samples for PRC test. The patient needed immediate ventilator support but all three ventilators that were available there were occupied. The patient was then referred to Dharan-based BP Koirala Institute of Health Sciences. He died on the way to the hospital. The man’s PCR report came out positive and his family members blamed the hospital for his death.[21]

Many people had to unnecessarily stay in quarantine centres for relatively longer period as they had to wait for their PCR test done. Some people who tested positive in RDT also complained of waiting for very long to get their PCR tested done.

On June 8, media reported that 151 infected patients staying in isolation centres in Kapilvastu’s Yasodhara Rural Municipality failed to receive medical attention and were in allowed to have contacts with other people.[22]

On August 3, media reported that a total of 44 persons, who were sent to their home from quarantines in Kailali district without waiting for their coronavirus tests results, were found to be COVID-19 positive after they had been sent home. According to District Administration Office of Kailali, local bodies collected swabs for tests on July 26 and sent them to their homes without the results.[23]

Access to basic hygiene and sanitization: Items like hand sanitizers, masks, soap etc for women and girls, particularly those in quarantine sites and/or hospitalized for screening and treatment for COVID-19, was essential items. However, such measures were not strictly flowed in most of the quarantines and isolation wards.

During THRD Alliance’s monitoring in Janakpurdham, Dhanusha, a total of 205, including 18 women, were kept in one quarantine center. Among them, 22 people had tested positive. However, everyone was sharing common toilet and bathrooms. Quarantine centers in province 2 lack separate facilities for men and women.

Challenges to maintain Home Quarantine

On July 30, the government directed that schools should not be used for quarantine or isolation facilities;[24]

Mismanagement of quarantine and isolation centres, lack of proper sanitization and enough spaces, lack of access to health facilities and timely check-ups, unavailability of food on time as well as delay in tests, created a sense of fear among people living in such centres as a result people tried to flee from such centres.

However, since the government came up with the policy to maintain home quarantines, maintaining physical distances could be challenging at private homes due to lack of space and social practices. People staying in home quarantine may face some other risks as they might not be able to get care easily from health professionals and the required medicines. They might also not be able to get their PCR test done when they want the test done.

Likewise, daily wagers, marginalized communities and poor people who lost their jobs during the lockdown and the pandemic could struggle to get timely food and sanitization if kept at home quarantine.

There could be chances of community transfer if home quarantines are not managed properly and that could be disastrous.

Recommendations

Based on the field monitoring, observation and media reports, THRD Alliance makes following recommends for the state authorities, including local, provincial and federal levels:

-Ensure access to health facilities, healthy foods and sanitizations for those staying in home quarantines/isolations as well for those people staying in such centres at various places. Also ensure vigilance at home quarantines.

-Ensure proper treatment for coronavirus patients as well as tracing and tracking for those who came in contact with the coronavirus positive persons.

-Ensure accurate and timely dissemination of information related to COVID-19 that could directly impact to the general people and could make them aware.

-Ensure synchronized efforts to address culturally and linguistically appropriate guidance on social distancing, hand-washing, self-isolation and quarantine, safe home care of infected people, and support to governments’ ability to contain the spread and take care of public health.

[FOR PDF COPY Situation Update on Effectiveness of Quarantine-Isolation in Nepal ]

REFERENCES:

[1]https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/

[2]https://thehimalayantimes.com/nepal/birgunj-announces-indefinite-curfew-from-tomorrow/

[3]https://risingnepaldaily.com/featured/mohp-sets-forth-standards-for-home-quarantine

[4]https://www.setopati.com/social/212586?fbclid=IwAR0IvS_t2UXCJ5LxJkOG-CHVlkNuY-gsVqnPfb8YBQbYineexadPqo948_s

[5]https://kathmandupost.com/editorial/2020/06/08/death-by-negligence

[6]https://covid19.ndrrma.gov.np/

[7]https://covid19.ndrrma.gov.np/

[8]https://covid19.mohp.gov.np/#/

[9]https://kathmandupost.com/editorial/2020/06/08/death-by-negligence

[10]http://mosd.p2.gov.np/node/390