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FLASH ALERT: NEPAL COVID-19 SURGE

May 7, 2021 | Sam Shames and Jade Patel, EMH2


FLASH ALERT: NEPAL COVID-19 SURGE HAS SEEN AN UNCONTROLLABLE INCREASE OF CASES, LEADING TO A MASS INFLUX OF PEOPLE SEEKING MEDICAL ATTENTION. A SIMILAR SITUATION OCCURRED IN INDIA, WHERE PEOPLE WERE UNABLE TO ACCESS MEDICAL TREATMENT, CAUSING AN OVERSPILL FROM INDIA INTO NEPAL, PLACING THE NAPOLESE HEALTH SYSTEM AT HIGH RISK OF HITTING BREAKING POINT. APPEALS FOR OXYGEN, BEDS, AND RESOURCES ARE ONGOING IN AID OF ALLEVIATING DEMANDS. THE DEATH TOLL HAS REACHED UNPRECEDENTED NUMBERS AND FAILURE TO ACT IS EXTREMELY LIKELY TO LEAD TO MORE COVID-19 CASES.


Current and Potential Resurgences[1]


The Counterterrorism Group (CTG) is issuing a FLASH ALERT for hospitals, citizens, the Government of Nepal, and other countries bordering India as India’s massive COVID-19 resurgence has split over borders. Nepal has experienced a 1,200% increase in positive cases over the past few days, leading to a rapidly increasing number of hospitalizations. As a result, hospitals are running out of beds, resources like oxygen, and the capacity to effectively treat patients. This will likely lead to high fatality rates. In addition to India, Nepal is the second country to request assistance from the international community over the past week, suggesting that this wave of cases is the most severe to date. The current CTG Threat Matrix indicates there is a HIGH likelihood that Nepal’s health system will collapse within the coming week, as the Emergency Management, Health, and Hazards (EMH2) team has predicted that cases will continue to rise in number and severity.


CTG is on HIGH alert and cautions that the resurgence must be closely monitored to determine why case numbers are increasing, how the health system in Nepal is responding, and what resources the international community can contribute. Despite some countries instituting travel bans to and from India, bordering countries are at higher risk for disease spillover as people can easily travel across borders. As cases increase, it is likely that people will move across borders in hopes of receiving medical attention as this is unavailable in their own countries. With delayed vaccine exports from India due to their crisis, Nepal will likely experience a major lag in vaccine rollout, further contributing to increased caseloads.


Nepal is in the top 50 countries most impacted by COVID-19, with 394,667 cases and 3,720 fatalities as of May 9, 2021.[2] Until recently, Nepal was on track to combat the spread of the virus before a major influx of cases in neighboring India led to people crossing borders in an attempt to escape the crisis, causing a sharp spike in cases. Nepal experienced a steady decline in cases at the beginning of 2021, allowing the government and citizens to let their guard down and loosen restrictions, leaving them unprepared for another wave. As new and deadlier variants are discovered, it is evident that many countries are underprepared due to pandemic fatigue and the false sense of security provided by increasing vaccination rates. Nepal is most affected by the recently discovered Indian Variant, characterized by a double mutation similar to those seen in the Brazilian and South African Variants.[3] Scientists are still debating on the virulence of this strain, but recent trends in India, and now Nepal, suggest that it at least has the ability to spread rapidly.


The impacts from India have caused Nepal to experience a massive spike in daily cases and deaths, which is likely to continue over the coming weeks due to the high transmissibility of the Indian variant. Nepalese medical staff has warned that the unmanageable influx of COVID-19 patients is extremely likely to devastate the health system, leading to the declaration of a major crisis. Medical insecurity due to under-resourced and understaffed hospitals will likely encourage further appeals for international aid to relieve the pressures and reduce fatalities as swiftly as possible.


Alongside lockdowns and other preventative measures, Nepal has begun its vaccination campaign, with over 2.45 million vaccines administered throughout the country. Out of this figure, 362,000 people have now received both doses, and are fully vaccinated, equating to 1.3% of the population. The vaccines used are BBIBP-CorV, AstraZeneca, and Sputnik V, two of which have been flagged for safety issues in the past month. Despite the semi-successful vaccine rollout, Nepal experienced shortages when India was unable to continue providing donations as they had to prioritize their vaccine rollout. Nepal has appealed to the international community for more vaccines to deal with the COVID-19 surge and to decrease future acute, but sustained spikes in cases.


The most pressing concern is that Nepal will follow India’s direction, with a breakdown of the healthcare system as high numbers of patients coupled with scarce staff and resources create unmanageable pressures. The country has already been nicknamed “Mini India” as it is expected to experience the same situation that India is currently battling. This is concerning because it suggests that the Indian Variant is quickly crossing borders, putting other nearby countries such as Bangladesh, Pakistan, and even remote areas of China at risk for resurgences. With international aid organizations already struggling to obtain resources for combatting COVID-19, and their continued efforts to assist countries affected by natural disasters, multiple simultaneous international crises will further strain these partnerships. As a result, long-term recovery in other countries will be hindered, and fighting acute spikes in cases will be increasingly challenging.


Nepal was already appealing to the international community weeks ago for oxygen, antiviral drugs, and intensive care beds.[4] Now, it is highly likely that the surge has increased their needs dramatically. Hospitals are likely at high risk of mass overcrowding, leading to further bed shortages, resulting in bed-sharing to maximize capacity. Those who do not receive a bed and medical attention are placed on a long and growing waitlist for patient admissions. These conditions contribute to a decline in quality of care and increase the likelihood of other disasters, exemplified by the recent hospital fire in India, likely caused by difficulties in following protocols due to the stresses of overcrowding and lack of resources. Crematoriums and temples have also run out of space, and have resorted to other methods of laying people to rest, such as fires in car parks and rural areas.[5]


Lockdowns in high-risk areas are being extended to alleviate the unfolding crisis, with the International Red Cross and Red Crescent (ICRC) placed on alert for if and when emergency response is needed. Nepal is not the only country that is experiencing a resurgence of COVID-19. India, Latvia, Bangladesh, and Thailand are also seeing surges in cases, placing them on high alert. All of these countries have recently detected their first cases of the Indian Variant, suggesting that this strain is spreading rapidly. With multiple countries appealing for assistance at the same time, it is extremely likely that emergency and foreign aid demand will continue to increase, and could limit the amount of aid available for each country. Receiving some aid is likely to help towards decreasing the resurgences, but restrictions to resources may prolong and be ineffective to stop a further COVID-19 influx.


CTG assesses that the current threat climate of further COVID-19 related surges is HIGH, likely causing Nepal’s healthcare system to collapse. Before the pandemic, nearly 25% of Nepal’s population lived below the poverty line.[6] This number has likely increased throughout the pandemic, and it is predicted to continue rising if this wave persists. These vulnerable populations are disproportionately affected by COVID-19 as they have limited access to resources and healthcare, preventing them from effectively preventing and treating disease. Nepal is particularly unique as vaccine campaigns have managed to reach refugee populations, making them the first country to tackle this feat with the help of UNICEF and other partners.[7] It is essential that the government of Nepal leverage these partnerships in an attempt to continue treating and vaccinating all populations, including those that are remote and under-resourced.


CTG recommends that the situation in Nepal is monitored over the coming weeks to assess and track developments of the ongoing crisis. Other countries bordering India and Nepal must remain vigilant in testing and should reinstitute lockdown measures to stop the spread of disease. Additionally, they should prepare their health systems for a rise in cases as the India Variant continues to spread across borders. The resurgence has made Nepal vulnerable to internal and external threats, and it is critical that threats are reduced swiftly and effectively. For more detailed information, such as a Threat Assessment report, or more tailored reports to specific threats, contact us at info@counterterrorismgroup.com.


Analysis indicates that there is a HIGH PROBABILITY that the resurgence will continue until stricter preventive measures are implemented and efficient vaccine campaigns are undergoing in both Nepal and India. Without access to plentiful vaccinations, it is likely that India will still overspill into Nepal, and that Nepal will experience more cases and fatalities.


The Counterterrorism Group (CTG) is a unit of the global risk consulting and security firm Paladin 7. CTG proactively searches for and analyzes the threat of terrorism that comes from International Terrorist Organizations, Domestic Terrorist Organizations, and Individuals determined to inflict terror upon societies, organizations, and individuals. Our international and national security professionals set up protective measures to detect, deter, and prevent, discourage, and dissuade any terrorist organization or individual from attacking organizations and individuals. We work to protect our clients from any terrorist threat or attack. We also work proactively with the proper authorities to find those in terrorist organizations and individuals who will cause harm and assist in bringing them to justice and mitigating the threat long-term.

[1]As India's Covid crisis and variant spreads, neighboring countries go on high alert” by Sam Shames via Mapchart.net

[2] Nepal, WorldoMeters, May 2021, https://www.worldometers.info/coronavirus/#countries

[3] What is the India Covid variant and will vaccines work?, BBC, May 2021, https://www.bbc.com/news/world-asia-india-56844925

[4] Nepal seeks support in virus fight from crisis-hit India, The Kathmandu Post, May 2021, https://kathmandupost.com/national/2021/04/24/nepal-seeks-support-in-virus-fight-from-crisis-hit-india

[5] Nepal’s COVID-19 Crisis Becomes “Unmanageable” Amid Exponential Rise in Cases, Democracy Now, May 2021, https://www.democracynow.org/2021/5/4/headlines/nepals_covid_19_crisis_becomes_unmanageable_amid_exponential_rise_in_cases

[6] From lockdown to vaccines: challenges and response in Nepal during the COVID-19 pandemic, The Lancet, April 2021, https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00208-3/fulltext

[7] Reaching the unreached: COVID-19 vaccinations in Jumla, UNICEF, March 2021, https://www.unicef.org/nepal/stories/reaching-unreached-covid-19-vaccinations-jumla

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