It is clear that Nepal is exposed to multiple forms of infectious diseases. So, it becomes imperative for the Nepal government to be better equipped and expedite viral monitoring to stop possible outbreaks in the future, writes Jivesh Jha for South Asia Monitor
Coronavirus is not just the only pandemic. The world has seen far worse pandemics over the centuries. Some of them have claimed millions of lives, demolished civilization, and brought the political will and economic strength of the states to their knees. Take the Spanish flu. It has stalked humanity for years. It spread through Europe in 1918. More than 18 million people died in undivided (British) India and this was the largest number of death in a country due to Spanish flu. Mahatma Gandhi also felt the burn of this disease.
So, what it signifies is that in our grandfather’s generation many people lost their lives. The available researches suggest that the pandemic of smallpox may have taken an estimated 300 million people across the world in the 20th century.
On November 20, 1816, King Girvana Yuddha Bikram Shah, the fourth king of Nepal, died of smallpox. Like some other parts of the world, these epidemics/pandemics have cost very dearly to Nepal. So, in the time of the coronavirus pandemic, we should not forget epidemics that had wreaked havoc on Nepal and its people.
The country witnessed frequent outbreaks that badly affected the country. Of many pandemics, cholera existed in Nepal for a long time. The first recorded cholera epidemic took place in 1823, followed by a series of epidemics occurring in the Kathmandu valley in 1831, 1843, 1856, 1862, and 1887.
The largest cholera outbreak reported in Nepal, with more than 30,000 people affected, was in Jajarkot district in 2009. Tragically, more than 500 people lost their lives. More recently, during the 2014 monsoon, a cholera outbreak was reported in Rautahat in the Terai region adjoining northern states (Bihar and Uttar Pradesh) of India. The outbreak, during which more than 600 people were affected, was laboratory-confirmed to be cholera.
The government of Nepal found poor sanitation and unavailability of clean water as the reason behind the frequent outbreak of cholera. In this light, National Preparedness and Response Plan for Acute Gastroenteritis/ Cholera Outbreaks in Nepal (2017), a report issued by the Department of Health, Government of Nepal, says that the country is at high risk for outbreaks due to a steady increase in urban population density accompanied by an inadequate supply of safe drinking water and improved sanitation. Outbreaks of cholera are reported in different regions of the country every year, making it difficult to predict the location of outbreaks.
P N Shrestha in his article, “History of Smallpox” published in the Journal of Nepal Medical Association (1972) stated that the 1816 smallpox was already present in the west much before reaching Kathmandu. But more recent references suggest that not all parts of the country suffered from smallpox. The death of the king in 1816 was not an isolated event in Nepal’s history – although it was the last time a king of Nepal died from the disease. In 1715, King Mahindra Malla of Lalitpur died of smallpox. Deaths due to smallpox at that time within the upper echelons of society suggest that smallpox affected a wider Nepalese population. A royal order in 1805 recorded an outbreak of smallpox among the jhara (bonded) labourers at Chisapani in the hills.
In 1856, then prime minister Jang Bahadur Rana conducted the first population census of Nepal. Data collected for urban and rural Kathmandu, Patan and Bhadgaun referred to houses depopulated as a result of epidemics. Urban Patan had 22,000 ‘old Newar houses’, but this total was ‘exclusive of 2,000 houses depopulated as a result of a pox epidemic’, and urban Bhadgaun had 11,500 ‘old Newar houses’, a total ‘exclusive of 500 houses depopulated as a result of a smallpox epidemic writes historian Susan Heydon in an article entitled “Death of the King: The Introduction of Vaccination into Nepal in 1816,” published in the journal of Medical History (2019).
In 1962, smallpox control activities were commenced in Nepal and the eradication programme started. The last case of smallpox occurred on April 6, 1975. But, the eradication of smallpox was declared on April 13, 1977.
Moreover, the Japanese Encephalitis (JE) has been occurring in South East Asia and Western Pacific Regions for a long time. Mahendra Bahadur Bista and J M Shrestha in their research article, “Epidemiological Situation of Japanese Encephalitis in Nepal” published in Journal of Nepal Medical Association (2005) explain that in Nepal, it has occurred the first time in 1978 in Rupandehi district than in Sunsari, Morang and latter in all 23 districts of Terai and inner Terai areas. In Nepal, about 5,000 people died due to JE from the year 1978 to 2006. Every year 3,000 to 4,000 people are at risk and about 200-300 people die from complications associated with JE. About 12.5 million people in Nepal live in Japanese Encephalitis risk areas, argue Durga Datt Joshi and Jeevan Smriti in the Review on Japanese Encephalitis Outbreak Cases in Nepal During the Year 2011. Children who are less than 15 years of age are more likely to develop the disease during a JE outbreak. Approximately 50 percent of JE survivors are left with chronic neurological syndrome and organ damage.
The Himalayan republic witnessed yet another pandemic in 2004. Dengue fever was first reported in 2004. Since then dengue cases have been reported every year with a circulation of all four serotypes. In 2018 a total of 3,425 cases with one death were reported. In 2019, the first dengue case was reported on May 13, 2019, from the Sunsari district in the east of the country followed by Makwanpur, southwest of Kathmandu, on July 27, 2019. The outbreak then spread like wildfire reaching 68 out of 77 districts over the next two months. In 2019, the outbreak was remarkable both in its scale and reach. Kathmandu valley recorded almost 2,000 cases of dengue in 2019.
Like India, the Chikungunya virus spread in Nepal too in 2016. Almost half a dozen of Chikungunya viruses were detected in patients with febrile illnesses at Sukraraj Tropical and Infectious Disease Hospital (STIDH).
More so, the pandemic of H1N1 Swine flu influenza is unique in the sense that it is caused by a novel mutated influenza-A virus and was first detected in April 2009, in Mexico. Nepal saw its first case in June 2009 among people returning from the US, wrote A. Neopane in his article, The Swine Flu pandemic in Nepa published in Kathmandu University Medical Journal (2009). According to the national public health laboratory report, until May 2010, there were 172 confirmed positive cases. Out of them, 36 cases were recorded before the declaration of community transmission, 29 Nepalese citizens residing within the country, two foreigners, and five close relatives of confirmed positive cases. The remaining 136 cases were found after community transmission. After the community outbreak, most of the swine flu cases were found from Kathmandu district followed by Kaski and Chitwan. All the confirmed cases of pandemic influenza A/H1N1 were in the age group from 1-74,” said Ranjita Karmacharya, in her article, Human infection with pandemic influenza (H1N1): A Review Article published in Janapriya Journal of Interdisciplinary Studies (JJJIS) (2019).
It is clear that Nepal is exposed to multiple forms of infectious diseases. So, it becomes imperative for the Nepal government to be better equipped and expedite viral monitoring to stop possible outbreaks in the future. The government could establish super-specialized labs in coordination with World Health Organisation (WHO) and domestic hospitals to test, and treat patients with possible viral infections.
Despite this, in countries with weak institutions and legacies of political instability, pandemics can increase political stress and tensions. The acute lack of health practitioners and medical infrastructure is yet another issue. The bitter reality is that the healthcare system in the country has been inadequate. While the poor suffer, Nepal’s elite class can afford highly specialized hospitals, which are world-class. Thus, the healthcare system offers limited comfort to ordinary people. It's high time we brought a change in the existing regime with the view to spearheading a system that provides for all without any social distinction.
(The writer is Judicial Officer, Janakpur High Court (Birgunj Bench), Nepal. He is the author of Socio-legal Impacts of COVID-19: Comparative Critique of Laws in India and Nepal” (2020). The views expressed are personal. He can be contacted at firstname.lastname@example.org)