University’s critical role in coronavirus testing in remote areas

The Himalayan country of Nepal, squeezed between China to the north and India to the south, is considered by the World Health Organization to be “very vulnerable” to the coronavirus pandemic because of poor healthcare infrastructure.

But with the government taking COVID-19 testing very seriously to contain the spread of the disease, remoter regions have called on the huge Tribhuvan University for help in carrying out tests – a demanding task for the university, which has sent testing equipment, experts and volunteers to help in at least three provinces.

The provincial government of Karnali province, which is the least developed in Nepal, wrote to Tribhuvan University on 12 April asking for help with human resources and equipment to carry out COVID-19 testing in the mountainous region.

Thousands of Nepali migrant workers in India returned to Karnali and other parts of Nepal after India’s lockdown was announced on 24 March, raising fears of a difficult-to-control outbreak in Nepal.

University testing team

On 23 April the university sent a five-member team led by Megha Raj Banjara, head of the department of microbiology, along with a real-time Polymerase Chain Reaction (PCR) machine for testing.

The province, where over half the population lives below the poverty line, “had just one portable PCR machine, which could test hardly a dozen samples per day,” Banjara said.

“We had to seek the university’s support as we lacked both human resources and the machine for testing,” said Laxmi Basnet, secretary at the Office of the Chief Minister in Karnali. So far, no cases have been registered in the province, Nepal’s largest by area – but without testing no one can be sure if the disease has reached there, officials said. Basel said Karnali is now planning to send the teams into rural areas as well.

Dr Dharma Kanta Banskota, vice-chancellor of Tribhuvan University, said: “We also have deployed two teams in Sudurpaschim province and Province 5 to set up a PCR laboratory and train medical people for the tests.”

Nepal’s Province 5 has had 24 cases of COVID-19 so far, and five cases were registered in Sudurpaschim province. But the provinces do not have enough trained people to carry out tests and operate the labs.

Lab set up in Karnali

In Karnali, the team from Tribhuvan University’s department of microbiology established a laboratory in Surkhet, the provincial headquarters, which can test and deliver a result on 96 samples in each three-hour shift.

The team also trained health technicians in the province and helped with the installation of another PCR machine. Before this all test samples had to be sent to the capital Kathmandu to get a result, Banjara said.

Just 1,096 PCR tests have been conducted in the province so far, including the university team’s tests, while the province conducted around 5,000 rapid diagnostic tests, mainly in the provincial headquarters and towns where returnees from India are quarantined. The rapid tests are not considered reliable – these types of tests have already been stopped in India and must now be supplemented by PCR tests.

One in 10 districts in the hilly province lack even a road connection to the regional headquarters, and the province – the largest in Nepal – has only 10 small hospitals to serve two million people.

Overall in Nepal, federal Ministry of Health and Population records show that PCR tests have been conducted on 14,096 people while 52,870 have gone through rapid tests. There are 14 PCR labs in the country, including the one installed by Tribhuvan University in Karnali province.

“The help from the university is very significant. We appreciate their support at this time crisis,” said Dal Rawal, minister for social development of Karnali province.

The province was sealed off from the rest of the country on 4 May after a big spike in the number of COVID-19 cases in Nepalgunj in neighbouring Province 5. The city is just a few kilometres away from the provincial border. The Karnali Province Disaster Management Council said all entry points to the province would be sealed for a week.

Shortage of test kits

Vice-Chancellor Banskota said government agencies had been informed that the university was ready to dedicate its laboratories in the department of microbiology and biotechnology, which have three state-of-the-art real-time PCR machines, to the battle against COVID-19.

Hundreds of samples could be tested on a daily basis in those labs if there is adequate supply of the kits and reagents, he said. However, there have been some problems with testing within the province due to a lack of supplies.

“We haven’t been able to use our labs fully-fledged because of the lack of test kits,” said Dev Raj Joshi, a Tribhuvan University associate professor and member of the team deployed to the province. Tests have not been conducted even among those who have been quarantined, he said.

Anil Sah, a graduate in microbiology from Tribhuvan deployed to Sudurpaschim province, said a lack of the kits and availability of trained personnel outside Kathmandu are the major problems in carrying out the tests. “Also, travel to remote places by road is challenging and air service is not easily available,” he explained.

The Nepal army has been providing helicopter services to collect samples from rural areas. However, this is limited.

Nepal’s federal health ministry provides testing kits to provincial governments who provide them to the university, but there has been a problem securing enough kits.

The Nepal government imported testing kits and reagents used for chemical analysis from China, which is running out of stock. Officials say Nepal’s authorities have been trying to get a second consignment from China for more than a month. Now officials say they expect delivery within a week so that they can increase the number of tests.

The Qatari and German governments have provided the kits currently in use, while 30,000 PCR test kits donated to Nepal by Switzerland are currently stuck in transit in Singapore.

Less than 100 cases in Nepal so far

Nepal has registered 99 registered cases and no deaths so far. The first positive COVID-19 case in the country was reported on 13 January in a 31-year-old PhD student who had been studying in Wuhan, China, where the disease was first reported. The student returned to his home in Nepal on 5 January – before the Wuhan lockdown was announced on 23 January.

It was only on 22 March that the second case was reported in a 19-year-old woman, who had returned to Nepal from Paris. Other positive cases are either returnees from India or their family members.

“It is a relief that only 99 cases have been reported and there’s no death from the disease so far,” said health ministry spokesman Dr Bikash Devkota. “However, the threat hasn’t been averted. The fact that most of the positive cases were asymptomatic shows there could be other cases.” The threat from asymptomatic patients is high because they can transmit the disease without showing symptoms, he said.

Karnali is the only province in the country where no cases have been confirmed. A severe lack of hospital isolation wards and laboratories has made it important to keep COVID-19 at bay.

Banskota, the vice-chancellor, said the university has also informed the government it is ready to mobilise teachers and students to assist in the supply of relief materials to the needy. During Nepal’s devastating 2015 earthquake, students and teachers volunteered to assist in the relief and recovery of thousands of victims in different places affected by the quake.

Naresh Regmi, a student leader at Ratna Rajya Laxmi Campus, a Tribhuvan University constituent campus in Kathmandu, led a team of students to help clear quake debris and other relief efforts in Sindhupalchok district in Nepal’s Bagmati province. He said students were ready for any sort of volunteer work if they are allowed to travel and can get protective clothing.

Quarantine centres

Along with the tests, the university has made available at least a dozen of its constituent campuses in different parts of Nepal to be used as quarantine centres. Tribhuvan University, which is among the largest universities in the world in terms of student enrolment, has 61 constituent campuses across the country and, in addition, more than 1,000 affiliated colleges.

As academic activities at the university stopped on 18 March, when the government shut down all schools and higher education institutions to prevent the spread of the coronavirus, university buildings that have the capacity to accommodate hundreds of people, are empty.

Already the university’s campuses in the southern belt of the country bordering India have been turned into quarantine centres as the government lacked adequate space to house the thousands of people who returned home from various Indian states after that country’s lockdown.

Officials at the university say they are now preparing to study the nature of the virus and to find out why so few people have been infected by COVID-19 in Nepal, with most of them asymptomatic.

“We have to study whether it is because of less virulence of coronavirus or high immunity of Nepali people,” said Tribhuvan’s Banjara.

A comparative study of the coronavirus gene found in China, India and Nepal could be useful in finding out why the virus has not had severe outcomes in Nepal. “We are planning to work with support from researchers from China and India,” Banjara said.

The university is currently conducting research on the economic, social and psychological effects of the COVID-19 pandemic.

As in other parts of the world, Nepal faces huge economic loss due to the lockdown imposed to contain the spread of the disease. The government had projected over 8% economic growth for the current fiscal year, which it has now revised down to 2.7%.

Thousands of people, mainly from the hospitality, manufacturing and service sectors, have lost their jobs. “The impact of the pandemic will be seen for years. Our study, we believe, will be helpful for the Nepal government in preparing the budget and policies in the future,” Banskota said.