Coronavirus Pandemic in Nepal: No Strategy…So Say The Charts

READING TIME: 5 minutes

Aug. 19, 2020 note. For your information, while this blog post was published on June 7, 2020 the charts are ALL live. In other words, they are up-to-date. Some of the texts and/or comments about the charts, therefore, might NOT be correct. Plus, the lockdown the country had been under then, since March 24, ended on July 21. Following a steady rise in cases, we are starting — to begin with — a week-long round of what appears to be essentially yet another lockdown from midnight, tonight.

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Nepal’s leadership, in the less than even half-hearted attempt at tackling the coronavirus pandemic, has omitted one of the most important weapon in their arsenal: a strategy. Ad hoc-ism has been the flavor of the last two months!

But then again what can one expect from a leadership that’s always been incompetent, ignorant, and arrogant, among many other things?! They were no different in the aftermath of the biggest natural calamity to hit the country in living memory — the 2015 quakes.

We first heard about the virus five months ago. We had our first case four months ago. We went  under lockdown on March 24, a decision taken just the day before, might I add. Every single time we approached the end of the lockdown period, it was renewed for an additional week or two. Following a few such renewals, we have been under lockdown for over 70 days now! What have we accomplished in that period?

The charts below come from a Google Drive spreadsheet I maintain of the official coronavirus-related figures the Ministry of Health and Population publish. The charts confirm the complete lack of strategy in confronting the pandemic. The charts are for data since the lockdown, March 24.

Incidentally, if you are interested in updating yourself later, just return to the blog. All the charts are live. They, therefore, update automatically when the spreadsheet is updated. Hence their unusual appearance.

The following two charts are about testing. The first one (chart 1) shows polymerase chain reaction (PCR) tests (blue) and PCR test moving averages (red).

The following one (chart 2) shows the daily PCR (blue) and RDT tests (the first red curve) and Antigen tests (the second red curve) conducted.

I will not be including any analysis of RDT data for two reasons. The first is that it’s NOT been a reliable test, and the second is that the government is NOT counting the positive results anyway (about which I’ll have more to say later).

The above charts demonstrate how the Government of Nepal has had NO strategy to speak of when it comes to tackling the pandemic. I pointed this out the first time on May 21 in a tweet.

The Government of Nepal “bought time” by imposing a lockdown when the cases of coronavirus was still small. It did NOT use it wisely at all though. It’s clear that when they initiated the lockdown on March 24, they had NO strategy — did I mention the decision was made the previous evening? —  and has had NO strategy since either.

How do the charts show that? Simple. Just incremental and steady rise in the moving averages and tests performed per million population (chart 1) for one point at that. For another, the number of tests per day going up and down, and up and down over pretty much the entire lockdown period (chart 2).

The next two charts are about the cases of coronavirus infections. The following (chart 3) shows the number of cases of coronavirus infections.  

Two things about the graph. Firstly, apparently, positive RDT results are NOT being reported. In other words, conducting RDT tests was NOT strategic in any way! When I discovered that I tweeted saying how that was crazy!

I personally found confirmation for the contention — that they weren’t reporting the positive results — on May 17, and tweeted about it.


What that means is that the number of cases shown in the graph is (much?) smaller than the real cases in the population.

Secondly, notice how it has started to curve upwards? That means we are now in the exponential growth rate of cases. I’ll have more to say about that below. Given that the numbers are under-estimated, we likely have been on the exponential growth rate phase for longer.

So what does the exponential growth rate mean? Well, it means that the number of cases keep shooting up rapidly and takes shorter and shorter time for them to double.

(Another graph charting the cases but this one uses log scale. As such, you can get a better sense for the exponential growth rate of the cases.

Graph added on Sept. 16, 2020.)

The graph below (chart 4) shows the doubling rates: the number of days it would take for the cases to double.

The blue line charts the instantaneous doubling rate (rate calculated using cases from that and the previous day) and the red line charts the 3-day average doubling rate (the average over the last three days) for after a couple of days of lifting the first lockdown.

As you can see, the doubling rate has been around five days for several days now. Had the RDT results been included, these doubling rates would have been reached earlier.

So, in essence, all that the lockdown appears to have achieved — while bringing a lot pain and suffering on women, on the poorest, including the day laborers — is the postponement of the inevitable. With the easing of the lockdown, that curve charting the number of cases (chart 3) is likely to continue sloping upwards, getting steeper by the day.

COVID-19 could potentially still cause a lot of deaths in spite of the numbers being low since the identification of the first case in January. One of the reasons for the low death rate, of course, is the lockdown. But, the complete lack of strategy and competency and, in its place, the abundance of arrogance and ignorance in those at the helms means that the whole situation turning into a major humanitarian crisis is a possibility.

My real worry, as expressed in a tweet some time ago is this:


What do you think?

 

June 18, 2020 Update

This chart shows the daily cases (blue) and three-day average (red).

This chart tracks the daily cases (blue) and seven-day average (red).

The following chart shows the detection rate, that is, the daily number of cases per 1000 PCR tests.

The following shows the positivity rate (percentage of daily tests that are positive) and daily PCR tests. According to criteria set by WHO, a positivity rate of 5% is an indication that the pandemic is under control in the country. With Nepal however, we have yet to peak! 

[Aug. 26 Update.] The following charts the numbers of tests conducted per confirmed case. As such, it gives an indication of whether the number of tests being conducted is adequate. WHO recommends that the number be between 10 and 30. 

Aug. 11, 2020 Update

This chart tracks the fatality rate (blue) and deaths (red).

Given that the incubation period is between 2 and 14 days, and the turn-around for PCR test reports is around 3 days in Nepal, it’s not surprising that the seven-day average start climbing from June 28, a week after the lockdown was lifted.

Aug. 19, 2020 Update

Adding two more charts. Doubling rates (chart 1) and Growth rate (chart 2) since the end of the first round of lockdown — for July 22 onwards.

Adding another one. This one charts the daily PCR tests per million vs. daily positive case per million. The steeper the trend line the better.

(If interested in other blog posts about COVID-19 in Nepal, click here, here, here, here, here, here, here, here, and here.)
 

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