Lessons learned from

War against COVID 19

Nepal’s strategies to control the disease

Devi Prasad Prasai, PhD

3/27/2020
 Why did new cases of China
diminish quickly?
• Adapted right approach of disease control i.e. universalization ( lockdown whole
Hubei province)
• Transmission cutdown more rapidly,
• Strong public health network,
• Compliance of rues and regulation,
• Disciplined life style,
• Limited movement of people,
• High priority to the health as a result locked down whole province,
• More focus on cutting down the transmission,
• Balanced between the preventive and curative approach, interlinked
 Why are new cases rocketing in
US?
• The United States now has more coronavirus cases than any other country with over
82,400, according to Johns Hopkins University (As of 3/27/2020) . 
• Less effective approach of disease control i.e. Selective approach rather than
universalization ( only selected district, province lockdown)
• High transmission (1st case spreads to 372 cases )
• Weak public health care network,
• Free life style (enjoyed more freedom),
• Movement of people and market activities did not control,
• High priority of economic sector and less to health, as a result did not close all the firms,
• More focus to case management and less to prevention,
• Less cross states learning on disease control,
 Why could Italy not control the COVID
19?
• More movement of people with strong commercial links in Northern region of
Lombardy.
• “Milan does not stop.” was the slogan. Now it has converted as a dead city
because of the disease.
• Adapted less effective approach in the beginning -selective approach (lockdown
only eleven towns in southern Lombardy) as a result spread the disease rapidly.
• Weak public health network,
• Culturally, Italian spend more time together under the same roof. No social
distancing,
• Could not limit the movement of its citizens,
• More elder and smoker population.
• Less effective PPEs as a result 4,000 health care workers have tested positive for
the virus — acted as transmission channels themselves. 
 Nepal’s major strategies
War against COVID 19
Assessing the need of the country and learning from the international
experiences, Nepal has adapted the following major strategies to
control the diseases:
• Preventing strategies
• Case management strategies
• Health system strengthening strategies
• Multisectoral collaboration and cooperation strategies
 Preventing strategies
• Stay at home

• Promotion of public health measures

• Handwashing,
 Preventive strategies
• Respiratory etiquette,

• Social distancing

• Postponement or cancellation of
large-scale public gatherings.
 Advancement of case
management
• Self-isolation or home quarantine;
• Testing
• Contact tracing
• Advancement of health systems (training, orientation,
information management system)
• Readiness (Isolation beds, mechanical ventilation and oxygen)
• Strengthening health facility infection prevention and
control system
Choices of case management

Mild cases
Home based care 80 %
Moderate cases
Hospital based 15%

Critical cases 5%
 Nepal’s situation
Civil society assessment
Willingness and political commitment : Very high
Preparedness: Delay in preparedness but aggressive in the last 2 weeks)
Readiness: Inadequate PPEs, ventilators and ICUs, and patient transport
system etc.
Response: Moderate (more to prevention, moderate to intermediate
care and less to advanced case management)
Nepal lacks readiness
Personal Protection Ventilators
Equipment (PPEs)

Laboratory equipment to
Sanitizers
establish additional labs
 Good initiation
• Closed schools, postponed the gatherings.
• Built temporary hospitals, allocation of isolated beds in the hospital.
• Quarantine halls
• Lockdown Nepal for a week
• Awareness campaigns
 Increased risks
• Outflow of people from Kathmandu to districts and towns (1 million)
within a week.
• Inflow from India (about 1 million within a week).
• Increased contacts, increased the risks spreading disease to districts
and towns ,
• Health desk with poor equipment,
 Challenges
• Increasing the tests,
• Protecting doctors and other health workers from COVID 19.
• Discouraging unnecessary referral from private to public and avoiding
suspected cases at private hospital.
• Ensuring access to the critical care.
• Patient transport and referral system.
• Avioding panic
Thank you for attention