Compliance with Social Distancing, Face Mask and Sanitizer Use Measures against COVID -19 in Kathmandu Valley.

BACKGROUND: The novel coronavirus has caused significant global impacts and is still continuing. Social distancing, the use of face mask and sanitizer (SMS) measures have become the prominent security measures to diminish the COVID-19 transmission. Hence, this study aims to assess the general public's compliance towards SMS measures set by the Government of Nepal against COVID-19 in Kathmandu Valley. METHODS: This cross-sectional study was conducted in selected public places of Kathmandu valley, Nepal employing an observational checklist from 5-6 August 2020. The practice of using facemask and its types were observed at the individual levels (malls, groceries, shops and 30 vehicles). The practice of SMS was studied in 23 public places that included banks, hospitals, vegetable markets, shopping malls, temples, restaurants and public buses. RESULTS: A total of 23 public places and 4502 individuals were included in the study. More than two-third (72.6%) participants were observed using mask. Among the mask users, 27% did not follow the appropriate technique. Maintaining social distance of 2 meters was less followed by the people in the public places, hospitals and public vehicles. Only 37.5% institutions had set the marking of the social distance of 2 meters. Availability of hand washing facilities with soap or sanitizer was found less in the public places. CONCLUSIONS: Overall, the compliance measures of SMS set by the Government of Nepal against COVID-19 were not followed appropriately. Efforts are needed to improve the proper practice of using the mask and conveying the SMS message by the Nepal Government which is important step for the prevention of COVID-19 in Nepal.

Revisiting the clinical trial history and regulatory mechanisms in Nepal in the context of COVID-19 pandemic.

Presence of Nepal in global clinical trials has been visibly negligible despite the history of conducting large scaled randomized controlled trial on Hepatitis E vaccine decades ago. Majority of the problem is attributed to the lack of collaborative work, financial and human resource constrains. COVID-19 pandemics seems to have triggered urgency among the authorities of Nepal leading to a substantial increase in the number of clinical trials in collaboration with national and international organizations/institutions. Immediately after detection of the first COVID-19 case on 13 January 2020, the Ethical Review Board (ERB) of NHRC received several research proposals, subsequently leading to the approval of the first clinical trial for COVID-19 on 01 July 2020 to investigate potential of traditional Ayurveda based medicine for COVID treatment. Soon, number of other clinical trial proposals received approval and implemented in the country, however budgetary allocation from the Government of Nepal (GON) was prioritized for COVID-19 outrage management and vaccination coverage only. Collaborations with various international institutions played a significant role in the successful implementation of large-scale clinical trials in the country and further laid the path for future. In this review paper we present the recent developments in clinical trials in Nepal, budgetary allocation from the government and the mechanisms in place for regulation of clinical research in the country along with challenges and way forward.

Experience of Treating COVID-19 With Remdesivir and Convalescent Plasma in a Resource-Limited Setting: A Prospective, Observational Study.

BACKGROUND: Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. METHODS: In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death. RESULTS: Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compared with those who received REM alone (73.3% and 57.5%, respectively). Of 1083 patients with reported outcomes, 78.4% were discharged and 21.6% died. The discharge rate was 84% for REM (n = 910), 39% for CPT (n = 59), and 54.4% for CPT + REM (n = 114) recipients. In a logistic model comparing death vs discharge and adjusted for age, gender, steroid use, and severity, the predicted margin for discharge was higher for recipients of remdesivir alone (0.82; 95% CI, 0.79-0.84) compared with CPT (0.58; 95% CI, 0.47-0.70) and CPT + REM (0.67; 95% CI, 0.60-0.74) recipients. Adverse events of remdesivir and CPT were reported in <5% of patients. CONCLUSIONS: This study demonstrates a safe rollout of CPT and REM in a resource-limited setting. Remdesivir recipients had less severe infection and better outcomes.ClinicalTrials.gov identifier. NCT04570982.

Assessment of Preparedness of Government of Nepal in COVID Designated Hospitals and Clinics for Pandemic Response.

BACKGROUND: Preparedness, readiness, and response status of any country is integral in identifying, managing, and preventing COVID-19 pandemic. The objective of this study is to assess the status of the Government of Nepal designated COVID hospitals and COVID clinics to respond against COVID-19. METHODS: A cross sectional study was conducted with the focal persons of COVID hospitals and COVID clinics using a semi-structured questionnaire from April 26, 2020 to May 27, 2020 via face to face interview with onsite observation and telephonic interview in few unreachable health facilities.  Results: Government of Nepal designated COVID hospitals and COVID clinics demonstrated efforts in establishing preparedness plans and committees such as COVID management core team (96.7% and 86%), provision of coordination with the government authority (both 100% ), preparedness response plan (93.3% and 84%), and infection prevention and control committee (63.3% and 65.6%) to respond to COVID-19 respectively. The participants reported differences in training provided to their health care workers with maximum COVID hospitals (80%) providing training on use of personal protective equipment and least (43.3%) on handling dead bodies. Only half of the COVID clinics (49.5%) had provision of triage systems. CONCLUSIONS: COVID hospitals and COVID clinics in Nepal demonstrated different status of COVID pandemic preparedness and readiness. In case of surge, Nepalese hospitals would struggle due to lack of trained workforce and infrastructure.  Interdisciplinary, multi-sectoral collaboration with various focused strategies, including in-service training to staff, is paramount to increase preparedness and readiness.  Keywords: COVID-19; Nepal; preparedness; readiness.

Stress, Anxiety, Depression and Their Associated Factors among Health Care Workers During COVID -19 Pandemic in Nepal.

BACKGROUND: Frontline Health Care Workers are at risk of developing mental and psychological distress during Corona virus disease 2019 pandemic. This study aimed to assess level of stress, anxiety, depression and their associated factors among health care workers during Corona virus disease 2019 pandemic in Nepal. METHODS: This is a web based cross-sectional survey conducted among 404 Health Care Workers during early phase of Corona virus disease 2019 pandemic. The participants were selected using convenience sampling technique and were invited to participate via various online networks. Depression, anxiety and stress were assessed using the Depression Anxiety Stress Scale-21 (DASS-21) and their associated factors were measured using structured questionnaires. Multivariable logistic regression was carried out to determine the associated factors. RESULTS: The symptoms of stress, anxiety and depression among health care workers were found to be 28.9%, 35.6% and 17.0% respectively. Females were found to be 2 fold more likely to have anxiety and depression than male. Nurses were found to be two times more likely to have anxiety than doctors. Laboratory personnel were almost three folds more likely to have anxiety than doctors. Health care workers with insufficient/ no PPE were almost three fold more likely to have depression. health care workers working in high-risk areas had almost 2 fold higher odds of having depression. CONCLUSIONS: Health care workers experienced symptoms of stress, anxiety and depression in varied level of severity. This experience was higher among the nurses and laboratory workers than doctors. Pandemic preparedness assuring PPE and appropriate psychological interventions may be beneficial to promote mental health and well-being of health care workers.

Gender Disaggregation in COVID-19 and Increased Male Susceptibility.

Novel coronavirus disease 2019 (COVID-19) is a growing public health crisis. Despite initial focus on the elderly population with comorbidities, it seems that large studies from the worst affected countries follow a sex-disaggregation pattern. Analysis of available data showed marked variations in reported cases between males and females among different countries with higher mortality in males.  At this early stage of the pandemic, medical datasets at the individual level are not available; therefore, it is challenging to conclude how different factors have impacted COVID-19 susceptibility. Thus, in the absence of patients' level data, we attempted to provide a theoretical description of how other determinants have affected COVID-19 susceptibility in males compared to females.  In this article, we have identified and discussed possible biological and behavioral factors that could be responsible for the increased male susceptibility. Biological factors include - an absence of X-chromosomes (a powerhouse for immune-related genes), a high level of testosterone that inhibits antibody production, and the presence of Angiotensin-converting enzyme 2 (ACE2) receptors that facilitate viral replication. Similarly, behavioral factors constitute - higher smoking and alcohol consumptions, low level of handwashing practices, and high-risk behavior like non-adherence to health services and reluctance to follow public health measures in males. Keywords: COVID-19; gender; males; sex disaggregation; susceptibility.

Safety and Efficacy of Different Therapeutic Interventions on Prevention and Treatment of COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of coronavirus that causes coronavirus disease 2019 (COVID-19), a respiratory illness. COVID-19 has now become a global public health crisis causing alarming numbers of morbidity and mortality. Ever since the COVID-19 pandemic started scientists, researchers, universities, companies, and institutions all around the world have been endeavoring to discover a potential treatment for COVID-19. Numerous studies and clinical trials on vaccines and drugs for the prevention and treatment of COVID-19 are underway across the world. However, the uncertainty around the efficacy and safety of various treatment regimens have become one of the biggest challenges in the battle against the SARS-CoV-2. This paper is a narrative review of articles regarding the various treatments and vaccines being tested for the SARS-CoV-2, available in the PubMed database along with Google Scholar. There are ongoing clinical trials on potential drugs such as remdesivir, favipiravir, lopinavir/ritonavir, chloroquine, and hydroxychloroquine, corticosteroids tocilizumab, azithromycin, anakinra, etc. and other therapeutic modalities like convalescent plasma therapy. Likewise, vaccines against SARS-CoV-2 are being developed and tested, including mRNA, non-replicating viral vector, DNA, protein subunit candidate vaccines, etc. Although some early-stage clinical trials and studies on these drugs and vaccines have shown positive results, definitive and conclusive results are yet to be obtained. Keywords: COVID-19; antiviral drugs; COVID-19 treatment; COVID-19 vaccine; SARS-CoV-2.