Assessment of COVID-19 Pandemic in Nepal: A Lockdown Scenario Analysis

The Government of Nepal issued a nationwide lockdown from 24 March to 21 July 2020, prohibiting domestic and international travels, closure of the border and non-essential services. There were only two confirmed cases from 610 Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests and no fatalities when the government introduced nationwide lockdown. This study aimed to explore the overall scenario of COVID-19 including spatial distribution of cases; government efforts, and impact on public health, socio-economy, and education during the lockdown in Nepal. We collated and analysed data using official figures from the Nepalese Ministry of Health and Population. Nepal had performed 7,791 RT-PCR tests for COVID-19, the highest number of tests during the lockdown. It has recorded its highest daily rise in coronavirus infections with a total of 740 new cases from the total of 4,483 RT-PCR tests performed on a single day. Nepal had reported a total of 17,994 positive cases and 40 deaths at the end of lockdown. The spatial distribution clearly shows that the cases were rapidly spreading from the southern part of the country where most points of entry and exit from India are located. To contain the spread of the virus, the government has also initiated various preventive measures and strategies during the lockdown. The Government of Nepal needs to allocate more resources, increase its capacity to test and trace, establish dedicated isolation and quarantine facility and impose local restrictions such as a local lockdown based on risk assessment rather than a nationwide lockdown.

Multidisciplinary approach to COVID-19 risk communication: A framework and tool for individual and regional risk assessment

The COVID-19 pandemic has exceeded over ten million cases globallywith no vaccine available yet. Different approaches are followed to mitigate its impact and reduce its spreading in different countries, but limiting mobility and exposure have been de-facto precaution to reduce transmission. However, a full lockdown cannot be sustained for a prolonged period. Evidence-based, multidisciplinary approach on risk zoning, personal and transmission risk assessment on a near real-time, and risk communication would support the optimized decisions to minimize the impact of coronavirus on our lives. This paper presents a framework to assess the individual and regional risk of COVID-19 along with risk communication tools and mechanisms. Relative risk scores on a scale of 100 represent the integrated risk of influential factors. The personal risk model incorporates: age, exposure history, symptoms, local risk and existing health condition, whereas regional risk is computed through the actual cases of COVID-19, public health risk factors, socioeconomic condition of the region, and immigration statistics. A web application tool (www.covira.info) has been developed, where anyone can assess their risk and find the guided information links primarily for Nepal. This study provides regional risk for Nepal, but the framework is scalable across the world. However, personal risk can be assessed immediately from anywhere.

Role of polymerase chain reaction in breast tuberculosis.

BACKGROUND: Breast tuberculosis (TB) is an uncommon condition even in endemic countries. Breast abscess is usually seen in young females. PCR helps in such challenging cases to clinch the correct diagnosis. OBJECTIVE: The present study was performed to compare FNAC and TB PCR in inflammatory lesions of breast. METHODS: FNAC cases reported as breast abscess, necrosis, non-specific and granulomatous inflammation on cytology was taken. The material for PCR was obtained from archived MGG smears and PCR for Mycobacterium tuberculosis for insertion sequence IS6110 was performed. RESULTS: A total of 54 cases were studied. The age ranged from 19-55 years. On FNAC, acute suppurative inflammation without granulomas and negative AFB staining was noted in 18 cases; granulomatous inflammation/mastitis in 26 cases and granulomatous inflammation with necrosis with AFB positivity confirming tuberculosis in 10 cases. PCR for Mycobacterium tuberculosis for insertion sequence IS6110 was performed. None of the 18 cases of acute suppurative inflammation had positivity for PCR. 13/26 [53.3%] cases of granulomatous inflammation/ mastitis with AFB negativity were positive for PCR. 10/10 cases of granulomatous inflammation with necrosis with AFB positivity showed PCR positivity. Therefore, proven cases of TB after FNAC were only 10/54 [17.24%] and the sensitivity increased to 23/54 [42.6%] after performing PCR on FNA aspirate. CONCLUSION: PCR helped in identifying 13/26 [50%] cases reported as granulomatous inflammation on cytology as tuberculosis. FNAC acted as an efficient modality for collection of material for PCR. This study shows how PCR aids in diagnosis of breast TB.

Multiplex PCR for rapid diagnosis of tuberculous meningitis.

Rapid and specific diagnosis of tubercular meningitis is of paramount importance to decrease morbidity and mortality. The aim of the study was to evaluate multiplex PCR using protein b, MPB 64, and IS6110 primers directed against M. tuberculosis complex for the diagnosis of tuberculous meningitis (TBM). Multiplex PCR was performed on 18 TBM confirmed cases (culture was positive), 92 clinically suspected TBM cases and 100 non-TBM (control group) patients. Multiplex PCR had a sensitivity of 94.4% for confirmed cases and specificity of 100% for confirmed TBM cases. In 92 clinically diagnosed but unconfirmed TBM cases, multiplex PCR was positive in 84.78% cases. The overall sensitivity of microscopy, culture and multiplex cases were 1.81, 16.73, and 86.63% and specificity was 100, 100, and 100% respectively. Multiplex PCR using protein b, MPB 64, and IS6110 primers has a high sensitivity and specificity in diagnosis of tubercular meningitis.