KATHMANDU, Nepal – Ram Singh Karki escaped the first wave of the Indian pandemic by getting on a crowded bus and crossing the border into Nepal. Months later, when the new infection rate dropped, he returned to his job at a printing company in New Delhi that had supported his family for two decades and paid his three children’s school fees.
Then a second wave hit India and Mr. Karki was not so lucky.
He was infected last month. New Delhi hospitals were overwhelmed. When his oxygen levels dropped, his manager arranged for an ambulance to take him back to the border. He crossed Nepal and only carried the clothes on his back – and the virus.
Nepal is now considering declaring a health emergency as the virus rages virtually unchecked in the impoverished nation of 30 million people. Carried by returning migrant workers and others, a vicious second wave has strained the country’s medical system beyond its meager limits.
Nepal has recorded half a million Covid cases and 6,000 deaths, numbers experts believe deeply underestimate the toll. Testing remains limited. A number could indicate the true severity: For weeks around 40 percent of the tests carried out have been positive.
A disordered government made the problems worse. KP Sharma Oli, Nepal’s embattled prime minister, pushed for an election in November after the country’s parliament was dissolved this month, an event that could worsen the spread.
Last week, Hridyesh Tripathi, Nepal’s Minister of Health and Population, said the government was considering declaring a health emergency as infections rise.
But such an explanation could be sought in politics. The move would allow officials to restrict people’s movements – a level of control opposition groups fear could be used to quell dissent.
Meanwhile, officials in the capital, Kathmandu, have asked people to store food and stay at home for at least a week.
The effects extend beyond the infected. Remittances from migrant workers have slowed. Tourism and the economy were damaged.
“Millions of people continue to feel the increasing pressure not only from the direct health effects of Covid-19, but also from food, jobs, medical bills, children outside of school, repayment loans, psychological pressure and much more,” said Ayshanie Medagangoda Labe, who resident representative of the United Nations Development Program in Nepal.
Nepal’s close ties with India helped make it vulnerable. India has long been its main trading and transit partner. The two nations share a deep cultural connection across a porous 1,100-mile boundary. Nepal’s devastation mirrors that of its big neighbor – from patients spilling in hospital corridors and lawns, to long lines for oxygen refills, to a government unprepared for a crisis.
Officials say workers like Mr Karki, who were forced to come home by the second wave, brought the virus with them. Villages along the border are hardest hit. The Nepalese Ministry of Health said that about 97 percent of cases sent for genome sequencing show variant B.1.617.2 found in India, which has been classified as a “variant of global concern” by the World Health Organization.
Nepal’s leaders were unprepared. During India’s first wave last year, when about a million Nepalese migrant workers returned home, Nepal introduced testing and quarantine measures at border crossings.
But during the second wave of this spring, these measures came too little too late. When Nepal closed two-thirds of its border crossings in early May, hundreds of thousands of workers had returned and entered their villages without adequate testing or quarantine. Thousands continue to return daily.
Government attention had shifted elsewhere. In February, when the virus appeared to be on the wane, Mr. Oli held rallies with thousands of supporters in Kathmandu and other cities. Opposition parties held their own rallies. Last year, Mr Oli said the health of the Nepalese people would put the disease off.
Government defenders say the pandemic is a global problem and officials with few resources or vaccines are doing their best.
Mr Oli has asked for international aid, but it will not be enough to meet Nepal’s needs. China donated 800,000 vaccine doses, 20,000 oxygen bottles and 100 ventilators. The United States and Spain have sent plane loads of medical equipment, including oxygen concentrators, antigen tests, face masks, and surgical gloves. The United States allocated $ 15 million this month to expand Covid testing in Nepal. Nepalese migrant workers in the Persian Gulf countries have arranged for oxygen bottles to be sent home.
But Nepal cannot fight the pandemic without help from India. An Indian vaccine manufacturer has already told Nepal that it will not be able to deliver the one million doses it promised.
Nepal also depends on India for half of its medical equipment needs, according to the Chemical and Medical Suppliers Association of Nepal, but the latter country keeps almost everything domestically for its own urgent needs. The already expensive equipment from China is harder to come by due to the Chinese pandemic restrictions.
“For a month now, India has also stopped delivering medical equipment and drugs, not just vaccines,” said Suresh Ghimirey, the association’s president.
Hospitals are running out of beds in some provinces to which many migrant workers have returned in India. In the Surkhet district, the province’s main hospital said it could no longer accept patients. Small, remote villages quietly mourn their dead. Testing was slow.
“With the exception of a few villagers, many cannot come out and do the daily agricultural work,” said Jhupa Ram Lamsal, community leader of the village of Gauri, where nine people died of Covid earlier this month. “The worrying thing is that even symptomatic people are not ready for Covid tests.”
Mr Lamsal said he recently reached Gauri, which is remote and has no health facilities, along with a team of doctors to do antigen tests. Locals turned down health professionals’ requests for Covid tests, he said, arguing they would be discouraged if they found out they were positive.
“The situation is out of control,” said Mr Lamsal. “We are hopeless, helpless.”
Mr. Kakri, the printing worker, was from a village in Bhimdatta Municipality in western Nepal. According to the local health director Narendra Joshi, the area with a population of 110,000 has officially registered 3,600 infections. However, the lack of action at the border means that the data may not fully measure severity.
“Since the beginning of the second wave in India, more than 38,000 people have returned from one of the two border points in the district,” said Joshi. “It’s hard to manage.”
Mr. Karki was a high school dropout who went to India as a teenager to work as a manual worker, said his wife Harena Devi Karki. During his home visits twice a year he was the life of meetings – joking, making fun. The $ 350 monthly he sent home covered his family’s household expenses as well as the private tuition of their two teenage daughters and a 12-year-old son.
Even when last year’s lockdown resulted in Mr. Karki being stuck at home for months with no income, he insisted that the children go to private school. He would repay the debt as soon as the print shop opened again. He dreamed of seeing his eldest daughter – “she is the most talented” – grow up to be a doctor.
“I couldn’t finish my studies,” Ms. Karki recalls of her husband’s words. “Let me eat less, but we should send them to a better school for their education.”
When Mr. Karki met her husband at the border around 2:30 a.m. on April 29, she said he was frail and did not have the energy to get up at all. He was taken to a nearby hospital where he died.
“‘Everything is ok. Go home,'” said her husband, said Mrs. Karki. “But he never came home.”