key: cord-0752539-hnegqdmy authors: Pokharel, Sunil; Raut, Shristi; Rijal, Komal Raj; Adhikari, Bipin title: Coronavirus Disease 2019 Pandemic – Public Health Preparedness in Nepal and One Health Approach date: 2020-05-29 journal: Disaster medicine and public health preparedness DOI: 10.1017/dmp.2020.172 sha: 8a24463c063ece94a44a7b80d03f4e5f99498469 doc_id: 752539 cord_uid: hnegqdmy nan T he coronavirus disease 2019 pandemic that originated in Wuhan, China, in December 2019 has spread to 210 countries, infected more than 4 million people, and claimed 313 220 lives as of May 17, 2020. 1,2 While high-income countries are struggling to control the disease, of the bigger concern is whether low-and middle-income countries (LMICs) with weak health systems have adequate capabilities to tackle the infection. Drawing on our perspective from Nepal, we outline the challenges and recommendations relevant for LMICs. LMICs, like Nepal, have a high burden of poverty, diseases, and a poor health system infrastructure. 3 Intervention measures, such as a complete lockdown, have apparently successfully delayed the spread of COVID-19, but they bear catastrophic socioeconomic consequences and are alone unsustainable. 4 While an effective vaccine to generate sufficient herd immunity is not a solution for the foreseeable future, alternative strategies to contain the virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on robust surveillance data, are urgently required. Strengthening health system capacity focused on sustainable COVID-19 preparedness and targeted interventions with extended diagnostic testing, contact tracing, and enhanced capacity for early isolation and treatment of cases are imperative for future containment efforts. LMICs lack adequate diagnostic infrastructure. A central lab in Kathmandu and few provincial labs in Nepal with limited testing capacity for reverse transcriptase polymerase chain reaction (RT PCR) and poor capacity for sample chain logistics for testing from the peripheral health facilities, impeded by poor network and transportation infrastructure, are unlikely to manage the timely diagnosis and response. 4 The available rapid test for disease screening has low specificity for active infection and offers little help for diagnosis and clinical monitoring. The current hospital preparedness of Nepal is constrained by inadequate isolation rooms, intensive care unit facilities, and ventilators limited to urban settings. 5 In addition, Nepal, like other LMICs, suffer from high syndemic burden of infectious diseases, which can compound the diagnosis and strain the existing scarce health care resources. In addition, high comorbidities may simply offer a sense of complacency for the justification of high mortalities. Nepal has been struggling with inadequate personal protective equipment for the frontline health care workers, which has increased their vulnerability to infection. 6 Measures for quarantine and isolation have prompted fear, discrimination, and rejection among the population in Nepal. 7 Fear and stigmatization are recognized barriers to early health seeking and hinder early case identificationperpetuating community transmission. 8 Linked to fear and stigmatization, hyped up, uncensored, and unverified news in both formal and informal media can have an adverse impact on social harmony. 9 Urgent actions toward censoring the fake news, rumors, and unproven messages in both formal and informal media require strict scrutiny and regulation. Although the transmission of SARS-CoV-2 from animals to human has not yet been established, the identification of this virus from both domestic and wild animals demands further precautionary endeavors. 10 In addition, reports of the dissemination of the virus in human excreta 11 and the long survival of the virus in the environment institute it as a strong reservoir for the circulation of the virus. 12 The control efforts should encompass protection of domestic animals and environmental hygiene. One health surveillance of SARS-CoV-2 is needed for early detection of this virus in animal and the environment to prevent transmission in communities. Human species are non-immune to the huge reservoir of circulating pathogens in wildlife, and the consequent (re-) emerging zoonotic infections pose the highest pandemic potential. 13 Outbreaks of coronavirus infections, including the SARS outbreak in A novel coronavirus from patients with pneumonia in China Coronavirus cases Tackling antimicrobial resistance in low-income and middle-income countries COVID-19 pandemic: what can Nepal do to curb the potential public health disaster? Critical health care centralized in capital One hundred Italian doctors have died of coronavirus Fear and loathing: stigma and ostracisation for those who've returned from abroad Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: a qualitative study among patients, community members and health care workers Fighting fake news: the new front in the coronavirus battle Is COVID-19 the first pandemic that evolves into a panzootic? COVID-19: faecal-oral transmission? World Health Organization. Water, sanitation, hygiene and waste management for the COVID-19 virus World Health Organization, Regional Office for the Eastern Mediterranean Novel coronavirus (COVID-19) outbreak: a review of the current literature The proximal origin of SARS-CoV-2 The authors have no conflicts of interest to declare.