Thread by @AnupSubedee

What can those who want to help from outside Nepal do?
(So many friends are asking. Let me share where I think there is the biggest bang for the buck.)
Answer: buy tons of COVID test kits (antigen & PCR), hand them over to municipalities to run mass free testing campaigns.
1/n

While all attention is on the needs of the hour –O2, ICU, ventilator, etc., let’s remember that intervention there won’t impact at all the numbers of new cases needing same things 1 week from now. (This is NOT to dissuade anyone from working on these immediate challenges.)
2/n

There's too little happening in terms of public health response to the pandemic surge- test/trace/isolate & quarantine/vaccinate – the only interventions that can reduce the number of new cases in community and the number of those needing hospital beds, oxygen or ICU care.
3/n

It may appear we're nearing the peak of the pandemic right now, but what the bridal on the tiger we are riding – lockdown- is let loose? When do we relax it? Since there is no system to intervene in the community, we'll be back in square one as soon as we loosen the lockdown.
4/n

There’s just too much reluctance, incomprehension, sheer lack of interest on the govt’s side to work in mitigating the community spread. Outsiders like us cannot help much with contact tracing, isolation or quarantine facilities, without support from local government. But..
5/n

Let’s think about testing. Currently the test positivity rates are around 45% nationally --> the real number of daily new cases is many times higher than the reported numbers. People are not getting tested because of lack of kits in towns and villages and border checkpoints.
6/n

Municipalities do collect PCR swabs, and send to NPHL which reports on them – free of cost to individuals. But the numbers are too small. (400/day in Kathmandu Metropolis last week) And noone knows that free tests are happening.
7/n

If we were to invest primarily in testing – buying cheap (FDA EUA/CE, meeting the govt’s requirements) antigen and PCR kits from China, handing them over to municipalities & asking for mass testing campaigns using certain protocols, many more positive cases will be identified.8/n

Cool thing about testing: testing alone will help drive some level of contact tracing, isolation and quarantine without the state’s intervention. Once you identify someone as positive, they tend to self-isolate, try to protect dear ones, & neighbors will be more careful.
9/n

Pathway for such testing drive:
Symptoms present-> antigen test. Ag test positive-> treat as COVID case. Ag test negative-> send PCR swab and isolate.
Asymptomatic, exposed to someone with COVID-> PCR test after quarantine period
10/n

While some are working on immediate priorities like oxygen supply,
others should think about how they can help to mitigate the pandemic spreading like wildfire in the community.

Let's help run these massive test campaigns that are so acutely needed in our communities.

Fin.