COVID-19 Containment Efforts of a Low-Resource Nation: The First Four Months in Nepal

A novel coronavirus (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) was identified in hospitalized patients in Wuhan, China, in December 2019. It rapidly spread across the globe within the span of a few months. Nepal is a low-resource country with limited critical care delivery infrastructure. Coronavirus 2019 (COVID-19), the disease caused by the virus, could potentially cause a medical catastrophe in Nepal. We reviewed all pertinent documents published in the public domain by the Ministry of Health and Population of Nepal and other relevant literature. We aimed to describe the key strategies Nepal embraced in the first four months in its attempt to curtail the disease immediately following the identification of its first case and the challenges it faced. In our review, we determined that the key steps taken by Nepal included border control to prevent the importation of cases, strict quarantine in facilities for anyone entering the country, early case detection, and isolation of all infected cases irrespective of symptoms. Testing capabilities, quarantine facilities, and isolation beds were also rapidly increased. We discuss how Nepal achieved some success in the first four months between January 13, 2020, when the first case was identified, to May 13, 2020. However, it faced several challenges that ultimately led to an exponential rise in cases thereafter.