As with other coronavirus-affected countries, Nepalese medical fraternity also expressed concerns regarding public health strategies of government and hospital readiness in response to upgoing case surge. To gauge such response, we assessed service availability and Infection prevention and control (IPC) status in 110 hospitals situated across seven provinces. An electronic survey was sent out to the frontline clinicians working on those hospitals between 24th March and 7th April 2020; one response per hospital was analyzed. Hospitals were divided into small, medium, and large based on the total number of beds (small:<=15; medium:16-50; large:>50), and further categorized into public, private, and mixed based on the ownership. Out of 110 hospitals, 81% (22/27) of small, 39% (11/28) of medium, and 33% (18/55) of large hospitals had not allocated isolation beds for COVID-19 suspects. All small, majority of medium (89%; 25/28), and 50% of large hospitals did not have a functional intensive care unit (ICU) at the time of study. Nasopharyngeal (NP)/throat swab kits were available in one-third (35/110), whereas viral transport media (VTM), portable fridge box, and refrigerator were available in one-fifth (20%) of hospitals. Only one hospital (large/tertiary) had a functional PCR machine. Except for General practitioners, other health cadres- crucial during pandemics, were low in number. On IPC measures, the supplies of simple face masks, gloves, and hand sanitizers were adequate in the majority of hospitals, however, N95-respirators, Filter masks, and PPE-suits were grossly lacking. Government COVID-19 support was unevenly distributed across provinces; health facilities in Province 2, Gandaki, and Province 5 received fewer resources than others. Our findings alert the Nepalese and other governments to act early and proactively during health emergencies and not wait until the disease disrupts their health systems. Other countries of similar economic levels may undertake similar surveys to measure and improve their pandemic response.

Nepal rolled out a nationwide COVID-19 vaccination drive on January 27, 2021, which became possible as the Indian government donated one million doses of Covishield (Oxford-AstraZeneca) vaccine. This realm of regional vaccine diplomacy and strong political will could be an example for many countries that have not started vaccination yet.

Authors acknowledge the patient and their family for cooperation and consent. We thank all clinicians and support staff from the Department of Internal Medicine and the Department of Anesthesia and Critical Care who were involved in patient care.

Background As with other coronavirus-affected countries, Nepal’s medical community also expressed concerns regarding the government’s public health strategies and hospital readiness in response to increasing COVID-19 case surge. To gauge such response, we assessed service availability and readiness status in hospitals situated across seven provinces. Methods A web-based observational study was conducted between March 24 and April 07 in 110 hospitals, all of which were later designated as COVID-19 clinics or hospitals by Nepal Government. An electronic survey link was sent out to the clinicians working at the frontline in those hospitals. One response per hospital was analyzed. Hospitals were divided into small, medium, and large based on the total number of beds (small:15 or less; medium:16–50; large:>50), and further categorized into public, private, and mixed based on the ownership. Results Out of 110 hospitals, 81% (22/27) of small, 39% (11/28) of medium, and 33% (18/55) of large hospitals had not allocated isolation beds for COVID-19 suspects or cases. Majority of medium (89%; 25/28), and 38% of large hospitals did not have a functional intensive care unit (ICU) at the time of study. Nasopharyngeal (NP)/throat swab kits were available in one-third (35/110), whereas viral transport media (VTM), portable fridge box, and refrigerator were available in one-fifth (20%) of the hospitals. Only one hospital (large/tertiary) had a functional PCR machine. Except for General practitioners, other health cadres—crucial during pandemics, were low in number. On IPC measures, the supplies of simple face mask, gloves and hand sanitizers were adequate in the majority of hospitals, however, N95-respirators and PPE-suits were grossly lacking. Government’s COVID-19 support was unevenly distributed across provinces; health facilities in provinces 2, 4, and 5 received fewer resources than others. Conclusions Our findings alerted the Nepalese and other governments to act early and proactively during health emergencies and not wait until the disease disrupts their health systems. Other countries with similar economy levels may undertake similar surveys to measure and improve their pandemic response.

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