KIRAN PANDAY WARM WELCOME: A TIA official goes through the motions

An outbreak of the H1N1 virus, or swine flu, could dampen the holiday cheer this Dasain as Nepalis flock home from flu hotspots abroad and fan out into the countryside. The danger is clear and present, but the government hasn't stepped up measures to keep out the deadly virus.

Nepal has remained largely untouched by swine flu despite the heavy toll it has taken in India, where close to 200 people have already died. So far, only 35 people have contracted the virus here, and there have been no deaths. Of these, two were foreign tourists and 28 were Nepali workers returning from abroad. The remaining five caught it from recently returned family members and friends.

These numbers may understate the flu's true prevalence since the spot checks conducted at Tribhuvan International Airport, where the government has a health desk to scan new arrivals for symptoms of the flu, are inadequate.
"They simply check temperatures and have people fill out questionnaires. That isn't enough, we don't know if we've actually detected most cases of swine flu," warns Sameer Dixit, Country Director of the Center for Molecular Dynamics.

Dixit has joined a chorus of people calling on the government to allow private labs to test for the flu. The government has so far refused to sanction this, out of concern for the costs and the reliability of tests.

"If they offer to do it for free, then sure, they can test. But will they?" wonders a dubious Jitendra Man Shrestha of the Avian Influenza Project at the Ministry of Health.

However, experts are widely agreed that the low official figures are fair estimates. Epidemiologist Raj Kumar Mahat, who coordinates health desk activity at the airport, says that fewer and fewer people are feverish upon arrival, even as the number of arrivals has jumped from about 2200 a day to up to 3100 a day. The World Health Organization says the intensity level of the flu in Nepal is 'low'.

Yet this may only be the lull before the storm as unknowing carriers of the flu, which has an incubation time of 7-10 days, come home from abroad this Dasain. Many will return from flu hotspots like Mumbai and the state of Bihar where they work in cramped and cloistered spaces like restaurant kitchens, making them especially vulnerable.
"There is definitely increased risk of an outbreak during Dasain as more people migrate back to the country," warns Shrestha.

Cooler temperatures, which are favourable to flu outbreaks, could make matters worse. Experts at a regional conference held in Kathmandu on 7 September warned of a 'winter resurgence' of the flu that could sweep through much of south and southeast Asia, including Nepal.

Ominously, the flu has shown surprising resilience during the warmer spring and summer months. Experts worry that if it's this bad already, we really should be prepared for the winter.

Has the Nepali government stepped up measures to combat the flu? No. There have been no additions to the health desk at the airport, which hasn't received any special Dasain directives. Dixit says he hasn't come across the government's Dasain contingency plan. And checkpoints along the southern and western borders remain relaxed.

"It's almost impossible to screen everyone that comes across the border," says Shrestha. There are currently 50 checkpoints along the border, 18 of which see a lot of traffic, but seven of these are ill-equipped.

Besides these border checkpoints and the airport health desk, Nepal's preparations include 40 rapid response teams across the country, a number of surveillance teams, and government aid to a couple of prominent hospitals to enable them to provide special treatment and buy the necessary drugs and equipment.

So what else can we do to steer clear of swine flu this Dasain? The age-old mode of greeting people with a folded-hand Namaste may minimise risk of transmission. But in the age of hugs and handshakes this may not go down too well, as some sociable but conscientious types have discovered already. In the meantime, Shrestha suggests, "Wash your hands."