KATHMANDU, Nepal – Ram Singh Karki escaped the first wave of the pandemic in India by getting on a crowded bus and crossing the border into Nepal. Months later, when the number of new infections fell, he returned to work at a printing company in New Delhi that had fed his family for two decades and helped pay his three children's school fees.
Then a second wave hit India and Mr. Karki was not so lucky.
He was infected last month. New Delhi hospitals were overwhelmed. When his oxygen levels dropped, his manager had an ambulance take him back to the border. He went to Nepal and only carried the clothes on his back – and the virus.
Nepal is now considering declaring a health emergency as the virus rages virtually uncontrollably in the impoverished nation of 30 million people. A vicious second wave carried by returning migrant workers and others has stretched the country's medical system beyond its meager limits.
Nepal has recorded half a million Covid cases and 6,000 deaths, numbers experts believe deeply underestimate the toll. Testing remains limited. A number could indicate the true severity: For weeks about 40 percent of the tests performed have been positive.
A disordered government has exacerbated the problems. K.P. Sharma Oli, Nepal's contested prime minister, pushed for an election in November after the country's parliament was dissolved last week, an event that could worsen the spread.
Earlier this week, Hridyesh Tripathi, Nepal's Minister of Health and Population, said the government was considering declaring a health emergency if infections worsened.
But such a statement could be trapped in politics. The move would allow officials to restrict people's movements – a level of control opposition groups fear could be used to quell dissent.
Meanwhile, officials in the capital, Kathmandu, have asked people to store food and stay at home for at least a week.
The effects go beyond the infected. Remittances from migrant workers have slowed. Tourism and the economy were damaged.
"Millions of people continue to feel the increasing pressure, not only from the direct health effects of Covid-19, but also from groceries, jobs, medical bills, school dropouts, repayment loans, mental pressures and much more," said Ayshanie Medagangoda Labe, who is based in Nepal resident representatives of the United Nations Development Program.
Nepal's close relationship with India has contributed to making Nepal vulnerable. India has long been the main trading and transit partner. The two nations share a deep cultural bond across a permeable border of 1,100 miles. The devastation of Nepal mirrors that of its big neighbor – from patients walking into hospital corridors and lawns, to long lines in oxygen refills, to a government unprepared for a crisis.
Officials say workers like Mr Karki, who were forced to come home by the second wave, brought the virus with them. Villages along the border are hardest hit. The Nepalese Ministry of Health said about 97 percent of cases sent for genome sequencing show variant B.1.617.2 found in India, which the World Health Organization has classified as a "variant of global concern".
Nepal's leaders were unprepared. During India's first wave last year, when around a million Nepalese migrant workers returned home, Nepal initiated tests and quarantine measures at border crossings.
But during the second wave of that spring, these measures were too late. When Nepal closed two-thirds of its border crossings in early May, hundreds of thousands of workers had managed to get into their villages without proper testing or quarantine. Thousands continue to return daily.
Government attention had shifted elsewhere. In February, when the virus appeared to be on the wane, Mr. Oli held rallies of thousands of supporters in Kathmandu and other cities. Opposition parties held their own rallies. Last year, Mr. Oli said that the health of the Nepalese people would put the disease off.
Government defenders say the pandemic is a global problem and officials with few resources or vaccines are doing their best.
Mr Oli has asked for international help, although it is not enough to meet the needs of Nepal. China donated 800,000 doses of vaccine, 20,000 oxygen bottles and 100 ventilators. The United States and Spain have shipped aircraft loads of medical equipment, including oxygen concentrators, antigen tests, face masks, and surgical gloves. The US allocated $ 15 million this month to expand Covid testing in Nepal. Nepalese migrant workers in the Gulf States have arranged for oxygen bottles to be sent home.
But Nepal cannot fight the pandemic without the help of India. An Indian vaccine manufacturer has already told Nepal that it cannot deliver a promised million doses.
According to the Nepalese Association of Chemical and Medical Suppliers, Nepal also depends on India for half of its medical equipment needs. The latter country, however, retains almost everything for its own urgent domestic needs. Equipment from China, which is already expensive, is more difficult to source due to Chinese pandemic restrictions.
"For a month now, India has stopped supplying medical equipment and medicines, not just vaccines," said Suresh Ghimirey, the association's president.
Hospitals have run out of beds in some provinces where many migrant workers have returned to India. In the Surkhet District, the Main Provincial Hospital announced that it would not admit any more patients. Small, remote villages quietly mourn their dead. Testing was slow.
"With the exception of a few villagers, many are unable to do their daily agricultural work," said Jhupa Ram Lamsal, community leader of the village of Gauri, where nine people died of Covid over 10 days earlier this month. "The worrying thing is that even symptomatic people are not ready for Covid tests."
Mr Lamsal said he recently reached Gauri, which is remote and has no health facilities, along with a team of doctors to do antigen testing. Locals turned down health professionals' plea for Covid testing, arguing they would be discouraged if they found out they were positive.
"The situation is out of control," said Mr Lamsal. "We are hopeless, helpless."
Mr. Kakri, the press operator, was from a village in Bhimdatta Township in the western corner of Nepal. The area of 110,000 people has officially registered 3,600 infections, according to the local health director Narendra Joshi. However, the lack of action at the border means that the data may not fully measure severity.
"Since the second wave began in India, more than 38,000 people have returned from either of the district's two border points," said Joshi. "It's difficult to manage."
Mr. Karki was a high school dropout who went to India to work as a worker when he was a teenager, said his wife Harena Devi Karki. During his home visits twice a year he was the life of meetings – joking, making fun. The $ 350 a month he sent home covered his family's household expenses as well as fees for their two teenage daughters and a 12-year-old son's private school fees.
Even when last year's lockdown meant Mr. Karki was stuck at home for months with no income, he insisted that the children continue to private school. He would repay the debt as soon as the press was reopened. He dreamed of seeing his eldest daughter – "she is the most talented" – grow up as a doctor.
"I couldn't finish my studies," Ms. Karki recalls of her husband. "Let me eat less, but we should send them to a better school for their education."
When Mr. Karki met her husband at the border around 2:30 a.m. on April 29, she said he was frail and did not have the energy to get up at all. He was taken to a nearby hospital where he died.
"& # 39; Everything is ok. Go home," said her husband, Mrs. Karki. "But he never came home."