In a hurriedly called press conference on May 2, the Ministry of Health and Population announced that a person had died from bird flu, the first human casualty in Nepal by H5N1 virus. The 21-year-old had died on March 29, according to the ministry.

It was the first H5N1 human infection in the world since February 2017 and there were immediate concerns whether the virus was making a resurge. But the authorities concerned, it seems, are still too slow to recognise. Nor is there any preparedness to control further infection.

On Sunday, the Epidemiology and Disease Control Division under the Department of Health Services imparted an orientation to doctors and lab technicians to ensure surveillance of bird flu virus.

The Sukraraj Tropical and Infectious Disease Hospital and the National Public Health Laboratory have sent six doctors and four lab technicians respectively at the request of the division for the orientation. These doctors and technicians will carry out surveillance for four days.

Read: First bird flu death in the country exposes passive surveillance and poor preparedness

It is unclear which area and the size of the population they are going to cover during the surveillance. It is also unclear how many people might have come into contact with the person who died.

“The government actions suggest our mechanisms are not ready to detect and respond to the disease,” Dr Sher Bahadur Pun, a virologist, told the Post. “First and foremost, the authorities must recognise the fact that bird flu is a highly pathogenic disease.”

The World Health Organization says H5N1 is a lethal bird flu virus strain that is highly pathogenic, which has a 60 percent fatality rate.

According to the division, doctors and technicians who took part in the orientation will carry out an epidemiological investigation to find the presence of the virus.

But experts have questioned whether the move is too little too late. Officials concerned provided little answer to preparedness strategy.

Health facilities in the country are ill-equipped to handle cases of contagious diseases.

An isolation centre built at the Sukraraj Tropical and Infectious Disease Hospital, with the financial support from World Health Organization, has been lying idle for the last one decade, largely due to lack of manpower and required infrastructure.

“Officials at the Ministry of Health and Population has time and again assured that it would provide technical manpower to the centre, but this is yet to materialise,” said Dr Basudev Pandey, director at the Sukraraj Tropical and Infectious Disease Hospital, Teku. “We have neither any dedicated team nor equipment.”

According to him, dedicated ambulances, drivers and special training are required to health workers to handle patients infected with contagious diseases like bird flu.

Moreover, infectious disease control hospital and central laboratory are in the city centre, which could also pose a greater risk as a disease can spread in masses.

“The good thing is no one has come in contact with the virus. The incubation period of the virus is one week and there have been no cases of infection even after five weeks,” said Dr Bibek Kumar Lal, director at the Epidemiology and Disease Control Division, said. “No other patients in the area where the person died—or elsewhere—have been diagnosed with the disease as per our laboratory records.”

According to the Epidemiology and Disease Control Division, doctors and technicians, selected for the epidemiological investigation, would now start collecting samples from the hospital where the man died, and from his house. The samples will be secured at the National Public health Laboratory, which will be examined in a WHO reference laboratory abroad to ascertain if the virus still exists or not, said officials at the division.

Viruses like H5N1 have perplexed scientists for long. There were 469 human infections and 282 deaths across the world between 2003 and 2009, according to the WHO. And between 2012 and 2014, there were 233 human infections and 125 deaths and in 2015, there were 145 human cases and 42 deaths. But in 2016 human cases and deaths were 10 and 3 respectively.

Similarly, the last time human cases were in 2017 when there were four infections and two deaths. It was not clear why and how H5N1 infections suddenly went down, but there were always concerns that the virus could make a comeback, as viruses do mutate.

Nepal’s first bird flu human case resulting in death has now drawn international attention.

“Experts and officials from the World Health Organization headquarters and its Delhi office have arrived in Kathmandu who will assist Nepali doctors and technicians in the surveillance,”said Mahendra Prasad Shrestha, a spokesperson for the Health Ministry.

Authorities have not disclosed the details about the deceased. But it is learnt that the 21-year-old man from Kavrepalanchok district was residing in Bhaktapur.

He was admitted to a Kathmandu hospital for treatment of fever and cough. Doctors at the hospital suspected influenza infection and sent throat swab specimens to the National Public Health Laboratory on March 25.

The same day, before the laboratory results were out, the patient was administered Oseltamivir, an influenza antiviral medication taken from the Epidemiology and Disease Control Division. But the laboratory failed to identify the strain of the virus, according to the Health Ministry.

Four days later, on March 29, the patient died due to respiratory complications while undergoing treatment.

The national laboratory then sent the throat swab specimens to the WHO Collaborating Center for Influenza in Japan, which on April 30 confirmed that the cause of the death was H5N1 virus. The ministry made it public two days later.

The H5N1 bird flu virus was first detected in birds in Nepal in 2009. The country declared itself free from H5N1 in 2012 but this strain of the deadly bird flu virus continues to be found in poultry farms in Nepal.

According to Dr Bansi Sharma, director general at the Department of Livestock Services, this year alone, 52 samples collected from poultry farms examined by the central veterinary laboratory tested positive for H5N1 virus.

Following the confirmations, rapid response teams of veterinary technicians were deployed to poultry farms in Kathmandu, Bhaktapur, Lalitpur, Makwanpur, Morang, Sunsari and Kaski districts and over 100,000 infected chickens were culled