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More travellers are making swift ascents to higher altitudes without sufficient acclimatization or pharmaceutical prophylaxis as road connectivity develops in the Himalayan region of Nepal. Our study connects ascent rate with prevalence and severity of acute mountain sickness (AMS) among patients admitted to the emergency ward of the Mustang district hospital in Nepal. A register-based, cross-sectional study was conducted between June 2018 and June 2019 to explore associations of Lake Louise scores with ascent profile, sociodemographic characteristics, and comorbidities using chi-square test, t-test, and Bayesian logistic regression. Of 105 patients, incidence of AMS was 74%, of which 61%, 36%, and 3% were mild, moderate, and severe cases, respectively. In the Bayesian-ordered logistic model of AMS severity, ascent rate (odds ratio 3.13) and smoking (odds ratio 0.16) were significant at a 99% credible interval. Based on the model-derived counterfactual, the risk of developing moderate or severe AMS for a middle-aged, non-smoking male traveling from Pokhara to Muktinath (2978m altitude gain) in a single day is twice that of making the ascent in three days. Ascent rate was strongly associated with the likelihood of developing severe AMS among travellers with AMS symptoms visiting Mustang Hospital’s Emergency Ward.

Background Vaccination is the most effective method to prevent the spread of infectious diseases and helps reduce mortality rate and economic costs associated with the pandemic. Despite these advantages, misinformation on vaccine safety and efficacy can lead to increased hesitation towards vaccination. This study reports the incidence of adverse events following Covishield vaccination, their associated factors, medication used for their management, and attitudes about vaccine safety. Methods A cross-sectional study was conducted from the sample of Covishield-vaccinated individuals from a secondary hospital, two primary health centres, and 36 health posts in eastern Nepal. Individuals (n = 602) were randomly sampled from a population (n = 1013) who had received the first dose of Covishield, namely frontline workers and other high-risk populations. The second-round follow-up had 516 participants. Association of incidence and severity of post-vaccination events with socio-demographic variables, comorbidity status, and medication use were estimated. Results Among the 79.9% of participants who reported adverse events after receiving the first dose, two-thirds of complaints were mild (67.4%, 95% CI 63.2–71.6) with the most common complaint being pain at the injection site (86.5%). Paracetamol or its combination with NSAIDs were used in the majority of cases (95.2%). After the second dose, only 31.2% (95% CI 27.2–35.2) reported adverse events, the overwhelming majority of which were mild (95.7%) and required a lower frequency of medication (7.5% vs. 26.0%). Adverse event following immunization were significantly associated with being 18–30 years old (χ2 = 16.9, df = 3, p < 0.001) and female gender (χ2 = 5.2, df = 1, p < 0.05). Prior to the first dose, 86.0% of participants (95% CI 83.3–88.8%) perceived the vaccine to be safe, and 96.0% recommended the vaccine post-vaccination, while 96.8% were interested in receiving the second dose. AEFI severity was negatively associated with vaccine recommendation to the peers (odds-ratio 0.062, p < 0.05) following the first dose, whereas, the optimistic pre-vaccination perception was associated with positive vaccine recommendation post-vaccination (odds-ratio 28.658, p < 0.01). Conclusions Overall, vaccination-associated events were mild and majority were managed with paracetamol or its combination. Effective counselling about adverse events before vaccination should be prioritized to reduce hesitation and fear.

This paper assesses the macroeconomic implications of COVID-19 in the context of Nepal. The study uses a susceptible, infected, and recovered macro model (SIR-Macro model) where epidemiological variables are interacted with macroeconomic variables namely consumption and working hours to simulate the implication. The model estimates show that the containment measures of the government reduced the spread of the disease by 17 percent. However, the COVID-19 pandemic had a significant negative impact on macroeconomic outputs. On average, both consumption and working hours declined by 20 percent which otherwise would be more serious if no containment measures were adopted. In addition, the study also finds that the impact has been heterogeneous across susceptible, infected, and recovered population. Interestingly, the study also indicates that the individual utility lowered while societal utility improved with containment policies.