THE YETI, EVEREST & COVID-19: A TALE OF THE NEPAL VARIANT
I awoke to yet another Kathmandu lockdown morning on 3 June 2021 to find the headline ‘”Nepal Variant” Threat to Our Holidays” and links to the online version of the UK tabloid, Daily Mail, which had carried the story popping up like mushrooms all over my social media accounts and groups. Nepal Variant? I was baffled. And read on.
“Ministers are worried about a new Covid variant, the Mail can reveal. Scientists have alerted ministers to the mutant strain — thought to have originated in Nepal — which has apparently spread to Europe. They fear the strain is resistant to vaccines,” alerted the article.
The news was very soon picked up and reported in other, more respected, UK press, like The Independent and Daily Telegraph: true or not, the damage had been done. Nepal had well and truly become associated with a new COVID variant in a world which was weary of the pandemic and longing for it to end.
The thrust of the blue-collar Daily Mail’s article was the impact the Nepal Variant would have on holidaymakers’ travel plans just as the situation seemed to be easing and high summer was approaching. The white-collar Telegraph took slightly higher ground, linking the topic to PM Boris Johnson and his insistence on enforcing the so-called traffic light scheme for countries, labelling them red, amber or green according to the prevalence of COVID and associated risks.
But where was Nepal in all this? The Mail did at least acknowledge the grave situation in Nepal in two short sentences at the end: “Hospitals in Nepal are on the brink of collapse after cases of Covid surged over the past month. Cases had fallen to fewer than 100 a day in March but reached more than 9,000 a day in mid-May.” Bizarrely, the Telegraph made no further mention of the country, preferring to use an image of the situation in Venezuela to give an international flavour.
Early that same afternoon the local Nepal press started to pick up on the issue and reported WHO Nepal’s denial of the news: the organization’s Twitter post read as follows: “WHO is not aware of any new variant of SARS-CoV-2 being detected in Nepal. The three confirmed variants in circulation are: Alpha (B.1.1.7), Delta (B.1.617.2) and Kappa (B.1.617.1). The predominant variant currently in circulation in Nepal is Delta (B.1.617.2).”
As if to underline this, the online Republica referred to the Ministry of Health and Population’s denial of there being a Nepal Variant, quoting the ministry’s assistant spokesperson, Dr. Sameer Kumar Adhikari, as saying, “So far, no new variant has been detected. We have confirmed three variants only.”
So where had Messrs. David Churchill and Eleanor Hayward, the co-authors of the Mail’s article and graduates of the University of East Anglia and Cambridge respectively, obtained their information?
Perhaps in a knee-jerk reaction to the naysayers, later in the same day the Daily Mail published another article on the issue by different journalists (Luke Andrews, Health Reporter; Connor Boyd, Assistant Health Editor): “Everest Climbers could have Spread Nepal Covid Variant Across the World” was the headline. This article was far more specific while also being less credible in some ways.
The apparent facts were clearly stated:
— The Nepal Variant is a mutated version of the Indian variant, now known as ‘Delta’, combined with K417N*, believed to make vaccines weaker
— It has been located in Nepal (at least 1 case), Japan (13 cases), Portugal (at least 1 case), USA (at least 1 case), India (at least 1 case) and the UK (at least 43 cases).
— The 13 cases in Japan had all, apparently, been passengers on a flight from Nepal.
*Author’s note: The origins of the K417N mutation are rather complex and beyond the scope of this article. However the abbreviation was already in use as far back as the fourth quarter of 2020. It is therefore not accurate to claim, as some have been doing, that the final ‘N” is a reference to Nepal.
At the same time the article’s unsubstantiated claim that, according to experts,“‘Delta+K417N’ could have been spread by climbers travelling home from Mount Everest” seemed more open to doubt. However, the rather clumsy headline of the Daily News & Analysis (DNA) India’s online article was even more specific about the Everest link: “COVID-19: Know about Delta+K417N Variant that Affected at least 100 Everest Climbers.”
Time to stop and pose some questions: who are the nameless ‘experts’ and ‘scientists’ referred to in the Mail’s articles? And was it really feasible that all of the COVID cases detected among Everest expedition climbers and their porters were the Delta+K417N variant, as the DNA India article goes on to claim? This spring’s Everest season, running from late March to the very beginning of June, had indeed been peppered by claims and subsequent official denials by the Nepal government of COVID erupting at Everest Base Camp (EBC): located at an altitude of over 5,000m, EBC is where expeditions pitch camp, strategize and acclimatize for the challenge ahead. There had been reports as early as April that climbers, apparently afflicted with High Altitude Pulmonary Edema (HAPE), an extreme form of Acute Mountain Sickness (AMS), were being diagnosed COVID positive after being evacuated back to Kathmandu. A little later one team totally cancelled its expedition as a result.
The headline of the New Zealand NewsHub’s online article of 10 June — “Delta COVID-19 Variant Ravaging Everest Base Camp, but Nepal Government Denies Spread” — seemed also to imply that it was the Nepal Variant that was at EBC. The article quotes Mingma Gyalje Sherpa, a member of the lauded Nepal team that achieved the first winter ascent of K2, as saying, “When the news came about COVID-19 cases at Base Camp we were very scared.” He is also reported as stating the numbers involved to be “not less than 80 and not more than 150 — but that’s quite a lot.”
The same NewsHub article refers to comments made on the situation by Himalayan Trust Chair, Peter Hillary, son of Sir Edmund Hillary who, together with Tenzin Norgay Sherpa, was the first to summit Everest. ‘Isolation facilities have been set up — including one at a school Sir Edmund Hillary built — but he [Peter Hillary] says the chain of transmission can’t be stopped until all the climbers leave. “They really need to evacuate the mountain, and get everyone off the mountains, the foreign climbers, the Nepalese climbers and all these porters, so that they can really effectively lock down their communities.”’
This seems to make it clear beyond a doubt that, contrary to the Nepal’s official stance, COVID, whether or not the “Nepal Variant’ was indeed rampant, not only at EBC but in Khumbu as a whole.
For me a major element in the story is the thirteen Japanese whose infection with the new mutation was supposedly detected while they were in quarantine after a flight from Nepal. DNA India was more detailed about these individuals, linking them specifically with an Everest expedition: “Thirteen samples were found among passengers on flights from Nepal to Japan, leading some to believe they were infected during climbs on Mount Everest. The thirteen cases in Japan were spotted during hotel quarantine after the individuals returned from Nepal.”
According to the current lockdown modality, in theory all climbers, healthy or otherwise, would have had to quarantine on their return to Kathmandu. Even if this regulation was bent — as it surely was — and/or just supposing that the Japanese in question had not come from EBC, at the very least they would have had to show a negative PCR test result to enter the airport and board their flight. However, it would still have been feasible for them to have a negative/a false negative result and subsequently contract/show symptoms of COVID.
But when had that flight to Japan taken place? Tribhuvan International Airport has been closed to commercial flights from 7 May: since then there had indeed been repatriation and charter flights but none that I could recall to Japan. In an attempt to verify whether the Japanese had actually been on an Everest expedition, I contacted Alan Arnettte, well-known for his meticulous annual blog detailing all aspects of the Everest climbing season. His response was categorical: “I never heard of ANY Japanese climbers being there this year.” When all attempts to scour the English-language Japanese online media for details of these Japanese trekkers/passengers failed, I also contacted Masayuki Kodama, a lecturer in Medical Ethics and my former colleague: could he discover anything on this issue in the Japanese language media? He kindly obliged but was only able to find a reference to a family of six returning to Japan on 17 May who tested positive. However, according to Kodama no Nepal Variant cases had occurred in Japan. More contradictions and another dead-end, it seemed.
Meanwhile the whole Nepal Variant issue had inevitably not gone unnoticed in diplomatic circles. The Nepal Embassy in London soon issued a Press Release.
“A serious attention [sic] of the Embassy has been drawn to a news report published in Daily Mail tilted ‘Nepal Variant Threat to Our Holidays’ which baselessly claims about the’ origin’ of a ‘mutant strain’ of the SARS-CoV-2 in Nepal.// The variants of concern identified in Nepal so far are Alpha and Delta, both of which did not originate there. The World Health Organization (WHO) has rebutted the origin of a new variant in Nepal stating that the prevalent variant currently in circulation in Nepal is Delta (B.1.617.2). //The Embassy has sent a letter to Daily Mail refuting this baseless news and requesting to correct it.
Embassy of Nepal, London, 3 June 2021”
It remains unclear whether the Mail did as it was bidden: probably not.
Amid a lot of ridicule in the Stranded in Nepal WhatsApp group — which consists of, as the name suggests, travellers trapped in Nepal by the sudden closure of the airport — about the whole notion of there being a Nepal Variant, one post stood out:
“We (fellow epidemiologists) begin to name a variant by the host country even prior to knowing for sure its origin, this can lead to problems with people/governments feeling as if there is a misnomer or anti-country bias until the origin is known for sure. There are currently, as of yesterday, three variants of the B.1.617 [the Delta variant] in Nepal and as was discussed in a meeting this morning, there comes a point when one of the strains, (most likely B.1.617.3) will be referred to as the Nepal Variant. There is no strict policy governing naming for these circumstances.”
The post had been made by Robert Stephenson (not his real name), someone I had never met in person but who I knew to be solid and reliable from his previous posts in various Nepal-related social media groups. I grasped at this statement as something that supported my unaccountable hunch that there was some truth in the Nepal Variant news, something that the government was not owning to: after all, if it had not only been in denial over the existence of COVID in Everest Base Camp throughout the Spring climbing season but had also instructed expedition leaders to keep quiet about the issue, it was not difficult to imagine that it would do its best to refute any news about a Nepal Variant.
I contacted Robert directly, asking for further information if at all possible. His response was a disappointment, but not totally unexpected:
“I’m not allowed to share, I shouldn’t have shared yesterday but felt the keyboard warriors, while justified about the Daily Mail article, did not have the full picture. But sorry I’m not allowed to share. I’ll ask if there is an ‘official’ spokesperson you can contact.”
So the only possible evidence I could take from Robert’s unguarded comment was the reference to the B.1.617.3 ‘strain’ which had the potential to become known as the ‘Nepal Variant.’
This B.1.617.3 strain had been identified and referred to two weeks prior to the Mail’s piece in a short academic article entitled “B.1.617.2 variant and increasing surge of COVID-19 in Nepal” written by Umid Kumar Shrestha of Nepal Mediciti Hospital, Lalitpur and published on 21 May 2021. In his abstract Shrestha writes:
“Among different strains of B.1.617, the mutations of great concern are E484Q, L452R, P681R and T478K, because of the stronger affinity of the spike protein of these mutants for the Angiotensin Converting Enzyme (ACE) 2 receptor making it more transmissible and infectious, and causing decreased recognition capability of the immune system. Among the sub-variants of B.1.617, the B.1.617.3 shares the L452R and E484Q mutations found in B.1.617.1, whereas B.1.617.2 does not have the mutation E484Q, but it has the T478K mutation, not found in B.1.617.1 and B.1.617.3.”
Both Robert’s comment and Shrestha’s article made me look again at part of WHO Nepal’s statement: “The three confirmed variants in circulation are: Alpha (B.1.1.7), Delta (B.1.617.2) and Kappa (B.1.617.1).” It made no mention of B.1.617.3. The MoPH’s assistant spokesperson also referred to a trio of variants. Perhaps, to use its own terminology, the WHO “was not aware of it.”
Also of interest, the L452R and E484Q mutations to which Shrestha refers were mentioned in the second Mail article’s infographic: the co-authors had clearly researched their topic.
Meanwhile the scorn and derision being heaped on the very idea of a Nepal Variant was growing among my social media circles here. A respected Nepali friend did a creative, tongue-in-cheek Facebook post, initiating a new hashtag:
“BREAKING: UK Media reports of Nepal Variant though WHO is yet to confirm it exists! Have you spotted our variant? Please report all sightings — hair, toes, footprints, fingerprints, or its entirety where you have spotted it around the world. Hashtag it #nepalNOW #NepalYetiVariant”
I smiled wryly on reading it but still felt uneasy about the ridicule and was ever more curious about the possibility of there being some nuggets of truth to be unearthed.
I was encouraged to see that the BBC had taken up the story sometime in the night of 4th /5th June Nepal time.
In the article, “‘Nepal Variant’: What’s the Mutation Stopping Green List Trips to Portugal?”, the BBC reporter Rachel Schraer pertinently asks, “Is there a Nepal variant?” and goes on the try to answer the question:
“A mutated virus has been spotted in Nepal and elsewhere. But that doesn’t mean a new variant of coronavirus has been found……A small number of cases of the Delta variant have been identified as having an extra mutation — called K417N. The change is in the virus’s distinctive spike protein and has been seen before, including in the so-called South African or Beta variant. Samples of the Delta variant with this extra change have been spotted about 90 times worldwide. Of these, 12 cases were spotted in Portugal, 36 in the UK, 12 in the US and four in India…..More up-to-date UK data from Public Health England suggests 43 cases have now been spotted through genetic analysis (a process called sequencing). The Wellcome Sanger Institute said it had been observed “once in Nepal (which does very little sequencing), and 14 times in Japan, of which 13 are samples from airport quarantine from travellers from Nepal”.
Schraer also asks “When does a mutation become a variant?”
“Remember that viruses mutate constantly. When the changes are drastic enough, we start describing it as a new variant…..There is no scientifically agreed definition of when a mutation becomes a variant…..If a distinctive set of changes, or variant, appears to be spreading better, making people sicker or resisting vaccines, then it will be upgraded to being a ‘variant of concern’. This hasn’t happened with the mutation identified in Nepal and elsewhere, so far. It is mentioned by Public Health England as a ‘spike mutation of interest’, but it is not categorised as a variant.”
Schraer’s final probe is, “Will the Nepal mutation become a problem?”
‘This change to the virus’s spike protein….is thought to be part of why [a] variant is more resistant to vaccines. “Because of this possibility, and because Delta appears more transmissible than Beta, scientists are monitoring it carefully,” the Sanger Institute explained.’
A few days passed and by 7 June I was frustrated to be turning up no significant new data — that is until I saw the latest edition of the Independent with the headline “Covid: 23 Cases of New ‘Nepal’ Variant Detected in UK, Downing Street Confirms.” The opening sentences expanded on the information:
“Some 23 cases of a new Covid mutation — sometimes referred to as the Nepal variant — have been detected in the UK, Downing Street has confirmed. Boris Johnson’s official spokesperson said the “spike mutation” K417N is being investigated by Public Health England.”
Then silence descended again: no further news from Robert except to say that his promise to try to get a spokesperson from his epidemiologists’ group had come to nothing: “Unfortunately everyone is running a bit scared, due to the potential controversy caused by the UK / Daily Mail / Portugal, no one wants the attention it seems…. a conservative lot,” he lamented. My emails to the Daily Mail reporters had gone unanswered and as referred to above the leads I had tried to follow to unearth more about the ‘thirteen Japanese’ had drawn a blank.
Maybe Dr. Jemma Geoghegan, an evolutionary virologist at the University of Otago, New Zealand, correctly pinpointed the problem in an earlier, 4 June, NewsHub article headlined, “COVID-19: Reports of New ‘Nepal variant’ Spark Alarm, Confusion”:
‘“We don’t actually really know if a variant exists or if we should be concerned at the moment”… She said although it was a possibility the new variant existed, Nepal has not publicly released enough genome data for scientists to confirm or deny the reports. “Until they publicly share data it can’t really be recognised as a variant,” Dr. Geoghegan said.’
Perhaps this correctly pinpoints the obstacle to unlocking the mysterious Nepal Variant: the tight-lipped silence, the obdurate denial by WHO Nepal and the Nepal government, the lack of shared data.
The situation in Nepal — denial, refusal to share data and information — ironically seems to mirror, on a much smaller scale, that in Wuhan itself where the SARS-CoV-2 virus originated. Perhaps both mysteries will never be solved. In the increasingly unlikely event that a ‘Nepal Variant’ is ever acknowledged, then following the new pattern of replacing country names with Greek letters to designate VOCs (variants of concern), it will soon be renamed Lambda, Omikron or the likes and Nepal will have had its moment of glory — or notoriety — in the annals of COVID. And if it is proven that there was never any such mutation or the matter is allowed to quietly disappear, then the ‘Nepal Variant’ will quietly slip away to be ranked alongside the yeti as something thought to have once existed in the high Himalayas…and perhaps, just perhaps, roaming there for all eternity.
