mosque in bhulke of udayapur, tested positive for the disease. increased testing in the bhulke area discovered 16 new cases within a week. only four new patients were found in bhulke in the following weeks; the first case outside bhulke was confirmed on 14 may in a journalist from gaighat bazaar who had reported from bhulke and attended other coronavirus-related events, bringing the total in udayapur to 33. on 30 april, the total number of confirmed cases stood at 57; 16 of them had been discharged from hospitals after recovery. banke district recorded its first case on 1 may. contact-tracing in the district discovered 22 new patients by 5 may. parsa district, which had found seven cases of the disease in the preceding months, recorded 17 new cases on a single day on 5 may. two youths who had been quarantined in kapilvastu, having returned from mumbai, tested positive for the disease on 6 may. by 11 may, kapilvastu had a total of 15 cases; the district was sealed off for a week. the neighbouring district of rupandehi which had recorded its first case on 30 april, also emerged as a hotspot. with jhapa and rautahat also recording more than 20 cases each, and isolated cases throughout the country, nepal's coronavirus tally doubled almost every week in may – it was at 59 on 1 may, but had reached 1042 on 28 may. the first covid-19 death in nepal was that of a 29-year-old postnatal woman from sindhupalchok on 14 may. response sukraraj tropical and infectious disease hospital is the designated primary hospital for the treatment of covid-19; isolation wards, makeshift hospitals and quarantine centres have been established throughout the country. nepal public health laboratory in kathmandu was the only laboratory capable of testing for the disease as of 15 march; laboratory capabilities were later expanded to other major cities. the epidemiology and disease control division devised its own treatment protocol in early february, based on the one developed by un health agency, and directed all private hospitals to strictly follow the guidelines. on 29 february, the government formed a high level committee to prevent and control the spread of covid-19 under the leadership of deputy prime minister ishwar pokhrel. on 20 march, the health ministry instructed public employees to report on weekends as well, and not leave the kathmandu valley. the government declared a rs 500 million fund with contributions of a month's salary from government ministers. it also increased the allowances for health workers working at the front desks of hospitals by 50–100%. the minister of health declared that all patients of covid-19 would be rescued as necessary and provided free treatment. hospitals on 23 january, dr. bashudev pandey, director of teku hospital, was quoted as saying that the hospital was on high alert, while three other hospitals – nepal police hospital, patan hospital and tribhuvan university teaching hospital – would also treat the disease. six beds in teku hospital had been allocated for isolation of suspected patients. by 4 february, national capacity for treating coronavirus was at 43 beds. by 21 march, gandaki province had set up 111 isolation beds. a meeting of the high-level coordination committee for prevention and control of covid-19 on 17 march decided to add 115 icu and 1,000 isolation beds in the kathmandu valley. it also instructed the provincial governments to set up a total of 120 icu beds. on 20 march, the health ministry decided to halt non-urgent health check-ups and surgeries until 12 april in hospitals in the kathmandu valley with 50 or more beds. on 21 march, the health ministry informed that private hospitals with more than 100 beds would not be allowed to refer patients to other hospitals; they were required to treat suspected patients, wait for test results and provide free treatment if the disease were confirmed. quarantines the passengers and crew of the flight that evacuated the stranded from hubei in mid-february were quarantined for two weeks at kharipati in bhaktapur. on 21 march, around sixty passengers from covid-19 affected countries that landed on tribhuvan international airport were sent to quarantine at kharipati, bhaktapur; they had not presented any symptoms. testing the first case was confirmed by testing done in hong kong. nepali public laboratories did not have the reagents required for testing, which cost around rs 17,000 per test and need to be bought in bulk. as there were no other suspected cases needing testing, the officials elected to send the samples to hong kong. the first tests inside nepal were conducted at the bio-safety level-2 labs of the national public health laboratory on 27 january. reagents sufficient for 100 tests were borrowed from the centre for molecular dynamics, and test kits were provided by the world health organisation. as of 23 march, the day nepal confirmed the second case, 610 tests had been performed at the national public health laboratory. testing capabilities were expanded to bp koirala institute of health sciences, dharan on 29 march, and to pokhara on 31 march. by 6 april, the testing capabilities had been expanded to all seven provinces; a total of 10 laboratories were operational, four in bagmati province and one each in the other six. they were in dharan, janakpur, kathmandu, dhulikhel, hetauda, chitwan, pokhara, bhairahawa, surkhet and dhangadi. on 10 april, koshi hospital, biratnagar, became capable of testing for covid-19. five thousand rapid diagnostic test (rdt) kits were distributed to each of the provinces; around 500 rdts were performed in three districts on the first day. on 11 april, bir hospital and teku hospital began performing tests for covid-19; rdt kits reached all 77 districts. most of the polymerase chain reaction (pcr) testing done until then had been limited to quarantined recent arrivals to the country, and individuals identified via contact-tracing; the arrival of rdts allowed more liberal use of the testing services. by 14 april, more rdts than pcr tests had been performed. health-desks and checkpoints on 17 january, urged by the who, nepal began screening passengers arriving in tribhuvan international airport from china, thailand and japan, the three countries with multiple confirmed cases. eight people manned the health desk. the airport did not have infrared scanners and was therefore using thermal scanners as preparations were being made to install the infrared ones. the passengers who showed fever were being asked to remain in contact and visit the hospitals if they showed additional symptoms. by 4 february, health desks had been setup in pokhara, chitwan and bhairahawa. by the first week of february, districts bordering india began setting up health desks at border crossings. by the end of february, the health desk at tribhuvan international airport was screening passengers from china, south korea, thailand, singapore, malaysia, japan and saudi arabia, but did not have sufficient manpower and equipment to screen all new arrivals. a total of six infrared scanners had been setup; the only thermal scanner had yet to be repaired, but plans were underway to purchase three more. passengers were not being asked to fill locator forms that would make it possible to track them down later. on 21 march, kathmandu city launched a central help desk and a toll-free 24-hour hotline. travel restrictions and border closures on 28 january, nepal closed down the rasuwagadhi border with china, bringing nepal-china trade to a complete halt. nepal announced suspension of visa-on-arrival service for nationals of five countries badly affected by covid-19 – china, south korea, japan, italy and iran – to be enforced from 7 to 30 march, although the implementation date was later reported to be 10 march. from 2 march, the visitors coming from or via countries with multiple cases of the disease were required to submit a health certificate. health checkpoints began to be established at all major entry points from india, and third country citizens were allowed to cross from select border check-points only. the government issued a travel advisory against non-essential travel to countries hardest hit by the disease, including china, iran, south korea, japan and italy. nepal decided to suspend on-arrival tourist visa for all countries, with an exception to diplomatic and official visas, to last from 14 march until 30 april. the government closed land border entry points for third country nationals, and cancelled all mountain climbing expeditions including on mount everest, to be enforced from 14 march to 30 april. it also declared two-week mandatory self- and home-quarantines for everyone visiting nepal. by the third week of march, the land-border checkpoints with china began releasing imported goods following quarantine procedures as cases in china began to drop. the government banned all passengers, including nepalis, from eu and the uk, west asia and the middle east as well as malaysia, south korea and japan, effective from 20 march until 15 april. all international flights were stopped from 22 march and vehicular movement on long routes were closed from 23 march. nepal tourism board announced the suspension of issuance of trekking permits. nepal decided to close its land border with india and china for a week effective from 23 march. lockdown on 19 march, the government declared suspension of all classes and postponement of all academic examinations including the secondary education examination until 12 april, the end of the month of chaitra, the last month of nepali calendar year when all schools hold the final examinations. tribhuvan university and the public service commission also postponed all their examinations. all government services and private offices except those providing essential services were closed. the house of representatives meeting was postponed. the national assembly was suspended indefinitely. a full-bench meeting of the supreme court presided over by the chief justice decided to halt all non-urgent proceedings in courts across the country. on 23 march, kailali district declared an indefinite lock-down effective from 2 pm. arghakhanchi district also declared an indefinite lock-down. the country-wide lockdown came into effect on 24 march. there were only two confirmed cases from 610 rt-qpcr tests and no fatalities when the government introduced nationwide lockdown but these number increased to 17,994 positive cases and 40 deaths at the end of lockdown. the spatial distribution clearly shows that the cases were rapidly spreading from the southern part of the country where most points of entry and exit from india are located. public awareness on 21 march, the metropolitan traffic police division deployed 200 of its personnel to display placards with awareness messages about the disease by the roadside. evacuations nepal evacuated 175 people, mostly students, who had been stranded across hubei, on 16 february, using a nepal airlines chartered aeroplane and placed them in a 14-day quarantine at kharipati in bhaktapur. although 180 nepalis had applied for immediate evacuation from china by 2 february, the effort took almost two weeks, as the government struggled to meet who's evacuation standards, and to find a suitable venue for quarantine. the government was criticised for its slow response; a public interest litigation was filed at the supreme court, while the locals around the designated quarantine site in bhaktapur protested the government's decision which they viewed as endangering to the local community. on 19 february, the health ministry reported that all of the evacuees had tested negative. rescue of tourists stranded throughout nepal was initiated in the final week of march. by 28 march, hundreds of tourists had been rescued and brought to kathmandu; many were being repatriated via chartered flights. international response after the first case in south asia was confirmed in nepal on 23 january, bordering districts of india were reported to be in high alert, and medical personnel had been deployed to various entry points along the indo-nepal border. by the end of february, india started screening passengers from nepal and making masks compulsory for all visiting nepalis. it was also screening nepalis travelling into india by land, at various checkpoints at the border. india declared suspension of all passenger movement through indo-nepal border, except a few designated checkpoints—banbasa, raxaul, ranigunj and sunauli—with intensified health inspections, effective from 15 march. in march, germany pledged an additional one million euros to its existing health programmes in nepal to help combat the disease. the us government pledged $1.8 million to nepal. indian prime minister narendra modi proposed starting the saarc covid-19 emergency fund for the saarc region; he also said