Temporal Analysis of SARS-CoV-2 Variants during the COVID-19 Pandemic in Nepal

Round 1

Reviewer 1 Report

1. The description of the infected sample and the related infected area, such as occupational type or moving line, can be further revealed.

2. The authors should provide more complete research related to infection research topics to structure the overall development of the literature that describes the relevant research topics.

3. The presentation of research results through visualization and graphical  representation does have different research results (3. Results). It is suggested that the author can use this as a basis to explore the causal relationship between relevant important shadow variables, and then make more specific research contributions.

4. The conclusion could be more specific and direct. I would like to see some explicit information on the literature gaps, possible contributions in introduction.

Author Response

Revisions were made based on two reviewer comments. Changes made in the text are highlighted as track changes. The first reviewer comments were hard to understand. We have made revisions based on what we could understand from the reviewer comments. The changes we have made regarding each point raised by the reviewer is mentioned in the text below the comment section. We thoroughly proofread the paper and corrected any outstanding grammatical and typo mistakes.

The following detailed revisions were made:

Reviewer 1

1. The description of the infected sample and the related infected area, such as occupational type or moving line, can be further revealed.

Deaths per million population of Nepal and other countries throughout the world was plotted. Infected area around Nepal was shown in Figure 6.

2. The authors should provide more complete research related to infection research topics to structure the overall development of the literature that describes the relevant research topics.

The information that death rate of delta variant was higher than other variants was added in the discussion.

3. The presentation of research results through visualization and graphical representation does have different research results (3. Results). It is suggested that the author can use this as a basis to explore the causal relationship between relevant important shadow variables, and then make more specific research contributions.

Two figures, Fig 1a and Fig 7 were added.

4. The conclusion could be more specific and direct. I would like to see some explicit information on the literature gaps, possible contributions in introduction.

Why Nepal had lower fatality than countries in the West was discussed. Vaccine technology, safety and efficacy data was also discussed.

Reviewer 2 Report

This is an interesting analysis of SARS-CoV-2 variants during different phases of the COVID-19 pandemic in Nepal and could be published after the following revisions.

1-the authors should give a (even if approximate) picture of the ratio COVID-19 deaths/total infection cases for the first and second wave in Nepal and compare also lethality given by the variants. A specific comment not only on different transmissibility but also on intrinsic lethality of variants like delta and kappa should be provided also in the light of the literature in this regard.

2-all links mentioned in the text should be provided with date when they were visited

3-more details on vaccines should be given already in the introduction citing at least the works with DOI:  10.2174/0929867328666210521164809 and 10.1016/j.prrv.2021.07.001

4-did you find a relation among COVID-19 death numbers and population density in different regions of Nepal? Moreover, Nepal is a forest-rich country and there are clues of relationships between COVID-19 impact and environmental factores.  Based on available regional pandemic data and, if available, forest ectars/inhabitant in the different Nepal regions, was there a lower impact in greener areas of the countries? If yes discuss it briefly and mention briefly the importance of forests in protecting populations of green areas against COVID-19 as in work with DOI: 10.1007/s10311-021-01309-5

5-SARS-CoV-2 and COVID-19 terms should be reported always in this way and not in any other forms like SARS-CoV2, COVID 19 etc

6-lines 153-155: 'Although cases reached a baseline level in February and March of 2021, deaths from earlier infection or the introduction of new variant (delta) started rising again.' I am not convinced that deaths in Feb-Mar 21 could be already caused by delta variant if -as you report in Fig. 1- this variant first appeared in Jan 21 in Nepal and there were no enough COVID-19 cases since Jan 21 to justify the number of deaths found: may be these fatalities were given by infections with previous variants? Please discuss and in case correct.

7-Nepal has about 10,000 COVID-19 deaths. Considering the total population of the country (less than 30 millions people) I feel that impact of the coronavirus, even if significant, was lower than other countries especially from Europe. Could you check numbers and discuss it briefly?

Author Response

Revisions were made based on two reviewer comments. Changes made in the text are highlighted as track changes. The first reviewer comments were hard to understand. We have made revisions based on what we could understand from the reviewer comments. The changes we have made regarding each point raised by the reviewer is mentioned in the text below the comment section. We thoroughly proofread the paper and corrected any outstanding grammatical and typo mistakes.

The following detailed revisions were made:

Reviewer 2

1-the authors should give a (even if approximate) picture of the ratio COVID-19 deaths/total infection cases for the first and second wave in Nepal and compare also lethality given by the variants. A specific comment not only on different transmissibility but also on intrinsic lethality of variants like delta and kappa should be provided also in the light of the literature in this regard.

Death per new cases was plotted. Death rate rose after introduction of delta variant, which was discussed in discussion section.

2-all links mentioned in the text should be provided with date when they were visited

Dates were added.

3-more details on vaccines should be given already in the introduction citing at least the works with DOI:  10.2174/0929867328666210521164809 and 10.1016/j.prrv.2021.07.001

vaccine efficacy, safety and technology discussed in the discussion section.

4-did you find a relation among COVID-19 death numbers and population density in different regions of Nepal? Moreover, Nepal is a forest-rich country and there are clues of relationships between COVID-19 impact and environmental factores.  Based on available regional pandemic data and, if available, forest ectars/inhabitant in the different Nepal regions, was there a lower impact in greener areas of the countries? If yes discuss it briefly and mention briefly the importance of forests in protecting populations of green areas against COVID-19 as in work with DOI: 10.1007/s10311-021-01309-5

Forest coverage data of Nepal not available to carry out this analysis.

5-SARS-CoV-2 and COVID-19 terms should be reported always in this way and not in any other forms like SARS-CoV2, COVID 19 etc

This correction was made.

6-lines 153-155: 'Although cases reached a baseline level in February and March of 2021, deaths from earlier infection or the introduction of new variant (delta) started rising again.' I am not convinced that deaths in Feb-Mar 21 could be already caused by delta variant if -as you report in Fig. 1- this variant first appeared in Jan 21 in Nepal and there were no enough COVID-19 cases since Jan 21 to justify the number of deaths found: may be these fatalities were given by infections with previous variants? Please discuss and in case correct.

The possibility of deaths rising from delta variant was removed.

7-Nepal has about 10,000 COVID-19 deaths. Considering the total population of the country (less than 30 millions people) I feel that impact of the coronavirus, even if significant, was lower than other countries especially from Europe. Could you check numbers and discuss it briefly?

This is true. A figure of death per million population was added and two possibly reasons why Nepal might have fared better than the West was discussed.