Nepalese Sherpas who guide paying customers to the top of Mount Everest are facing a second year of no income after COVID-19 forced the closure of the border.
Nepal's answer to the deepening humanitarian crisis is to reopen the border and welcome back mountaineers to the Himalayas - but a Sherpa doctor fears they'll bring a second, more deadly wave of the virus with them.
It comes as Adventure Consultants, the decades-old Kiwi mountaineering company who were the first to guide paying customers to the top of Mount Everest, closed due to COVID-19.
They would usually be at Everest base camp, employing 75 Sherpas. But due to the ongoing pandemic, 2021 is the second year Sherpas face without income.
Dr Kami Temba Sherpa of the remote Khunde Hospital in the Himalayas has concerns about the border opening after he contracted COVID-19 in December.
"When I developed pneumonia or my oxygen saturation was dropping down, I thought I was not going to make it," he tells Newshub.
He believes there's a high chance new strains of COVID-19 will come in with the mountaineers.
"People are working, walking, without any masks, there's no social distancing, there's no physical distancing. So yeah, we are worried."
The remote Khumbu region of the Himalayas is home to thousands of Sherpas, and the virus has made its way into the far reaches of those secluded mountains and valleys.
"COVID-19 has been a major impact for the Sherpa community in Nepal in total over the last year," says Mingma Norbu Sherpa, CEO of the Himalayan Trust in Kathmandu.
He says the pandemic has been devastating, killing more than 3000 people and disrupting tourism for a year - wiping out the 2020 Everest season which 80 percent of locals rely on for their entire income.
"It's the worst kind of disaster really," he says.
Himalayan Trust chair Peter Hillary, son of Sir Edmund Hillary, agrees the situation is dire.
"A lot of them are actually running out of food up in the high villages, so it's a serious business," he says. "There isn't a wage subsidy, there isn't a welfare programme."
Despite surging COVID-19 cases in Nepal and in neighbouring India, the Nepalese government has relaxed border restrictions in an effort to attract more climbers.
The seven-day quarantine has been scrapped and instead, tourists are tested on arrival and are free to go as soon as they return a negative result.
But Kiwi mountain guide Guy Cotter decided months ago it would be irresponsible for his company, Adventure Consultants, to take an expedition to Everest this year.
"For us, it is not a good move to actually be over there with the potential of spreading the virus into these vulnerable communities," he says.
Instead, they raised $70,000 and sent it directly to the Sherpas they would have been working with. But he knows just how desperate the Sherpas are for mountaineering to continue.
"Very much a catch-22 and that's why I'm reluctant to place judgement on why they might be operating and inviting tourists in."
American Kim Bannister, who is based in Kathmandu and runs treks in the Himalayas with her Sherpa business partner, is holding off taking groups until October, but understands why Nepal has opened its borders.
"People are not scared or worried of the virus anymore, they're really just scared of not being able to survive for another year," says Bannister, who owns Kamzang Journeys.
But COVID-19 is another risk she doesn't want her clients dealing with.
"The virus is spreading here and I'm not encouraging my clients to come to Nepal for that reason."
One positive for the people of Nepal is the vaccination effort is underway. It began ahead of New Zealand's rollout and so far, 1.6 million doses have been administered.
However, it remains to be seen if the vaccine is as successful as the virus at reaching the remote Sherpa communities.