The Bhutanese Leading the way.
Test to be repeated if symptoms show
In a collective national relief all the 39 first contact people who had direct contact or came in touch with the Bhutan’s first COVID-19 case all tested negative by Friday night.
As of today 141 have tested negative which include 62 first contact cases and the rest are suspected cases.
A 76-year-old American tourist had been diagnosed with COVID-19 on the night of March 5th and the MoH had done the first contact tracing to around 39 people first followed by 62 later.
Prime Minister Dr Lotay Tshering first announced that the first 18 tests of those who had first contact with the 76-year-old COVID-19 afflicted American Tourist were all negative, according to the results of the Royal Centre for Disease Control (RCDC), released on Friday evening.
The negative tests included the 56-year-old partner of the patient including the travel guide and the driver.
The Bhutanese soon found and was the first to report that even the second batch have all tested negative for the COVID-19 bringing the total to 39 except the 76-year-old who was re-tested.
However, as per medical protocol though the tests are all negative for all 39, the tests will be repeated once again if any of the people show symptoms.
The Health Minister Lyonpo Dechen Wangmo said the negative tests tallied with the record of the patient who did not move around much as he was not well and so had unknowingly quarantined himself to his room.
Earlier in the day long before the goods new of the 39 had come, the setting of the press conference on Bhutan’s first COVID-19 case was almost unreal as Ministers, the NA Speaker, NC Chair and NA and NC MPs sat along with NA and NC secretariat staff and journalists to listen to the Prime Minister and Health Minister.
An MP was overheard saying the government would have a tough time today while a few secretariat staff joked about COVID-19.
The Prime Minister appeared wearing a somber look and said while he usually like to start a press conference with a joke but not this time.
He said, “You all must have heard the news. While we all wished for the virus to not come to Bhutan a 76-year-old American tourist was confirmed to have the virus.”
“He came for check at 4 pm and we started and around 10 pm the initial screening showed high chances of the fever and a confirmatory test was done which turned positive at 11 am and again another test was done and it was positive at 12.30 pm.”
He said that before the final test before 11 pm all the ministers turned up at the Health Minister’s office with the experts and plans were made for Tier-1 and Tier 2 and Tier 3 levels programs and that if the case came positive then Tier-2 program would have to start.
Lyonchhen said that His Majesty The King also arrived at the Health Ministry and was there the entire night till morning.
Adhering to the National Preparedness and Response Plan, and the operating procedures in place, and all follow-up actions were initiated immediately.
His Majesty The King personally oversaw implementation of the response strategy, as teams operated from Ministry of Health all through the night.
The Health minister said that the patient already had blood pressure, cholesterol and hypertension. She said that he also has a partner.
The patient had started his travel from Washington DC on February 18 to London and from there to Mumbai. On 21st February he had travelled from Mumbai to Kolkata and on 22nd February he took an Indigo flight from Kolkata to Assam.
From 23rd he undertook a 7-day Brahmaputra River Cruise and then on 1st March he reached Guwahati.
On 2nd March he reached Paro on KB 241.
At the Paro International Airport, the patient’s health declaration form was assessed. He had indicated “negative” against all conditions. He did not have a sign of fever.
His partner or close contact had started from Los Angeles on 17th February, and stayed in Delhi for three nights and on 21st she had gone from Delhi to Kolkata. From 22nd she went from Kolkata to Assam and on 23rd they two went on the river cruise. The partner is asymptomatic with no symptoms.
His flight in Paro landed at 11 am and he visited the National Museum in Paro and restaurants in Paro and then he came to Le Meridien, Thimphu for the first night.
However, upon reaching Thimphu, around 3pm, he visited the medical OPD at JDWNRH, complaining of bloated abdomen (dyspeptic symptoms) and nausea. However, even at that time, he did not have any flu symptoms. The following day, he stayed indoor most of the time and went to the hospital again around 3.30pm for stomach upset and diarrhea.
The Health Minister said that since he was not feeling well he mostly stayed in the hotel but his partner did roam around.
He was in Thimphu on 3rd March and on 4th March he went to Punakha and since he was not well he did not go to many places in Punakha but had lunch at Punakha High School park and coffee at Druk Wangyal café at Dochula and he could not go to see the Punakha Dromchoe.
The lady, however, went to see the Dromchoe. He had stayed at Densa Boutique Resort.
On the 5th March when he returned to Punakha he again had coffee at the Druk Wangyal café and after that he directly came to the JDWNRH. He was suspected to have Corona and so tests were done.
The Minister said that MoH started contact tracing right from the restaurants and who he sat with. Similarly contact tracing was done at Le Meridien hotel in terms of his contact with staff and guests there.
Lyonpo said that by 6th March 6 am all the first contact cases were done. Lyonpo said he is the index case and his first contact case will include his girlfriend, driver, guide, hotel contact, restaurant contact, emergency contact with doctors there.
On 3rd March he stayed at the hotel and so people who worked there at the time including beverage and juice servers, restaurant, and housekeepers who were 25 of the and of them those who had direct contact were with 5 people or first contact.
The total first contact cases are from Thimphu and from Paro.
Lyonpo said that as of now they will test his first contacts and if any of them test positive the government will go into tracing the second contacts.
The minister said that in the flight two rows down and two rows up are being treated as suspect cases and have all been contact traced. “We know exactly where they are at this point and time.”
Lyonpo said that depending on how the first contact results come out they will start testing the second contacts because there is no point testing everybody and they have to go in a phased manner. However, with now all 40 testing negative there are no plans for second contact tests.
The contact tracing started around 12 and was dome by around 6.16 am. The contact tracing information includes their residence, telephone number and who stays around them. This has all been mapped.
The first contacts have been advised self quarantine and to not go anywhere and the minister said this has been reinforced.
“They are being visited by health workers to take the specimen and they will assure that we are there for them to take care of them. We also gave them information on self quarantine like not going anywhere, minimal contact in the house and sending away elderly or younger children in the house, cough etiquette, washing their hands and eating healthy. There is no other special treatment or precaution etc.”
The minister said they are following the date March 2nd and 3rd for contact tracing and not even the date 5th for contact tracing as even if they are tested there will be nothing.
At the time Friday morning, over 90 contacts have been traced. Health officials and other relevant agencies are in the process of carrying out primary disease management and contact tracing.
As of today apart from 1 tourist in isolation undergoing treatment, 62 first contact cases are in quarantine and another 330 who had contact with 62 are in self-quarantine. 330 are being followed up by MoH. If one of 62 test positive then their contacts among 330 will be moved into quarantine
The close contacts were his partner, the driver and the guide. All three were asymptomatic and were quarantined at the designated COVID-19 hospital.
The eight Indian passengers have also been quarantined. The government is closely working with the Indian Embassy.
Health ministry has asked the four crew members of the particular flight, and the hotel staff at both Le Meridien and Densa Boutique Resort to “home quarantine”. Which means they should stay home and maintain distance from people, including family members. Until all suspicions are ruled out, health officials will closely monitor and provide all services at respective homes.
Lyonpo informed that this is the third edition preparedness plan as the first was developed in January 11th along with sensitization and the goal then was prevention to not have Coronavirus in Bhutan, and as the case outside China increased then the strategy for the second and third edition was early detection, containment and clinical management.
She said that now anybody in the hospital will be managed by a team of clinical experts and they have identified five doctors and their contacts will be shared in the social media and are there on the preparedness plan. These five doctors will then advise the whole of the nation on what to do on clinical management.
She said that there is no medication and it is only supportive care and there are no rapid test kits globally and no vaccines.
“For us the priority is this person in our hospital who needs our support, care and love and that we are trying to do our best,” said the minister.
The Prime Minister said that the country has now stepped into the orange alert zone which now means that people should not gather in groups and schools should be given holidays but this is only for the region of Paro, Thimphu and Punakha and is not for all 20 Dzongkhags.
The man reached Thimphu, Paro and Punakha and so that is why the schools have been given a two-week break. The two-week period has been kept as the incubation period of the virus is anywhere between two days to two weeks. Wangdue and Phuentsholing were added later.
The PM explained that the schools have been shut to prevent a scenario where a parent came in contact with the tourist and spread the virus to the child who in turn could take it to 300 to 400 other students in school.
He said the three Dzongkhags had been chosen as the tourist is the sole confirmed case.
The PM said, “I did not say that people should not panic and when there is a reason to panic one must panic. Until last evening, there was no reason to panic so we have been calming down people, creating awareness that they do not need to worry and get scared but it is important to be aware. We earlier said that people should not panic but now it is time to worry. When there is solid reason to be panicked you should be panicked. One should not worry when it is not time to worry and vice versa.”
He said prayer was that Corona virus should not come to our small country but we have no option now as it has come. “It is now time to worry,” said Lyonchhen.
The PM said that fever is a non-specific test and if there is one scientist who can name a specific test for Corona virus he will get the Nobel Prize.
The PM said that fever is the only the screening test and that it is not 100 percent. He said that rapid test cannot be made as this virus was never found in human beings and one needs serums for which the virus would have to attack the bodies first. The PM said Israel is doing an experiment of giving Corona to rats and then using anti-viral treatment which can give to rapid tests.
The patient was travelling with his partner, aged 59. There were 10 passengers on board, of which eight others were Indian nationals.
