As Bhutan sees an increasing numbers of cases jumping from 1 on March 6th to five as of 2nd April, the only comfort is that they are imported cases with no evidence of community transmission yet.
However, if Bhutan does see large scale infections and community transfer then the Ministry of Health (MoH) has made a plan based on the current capacity to take care of 500 COVID-19 patients in Bhutan.
The Health Secretary Ugen Dophu said that Bhutan can handle 500 COVID-19 patients of which around 200 plus beds would be available in JDWNRH and the rest would be distributed in the referral hospitals in Mongar, Phuentsholing and Gelephu.
The Health Minister in a press interaction said that Bhutan has 68 ventilators and that another 28 are on the way.
The Health Secretary said that around 30, including portable ones, have been ordered.
He said that for the purpose of COVID-19 around eight ventilators are available with five in JDWNRH, 2 in Mongar and 1 in Gelephu.
The secretary said that the order for 30 ventilators has been placed through a local supplier.
Given the global shortage of ventilators the supplier is in the queue to get them, but the supplier has committed to get it within 60 days of the order being placed. Since the order was all placed in March after the first case by around 14th March and onwards, the supplier would have time until May or earlier to bring them in.
The health secretary said that normally the equipment comes in by ship but given the urgency of the equipment the ventilators, once ready, would be sent till Bangkok and from there Bhutan could pick it up via flight.
It is interesting to note that though the global COVID-19 crisis was already raging by January and February the government only placed purchase orders for ventilators and other critical equipment from 14th March onwards and that too after a Royal Command to get the life saving equipment in place.
Given the global demand for the equipment it will be an anxious wait for Bhutan until the equipment actually reaches here in Paro airport, despite any assurances from the local suppliers in Bhutan who are also dependent on the manufacturing company.
The hope is that some ventilators will arrive within this month with the rest coming after that.
Both the health minister and secretary said that ventilator services will be given only in JDWNRH and Mongar given the need of trained people to handle them. The minister also said that cases which are not serious can be handled in the smaller hospitals but only serious cases requiring ventilation would be sent to JDWNRH and Mongar.
The Health Minister and Secretary also both said that only around five percent of patients would need ventilators. So if there is the worse case scenario of 500 patients then this would mean around 25 may need ventilator support.
Less serious patients may not require ventilators and for them there are oxygen concentrators of which there are currently 7 in JDWNRH, 6 in Mongar and 5 in Gelephu.
Another important requirement is testing kits. Bhutan currently has enough testing kits to test around 4,000 samples but it has placed an order for 27,200 more.
However, there is again a high global demand as opposed to the supply of testing kits and, here too, Bhutan will have to compete in the international market to get what it wants.
With the government committing to test all quarantine cases after the 21-day quarantine apart from other tests, the current kits may just be enough to cover those in quarantine and some additional tests.
This does not even take into account around 5,000 Bhutanese who want to come back and will also have to be tested.
In the event that Bhutan starts seeing community transmission then a lot more tests will be required.
The Foreign Minister Dr Tandi Dorji said that the government does not want to be wasteful with the testing kits because it does not want to use up everything in case of community transmission.
The minister said that globally companies are accelerating the manufacturing of such kits with countries like South Korea manufacturing them.
The Foreign Minister said that even if there is community transmission in Bhutan it will be contained given Bhutan’s sparse population and lockdowns then.
The minister also expressed the hope that given Bhutan’s relatively young population, not many would require ventilation.
On the PPE front Bhutan has around 17,156 advanced sets and 59,377 basic ones. Orders have been placed for more.
The Health Minister said that the ministry anyhow orders basic PPE items like gloves, masks and head gear. She said that additional equipment like overalls are required and they are being ordered too.
The ministry on 13th March placed an order for 42,150 N95 masks which are required to care for COVID-19 patients and it is supposed to be delivered 26th March but it has not arrived yet.
Here again, Bhutan will have to compete with many countries for the much in demand masks.
Bhutan has also ordered large numbers of other PPEs like disposable gown, operation cap, shoe cover etc. which are yet to come in though the delivery date was 28th March.
It has also ordered 79,200 numbers of 150 ml alcohol bottle hand rub which was also supposed to come in by 28th March but has not yet been received. Neighboring India was the main source of supply of these hand rubs but India has banned the export of such items.
Even an order of 740,000 gloves are yet to arrive though the delivery date was on 28th March.
In terms of numbers of beds there are currently 384 isolation beds in the country with 12 ICU beds at the eye hospital in Thimphu for COVID-19 patients.
Between the PPE and consumable items Bhutan has placed Nu 113 mn worth of emergency procurement orders but not including equipment like ventilators, ICU beds and others.
Of the 113 mn around 50 mn were orders placed before the first case and rest after.
Bhutan has also placed orders for 31 sets of ICU beds on 19th March with delivery expected in 4th May, 13 cardiac tables, 13 infusion pumps, 9 laryngoscopes, 7 patient monitor, 100 oxygen cylinders, 15 nebulizers and many others all placed after 14 March and with delivery going into April and May.
The Health Secretary said that Bhutan currently has enough medicine to treat 200 COVID-19 patients with a full course of treatment and it has a back up of another 200 from medicines meant for HIV patients within the country.
While there are around 3,000 medical staff in the country including doctors, nurses, lab technicians and others currently 36 doctors, 83 nurses and 17 lab technologists are there in the COVID-19 team.
The health minister said that the preparation is to take of elderly people and people with chronic underlying conditions.
Apart from the 3,000 medical staff all 41 doctors in specialist training are called back. Even 92 students who are undergoing MBBS training are back. Even lab technicians in the Ministry of Agriculture are available.
The ministry also has access to retired doctors and those who have finished their studies and are waiting for RCSC deployment.
The MoH is getting a record of older people in 20 Dzongkhags and have finished with 12 Dzongkhags them. “If we go in the red zone and if there is an elderly patient who is diabetic then we are making plans to reach medicine to the person,” said Lyonpo.
DeSuups are in training by the MoH and so that they can take over the duties of medical staff at the quarantine centers to free up medical staff.