As more cases are reported from the South NI-TAG suspects the more transmissible B.1.617 variant has entered Bhutan

The current COVID-19 cases reported in the country possibly could due to the new Indian Variant called B.1.617 and found in 44 countries so far. The health ministry was supposed to send the samples of infected people from Phuentsholing and Thimphu for genome sequencing to a WHO recognized laboratory in Bangkok but due to some restriction, the samples could not be sent there.

Dr Sonam Wangchuk of National Immunization Technical Advisory Group (NI-TAG) said as more cases are reported from the south it is more likely that it could be the new variant. He said there is no doubt that Bhutan would get the same virus that the neighboring country is having and so the virus in Bhutan must be the new variant.

As of Monday evening the Ministry of Health recorded 161 total cases from the South with the current outbreak with 17 from community screening, 20 from flu clinics, 23 from frontliners  and 101 as the contacts. The majority of cases are in Phuentsholing but cases have also been found in Samdrupjongkhar and Samtse now.

The new B.1.617 variant is highly transmissible and the WHO has declared it a variant of global concern, along with the ones first identified in the United Kingdom, South Africa, and Brazil.

Dr Sonam said in the beginning one person could spread up to three people but the new variant can spread more as the Reproduction-Value (R) changes. Currently it is not there in the literature but compared to the previous virus the transmissibility of the current virus in Bhutan is high and it is proven by looking at the current COVID-19 cases reported in the country.

The R number is a way of rating coronavirus or any disease’s ability to spread. R is the number of people that one infected person will pass on a virus to, on average.

In terms of hospitalization and severity, there is not much change but there are some changes in manifestation and clinical progression in the cases in Bhutan.

Dr Sonam said most of the cases reported in the country are from quarantine centers and community outbreak possibly could be leaked out from the quarantine centers. And the other source of infection in the border areas is possibly from the import and export of goods as there will be someone who will breach the protocol. In this way there are many possibilities to bring in the virus in the country.

A clue could also be in the WHO recently updating its guideline to recognize aerosol or airborne transmission in poorly ventilated or indoor settings where aerosol remains suspended in the air or travels further.

The team has found out that there is no good containment protocol in Pasakha and that is why the virus has gone out in the community. Any person including those who are on duty in the quarantine centers should not have any link with the outside people and should follow the quarantine protocol and in emergency if they need go out of the centers then as per the protocol they need to go through testing. If a person has flu-like symptoms or the virus, there is a high chance that it can pass it on to others. Considering that monitoring 24 by 7 is very difficult said Dr Sonam.

A matter of concern is that cases are coming in from the community and positive cases are still being reported even after the lockdown, which shows that people are not following the lockdown norms. People think that lockdown is just movement restrictions, and people are seen mingling with their neighbors. The main objective of the lockdown is to stop the infection from further spreading.

Dr Sonam said whether it is a new variant or not, clinical management is the same and the same protocol is being followed. Also all the respective COVID-19 centers have in place all the trained health staff and facilities to manage. Bhutan has been prepared for very long time even for the worse case scenario. Since Bhutan has high vaccination coverage and the country will not have cases like in India. People might get infections even after the vaccination but in terms of severity, Bhutan will not come to the worse case situation like in the neighboring countries.

With regard to the efficacy of the vaccine, the study is still going on whether the efficacy of the vaccine will go down or not because of the new variant. Dr Sonam said people will still be protected from becoming severe even if the efficacy comes down. The main objective of the vaccine is not to prevent infection but to prevent severity and death.

Scientists believe existing vaccines will help control the variant when it comes to preventing severe disease and the vaccinations now available are still likely to slow down the spread of the disease.

Meanwhile, the source of infection outbreak in Samdrup Jongkhar and Tashichhoeling is unknown and it is still under investigation. Dr Sonam said it is very difficult to find the source because it is very hard to get the true information from the infected people.

Additional health staff are deployed in the Phuentsholing. Some positive cases are kept in hotel quarantine and some in COVID-19 centers. There are no severe cases so far. Most of the patients are symptomatic and some have mild symptoms.

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