Being a Watchdog in the time of COVID

From the time COVID-19 came onto the scene towards the end of the last year The Bhutanese Newspaper was the first to regularly update the rise of international cases country wise.

The paper was accused of causing alarm but the aim was to alert the nation to an incoming threat that would surely reach our borders one day.

Then we were again the first paper to openly ask the government to restrict tourists from countries with high COVID-19 cases, much before we got our first case in March.

Here again, the paper and I were accused by some of being unnecessarily alarmist given that WHO had not issued such guidelines.

After we got our first few cases the paper and I strongly took up the cause of wearing facemasks.

This was at a time when the flawed WHO advice prevailed which said only medical staff and those with symptoms needed them. It was also erroneously said by some of our officials that facemasks are not effective.

The paper and I put out a lot of science on the effectiveness of facemasks but not much heed was paid.

The paper and I were the first to bring up the issue of transmission of COVID-19 through micro-droplets that travel beyond 2 meters and hang in the air for a long time in enclosed spaces. This meant that good ventilation and facemasks was the need of the hour.

Despite there being a lot of good science on this we were basically not taken seriously as again WHO advice prevailed.

It took a while but WHO revised its advice on facemasks and asked the public to wear them while going to crowded or enclosed places, and it also accepted the dangers of micro-droplet transmission.

In May this year, the Health Ministry announced that a businessman in Jomotsangkha had Immunoglobin M (IgM) antibodies.

The MoH said that the person has IgM as he had been exposed to the virus though later certain officials pulled down the press conference video and tried to pass it off as a false positive case or a cross reactivity case where it had been confused for IgMs of another virus.

This is even though a more accurate second ELISA test two weeks later showed he did have COVID-19 specific antibodies.

The Bhutanese raised the possibility that this may be sign of a possible local transmission happening, based on the what the MoH itself said but the paper was dismissed and criticized.

A few weeks ago a Phuentsholing lady tested Immunoglobin G (IgG) antibodies positive and again the same experts rushed to conclude this was a false positive case even though she tested positive on two different types Rapid Diagnostic Test kits in numerous tests.

The Bhutanese was the only one who pointed out that a more accurate ELISA test is yet to be done to declare it as an actual false positive.

It now emerges that apart from the 25-year-old loader and his many contacts who tested positive, when 1,200 random people were tested there were 18 with antibodies and 4 positive cases showing local transmission.

The paper was also the first one to question the re-opening of private ECCDs, mainly located in Thromdes, saying that it did not make sense when virus was on our doorstep and when classes PP to VII were called off due to the dangers of community transmission.

We were accused of not understanding the problems of parents without baby sitters and the financial struggle of private ECCDs.

Now those same people can deal with the fact that of the positive cases in Phuentsholing so far one is a four-year-old and another is a five-year-old.

Also, who is accountable if silent transmission has been happening in Thimphu too, which is now a real possibility.

Now, going ahead, given how this virus behaves, the two most vulnerable places in Bhutan right now are Phuentsholing and Thimphu and to lesser degrees other Thromdes, especially in the border areas.

Everywhere, the experience of large cities from New York to Mumbai to Wuhan has shown that they are particularly vulnerable as large numbers of people are living together and so COVID-19 spreads like wildfire.

Our New York and Mumbai are Thimphu and Phuentsholing and so these two places will be the hardest hit over time, and we have to prepare for COVID-19 spreading like wildfire in dry shrub in these places.

It will also be important to assume that in other bordering places there are still undetected cases which apart from spreading in the border areas may have already travelled inland.

Now some may say that the recent 16,450 RDT tests in the southern Dzongkhags showed no community transmission and only the Phuentsholing lady showed up with IgG antibodies which was promptly dismissed as a false positive, too early in the day.

The positive take away from the sero-survey above shows that Bhutan still does not have large scale community transmission, however, a health warning here is that the RDT tests only have an accuracy rate of 70 percent or even lower in picking up active COVID-19 cases.

The contrast here can be seen in the fact that the 25-year-old loader tested negative in his RDT test which was one of the 16,450 survey tests done in the first week of August but tested positive on the RT-PCR in the second week of August.

This maybe why the MoH in the mass Phuentsholing tests ordered by His Majesty is now testing all 28,000 residents in Phuentsholing using both RT-PCR for current infection and RDT for possible past infection.

 Its effectiveness can be seen in throwing up 6 positive cases and 11 cases with antibodies showing a virus history so far.

So all future mass surveys have to be done using both RT-PCR and RDT, which I am sure the MoH will now follow.

As the Prime Minister said, the lockdown could not have come at a better time given that it was triggered by the Sershong lady case where all first contacts have tested negative till date, but during which the real danger in the Phuentsholing case surfaced.

Lockdowns world over have had a mixed result. It has worked best in countries that have prepare well for it and followed up with mass testing, tracing and isolation and where its citizens follow social distancing and wear masks.

It requires an effective health system and government machinery, a disciplined public, planning for exigencies, never tiring vigilance and some luck.

In all honesty, if Bhutan was left to its regular devices of turf battles, lack of coordination and an approach to do things at the last minute we would probably have have a raging community transmission with thousands of COVID-19 cases and multiple deaths by now.

For example, Maldives with a population of around 500,000 people has 5,785 cases and 22 deaths.

In that sense, the far thinking leadership of His Majesty The King has always kept us two steps ahead of the virus and so while it was inevitable that we would get community transmission one day, we are in a much better position to handle it now with various mechanisms in place and a possible vaccine a few months away.

Going ahead, all of us have to pick up valuable lessons from the leadership of His Majesty in planning and preparing for all exigencies, taking care of all related aspects like economic and social issues and in never taking the virus lightly.

While certain government officials and even expert committees may have tended to downplay dangers and issues, it has always been His Majesty who has stared the devil in its eye and not only acknowledged its presence but also geared the nation for its eventual arrival.

As His Majesty has stressed many times, complacency will get us in trouble with this virus and so we should always be alert and be prepared for it.

This is what we have been preparing and drilling for months now and the fight is now upon every Bhutanese to hold the line with the valuable time and resources His Majesty has given us, and to not let the virus wreck havoc on our society and country.

By Tenzing Lamsang

The writer is the Editor of the paper.

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