Bhutan at risk of major outbreak from transmissible variants where young are also vulnerable: MoH Minister, NI-TAG and WHO Rep

A combination of over confidence with the first dose of the vaccine and general COVID-19 fatigue is leading to an increasing number of people flouting COVID-19 safety protocols from not wearing facemasks to taking part in gatherings.

This is as seven community cases came up in Phuentsholing, including two young boys. In addition  four frontline workers working in a quarantine center in Phuentsholing also tested positive yesterday. (see separate story on page 1).

Across the border the pandemic has made a huge comeback in India with never before seen figures of infections and deaths. India recorded a high of 259,170 cases on Monday taking its tally to 15.3 mn cases and 1,761 deaths taking the total deaths to 180,530 though media reports indicate the real death toll is far higher.

Apart from high cases there is increasing evidence that the surge is being driven in part by variants which also infect children more easily leading to an increasing number of the young and even the very young being impacted.

Health Ministers says Bhutan at real risk from variants

The Health Minister Dasho Dechen Wangmo said Bhutan is at a real risk of Bhutan being a part of the global second wave of infections.

Lyonpo said there are two major concerns. The first is that the numbers are going up globally and especially in the neighborhood, and secondly there is evidence that the variants coming up are a greater threat to the country.

In neighboring India, the latest data from genome sequencing show that the double mutation corona virus which is an Indian variant called B.1.617 is the most common variant found in India. A report in the Hindustan Times paper said that in samples sequenced 60 days before 2nd April this variant was present in around 24 percent of the samples.

This is a rapid rise given the fact that it was quite obscure and detected only in 5th October 2020.

The Indian online news portal reported that India’s Health Ministry on 24th March talking about this variant said, “such mutations confer immune escape and increased infectivity.”

Immune escape means that the antibodies induced as a result of vaccination or an old infection become ineffective to counter the virus as should be the case under normal circumstances.

The second common variant was the UK variant or B.1.1.7 found in 13 percent of the samples in this same time period.

A worry for Bhutan is that apart from the presence of the two major and dangerous variants in India and other local mutations, around 80 percent of the cases in Bangladesh have been linked to the South African variant which a study in South Africa showed to be resistant to the AstraZeneca vaccine.

It is a matter of time when this infectious variant crosses over in large numbers into West Bengal and Assam both of which shares a long and porous border with Bangladesh.

Recently a total of 19 out of 35 member Bhutanese delegation led by the Prime Minister to Bangladesh tested positive even though they stayed only for a few days.

A lot of scientific data already shows that the variants are much more easily transmissible.

Lyonpo said the probability of having local transmission in Bhutan is a reality.

She stressed that the first round of vaccination is nowhere near the magic bullet that will protect people. She said that there is global evidence to show you still need to follow precautionary measures.

The Health Minister said that given the growing level of complacency the MoH will regroup and strategize to really address it from the current precautionary approach.

The minister said the vaccine does not mean that one cannot get infected and she said people must understand that around 30 percent of the population which is a huge number comprising of children, pregnant women, lactating mothers and youth are not protected and this group has a lot of vulnerable people like children under five, pregnant mothers and lactating mothers.

She said it is everyone’s responsibility to protect this group.

She said the full physiological implications of the new variations are not fully known and there are already cases of different kinds of impact like the sinus being affected.

Lyonpo said that the data so far is also indicating that the new variant is more prevalent in the ages 20 to 40 which one would assume is a fairly healthy group and unlike the first wave when it impacted the elderly much more.

The minister said that in some parts of India more than 80 percent of the cases are the UK variant.

Children now at risk

For Bhutan a matter of particular concern is the fact that the new variants seem to transmit easily into children compared to its original version.

The UK variant, which spread all over Europe was found to be transmitting much more easily to children unlike the earlier first wave. Research has show it is 30 to 50 percent more infectious for children.

India, this time, has seen a large number of not only its young people getting infected but also many small children which is also unlike the first wave.

In Brazil reports by BBC and NBC showed that 1,300 babies have died due to COVID-19 when the earlier conventional wisdom was that the virus rarely impacts the very young.

A report in The Lancet, said multisystem inflammatory syndrome in children (MIS-C) is a newly identified and serious health condition associated with Covid-19.

Dr Sonam Wangchuk of the National Immunization Technical Advisory Group (NI-TAG) explained that the new variants are more easily transmissible in children as in the earlier global first wave the virus could not attach easily to the less developed receptors of children in the nasal tract and lungs.

He said the variants have developed changes to make themselves attach more easily and thus more transmissible, and in the process they can more easily attach to the receptors in children.

He said the spikes on the surface of the virus are like a key which needs to lock in to enter the body or cell. He said the virus has improved this key.

Dr Sonam said the main concern now is observing the increasing number of quarantine cases from India.

He said, “Our only worry is that once there is another outbreak in the community it is likely to be a new variant which can lead to a sharp rise in cases in the community and also impact children.”

 He said the new variants so far are not very different in mortality and severity.

Dr Sonam said that if there is an outbreak in Bhutan there could be huge outbreaks in the schools since the bulk of the around 30 percent population not vaccinated are under the age of 18.

He also said that even for people who got the first dose it takes three to four weeks to develop antibodies and even then its does not mean that one will not get infected or pass on the virus.

He said the biggest risk factor right now for a local outbreak is the increasing complacency.

Dr Sonam said that if there is another outbreak then the government may have to go for a lockdown.

WHO Representative says virus can come in from the border 

The WHO Representative in Bhutan, Dr Rui Paulo de Jesus said, “When I drive around Thimphu, I have started seeing an increasing number of people not wearing masks or wearing them improperly and there is also an increasing number of gatherings.”

He said that the vaccine is only one of the bullets in the arsenal and other measures like facemask wearing, social distancing, hand washing etc must also continue.

Dr Rui said that people must understand that while vaccines will reduce the severity of the disease and prevent hospitalization even vaccinated people can also get infected and transmit the virus.

On the issue of a growing number of children being infected by the virus he said that from the beginning there was never any statement saying that any age group is immune. He said the youths may have better immune systems, but they need to mask up and be careful as those under 18 have not been vaccinated.

He said he has visited a number of schools in Bhutan and they have imposed strict preventive measures along with hand washing facilities and soap. He said such measures should not be relaxed and schools should continue to follow the ministry of education and ministry of health guidelines.

Dr Rui commended the government for keeping tight border controls, having the 21-day quarantine and not letting up on the restrictions and measures.

He, however, said people cannot get complacent as Bhutan has a long border and infected people can come across this border undetected and then spread it to local Bhutanese.

Dr Rui called on Bhutanese to not get complacent and he said everybody must come together and cooperate to keep the virus out.

Measures being taken

The health minister listed out some strategies to address the above issues. She said the first step is individual behavioral change as everybody is a potential carrier and can infect others. The second step is enhanced surveillance through more and continuous testing. She said that people are being tested including in institutions.

Lyonpo said testing had come down due to the vaccine roll out as medical staff were required for the roll out but now testing would go up.

The minister said that the capacity of the Royal Center for Disease Control (RCDC) is being enhanced to be able to do gene sequencing to know the variants coming into the country as that is very important for diagnostics.

She said that testing must remain relevant to detect the variants for there may be a need to change testing protocols.

The minister said that MoH has asked a list of people from the Dzongkhags who have chosen not to get vaccinated (see separate story on pg 1).

 Lyonpo said a study will also be done on Bhutanese to check the level of antibodies produced after the vaccinations as this will provide some evidence.

The minister who is a part of the National COVID-19 Taskforce said the Prime Minister has been in touch with the Regional Task Force members and has instructed them to have stricter surveillance and vigilance.

Both the southern and eastern taskforces have suspended the import of foreign workers for now.

Lyonpo said the MoH will continue its aggressive testing. She said the seven-day quarantine will also be continued.

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