Manning the the border gate at Phuentsholing Photo Courtesy: Sangay Tenzing

Exploring the reasons behind the COVID breach in Thimphu and Phuentsholing

The national capital was in high panic on 20th April as three staff, two females and one male, at a quarantine hotel in Lanjophakha tested positive but this was not the bad news as it was found that the male cook had violated the quarantine and containment protocol to slip out three times.

On two of those occasions he went to play cricket cricket matches at Pelkhil School and Dechencholing.

Thimphu and the nation breathed a sigh of relief when all the contacts of the cook tested negative by 21st April.

What went wrong in Thimphu

After the second outbreak in December last year a thorough shake up and major reforms were supposed to be carried out not only in the management of the Paro Airport, but also the quarantine hotels.

The Prime Minister’s office which looks after the quarantine hotels was supposed to carry out these reforms leading to the question of what went wrong this time and also how can it be prevented from happening again in the near future.

The Cabinet Secretary Sangay Duba said that currently an investigation is on to find out what happened in the breach at the hotel in Lanjophakha. “Thereafter, only we will be able to see what action to take.”

He said that they will have to see how to strengthen the security in the quarantine facilities. He said under the current protocol the cook was not supposed to leave the hotel but the hotel had a backdoor entry and that was how the security was not able to detect him leaving.

The Cabinet Secretary said that the hotel staff in a quarantine hotel with guests is supposed to be on containment mode with regular testing and they are not supposed to leave the compound.

The secretary said that they are yet to get the full details from the MoH surveillance team.

One of the major reforms after the second outbreak was to have a dedicated quarantine team with dedicated officers or managers and Desuups.

The secretary said that this had been put in place with a dedicated team to just look after the quarantine centers. He also said that the quarantine managers and staff themselves and even bus drivers stay at containment centers.

He said apart from dedicated management teams there were detailed SOPs that had been drafted.

He said the quarantine manager, security personnel and all were deliberately put in the lower floor of the hotel to check people.

“Despite all these measures, this has happened,” he said. He said it is possible that the hotel staff did not abide by these measures.

The Cabinet Secretary said that for now the cook after his recovery and quarantine will be charged in court for breach of quarantine protocols.

He stressed that whoever is in the facility including the staff there have to abide by all the protocols.

The secretary said that one thing that they are looking at it is also involving RBP personnel to look after the security at quarantine hotels in addition to Desuups. The RBP could visit, apprise and monitor.

As of now there are 27 hotels in Thimphu with 702 quarantine guests. Chukha which is mainly Phuentsholing has 1,060 people in quarantine, 311 are in Paro and there are others in Samdrupjongkhar, Gelephu, Samtse and Sarpang.

Nationally there are 302 hotels which keep around 2,000 to 3,000 people in quarantine and the bulk of them are the 7-day quarantine traveling from high risk areas.

The Secretary said that since in some cases the hotels in the south are not enough, especially with  Phuentsholing hotels keeping expatriate labour some of the 7-days quarantine cases are brought up and kept in Thimphu.

A common factor in the second outbreak and the latest breach in Thimphu is referral patients. The source of the second breach in December is mostly likely suspected to be a 27th November 2020 flight from Kolkata carrying primarily referral patients where the majority of the passengers turned positive.

Even in the Lanjophakha hotel breach the hotel had some referral patients it was keeping, some of whom had tested positive.

When asked about this the Cabinet Secretary said that though they have no proof they suspect that the logistics people or the hotel staff must be coming more into contact with the referral patients while helping them.

He, however, also pointed out that since the nurses on duty of these patients did not turn positive, maybe the hotel staff did not take adequate care or follow proper protocol in interacting with the patients.

The Phuentsholing breach

As of Monday Phuentsholing saw 31 cases from the community of which the MoH classified 8 as being from the community and 23 being the first contacts.

Apart from the above  six frontliners working in quarantine centers also tested positive till date.

Given the random spread of the cases with the first two being detected in the Toorsa colony, followed by the NHDCL colony and Pasakha the MoH is yet to establish a clear entry point or source of the outbreak in Phuentsholing.

However, what is clear is that the outbreak in Phuentsholing coincides with a dramatic rise in cases in neighboring West Bengal as part of the second wave in India, and also on the back of massive election rallies violating COVID-19 protocols in an unprecedented eight-stage polling election.

On 1st April, West Bengal only reported 829 daily cases but as of today it reported 15,992 cases with 68 deaths and 94,949 active cases. West Bengal is lower down the order when it comes to testing among Indian states and so the numbers could be even higher if testing is increased.

Professor Bhramar Mukherjee a globally prominent professor of Epidemiology and a biostatistician from the University of Michigan in a Twitter thread says that globally COVID-19 cases are underreported by a factor of 10 to 20.

She says currently the underreporting for India is around 15 times which means that West Bengal could actually be having a much higher actual rate of cases like the rest of India.

Given that fact that since the majority of Bhutan’s goods and skilled labour come via West Bengal into Phuentsholing, it may be no surprise that a breach has happened in the border town.

Another important factor of the spread of the virus in Phuentsholing and also among the frontliners on duty in the hotels there may be explained by a recent paper in The Lancet which shows that COVID-19 can be transmitted via aerosol.

The Home Secretary and head of the Southern COVID-19 Taskforce Sonam Wangyel said that at the moment it is not possible to pinpoint the source of the outbreak.

However, he said that as far as Pasakha is concerned it is clear that Druk Wang Alloys Private Limited is a clear source given the large number of employees and first contacts testing positive there.

This is why the taskforce took the call to shout down the factory as the contact tracing team conducts its contact tracing and testing.

He said there is less clarity on the Phuentsholing cases since a large number of the first contacts of the mother and son in the Toorsa Colony and the school have come out negative. He said the only link between the three cases in the NHDCL colony and the Toorsa case is they they had used taxi rides but this is very vague.

He said that as of Thursday testing on a large scale was already going on and so many were tested in Druk Wang, Phuentsholing town, DANTAK, IMTRAT, hospital staff, frontliners, students and others. He said around 5,885 were tested until Thursday afternoon alone.

The Home Secretary said that they are hoping it is the same old virus and not one of the new strains that has come to Phuentsholing.

When asked about what measures could be taken on ensuring there are no outbreaks in the future the home secretary said that the current lockdown in Phuentsholing will restrict movement. He said the MoH team who are the technical experts and are well versed about the situation are working as per a professional plan. The home secretary said the focus for now must be on the outbreak.

The Health Minister Dasho Dechen Wangmo said that currently cluster based testing is going on targeting 4,000 people at the NHDC colony, about 1,000 at Toorsa, 2,000 plus at Pasakha and other places.

She said the situation will be clear only a couple of days after all the testing.

Lyonpo said that the infections are all at an early stage. She said that some samples have been sent for genome sequencing (see separate story on page 1).

When asked what could have caused the breaches in Phuentsholing and Thimphu Lyonpo said it comes down to complacency.

Lyonpo said the lesson is that while the protocols are in place they have to be implemented again and again and so some complacency creeps in impacting behavior.

The health minister said that already the quarantine management team, Dessups and RBP are discussing and sorting it out between them to ensure better monitoring.

The minister said that everyone is giving it their 100 percent but when the duration is over 12 and 13 months some complacency comes in.

The minister said that the strategy and responsibility needs to come at the individual level.

The minister said that the first case in Phuentsholing could be detected due to the surveillance system set up in the schools as this was not a random case but picked up by this system.

Lyonpo said that the future course of action in Phuentsholing will depend on the test results of the clusters in the coming days. She said if there are more cases then a sweep may be conducted which is testing at a larger level.

She said for the lockdown to be lifted from Phuentsholing there should be no cases for 14 days after the last case has been detected.

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