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On day 3 of the lockdown on 22nd December the Prime Minister along with an announcement for a National Lockdown also announced mass testing for Thimphu.
He said a total of 15,000 to 20,000 people in Thimphu will be tested in a few days and we will have an idea of how far the virus has spread in Thimphu. Lyonchhen said that this would include representational samples in Thimphu.
However, now with a large number of cases coming up in Thimphu and with cases in other Dzongkhags also linked to Thimphu there is a burning question on if this could have been prevented by doing mass testing in August or September when the outbreak in Phuentsholing happened.
Mass testing planned but not carried out
Initially a Google doc form from the Prime Minister’s office was on Facebook in the later part of August to collect information for the planned mass testing.
The doc said, ‘There is a possibility of the corona virus in Thimphu. We are devising the most efficient way to test the population in the most scientific and quickest manner. This will be done through a sample testing of the population in the zones. The information you provide will be used to determine the sampling size and representative from households who may need to be tested in order to determine the extent to which the zones in Thimphu may have been affected by the virus.”
It asked people to provide the name and phone number of one person in the household who is the most active and goes out of the house the most. It said all information will be kept strictly confidential.
At the time, a Technical Advisory Group (TAG) member of the MoH had said that the government has planned to test one member of each household in Thimphu and that it would be done once the Phuentsholing mass testing is done.
With around 27,000 households in Thimphu at the time it would have meant testing around 27,000 people. A plan to that effect had been made.
Even the Health Minister at the time said that when it comes to Thimphu they have a general risk assessment criterion which looks at population, mobility, positive cases and containment measures.
She said that of the four criteria Thimphu already fulfilled three of them. Thimphu has high population with around 150,000 people all living together, high mobility and containment will be challenging as cases come up. She had said that if Thimphu gets positive cases then it is at high risk as it will be difficult to contain the cases and it can spread like wildfire.
However, this plan within the government to mass test changed soon after and it did not happen. A source at the time said the plan was changed based on the simple fact that none of those who had come forward as coming from Phuentsholing to Thimphu had tested positive.
This logic, however, did not taken into account those who may not have come forward for testing, and those who came earlier to Thimphu then the time period given by MoH of 1st to 12th August. The mass survey in Phuentsholing had picked up 11 confirmed cases of COVID-19 antibodies run through the more accurate ELISA test which indicated that the virus was there even before its discovery in August 2020.
Also, apart from Phuentsholing seeing an an outbreak of cases there were also cases coming up in Paro, Gelephu and Samdrupjongkhar.
Phuentsholing in August had undergone mass testing of all 25,000 to 27,000 residents minus those below the age of 14.
PM says dormant virus theory does not hold water
The Prime minister said it was very unlikely that a silent case had entered Thimphu in August and stayed dormant for four or five months.
He said there are 54 flu clinics across the country and 83,000 people had come to the clinics for testing. He said that the only cases that turned positive in the flu clinics was in Phuentsholing. The PM said around half to 30,000 of these tests would have been done in Thimphu, but not a single positive case was picked up which meant there was no indication of an outbreak.
Lyonchhen said that it was the same test, and so positive cases coming out now only means that the outbreak is quite recent.
He said that the strategy now is inside out using contact tracing, outside in using community screening and then random sampling or mass screening. Lyonchhen said the sample right now is a representative household. He said in Phuentsholing everyone was tested as there were only a few cases coming out and so the need to test everyone was felt to find out the cases.
He said if Thimphu’s mass screening showed a lot of cases then there would no point testing everyone as it would mean the virus is prevalent.
PM’s past arguments against mass testing for Thimphu in August
When The Bhutanese in August 2020 asked the PM on why mass testing was not being done in Thimphu despite the obvious risks the PM at the time said that they may mass screen today and tomorrow that population is still at risk.
At time he said that Thimphu has no indication of outbreaks as they had combed Thimphu in many ways. He said thousands of tests had been done in Thimphu which include all Thimphu residents who came from Phuentsholing from 1st till 12th of August, all frontline workers had been screened before coming out on duty and when they left their duty and all three armed forces institutions (RBA, RBG and RBP), DANTAK and IMTRAT are being screened and and all of the above are negative so far. He said even all patients and their attendants getting admitted to all hospitals especially like JDWNRH are getting tested and yet there is no evidence of cases.
He had said flu clinics pick up a few dozen samples everyday and they are all negative. The PM had said that even in the scenario of if there is local or silent spread 60 to 70 percent of the diseases is symptomatic and people would have come up but for the last month nobody came up.
Lyonchhen at the time said the Phuentsholing cases got picked up from the flu clinic and he said that is the tested and proven path.
However, while visits to flu clinics went up after the March scare and also the August outbreak it subsequently dropped sharply to the point that the Health Minister recently said that even many of the first contacts of the recent Thimphu cases had flu like symptoms and other symptoms but did not go to the flu clinic for testing.
At the time, the PM said that people should not create fear in the minds of the public saying this government is not screening Thimphu.
The PM at the time time had also explained the difficulties of doing mass testing in Thimphu. He said that if the government is to screen Thimphu then it will require to be locked down for 10 days to test everybody. This was in the middle of an ongoing 21-day lockdown at the time. He had said that people have to be indoors and cannot be allowed to move freely and so the trade off is not easy.
In Phuentsholing 20 teams had been deployed. He had said such a large team itself is a risk with travelling.
Lyonchhen at the time said if they lockdown Thimphu any day longer few people will come out and just shout.
Lyonchhen also said at the time that he is willing to debate anyone who feels Thimphu needs mass testing without any cases coming out.
TAG says mass testing in August would not help
The Bhutanese recently asked the TAG if its thinks that in hindsight perhaps doing mass testing in Thimphu in August-September would have been a good idea.
TAG on Thursday said, “No, going by the antibody found in the new cases, the infections look fairly new and therefore, mass testing 2 to 3 months back from now would have served no purpose. Moreover, at that time, there was a lesser risk in Thimphu.”
While the TAG logic holds good for fresh infections which they are anyhow chasing the real picture of the source of infections in Thimphu can only be known by doing a sero-survey to find out how many people have got and recovered from COVID-19. These will no longer test positive on the RT-PCR and may not even be the contacts or part of any community surveillance but this survey would involve random antibodies testing of people.
Some of these results could turn up in the mass testing being done in Thimphu but only if even antibodies are also being looked at apart from the active COVID-19 virus. However, there is little hope of this at least for now as the TAG has said that mainly RT-PCR tests will be done to check for only current infection.
Mass testing now
The Ministry of Health on 24th December said that more than 40 Teams from the Royal Center for Disease Control (RCDC) have been deployed to collect 8,400 samples from randomly selected households spread across 44 zones in Thimphu starting today. Only one person from the selected family is called.
The Health Minister on 24th December said that they plan to test around 10,000 people from the community in 2 to 3 days and this is to feel the pulse of the virus in the community.
In terms of the strategy going forward, in Thimphu Lyonpo said there will be aggressive contact tracing day or night. Then high risk clusters like taxi drivers, bus drivers, schools, frontline workers, shops are being tested.
They are also testing all workers and volunteers like RBP, Dessups, BBS staff and service providers. If there is one case from a school then we test all the students there like YHS,
Lyonpo said this will allow them to get a picture of what is happening after looking contact tracing, high risk clusters and and community testing figures
Lyonpo said in the case of Paro it is epidemiologically similar to Thimphu given the high level of interaction between the two cities. She said they are also doing aggressive contact tracing there along with cluster testing in Paro in risky places.
She said that within two to three days using the above data they will do mas screening in Paro too in the riskier areas. She said this will then give them a good picture of the situation there too.
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