Before the spread of the Delta Variant across the world one main hope and target of many countries was to achieve herd immunity of 60 to 70 percent which theoretically would be enough to eliminate the virus.
However, that reality has changed with the spread of the much more transmissible Delta variant. With growing breakthrough infections due to delta there is an increasing view globally among experts that COVID-19 will be here to stay as an endemic disease like the common cold, TB, HIV etc.
In Bhutan the official goal is still to have zero COVID-19 infections but the opening of the more than 100-days lockdown in Phuentsholing recently after two doses, and keeping it open despite subsequent cases and outbreaks offers a clue of the way ahead.
Earlier, Phuentsholing, like the rest of the country, followed a much stricter strategy of opening up which would be only 14 days after the last case and it was this approach that kept Phuentsholing in a lockdown for more than 100 days.
However, after the second dose and the opening up even though cases have come up including the 11 cases in the Medical Supply Division there has been no long lockdowns. Instead, after a 24-hour blackout there was a request to the public to follow protocols.
The health minister said the natural progress of COVID-19 will be from a pandemic into an endemic. However, the minister said that Bhutan is still on the infection prevention mode and the risk of living with COVID-19 is to risk outbreaks and mortality.
When asked what changes the government is bringing to ensure Bhutan can adapt to a COVID-19 that will not go away as pandemic for a while and then turn into an endemic, Lyonpo said a lot of things are already happening to adjust to that reality.
Lyonpo said that in case of Bhutan there are already changes as there are more virtual meetings and gone are the days of gathering large numbers of people.
Another long term measure pointed out by Lyonpo was the Zoning of towns and zoning done across the country.
“We have these mega zones and each of these mega zones will have their own services like vegetable vendors, meat vendors etc so that in case of future outbreaks each zone is a self-sustaining. This is why we are building vegetable outlets in zones,” said Lyonpo.
“Zoning is to prepare for the future,” added Lyonpo.
Lyonpo also pointed to the recent launch of satellite clinics which she said are strategically placed in clusters so that if there is an outbreak, the Dechencholing area has its own clinic for vaccination and other services, Hejo would have its own and Motithang will have its own etc.
She this would mean uninterrupted public services and also ensure that people form one zone do not spread an outbreak to another zone.
The other example is of the mobile testing services and Lyonpo said in another two to three days JDWRH will launch the delivery of medicines to avoid the crowding of JDWNRH.
“We cannot compromise JDWNRH and we have to save JDWNRH and so there will be decentralization as services from JDWNRH will be delegated to regions and other places,” said Lyonpo.
So if a person from Hejo has to do a blood test then they can give the sample at the local clinic which will be picked up so that in case there is someone positive in Hejo it will at least not reach the main hospital.
Lyonpo said that another long term change is now the government or others cannot think of coming up with any structure or office without a proper hand washing station. She this this will be a permanent feature including at bus stops and other public spaces.
The minister said that while Bhutan is not living with COVID-19 but every government policy and decision is around COVID-19, and also accounting for the fact that the next Coronavirus pandemic may just be around the corner.
Another major indication of the government preparing for a COVID-19 that will not go away is the massive 2,500 beds COVID-19 permanent quarantine facilities being set up in the south.
Lyonpo said the idea is to bring in workers in large numbers keep them in quarantine and then allow them to work in the country.
“People keep talking about recovery, but I feel that we are already on the path to recovery by building such quarantine centers, zoning, decentralizing services etc,” said Lyonpo.
Another major long term change is the effort to provide all services possible online. Lyonpo said the government is focusing on online services and online payment for services have gone up significantly.
When asked about why the government is not stressing more on ventilation as a long term measure given that COVID-19 is airborne, the minister said that the MoH already has issued advisories for good ventilation.
However, Lyonpo said the idea of ventilation will not work if there are 100 people in a hall or there is a large indoor crowd. She said the focus is more on preventing crowding. Lyonpo said that she personally has not been to any funeral, Dhar or other social events.
The minister made an appeal saying that now it has been 18 months since the pandemic and she still notices some people not wearing masks. Lyonpo said that she personally tells unmasked people to wear masks when she sees them.
She said that Bhutan cannot be a society where somebody has to keep chasing after people to wear masks but it should come naturally and those not wearing it should be made to not feel as comfortable as somebody wearing one.