Bhutan’s normal crude death rate was estimated to be around 6.7 in 2017 which means for every 1,000 people 6.7 will die in a year of various causes.
Given our current population of 748,931 this means that around 5,000 people will die in 2021 as part of our normal crude death rate. But there is no reason for panic as around 11,608 will be born as per our crude birth rate of 15.5 for every thousand people.
The above data means that of the 468,297 who have been vaccinated around 3,000 will anyhow die this year due to natural and medical causes like old age, accidents, alcohol, cancer etc which have nothing to do with the vaccine.
From the JDWNRH itself around 600 people die every year on an average which is close to two deaths a day.
In this sense doctors have already said that the three deaths that occurred after the vaccination are not due to the vaccines.
Dr Sonam Wangchuk of the National Immunization Technical Advisory Group (NI-TAG) said that since the entire eligible population above 18 is being vaccinated including those with comorbidities as well, there will be cases of people dying due to their own underlying medical conditions and not due to the vaccine.
The Asthma case
Dr Sonam clarified that the root cause of all three deaths was not the vaccine. The 84-year-old man from Pemagatshel was having a severe bronchial asthma and he frequently used to get asthma attacks and was using an asthma spray.
He said that even if a vaccinated person dies of a road accident it still needs to be investigated and so these are not unexpected.
During the vaccination time, he was fine and was observed for half an hour and there were no signs of any severe side effects. He died only after 40 hours of vaccination and in the two days after the vaccination he did not have any vaccine related side effects.
Dr Sonam said that the man usually got asthma attacks in the morning and on the morning of 31st March, he got an asthma attack and even if he had not got a vaccine he would have died that day. Although the family of the deceased informed the hospital he was already dead by the time.
The health team did a medical investigation and the report states that the vaccine was not the cause of death.
The medication of the deceased was not well controlled since asthma patients need to regularly be updated on their medicine and it looked like it was not adequately done and so it had become severe already.
Dr Sonam said some asthma patients are very bad, some are stable and some are controlled. “It is an unfortunate case otherwise there are many asthma people who got vaccinated and there were no complaints,” he said.
Another 47-year-old man from Bumthang died early this week. He was an alcohol dependent person and to get himself vaccinated, he had stopped drinking for some time. As per the record, he was fine even after getting the vaccine but he had minor alcohol withdrawal while at home.
It was learnt that he used to have seizures from time to time. In the morning at around 12 am the man had gone to the toilet. That’s when the man had fallen down and was experiencing a seizure on the floor. His wife heard the man falling and immediately went to see him.
The wife thought it was the usual seizure that he gets when he stops drinking. The wife helped him to get to bed and he slept and the next day he was not waking up so when his wife checked on him, and the situation had become severe. The wife immediately called the hospital and later found that he has a head injury and internal bleeding.
Due to bad weather conditions he was not airlifted and he was brought to JDWNRH by an ambulance. He was in a stable condition. Upon reaching the national referral hospital, the man had gone through CT scan and they found that he was suffering from internal bleeding and also had old bleeding which means the man must have fallen down many times and this time, he must have fallen harder than before.
After that the doctors started the operation but he died on the operation table.
Alochol Liver Disease
The death of a 44-year-old man in Gelephu was due to alcohol and he had liver disease. He was also an anemic patient. As investigated, the cause of his death was not linked to the vaccine at all.
Dr Sonam said he got vaccinated on 29th March and there were no vaccine reactions reported while keeping him under 30 minutes observation. Thereafter also there were no reports of any vaccine related side effects.
On 2nd April, he had breathing difficulty and was brought to hospital. Dr Sonam said he was already in a deteriorating condition and his vitals were not stable. Doctors there could not save him and within an hour after reaching the hospital, the man died.
The vaccine team from the Gelephu Regional Hospital said after investigating, there was no relation to the vaccine. The man was still under medication.
The cause is related to liver cirrhosis.
Asthma and alcohol related deaths quite common
Medical Superintendent of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) Dr Gosar said every year the hospital receives asthma and alcohol related death cases.
If a person with asthma is walking even on a flat ground and he is breathless it means he is very severe. There is a condition called status asthmaticus, which is an older, less precise term for what’s now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn’t improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours.
If a person with a status asthmaticus is not treated immediately, most people will die. If a person gets a severe attack, even their own medication, normally will not suffice and the person needs to come to the hospital and then take injection to dilate the lungs.
When a person has a severe asthma attack, the path in the lung collapses and the person can’t breathe in and out. The condition is not reversible by taking an oral medicine except for injection which can clear the airways at once and provide oxygen. Sometimes, the person needs to assess breathing.
So if this happens in the house then by the time the person is taken to hospital, there is every chance that the person will die. If there is a severe attack of asthma, it is not easy to reverse the person with the medication that is taken at home as most of the medication that a person takes at home is to prevent asthma from occurring.
Whether it is alcohol or not, the person had seizure and when a person has seizure, he or she is likely to fall down and alcoholic people normally bleed in the brain which is another condition that makes an alcoholic susceptible to bleeding in the brain.
When the deceased was brought to hospital it was found the cause of death is head injury and not because of the vaccine.
Alcohol liver disease is the biggest killer of medical patients every year.
Dr Gosar said if a person experiences anaphylaxis reaction to a vaccine which is a severe, potentially life-threatening allergic reaction it can occur within seconds or minutes of exposure to something you’re allergic to. Anaphylaxis causes your immune system to release a flood of chemicals that can cause you to go into shock, the blood pressure drops suddenly and your airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting.
So far NI-TAG saw only one case of anaphylaxis reaction and that too was taken care of on the spot with an injection and the patient was cured and released.
NI-TAG has also not seen any blood clot related cases.
No advice on stopping alcohol
The NI-TAG team advises people not to stop any medicines or anything. If a person is drinking alcohol, they need not have to stop. They can drink but not up to the extent of getting totally drunk. If drunk people are coming for the vaccination, the health team will not vaccinate them.
For now the study shows that the vaccine has no effects if a person drinks or not.
There are messages going around in social media that alcohol should be stopped if one is getting a vaccine and also the efficacy of the vaccine will be low if alcohol is taken. However, the ministry and technical team has not provided any statement on this. The NI-TAG team was aware that the people have stopped drinking alcohol only after the vaccination campaign started.
He said if a person is a chronic alcoholic person and if he stops drinking alcohol suddenly, then the person is most likely to get withdrawal seizures.
Meanwhile, the NI-TAG team collects all the data of any deaths if the person had the vaccination and the team will investigate the root cause of the death.
The team has received many cases of alcohol withdrawal. There are reports of severe cases where 10 cases are of alcohol withdrawal cases. This is not because of the vaccine, but due to the stoppage of drinking alcohol.