For all purposes, the Jomotsangkha case is probably Bhutan’s first local or community transmission case, but the government is in an all out drive to deny this, even after the Health Minister, in a live press conference, confirmed that the patient has the COVID-19 virus.
She even went further and said that the person has developed Immunoglobulin M (IgM) antibodies which develops as a reaction by the body to fight this virus and is specific to the Novel Coronavirus (COVID-19).
Soon after the press conference, the Health Minister received calls from two cabinet colleagues who did not agree with her. One of them even called the reporter to contest the Health Minister’s assertions saying that only a positive RT-PCR test would mean it is a positive case.
The MoH facebook page which had a live video of the press conference was also removed in the evening.
In its place a while later the MoH said that the third RT-PCR test conducted on the sample of the suspected case from Jomotsangkha tested negative for SARS-CoV-2 (the virus that causes COVID-19) at the COVID-19 Testing Lab in Phuentsholing.
It said that with the confirmatory test coming out negative, the lockdown in Jomotsangkha will be lifted from Saturday morning.
This statement completely overruled the Health Minister’s own assertion that the patient had the virus as he was exposed to it and developed antibodies.
The MoH said that however, as per existing protocol of the ministry, the primary suspect will be kept under quarantine for an additional 7 days.
The Health Minister earlier said, “IgM positive could mean early recovery (from the virus) or early exposure (to the virus) and IgG (which develops later) remains for life. So it means, you will have developed antibodies for life which means that is specific to the coronavirus, so the chances are the same strain of coronavirus will not affect you next time. So there is no chance of reinfection as your bodies would have developed antibodies to fight that virus.”
When asked again specifically on if the patients has the virus the Health Minister said, “He is exposed to it and so his body is reacting to that virus to develop that antibody. He has the virus. Now, it is also about whether he is an active case or not.”
Lyonpo said that RT PCR positive means that the person is infected with the virus and will be a transmittable host. Lyonpo said that currently the person is termed under “early recovery not infectious” state although he tested positive for IgM.
She said “The RDT tests will show two main signs, the Immunoglobulin M (IgM) and Immunoglobulin G (IgG)”.
The facility tested positive with serum tests on the RDT 6 times for Immunoglobulin M (IgM).
These 6 tests were done in order to avoid human error which was ruled out. She explained that since his IgM is currently positive, there is no sign of IgG as the latter will take a long time to develop.
She said that IgM are the initial antibodies that is developed in the body’s immune system to fight against the COVID-19 virus in case of an exposure with a positive person.
She said that the IgM will occur in the body prior to the Immunoglobulin G (IgG)- an antibody that would take a long time to form in the body but if the IgG sets into one’s immune system, it will remain for life. She added that those people who have recovered from COVID-19 will have developed it after an average of 3 weeks of time which will mean that the person will no longer be prone to the same strain of corona virus”
She added that generally IgM will remain for an average of 3 weeks of time after which the body would develop IgG as a sign of recovery.
She said “If we do a test for all the people who have recovered so far, they will definitely have IgG in their bodies since the body has finished fighting with the virus”.
She said that this is the reason why in other countries, after extracting the serum of those people their plasmas are being saved.
Lyonpo said that the two tests are done for different reasons and it is to be understood that RDT tests are to determine if the person has developed antibodies to fight the virus or not while the RT PCR is done in order to determine if the person’s transmission status is infectious to others.
Lyonpo said he tested negative for RT PCR as the virus has not yet been detected in the throat or nasal regions but he has been exposed to the virus.
She said that there are two plausible explanations in his case which is that since he tested positive for IgM he could either be in the state of an early recovery or an early exposure with a chance of developing the virus in his throat or nasal passages and becoming infectious.
“He is currently healthy. He has no signs and symptoms and if he continues to test IgM positive and RT PCR negative, he will have to be quarantined” she added.
She said “We have tested all the people with primary contact with him, but all results came negative. In case of any community transmissions we have set up guidelines prior to this situation and therefore we are well prepared and did not take a lot of time with getting lost in dilemma to deal with the current situation. Jomotsangkha in fact can be looked at as an example in case of a similar future scenario”
“If in case he had stated clearly about his movement whereabouts, we could have traced his other contacts and we could have contained the situation in another manner, but since he states that he had not gone anywhere other than Jomotsangkha, this might mean that the transmission is from the community. Due to this uncertain factor Jomotsangkha is in lockdown” she added.
“Now, where did he get infected from, if so? Therefore, we are taking this preventive measure of locking down the entire community” she said.
After the conference she said to The Bhutanese that this is the ‘most difficult part’ of this situation.
Adding on, in response to another question about the reliability of test kits, she said that previously they had been pouring the blood samples in the tubes for tests but due to the inconvenience of the process, the blood is now drawn out and then serum is taken and tested.
She said that there could be two main reasons why a test could fail, one being the innate fault of the test kits stating that no test kit in the world is 100 % accurate and another due to human error which she clarified that they had contained this possibility by doing several tests.
Another question was put forth during the press conference about the cross reactivity of the tests which means that sometimes a test could be hinting or have traced another virus or disease of similar nature.
However, the Health Minister said “IgM is specific to the Novel coronavirus,” ruling out other viruses or other Coronaviruses.
In case of a question regarding relapse and resurgence of the COVID-19 witnessed in people around the world she stated that the Health Ministry has a second layer surveillance system through which the ministry is in constant touch with the released facilities via calls as well as provides them precautionary notes on leaving the quarantine facilities. Other steps she mentioned was about advising these people to keep tabs on their own health conditions and inform the MoH in case they feel any abnormality.
Below is a link to the complete transcript of what the Health Minister said on the Jomotsangkha case and at what time https://www.facebook.com/TheBhutaneseNewspaper/posts/2592903894148858?__tn__=K-R