On 20 December 2020 Thimphu Thromde went into a lockdown after a 25-year-old female tested positive for COVID-19 at the JDWNRH Flu Clinic.
Soon enough, more community transmission cases of COVID-19 were detected in multiple dzongkhags, and the nation went into its second lockdown national lockdown, with Thimphu being locked down for 42 days.
The epicenter of the second outbreak was Thimphu and Paro, with a large number of cases, though cases had been detected in other dzongkhags too.
However, it was not clear why and how such an outbreak had happened, despite precautions being put in place after the first national lockdown.
The Bhutanese, in two long form investigative stories, “How complacency and lax protocols led to the nation’s second COVID-19 outbreak’ on 9 January 2021, and ‘A deeper look into the factors behind the perfect COVID-19 Storm’ on 16 January 2021, brought out the series of lapses and missteps by the government, which led to the second outbreak.
The most probable source of the outbreak was a 27 November 2020 flight, where out of the 55 passengers, 34 of them tested positive including the flight pilot. Mainly medical referral patients and some customs officials had boarded the flight.
Even the Shabha bus driver who ferried these passengers to a local hotel in Paro tested positive.
However, the outbreak could happen and spread in the first place due to a weakening system of oversight, and growing complacency in transporting passengers and keeping them at quarantine hotels.
This paper found that school buses of five schools in Thimphu and six schools in Paro were used to ferry passengers, and the drivers were not placed in quarantine except for between August and October 2020.
In addition, 80 city bus drivers had ferried passengers from March to December 2020, and they only stayed at a common garage during the first lockdown, but after that there was no quarantine for the drivers who ferried passengers, often ferrying local Thimphu commuters the next day.
Despite requests for COVID-19 tests, the city bus drivers were not tested, and only 10 of them were tested once.
A thromde city bus driver tested positive, and knew about his status only when he was about to be deputed to ferry health staff, and so had to undergo a mandatory test.
Drivers complained that there was no partition between them and the passengers, many of whom tested positive later.
However, this laxity was only part of a larger complacency setting into the system starting from August 2020 when a relatively large outbreak was detected in Phuentsholing with links to Paro and Haa, and later cases in Gelephu and Samdrupjongkhar that sucked up the majority of the attention to the south.
MoH which had been running the logistics show along with Paro Dzongkhag in Paro and all the quarantine centers handed over the charge to an under capacitated and understaffed PMO that was just not ready to take on such an onerous task.
Airport officials, Dzongkhag officials, and even bus drivers noticed a visible slacking after this August transition.
Earlier, it was very strict at the airport, as officials and DeSuups would be monitoring with very clear instructions on where to go. Then while reaching the hotel in Thimphu, again DeSuups and officials would come out, even before the bus stopped, and take charge.
From around September onwards, things became vey lax at the airport, where drivers would come out and seen mixing around, and also while dropping passengers at the quarantine hotels, whereby officials would not come out of the hotel to take charge even as the bus came in.
There was also a growing overall complacency, as until then, there had been no cases outside quarantine centers through the airport, and as the flights lessened, everybody assumed things were coming under control.
A sense of normalcy had also set in after the first lockdown ended, and government offices went back to normal and much delayed works and economic activities.
Also, while both airlines claimed it had strict quarantine for its staff with DeSuups on duty, but an airport official, on the condition of anonymity, had said the aircrew were more free to mix around than those in normal quarantine. Staff at the airport were divided into two teams, but the staff were allowed to go home everyday at the time.
There were three clusters containing the community transmission cases, with one being the archers at Dechencholing, the cluster of students and others in Shabha and then a third cluster among some painters and Zorig Chusum people. A common factor to all the clusters was the taxi driver or the uncle of the index case who tested positive at Norzin Wom in the Saabzi Bazaar area. There was also another link in terms of archery matches.
After theses stories by the paper, on the 18 January the Prime Minister Dasho (Dr) Lotay Tshering came on air and accepted there had been major lapses and the mistakes which happened from the Paro airport, leading to the second outbreak.
He said the government has done its own review, but he said no single person can be blamed for the lapses, and that if any accountability has to be fixed or punishment given, then he would take the blame and the punishment.
The coming out of these lapses led to the government overhauling and strengthening its standard operating procedures.
Paro Airport would be treated like a high-risk zone, like Phuentsholing, and there was tighter quarantine and testing around picking up of passengers with dedicated buses, and its responsibility was transferred to the Paro Dzongkhag Task Force.
Front liners around the airport, drivers, taxi drivers and high-risk schools were to be tested more regularly, as per the strict COVID-19 safety protocols.
Dedicated DeSuups were to look after the quarantine centers, as earlier DeSuups were changed frequently and each new team had to be briefed and trained again. A monitoring team was set up from across agencies to monitor and even audit quarantine centers, the airport, transport and at the Dzongkhag level. Various other safety measures were also carried out to safeguard the people and nation.