Is testing one per household enough to unlock Thimphu and Paro and how will future outbreaks be tracked

While the 18 Dzongkhags are in the green zone and back to normal with offices and schools having resumed, Thimphu and Paro have unlocked phase wise into the yellow zone after tests from one household each largely came up negative.

This is especially so in Thimphu where mass testing was carried out in the four mega-zones with one person from each household being tested.

Random sampling tests are being done again in Thimphu and Paro, and based on the these results they will be unlocked into the green zone.

However, while Thimphu was unlocked into the yellow zone with people being allowed to move around, the streets were still largely deserted for many days as people remained indoors.

One reason is the fear of community transmission with a large number of cases and the other related fear is that there could still be cases even after the tests as only one person per household was tested.

By contrast, Phuentsholing during the first outbreak was only unlocked after every resident was tested except those below the age of 14.

The fear is that there could be a positive and negative case in a family but random sampling may have only picked up the negative case.

The other question is how will the MoH catch future cases in Thimphu and Paro as and when they come out.

The Foreign Minister Dr Tandi Dorji said it is highly unlikely that a family of five locked in for more than 21 days would have one family testing negative and the other positive.

He said even then testing can never achieve that perfect stage but the test results can be relied upon with 99.99 percent certainty.

He said once the opening up is done and one or two cases come they they will be placed in isolation and contact tracing done. Lyonpo said that outbreaks can also be handled at the zone level.

The Bhutanese put the same question to the Technical Advisory Group (TAG) on how TAG or MoH is confident that testing only one per household is enough to unlock Thimphu and Paro as in the Phuentsholing case, with a less severe outbreak, everyone had been tested.

The paper asked TAG about the possibility of hidden cases.

TAG said that epidemiologically one person from each household is a good representation to determine whether there is anyone with COVID-19 infection in the house or a community.  “Furthermore, during the 21 days of the lockdown, the individuals who live together in one household have the same exposure risk,” said TAG.

The paper then asked how TAG and MoH will track future outbreaks in Thimphu. Here the TAG listed six points in this regard.

TAG said that MoH will ensure 100% compliance to the existing active surveillance of frontline workers (healthcare workers, De-Suup, RBP, RBA, etc) through Frontline Testing Management System (web-based Apps was developed).

A comprehensive database of frontline workers across the country was developed.

A dedicated Oversight and Monitoring Team will be established in each area to ensure compliance to SOPs for each high-risk sites (import and export depots, switching stations, frontline workers, Airports).

There will be enhanced active surveillance to test certain percentage of students, monastic institutions, drivers and travelers, vendors and customers at weekend vegetable markets in the strategic check posts.

School health coordinators who are trained on reporting the children with symptoms have been informed to remain vigilant to report any student with flu-like symptoms. 

54 Flu Clinics across the country will serve as surveillance tools to pick up any cases as MoH tests anyone visiting Flu Clinics with Antigen RDT.  

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