Phuentsholing in lockdown (Photo Courtesy: Kentsho Wangdi)

Local transmission among Phuentsholing’s loaders raises risk of community transmission within Phuentsholing

MoH to do mass testing in Phuentsholing and other areas where primary contacts test positive

The nation went into a lockdown from 11th August 2020 after a 27-year-old lady from Sershong Gewog  tested positive after being let go from quarantine in Paro. However, by Thursday, it became clear that she had not infected any of her first contacts.

However, the real threat emerged from Phuentsholing on 12th August 2020 when a 25-year-old male loader working in the Mini-Dry Port tested positive for COVID-19.

Subsequently, on 13th August it emerged that 12 men aged 22 to 45 who were primary contacts of the above case also tested positive. They were, however, from the dry port quarantine facility and not the community.

This led to the government to declare Phuentsholing a red zone whereby even essential travel to and fro from the Dzongkhag would be restricted and even those coming with essential supplies or people from Phuentsholing would first have to be tested at the Rinchending check post.

By the evening of 13th August a massive 421 primary contacts were traced so far for the 25-year-old positive case from Phuentsholing.

The MoH said that it very likely that the primary contacts for the 12 new positive cases will be the same as all of them have reportedly not moved out of the quarantine facility at the Mini Dry Port at all.

Then on 14th August there were three more cases with 2 men (aged 24 and 25) and a 32-year-old woman who are the primary contacts of the positive case from Phuentsholing. They were also from the Mini Dry Port quarantine facility and not from the community.

On 15th August a 34-year-old woman and a 4-year-old girl tested positive

This took the total to 18 cases as of Saturday afternoon.

The MoH already declared it as sporadic transmission. These cases now not only threaten to cause long lockdowns in Phuentsholing and other Dzongkhags but also extend the national lockdown and impact the supply of essential goods (see separate story on pg 1).

Right now there are two nightmare scenarios for the Ministry of Health. The first is if there is active community transmission from the MDP to people within Phuentsholing and an even bigger headache is a second scenario if any of the Bhutanese drivers who came in touch with the infected loaders got the virus and took it to other parts of Bhutan.

The Health Minister said to rule out community transmission in Phuentsholing mass testing would be done for a large number of people. Around 25,000 to 26,000 people living in the catchment area of Phuentsholing.

She said that in case of the drivers there were around 95 trucks and they have reached around six Dzongkhags with the most coming to Thimphu and others have gone to Paro and Tsirang among other Dzongkhags.

She said that these drivers have been traced and they and their family members and primary contacts would get tested. She said that if cases come up in places in Thimphu due to the drivers then even Thimphu would also see mass testing.

A gnawing and the main doubt that the MoH has to eliminate via mass testing is that while the loaders were kept in quarantine and had to follow a protocol to not come in contact with drivers, if the virus escaped out either due to protocol not being followed or due to unavoidable contact.

On day two of the lockdown when the Phuentsholing case first came to light the Prime Minister Dr Lotay Tshering in a press conference said that given their high risk the loaders were kept separately with different place to sleep and eat with guards and they were taken back and forth in vehicles.

The youth had been tested with RDT initially but tested negative as part of a larger Sero-survey to check for antibodies. He was tested later on PCR when he had symptoms like fever. He did not enter the hospital but was tested in the car.

 The 27 youths who worked with him are also in isolation.

“We asked him if he went out anywhere but he said he did not go,” said the PM.

The PM said the Phuentsholing youth had no direct contact with Bhutanese drivers as per the protocol, but they will trace and check all local drivers who came to the area.

Lyonchhen said they don’t know how he got the virus though with likely suspects being an infected Indian driver, infected goods or from other colleagues.

The PM said that as per the protocol there should be no contact between the foreign driver and the youth.

Lyonchhen said he must have got the virus around a week ago as it takes that long for the symptoms to show.

The Prime Minister said that Bhutan does not have community transmission yet as the Gelephu and Phuentsholing cases are imported cases and as per WHO this is not community transmission. He said in Phuentsholing they were already quite isolated and kept as a cohort.

He said there will be tests on the first contacts, secondary contacts and then the community.

He said its more important to find out if the Phuentsholing case has infected anyone else.

The Health Minister Dechen Wangmo revealed that there were 8 people who stayed in the room with the Phuentsholing case and 25 people in the RRCO who had direct contact with him.

On day three of the lockdown when news of the 12 additional people from the MDP also testing positive came the PM said they are not sure if the first case was the source or if he got it from his friends.

Lyonchhen said they suspect the virus to be brought by one of the drivers coming from India.

Lyonchhen said given the measures the hope is that the virus has not spread in the community.

“But we can’t be sure if they all have followed all the dos and don’ts even though a duty is there. The biggest worry is a doubt on if there is community transmission of the virus in Phuentsholing,” said the PM.

The PM said while the government has traced and is testing 95 drivers and their families, if a driver took the virus to the east, north and other parts of Bhutan then there would be big chances of community transmission.

“In Phuentsholing we are worried if there was transmission outside the areas and so until all tests are done and some confirmation is there it will be in a high risk red zone. With the lockdown all parts of Bhutan are like a red zone but within this the risk in Phuentsholing is even higher,” said the PM.

The PM was asked by the paper on how do they really know if the loaders did not leave their place or interacted with friends and family and if there was proper supervision or even CCTV cameras to be ensure none of them went out.

The PM said there are the MoH guidelines and when they asked them questions they said that they did not go out.

“The 12 who are positive say they did not go out as per MoH protocol. We believe them but if they did go out then community transmission would spread from them or they may have got it from community. We did not have CCTV cameras or guards going after them as they were not security risks,” said the PM.

The Health Minister, meanwhile, said that they are checking again and again with the primary contacts and developing certain assurance that they have not gone out.

Lyonpo said the first contacts are mostly loaders, RRCO, security, customs and immigration.

She said in terms of mass testing for Phuentsholing it will be a similar one like they did for Sershong.

The minister said that they are waiting for a few days because people who have had contact with him will develop symptoms in another three days. “For another three days we want to observe and again retest these people,” said Lyonpo.

Lyonpo said that while mass testing in Thimphu will depend on the primary contacts becoming positive people must know that the MoH are not just waiting for a positive person to come as they are already testing and one example is that since the last one week everybody with flu and cold coming to the health facility are being tested with RT-PCR. 

Every inpatient being admitted into JDWNRH are also being tested. 

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