MoH’s reduction of 4 categories of COVID-19 cases into 2 and its implications

When the COVID-19 outbreak first happened the regular Ministry of Health morning updates and the evening press conferences of the Health Minister came up with four categories of data, each with its own implication and meaning.

These were firstly the Close Contact cases who were the close contacts of cases who tested positive. This showed a clear link of the spread of the virus. As of 3rd January there are 142 close contact cases of the total 260 cases since day one of the lockdown.

This was followed by another classification called the Community Surveillance cases where a surveillance had been done in a particular locality and the cases coming out of that were called as such. 

This meant that these people were not close contacts or contact traced but had been found from this community testing. One such example was the testing done in Norzin Wom below the MoWHS office. There were 32 community surveillance cases.

A third category was the Flu clinic cases which are cases where people came by themselves to the flu clinics. The first case in fact was a flu clinic case.

The implication here is again that these cases are not contact traced or from the community surveillance for that matter and so more of a cause of concern than the above two categories. There were 22 flu clinic cases.

Finally, a fourth category of Mass Testing cases came in from 24th December onwards when the MoH launched 40 teams to collect 8,400 samples from randomly sampled households. This was increased to 8,821 samples later.

The people reported under this category were the ones who tested positive in this mass testing. The MoH reported a total of 64 mass testing cases all in Thimphu with 29 cases on 25th December, 5 cases on 26th December, 11 cases on 27th December and 19 cases on 28th December. Even the zones in Thimphu that had these mass testing cases were shared.

All of the above categories were clearly mentioned in the MoH Facebook updates and also in Lyonpo’s press briefs.

However, on 30th December in a surprising development the Technical Advisory Group (TAG) members Dr Sithar Dorjee and Dr Tshokey came on air to share that only 16 of the 8,821 sample had tested positive in the mass testing.

This was in direct contradiction to the 64 mass testing cases figures shared by the MoH between 25th and 28th December.

Dr Tshokey on Friday  or 1st January explained that during the initial mass testing in places like Dechencholing, many positive cases were counted as community cases (mass testing) without any link.

“However, on further contact tracing most were found to be contacts of earlier positive cases or contacts of each other. So many were excluded from community cases (mass testing) leaving only 16 as of now,” said Dr Tshokey.

The Health Minister Dasho Dechen Wangmo on Thursday 31st December also said earlier positive cases detected under mass testing were later found to be the first or close contacts of positive cases and so this is why the mass testing numbers must have reduced to 16.

She that a comprehensive report is being done along with in-depth analysis including demographic data and other information.

While the mass testing cases have been removed there is no official explanation yet on how the 22 flu cases and the 32 community surveillance cases were also added in the first contact data.

In response to a query by the paper an email from the TAG said that Thimphu has 16 mass testing cases and 134 first contact cases as of Thursday which is a total of 150 cases. Given that most of the flu and community surveillance cases are from Thimphu there is no official explanation yet on how even flu and community surveillance cases have all been included under first contact cases.

Here a MoH official said that even in the case of flu clinic cases it may be that the the flu clinic cases had some level of contact with other cases and quite a few flu clinic cases would have such contact.

However, this does not explain all flu clinic cases or even those in the community surveillance all now coming under the first contacts category.

The official said that the initial focus of the MoH had been to give a break down of the different types of cases to the public but the concern now including that of the minister is that such detailed break up of the categories of cases can lead to confusion.

So this had led to the push to broadly fit the cases into two categories of mass testing and first contact cases from the original four categories.

This story was published on 2nd January morning in PDF format for paid subscribers.

However, on 3rd January  evening there was yet another change in position and figures as the Health Minister came on air to say that of the 260 total cases 214 cases are close contacts, 26 are community screening cases and 20 are flu clinic cases.

The Health Minister’s statement was now contradicting her own past figures and even the TAG withouth explaining how and why. It also discounted 2 flu cases on the MoH facebook page.

As explained above, given that each of the original four categories are quire different with different implications on the spread of COVID-19 their simplification and constant changes and contradictions  withouth any explanation, may even be seen as being misleading and could underplay the real severity of the spread of the virus, especially in Thimphu and Paro. 

The onus will now be the health experts to show how all of the four categories could be put into two or changed constantly with detailed data and explanation in the coming days when their report is ready.

Otherwise the MoH will be contradicting the MoH over the constantly changing figures. 

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