The Bhutanese Leading the way.
As the fear of COVID-19 dissipates with some people starting to compare it to the Flu and others coming out to say they will not take the vaccine, The Bhutanese talked to doctors who treated COVID-19 patients to understand what Bhutanese COVID-19 patients go through.
Apart from that, there is growing international medical literature on the long term health impacts of COVID-19 (see main story on pg 1) even for those who had mild episodes of it.
A specialist doctor who took part in two rounds of taking care of COVID-19 patients, but requested that his name not be mentioned, said that some of the patients including those with comorbidities like diabetes, hypertension and the elderly were definitely quite symptomatic.
He said they had cough, sore throat, pain, fever, breathlessness and many of them could not even maintain their oxygen levels and had to be given supplemental oxygen.
The doctors said patients also suffered from severe body aches.
Patients had a loss of appetite and even severe aversion to food.
The doctor explained that many of the patients with symptoms were middle aged and even young and not just the comorbid.
The doctor observed that many of the patients including the young ones had a high level of fatigue and it was a struggle for them to even move between the bed and the bathroom.
Some of these patients including those who appeared to be asymptomatic showed changes in the lungs that looked like pneumonia.
Many patients also lost their sense of smell while quite a few had diarrhea. He said patients also suffered from lethargy and wanted to be mostly in bed.
The doctors said many had a runny nose and low grade fever including among the young.
He pointed that unlike in normal pneumonia where the lung goes back to spongy shape in COVID-19 there can be lung fibrosis where there are scars left in the lung indicating long term damage. The doctors said there can also be cognitive issues like memory.
The doctor recalled that they had a diabetic patient with hyper tension who had serious breathing issues and also experienced loss of appetite. He had to be put on oxygen and given medical steroids to stabilize him.
There were also two kidney dialysis patients who had turned positive and they also struggled and required oxygen and medication.
The doctors said that people comparing the flu experience to COVID-19 is totally erroneous. “When somebody has the flu they don’t say that they feel horrible or become breathless and get very tired to the extent that going to the bathroom is a challenge. Flu patients also do not see major changes in their lungs which are signs of pneumonia,” said the doctor.
The doctor noted that up to 25 percent of the patients developed changes in the lungs akin to Pneumonia including those who felt they were asymptomatic. Five percent of these were the more serious cases. He said with such changes in the lungs water starts to accumulate there leading to breathing issues.
The doctor said that an alarming thing he noticed in the blood tests of around 99 Percent of Bhutanese COVID-19 patients were very high levels of inflammatory markers like ferritin, CRP, IL-6 and LDH.
According to medical literature, higher than normal levels of ferritin is a condition that causes your body to store too much iron and could also point to liver disease, rheumatoid arthritis, other inflammatory conditions or hyperthyroidism.
A high level of CRP in the blood is a marker of inflammation. It can be caused by a wide variety of conditions, from infection to cancer. High CRP levels can also indicate that there is inflammation in the arteries of the heart, which can mean a higher risk of heart attack.
Patients who have increased Interleukin 6 (IL-6) levels have been shown to be at increased risk for complications such as pneumonia, multiple organ dysfunction syndrome (MODS), and death.
High levels of LDH indicate some form of tissue damage. Extremely high levels of LDH could indicate severe disease or multiple organ failure.
From the above indicators it is clear that even though it may have not been apparent the bodies of COVID-19 patients were getting internally battered by the virus.
The doctors said that it is a myth that young people or people with strong immune systems should not worry about COVID-19 as he observed the impact of COVID-19 even on the young and healthy.
He said that one does not know how the immune system will react to it. He says even the healthy immune system of a young person can over react to COVID-19 creating a cytokine storm which among other things affects the lungs and can damage it severely.
The doctor said that be it young or old more than 70 percent were symptomatic and there were lung changes even in the asymptomatic ones.
Another myth that has been going around is that Bhutanese could naturally be immune to COVID-19.
Here again, the doctor dismissed this saying that to be immune to COVID-19 one has to have antibodies that can fight it and he did not come across any Bhutanese with such natural antibodies or defenses against the virus.
A total of four COVID-19 patients were put on the ventilator as they could not breathe on their own. The first patient was the 76-year-old US tourist who survived and was airlifted to the USA.
However, the three others who were Bhutanese with comorbidities like lung cancer, auto immune disease and heart problem did not survive and passed away on the ventilator in the COVID-19 ICU ward even after clearing COVID-19 (see main story on pg 1).
The doctor said that another reason why COVID-19 is dangerous is that unlike the flu, in asymptomatic COVID-19 cases a person could have no symptoms and yet still be transmitting the virus to his family, friends and others.
The doctor said that compared to adults, young children seemed to have milder symptoms but he said that a factor here again is that children, unlike adults, cannot really complain and express their problems. He said he remembered a three-month old baby with COVID-19 who had vomiting and diarrhea.
The doctor said that COVID-19 also did not seem to impact men or women any less or more due to gender and both genders were equally hit.
In terms of the treatment regime the doctors said that guidelines keep changing and this is the 15th version of the guidelines. He said based on international scientific evidences all the patients are given Vitamin C and Zinc tablets to boost their immune system.
He said the latest drugs being given is Remdesivir which is an anti-viral drug and Dexamethasone which is an anti-inflammatory drug for more serious patients with pneumonia.
Apart from the medical effects COVID-19 also takes a mental health toll on patients.
A COVID-19 patient who tested positive in Phuentsholing from the community and went into quarantine on 17th August and only left 49 days later on October 3rd talked to the paper about her mental health toll.
She said that the most difficult part was the long stay as she was one of the patients who spent the longest time in quarantine as her tests kept fluctuating between negative and positive.
She said she wondered if she would ever leave the ward or the isolation unit and it was psychologically very trying for her as she went into depression and kept breaking into tears missing her family, and she even contemplated walking out of the isolation unit once. She said she talked to counselors but it was not much of help given her mental state at the time.
She said the uncertainty of the diseases, the long stay, the environment and her missing her children and husband made it the toughest period in her life for her. Something she never wants to go through again.
Counselors reported that the two main worries of COVID-19 patients were firstly on if they had given it to their family members and secondly on what would happen to them.
There is also the issue of societal discrimination experienced by former COVID-19 patients.
Another COVID-19 patient, a 20-year-old college student who had returned from abroad
tested positive on 29th March in quarantine and was released on 8th April from the hospital into de-isolation after testing negative.
The student said she completed her isolation and quarantine period and even stayed one week at home as advised by MoH.
After around 10 days she went out for some coffee with some friends when somebody who had spotted her called up the MoH and complained saying that she was in town. Though she had followed all the MoH advice the ministry called her and requested her to stay home. She said that she did not appreciate this kind of treatment.
Ever since, she has not been able to do things normally and she feels she has to be extra conscious so that people do not talk badly about her.
The doctor advised people to take the COVID-19 vaccine (Oxford-AstraZeneca) as he said it is the only option to fight COVID-19 apart from social distancing. He said there should not be any long term effects as the vaccine has already completed phase three trials. The doctor said people should take the vaccine as he has personally seen the suffering that COVID-19 patients go through and the dangers of long term health impact. He said he would happily take the vaccine himself.
In the meantime Bhutan’s first COVID-19 patient the 76-year-old American tourist had written to the doctor to say that he is doing fine and is even going for hikes and treks though it is limited.
The doctor had been involved in treating and managing him as part of the first medical team.
The Bhutanese repeatedly tried to contact the Technical Advisory Group (TAG) under the Ministry of Health for their inputs on this story but despite calls and official emails there was no response.
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