Nine new cases detected in 24 hours, the highest so far

Younten Tshedup  

With nine new Covid-19 cases detected in the last 24 hours, Bhutan’s Covid-19 tally has jumped to 20 as of yesterday.

This puts the total number of active cases to 15 of which 14 are in the isolation ward at the national referral hospital. One patient is in de-isolation, in a hotel after testing negative twice within 24 hours.

While those who are currently under isolation have active infection, majority of them are asymptomatic, according to health officials. This means that unlike in most of the countries, the patients are not put on life supporting machines like a ventilator. Apart from occasional fever, many live a regular life even at the isolation ward.


At the isolation ward

Clinical microbiologist, Dr Tshokey said that there is no definite treatment for Covid-19 and that patients at the isolation ward receive treatment based on symptoms.

Under the national treatment protocol, the microbiologist explained, that asymptomatic patients do not get any sort of treatment. “We monitor them regularly. If they have fever, we give them some PCM (paracetomol) and if they have difficulty eating, we provide nutritional support.”

The treatment protocol grades a patient on five levels – asymptomatic, mild, pneumonia, sever pneumonia and acute respiratory distress syndrome (ARDS). Except for the 76-year-old American tourist, all positive cases in Bhutan are asymptomatic or have mild symptoms for now.

A patient is monitored if he or she has mild symptoms. As the severity level of the disease progresses and the patient develops pneumonia or severe form of pneumonia, they are treated for the symptoms accordingly. This is called symptomatic treatment.

Dr Tshokey said that once the severity level reaches ARDS condition, the patient would require ventilation support. Antiviral drugs including other treatment regimes are provided based on the symptoms.

On drug usage, Dr Tshokey said that while there are some recommended medications, these medicines are not definitely proven and are under clinical trials.

“People say even if there is one percent benefit of using a drug, it should be given to all positive patients. But these drugs have a lot of side effects,” he said.

The much talked about hydroxychloroquine, the microbiologist said have side effect on the heart. Similarly, other drugs can affect the kidney and liver including other organs of the body.

He said that if a positive patient is asymptomatic without any abnormalities in his lungs and the blood test, giving unnecessary drugs which do not have any proven benefit could further complicate things.

“We can’t afford to have a situation where a patient has recovered from the virus and suffer from severe side affect from the drugs.”


Why isolate?     

Any person testing positive for Covid-19 is isolated in a health facility in Bhutan. This does not happen in most countries.

Dr Tshokey said that isolating a positive patient is to prevent the risk of transmission. He said that although most of the positive cases in the country so far have been asymptomatic, asking them to isolate at their respective homes, like in most countries, would increase the risk of transmission to others.

“Isolation is to ensure zero transmission after the confirmation of a case. After confirmation, if we let the patient out and he becomes the source of infection, it’s a failure on the part of public health mechanism of the country.”

The other objective of isolation is to provide timely medical services and to monitor the patient constantly. All patients undergo a baseline investigation that includes an X-Ray scanning and blood tests. This is done to identify the presence of any other underlying health conditions that could possibly complicate the case further.

“In the isolation ward, a team of health professionals will constantly monitor the patients and if there are complications we can immediately provide the treatments. This is why isolation is important,” Dr Tshokey said.

Dr Tshokey explained that when a virus or bacteria infects a person, there is a natural cause of infection. “The pathogen comes into the body, it multiplies and after a while the body will fight it. Ultimately the process has to come to and end as the viral shedding stops.”

However, the viral shedding takes different duration to stop in different person based on their immunity. “So in an isolation, a patient is just waiting for this to happen by enabling the body’s natural defense mechanism to fight the pathogen.”

Meanwhile, the microbiologist said that Bhutan’s current oldest patient is 33 years old. “The graph from China has indicated that the risk of Covid-19 increases only after 50 and 60 years, so the younger lot of patients can still be considered low risk,” he added.