The man dies of liver failure complications while also Covid-19 positive 

Younten Tshedup

A  34-year-old man with pre-existing medical condition became the country’s first casualty from the Covid-19 pandemic, Sowai Lyonpo (health minister) Dechen Wangmo confirmed late last night.

The death comes amidst the local outbreak in Thimphu and Paro, where 17 positive cases are detected daily on an average.

The deceased who was a known case of chronic liver disease under medical treatment had tested positive for Covid-19 on December 23 last year. Since then, he was managed at the isolation ward at the national referral hospital before he succumbed to his illness yesterday.

Clinical microbiologist and a member of the health ministry’s technical advisory group (TAG), Dr Tshokey said that during his illness, he had developed acute liver failure, which also led to acute kidney damage.

He said that while in isolation, the deceased underwent a repeat RT-PCR test on January 5. He was still diagnosed positive for Covid-19 and his blood tests were negative for the antibodies. A retest was due today.

Dr Tshokey said, “It was not easy and clear to include this as a Covid-19 death. The man died of acute hepato-renal failure complicated by Covid-19,” he said. “Such cases have very poor outcomes unless they undergo liver transplant. But since he died with Covid-19, we have included the death as a Covid-19 death.”

According to the treating physician, the prognosis of such cases with hepato-renal failure was grave. The microbiologist said that there were several arguments when it came to categorise a death as Covid-19 death. 

Some argue that to categorise a death as Covid-19 death, the deceased had to have severe respiratory problems or pneumonia typical of Covid-19.

Dr Tshokey said that the deceased did not have any respiratory problems while in the isolation. He, however, had severe liver damage where the laboratory examination had shown that his liver function test was ‘grossly deranged’.

On the management of the body, Dr Tshokey said that it would be taken care by the Red Cross Society as per existing protocols. The health ministry already has a standard operating procedure (SOP) to manage bodies in the event of death due to Covid-19.

Special body bags from Copenhagen, Denmark, have been procured to wrap bodies of those dying from Covid-19. The body would be prepared and placed in the body bag by health workers and then handed over to the representatives of the Bhutan Red Cross Society, who are already trained to handle them at the crematorium.

Dr Tshokey said that there was not much risk from it. “Covid-19 is spread through aerosols and droplets usually expelled while coughing or sneezing. It doesn’t transmit through other bodily fluids such as blood.”

The microbiologist said that the country so far has been fortunate in preventing deaths from the pandemic. “While countries worldwide are recording thousands of deaths daily, we have been very fortunate so far,” he said, adding that all Covid-19 positive cases were provided with the best care and medical attention by a team of dedicated health workers round the clock.

“However, no country has a death-shield against the pandemic and now we know it.” He said that when people become complacent and let their guards down, the unfortunate happen. “While the young could recover from the disease, elderlies and those with comorbidities might not. People should understand this by now that Covid-19 can infect anyone and kill someone.”

Dr Tshokey added if people do not adhere to the protocols and follow preventive measures, there will be more cases and complications.