Rumours of a local transmission spreads

Younten Tshedup 

Three people – two men and a woman test positive to Covid-19 outside the quarantine facility in Thimphu.  With no recent travel history to India or abroad or without known contact with a positive patient, it marks the first local transmission in the capital.  

All three suspects test positive on the reverse transcription-polymerase chain reaction (RT-PCR) on August 6, the confirmatory test for Covid-19.   

This is the scenario presented in a tabletop simulation (mock drill) conducted in Thimphu yesterday to assess Thimphu Thromde’s preparedness and to check its potential to handle a local transmission and a lockdown.

The pseudo or fictional situation is that on August 6, two Bhutanese men reports to the flu clinic at the national referral hospital with symptoms of cough, fever and general fatigue.

One is a resident of Changzamtog and works at a grocery store in the main town. The other resides in Taba. Also on the same day, a nurse with the national referral hospital tests positive on the rapid antibody test during health ministry’s routine serosurveillance. 

The nurse suffers from mild fever and headache one day ago.

The RT-PCR test result is positive for all the three.

With this information, incident commander of the capital city, Thrompon Kinlay Dorjee activates the thromde’s emergency system.

Officials working in groups begin activating their respective mechanisms such as logistical arrangements, reinforcing security protocols to restrict movement of people and vehicles, and stepping up surveillance.

Half an hour after the activation of the command, the groups begin activating the mechanism in place.

The logistical desk deploys five vehicles each in all the eight zones of the thromde along with volunteers. Food Corporation of Bhutan (FCBL), Sherza and Zimdra are alerted for food supply.

To restrict movement of people and vehicles, Royal Bhutan Police and De-Suup deploys additional manpower at various outposts including Hontsho, Chhuzom, Changtagang and Pangrizampa. Vehicles are strictly monitored in all junctions.

Immediately after the confirmation of the positive cases, the surveillance team of the ministry begins contact tracing of suspects. Various places visited by the three patients, mode of travel used and the people they had come in contact with are identified.

The health ministry’s IT team also begins tracing contacts through the Druk Trace App. All contacts are then quarantined.

The national referral hospital in the meantime has also activated its contingency plan.

Speaking to Kuensel, Medical Superintendent, Dr Gosar Pemba said the hospital was tasked to take care of the clinical management of over 130,000 people residing in Thimphu in the event of a local transmission.

The hospital has developed plans for both partial and entire lockdown of the facility based on the severity of the situation.

Dr Gosar Pemba said that although both the plans were ready to be enforced, for a hospital, a complete lockdown would not extend over 72 hours (three days). “We will get everyone out of the hospital and then sanitise the entire facility within 72 hours and then we can reopen.”

For this he said arrangements are already in place with designated accommodation for patients who would be removed from the hospital. For those who cannot be removed, several Covid wards have also been identified.

In an event a hospital staff tests positive, the medical superintendent said the entire hospital would not be closed. “Only a particular unit would be put under lockdown as the risk would be likely only where the suspect has been working.”

However, Dr Gosar Pemba said that the only challenge for the hospital management would be closing down diagnostic facilities such as the X-ray, ultrasound, CT and MRI units as these facilities has to be used during emergencies.

The hospital has around 140 beds allocated for Covid-19 patients. Dr Gosar Pemba said that it could be increased to 200 if needed.

Chairperson of the technical advisory group (TAG) of the health ministry, Dr Sithar Dorjee said that such exercise was critical in evaluating the preparedness plan and response mechanisms put in place among stakeholders.

Dr Sithar Dorjee, an epidemiologist, said that the main objective of the simulation was to see if the thromde’s coordination mechanism was capable enough to handle a lockdown situation.

“It is also to assess whether the SOPs and guidelines are effective and the roles and responsibilities of different teams are clearly outlined,” he said. “We also wanted to see how Thimphu Thromde’s contingency plan has mapped the risk and responses in collaboration with other sectors.”

Dr Sithar Dorjee said that following the simulation, the TAG would recommend the thromde to make changes if there was a need. Based on the recommendations, the thromde would then formulate a final action plan.

Meanwhile, following the simulation, by afternoon yesterday, news of a community transmission in Thimphu was circulating with people inquiring with Kuensel.

TAG members during the session yesterday reminded participants that the scenario shared for the simulation was a complete fictional creation and should not be shared outside.

Health ministry towards the evening posted a clarification requesting public to not panic and refrain from sharing fake news about a national lockdown.

The simulation was conducted to prepare ourselves if a lockdown is to happen tomorrow, stated the ministry in its Facebook post.