Following the positive case in a woman in Gelephu

Younten Tshedup

With 53 primary and secondary contacts of the 27-year-old woman testing negative to Covid-19 on the confirmatory RT-PCR test, Bhutan technically does not have a local transmission as of yesterday evening.

This, however, is the first Covid-19 positive case outside the secure boundaries of the quarantine facilities.

Prime Minister Dr Lotay Tshering said that a local transmission would happen only when the source of the infection cannot be traced. If a person tests positive without any recent travel history abroad or any contact with a positive case, then it would qualify as a local transmission, he added.

In the recent case, Lyonchhen said that the person came from a highly infectious country. “Moreover, she was IgG positive, meaning that she was exposed to the infection before.”



The Case

Before testing positive on the RT-PCR test on August 11, the woman had tested five times negative on the same confirmatory test while in the quarantine between June 29 and July 25.

After arriving in the country from Kuwait on June 26, she had tested IgG antibody positive on three occasions following which her quarantine was extended by another week.

Throughout the 45 days including the day she tested positive, the woman was asymptomatic.   

She is currently isolated at the regional referral hospital in Gelephu and is in stable condition.

On the 30th day of her quarantine (July 26), she was allowed to leave after testing negative on the RT-PCR. As per the health ministry’s protocol, she was recommended home quarantine.

Subsequent follow up by health officials on August 3 and 5 confirmed that she was still asymptomatic.

In keeping with health protocols, she was advised to report to a flu clinic on August 10. She reported to a flu clinic in Gelephu on August 11, where she tested positive on the RT-PCR.


Not a case of false negative

Explaining the Covid-19 testing mechanism to journalists yesterday evening, Lyonchhen said that a PCR test is a highly specific test, meaning that if a person tests positive on PCR then the person has the virus in him or her.

He said that although the likelihood of a false negative result by a PCR test is minimal, it couldn’t be ruled out completely. “But in our case, we have not said that the initial tests results were false negative. If it was just once (negative), there would have been a question, but she was tested five times and it was all negative.”

Lyonchhen said that the RT-PCR test for Covid-19 which Bhutan is using is the best and the most effective testing mechanism in the world today. However, given that the virus is fairly new, its behaviour has not been fully comprehended for now, he added.


Two probabilities of the infection  

With the woman testing positive in an unconventional manner, the prime minister said that they are considering two probabilities.

One probability, he said, could be that the woman was infected with the virus while returning to the country and that the disease had been in a dormant stage, which is why it was not detected by the PCR test.

Because the woman tested outside the quarantine and beyond the expected duration, Lyonchhen said that the other probability could be that the woman had picked up the infection from the community.

Health Minister Dechen Wangmo said that to ascertain that the woman did not pick the infection from the community, the ministry would be carrying out a cluster survey in places she had visited.

Lyonpo said that communities would be stratified into high, medium and low risk zones and collect representative samples for a RT-PCR test. “This should give us a clear picture of what is the pulse of the epidemic in that community.”

Meanwhile, Lyonchhen said that the woman’s case was identified because the government’s protocol and surveillance system were efficient.

The second layer of surveillance further monitors all those completing the mandatory 21-day quarantine period. He said that while there would be valid doubts if the earlier released individuals from the quarantine centres could test positive in a similar manner, quarantining the people for the rest of their life would be impractical.