Inside the Covid-19 isolation ward

Covid-19 cases cross the hundredth mark

Younten Tshedup 

With the confirmation of two more Covid-19 positive cases on July 30, Bhutan touched the three-digit mark (101) since the country reported its first positive case on March 5.

However, the country continues to be in the orange stage given that there is no local transmission of the virus yet.

Also with 88 people considered recovered, the Covid-19 recovery rate for Bhutan stands at 87 percent. There are 13 people with an active infection at the isolation ward and they are all asymptomatic for now. And there is no mortality from the pandemic so far.

 

At the isolation ward 

Donning the white coveralls (protective suit), doctors and nurses patrol the Covd-19 isolation ward at the new eye hospital at the national referral hospital. This is where the Covid-19 patients are kept once they test positive to the virus.

However, unlike the graphic hospital scenes portrayed in international media, the picture of the isolation ward in Bhutan is relatively tranquil.

Clinical microbiologist with the national referral hospital, Dr Tshokey, said that save for the little tense environment because of the protective gears, it was a usual affair at the isolation ward.

The patients, according to Dr Tshokey, spent their days watching and making videos and singing. “It’s a lively environment unlike the ones we see in news of people suffering in pain and dying.”

A strong patient-caregiver bond is also observed at the ward. “Sometimes when a patients’ stay is prolonged, the staff feel equally sad and sorry for them. And when someone tests negative it’s like winning a lottery for both the patient and the staff monitoring them.”

Sharing a recent incident, Dr Tshokey said that everyone at the ward was sincerely praying for a pregnant mother who had tested positive to the virus. “Everyone was eagerly waiting for the results expecting it to come negative. When the result was otherwise, all became equally depressed. Such is the bond between these people.”

He said that the clinical management team also took pride when an individual left the isolation after testing negative. “Some have even set targets to make sure a certain number of people get out during their shift,” he said. “At one time we had 29 patients at the ward and the staff really wanted to bring it down to a single-digit before the next shift.”

The feedback from the patients, once they leave for de-isolation, has also been positive so far, he added.

 

Reasons for isolation and treatment    

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

Dr Tshokey said that the primary objective of isolating a positive patient is to prevent the risk of transmission to others.

He said that although all 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 local transmission.

The other objective of isolating a patient in a health facility 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.

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

Patients are also provided symptomatic treatments. If a patient has headache painkillers are provided and if he or she develops cough, accordingly treatment for the symptom is provided in an isolation ward.

 

Zero death from Covid-19 and high  recovery rate

A major achievement for the country so far has been preventing any mortality cases from the pandemic.

An up-front reason for this achievement according to the clinical microbiologist is the age group of those who are infected. “The epidemiological data shows that risk of severe disease, complication and death from Covid-19 is higher in elderly people.”

Except for the two American patients the rest of the positive cases so far have been between the ages of 25-35 years.

Also, the stringent health protocol put in place by the government has helped achieve this success.

Dr Tshokey said that the mandatory isolation of individuals upon testing positive and making sure they are negative on multiple occasions before releasing them has helped the government prevent a community outbreak.

He said that in other countries only the severe cases were admitted to the hospitals. Asymptomatic cases are advised to isolate themselves at homes for about seven days. “After the seven days, if no symptoms, the individuals are considered recovered. There are no testing provisions also which is why there is a lot of community transmission in these places.”

However, in Bhutan, he said that for a person to be declared recovered he or she has to spend adequate time in isolation and tested negative at least twice within 24 hours. Following this, the person is removed to a mandatory two-week de-isolation facility. The individual is tested again on the last day of the two-week period.

Initially, only after testing negative upon completion of the de-isolation individuals were considered as recovered. However, the ministry recently revised its protocol declaring all people coming out of isolation as recovered.

“This was revised because technically people who have been removed from isolation are recovered. And although the chances of testing positive again are very slim, we do not want to take chances. We are also still continuing with the de-isolation.”

However, Dr Tshokey cautioned that with the high recovery rate and zero death, the public should not become complacent. In the event of a community transmission, he said that all age groups including children and elderlies would be infected. “The probability of having severe cases would increase and there will be mortality.”

With His Majesty selflessly leading in the frontline and because of the preventive measures put in place by the government, there has been no casualty from the pandemic so far, he said. “Also as a Buddhist country, we cannot deny the presence of the divine intervention. But for how long can we count on it?”

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