Younten Tshedup 

With two more people testing positive for Covid-19 on May 11, the total number of positive cases in the country has jumped to 11.

Of the total, six are active cases of which five are in the isolation ward at the national referral hospital. This is the highest number of patients the isolation ward has housed at the same time so far.

This could mean that the clinical staff manning the isolation ward could come under pressure for having to deal with more patients.

However, officials at the national referral hospital said that the existing human resources can manage.

The medical superintendent at the national referral hospital, Dr Gosar Pemba, said that currently, a clinical team comprising of eight to 10 members attend a single Covid-19 patient at the isolation ward.

The team includes a doctor, at least three nurses working on an eight-hour shift, three support staff and a technician. He said the same team could manage up to 10 patients.

If a patient is not seriously ill, the ratio of nurses to patients is 1:6. Only if a patient becomes seriously sick and requires intensive care unit (ICU) treatment, the ratio then drops to 1:1. A single doctor can cater to about 10 to 20 patients in a day.

However, Dr Gosar Pemba said that the provision would also depend on the condition of the patients. “The current arrangement would work provided we don’t have any severe cases,” he said, adding that except for the 76-year-old American patient (the index case) rest of the patients were mostly asymptomatic or with very mild symptoms.

This means most of the patients did not require critical support including ventilator support like in the case of the index patient.

When a patient is brought to the isolation ward, a baseline investigation is conducted which includes a chest X-Ray and blood test.    

Based on the investigation, Dr Gosar Pemba said that patients are categorised into mild, moderate or severe case and accordingly treatment for symptoms is carried out. “We don’t provide medication to all those who come to the isolation immediately.”

He said that patients were monitored daily and doctors on duty check for their vitals every morning and evening. “We have a patient management protocol that is applicable throughout the country.”


Isolation  arrangements  

The national referral hospital has identified three Covid-19 wards with different bedding capacities. The Covid-19 Ward I located at the new eye hospital can accommodate 29 patients of which 12 have ICU provision.

The Covid-19 Wards II and III have around 30 and 50 beds each. The medical superintendent said that the number of beds could be further increased if needed.

In the event of an outbreak, Dr Gosar Pemba said then those who are asymptomatic would be moved to Terma Linca Resort, which is currently a quarantine centre.

“With the present arrangement, we can manage anywhere up to 270 plus patients,” he said. “Moreover, we don’t expect positive cases in thousands given our demography and the geographical locations.”

He added that the existing trend of detection, which is between two to three cases over a period of 10-15 days, has given the hospital team an opportunity to prepare and plan for more cases.  “All of a sudden, if we get 50 or more cases at a time, then we might have some problem.”

However, for now, Dr Gosar Pemba said that people do not have to worry about the management of patients. “Even if the number of cases coming to hospital is 30 or more, there won’t be any significant disruption to the services and pressure on the human resource since the majority of the patients (80 percent) would usually not be serious.”


Back to station 

Initially, when the country saw its first Covid-19 case in March, to man the flu clinics, quarantine centres and other areas that require health expertise, nurses and doctors from other dzongkhags were pulled in at the national referral hospital.

Now with the majority of these activities, assumed by Desuups and volunteers from other departments, nurses and health professionals have been retracted and deployed for other clinical activities.

Some 15 nurses and seven doctors who were called from other dzongkhags have been sent back to their respective stations.

Also with the health contingency plan in place that identifies health professionals to reposition themselves in the event of an outbreak, Dr Gosar Pemba said there should not be any major disruption in the health services.

The national referral hospital has 439 nurses. Recently the hospital has recruited about 35 nurses.

Regional Covid-19 clinical facilities have also been arranged to manage cases in the event of an outbreak.

Meanwhile, the national referral hospital is training nurses and doctors from districts on ICU management.

“Every month we are training about 25 nurses to build up our core group that would be involved in case  management in case of an outbreak,” said Dr Gosar Pemba.