Dungkhag will return to normalcy after a week depending on the third test result

Younten Tshedup

With the highest preventive approach put in place two months after the detection of the first Covid-19 case, the country has so far prevented local or community transmission.

However, the recent ‘possible’ Covid-19 case in Jomotshangkha has once again raised questions on the testing procedure and the decision to restrict movements in the dungkhag.

On April 30, a 55-year-old shopkeeper in the dungkhag tested positive on the rapid diagnostic test (IgM positive). However, after two confirmatory tests conducted on the reliable reverse transcription-polymerase chain reaction (RT-PCR), the suspect tested negative.

As a precaution, the dungkhag was put under strict restrictions for a week. Depending on the result of the third test, restrictions will be lifted.

Many people took to social media to express disgruntlement with the decision. Many questioned the restriction imposed on movement despite two PCR tests coming out negative.


Testing mechanism   

The shopkeeper had tested positive for the IgM antibody on the rapid diagnostic test.

During a rapid diagnostic test, the blood sample of a suspect is tested for the presence of antibodies. Antibodies are produced when the body is exposed to any foreign substance such as virus and bacteria, as the body’s natural mechanism to fight the infection.   

The Covid-19 rapid diagnostic test scans for the presence of two antibodies – IgM and IgG.

Prime Minister Dr Lotay Tshering said that if IgM antibody is present during a test, it means the person has been recently infected or could have possible active infection. “This man had IgM, which means he had the infection and could still be having the virus.”

The antibody IgG shows the history of past infections a person would have had.

However, Lyonchhen said that the IgM antibody in the suspect could have also come from cross-infection with other coronaviruses. “There are many coronaviruses including the ones that are present in the common flu strains.”

Lyonchhen said that while the two RT-PCR tests on the suspect have come out negative, the results could be ‘false negative’. He said that the sensitivity of RT-PCR test is about 75 percent.

For a RT-PCR test, the sample used is a throat swab. Sometimes when the sample collected does not contain the virus or have a low virus-load, the PCR results could be negative.

“This is why, at least for a week, we have to assume he could still have the virus,” Lyonchhen said, adding that the international guideline on IgM is to keep the suspect under observation for at least a week.  “If he doesn’t show symptoms within a week and tests negative on the repeat test, the initial rersult could have come from a cross-infection.”

The Prime Minister added that when a person tests positive for IgM, he/she and their primary contacts will have to be kept in close surveillance for a week. “Because people do not understand what surveillance is, so the safest thing for us to do was restrict their movement because they could still have the virus.”


A professional approach  

While considering non-medical public to make such claims and accuse the government, Lyonchhen said that of all the governments in the world, Bhutan’s government is the most professional to deal Covid-19 situation.

He said that all the measures that the government is carrying out are based on scientific reason and facts. “A professional doesn’t mean he knows everything. A professional is one who should rationalize things.”

Meanwhile, with the businesses beginning to operate as usual and people becoming complacent, Lyonchhen said that while Bhutan has managed to be ahead of the virus, people should not be complacent.

“This is a virus that you cannot see. You can only see people struggling to breathe and people who need ventilators. And of course, we will see bodies too,” he said.

While the country, for now, remains in a comfortable state with no community transmission, Lyonchhen said people should not let their guards down.

Despite the patrolling and monitoring efforts including physical distancing advisories shared with the public, people are seen taking them lightly.

“We have been requesting the public and we will continue to do so. Personally, I would still leave this up to the public’s judgment.”