Dechen Dolkar 

New Covid-19 community cases were detected in Mongar, Trongsa, Punakha, Tsirang, and Zhemgang recently. However, as a transition to the new Covid-19 management strategy, these places have not been placed under lockdown, unlike earlier outbreaks.

Five community cases were detected from Trongsa, eight cases from Zhemgang, one community case each from Mongar and Tsirang, and 13 cases from Punakha recently.

The positive cases were asked to stay in home isolation and primary contacts were kept at home quarantine.

Health officials said that with the gradual relaxation, the positive cases will not hit so high. “The number of positive cases will be around 400 to 500 and people will get used to it.”

Officials said that if society has to return to normal living then things have to open up gradually. “Our only aim is to prevent death,” a source said.

Reverse quarantine

Reverse quarantine involves separating the vulnerable population from the general public who are at risk of the disease during an outbreak of infectious disease so that the associated mortality and morbidity could be reduced.

Most of the dzongdags who Kuensel talked to said that they were identifying the vulnerable population and isolation facilities for them should there be an outbreak.

Bumthang Dzongdag Kesang Choden Dorji said, “We’ve identified the elderly and the sick with a high probability of getting infected.” Those with underlying conditions and symptoms that can complicate are being identified for early detection and for appropriate interventions.

She said that all relevant personnel, within and outside of the task force members will be informed of the strategies that will be in place henceforth. “But most importantly, we need to align our plans and moves with the revised guidelines from the TAG team and the National Covid-19 Task Force,” she said.

In Samdrupjongkhar, to keep the vulnerable and elderly separate from the young adults who are exposed, they are discouraged from going to public places or gatherings.

Other dzongkhags are also working on similar interventions.

Of 12,000 active cases in the country, only three are serious who are already cancer patients and kidney patients.

The new strategy

“If we don’t open up now we’ll suffer. We’re fully vaccinated and boosted. For the next three months, our immunity is strong, then after three to four months, immunity will decrease,” a health expert said.

He said, “If we delay ourselves from being naturally infected then serious infection can happen. For now, there won’t be any serious infections.”

Officials also said that in between suddenly, if there is a new variant and if the vaccine doesn’t work, it will be the worst case. “But if we are naturally infected then it will protect us from the next variant.”

Bhutan has the highest percentage of vaccination in the world. Scientifically it is said that together with the vaccine and natural infection it will be prevented for a lifetime.

Many countries’ populations have gained immunity through a combination of vaccination and infection with an array of variants.

“Now it is the responsibility of the individual to protect themselves by avoiding crowds and wearing face masks,” the health expert said.

A Technical Advisory Group (TAG) member, Dr Tshokey said that they were revising the protocols on Covid-19 management.

He said that in the new Covid-19 management strategy, there will be no contact tracing, testing protocols and quarantine protocols will be changed.

He said that only high-risk positive patients will be isolated in the hospital.

What dzongkhags are doing? 

Dzongkhags are at various stages of transition to phase II of Covid-19 management.

A dzongdag said that despite the detection of new cases from the community, contact tracing and testing have been going on.

“A major problem is the receipt of results as it takes at least 48 hours from sample collection to shipping the samples to receiving the reports,” he said.

Dzongdags, who are also the incident commander of the Covid-19 task force in the dzongkhags, said that positive cases would be home isolated or quarantined and primary contacts would also remain at home quarantine. Options are also available to move to a quarantine facility.

While the dzongkhags their strategies ready, dzongdags said it has to be aligned with the new strategy the National Covid-19 Task Force announces.

In Trongsa, zone mapping system has started which will depict the location and address of home isolated or quarantined individuals. The strategies are reviewed as and when necessary in order to implement them ‘with no or minimal public annoyance’.

The establishment of isolation facility has been planned to admit anyone developing signs of increasing severity caused by Covid-19 and referral to isolation hospital.

Trongsa Dzongdag Phub Rinzin said, “The new normal strategy will be implemented in view of an improved public livelihood.”

Chief Medical Officer of Samdrupjongkhar hospital, Dr Kezang Dorji said that the dzongkhag has implemented red cluster/ building/ flat protocol, whereby positive individuals can choose to stay at home until recovery as per health protocol. “Primary contacts can as well choose to remain home quarantined as per the feasibility and their choice.”

The new Covid-19 management strategy will be rolled out nationwide as per the recommendations of TAG and endorsement through National Covid-19 Task Force.

“The medical desk in Samdrupjongkhar has roughly completed Plan B Covid-19 response. However, it has to align to the generic strategies designed by the National TAG.”

Dagana Dzongdag Duba said, “We are not going for blackout phase when the cases are few and their contacts are immediately traceable. We also close down the shops where positive cases visited to stop the spread.”

Dagana Covid-19 task force has been implementing this new strategy after February 27 positive case, he said.

Pemagatshel Dzongdag Yeshey Rangrik Dorjee said, “We are reviewing the detection of cases on daily basis very closely and have plans to open up fully under new normal conditions any of these days.”

Sarpang Dzongdag Lobzang Dorji said that in the new Covid-19 management strategy the dzongkhag would gradually move from “Zero Case” approach to controlling widespread virus infection while securing and protecting the vulnerable segment of the population.

“Saving lives and preventing preventable death due to Covid will be the next focus,” he said.

“While there are some continued cases in the community, we have transitioned all gewogs and four zones of Thromde to green allowing movement of people, no private vehicles are allowed except public transport. Namkhaling Zone, the main core town area is still classified as yellow zone,” he said.

The next phase of relaxation would be decided after releasing students from school containment when board exams are completed,  after completion of scheduled transitional testing, vaccination of children between 5-11 years, and administering booster dose vaccination for children above 12-18 years.

“The relaxation would also depend on the risk assessment and input done by the surveillance team,” he said.

Three positive cases were detected in Buli, Zhemgang on March 10 are isolated in their homes. No lockdown would be imposed under the new Covid-19 management strategy, according to the task force officials.

Incident commander, Dzongdag Chimi Dorji said that the symptomatic cases would be taken to the hospital. “The essential delivery team would be providing required supplies in the red building. All primary contacts are home quarantined.”

Zhemgang reported three cases from the community this week for the first time. The positive individuals travelled to the dzongkhag on March 5 after completing seven days quarantine and tested negative in Wangdue.

A total of 19 primary contacts are placed under home quarantine. The surveillance team traced

25 secondary contacts of the index cases. The movement inside and outside Buli is restricted currently. The visit to Buli Tsho is suspended for the time being.

During a recent national address, Prime Minister Dr Lotay Tshering said that the government will move to a phase II or a new Covid management strategy by mid-April.

The main objective of phase II is to prevent severity and hospitalisations from Covid-19 with a focus on vulnerable and high-risk groups.

New Covid-19 management trends 

Many countries around the world are transiting to a new phase of the Covid pandemic management.

Recently, the United States has announced a new strategy in handling Covid as a test to treat. Similarly, European countries now consider a new Covid strategy accepting the virus and living with the virus.

The Centers for Disease Control and Prevention also stated that it no longer recommends universal case investigation and contact tracing. Instead, it encourages health departments to focus those practices on high-risk settings.