34 health workers, including support staffs under quarantine  

Younten Tshedup

Three doctors – two specialists and a general doctor and seven nurses are constantly monitoring the 76-year-old patient who tested positive for the new coronavirus at the national referral hospital’s isolation centre.

At the end of their respective shifts, these medical staffs are put under quarantine. There are also laboratory, X-ray and ultrasound technicians, about 16 clinical nurses including three drivers, two cooks and six cleaners who assist in the monitoring of the patient.

A total of 34 health workers and support staffs are currently under quarantine, who directly and indirectly came in contact with the American patient.

The group will attend the patient for two weeks, after which they would be quarantined for two more weeks. During the four weeks, none of them are allowed to leave for home or any place other than the quarantine centre identified at the old Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) facility.

Medical superintendent at the national referral hospital, Dr Gosar Pemba, said that at the end of the 14-day quarantine period, if the individuals do not show any symptoms of the infection, only then can they leave for their respective homes and report to duty.

He said that although some of the staffs involved are a little apprehensive of the situation, the current situation does not demand overstressing of his staffs. 

“Usually, health staffs by nature are prepared to deal with such infectious diseases and many do not get scared,” he said.

“However, since it is a new disease and not much is known about it, some are little apprehensive.”

Dr Gosar Pemba said that some of the staffs had requested if the shift duration could be decreased to a week. “This was not possible because in doing so, a lot of staffs would have been involved and we could run short of staffs. Since we only have one case in hand, we decided to manage by one group who would monitor for a period of two weeks.”


Challenges and  preparations

Given that there is only one positive case so far, the medical superintendent said that the hospital has not faced any major challenges.

However, to man the flu clinics, the health ministry has mobilised additional staffs from other dzongkhags. Four general doctors and eight nurses take turns to monitor patients at the RBP flu clinic.

Another pediatrician has also been called from the Gelephu referral hospital.

Dr Gosar Pemba said that even if the number of COVID-19 cases increases to more than five, there would be no major disruption in providing other health services at the hospital.

A single doctor can cater to about 20 patients in a day. “Today the single patient is provided with two doctors. Even if the patient increases to five, the two doctors can manage the number,” he said.

If a patient is not seriously ill, the ratio of nurses to patients is 1:6. Only if the patient becomes serious and requires intensive care unit (ICU) treatment, the ratio then becomes is 1:1.

Should the number of patients goes beyond 50 and 100, Dr Gosar Pemba said, the current arrangement of nurses and doctors could change.

Although there are 83 specialists at the national referral hospital, there are only eight medical specialists who could tend to COVID-19 patients. But there are about 19 general doctors who can also monitor the patients.

The hospital has 439 nurses.

The medical superintendent added that for now other health services are continued as usual. However, patients requiring physiotherapy treatment have been slightly affected.

He said that since the outpatient physiotherapy unit was located near the isolation centre, the facility had to be shifted to the inpatient center inside the hospital. “Patients requiring emergency treatments can still avail the services, those without emergency needs have been asked to return once the physiotherapy unit reopenes.”

Dr Gosar Pemba added that the physiotherapy unit would be converted into isolation ward if the number of positive cases increases.

In the even of an outbreak in Thimphu, where more than 100 patients test positive, the current quarantine facility at old KGUMSB would also be converted into isolation ward.

Patient management is another problem, added the medical superintendent. “Since this is a new disease there are no standard treatment specified,” he said. “We are following the Centre for Disease Control and WHO guidelines and treating the symptoms for now.”

Lack of cooperation from public is another challenge. Many people were reluctant to wait for long hours for test results and this posed a major challenge, said Dr Gosar Pemba.

“Following two to three such incidents, we had a discussion in the ministry and had to deploy police,” he said. “Since this is the first time we are dealing with such case, there are bound to be hiccups. This is a national issue, and the idea is to prevent the spread of disease to the public.”