… Primary contacts not necessarily mean contacts of the loaders

Yangchen C Rinzin 

The fear was an explosion of a community transmission when primary contacts of the index case in Phuentsholing started testing positive. More than 900 primary contacts were traced in all the dzongkhags and 30 of them tested positive.

Efforts to contain the spread have worked and no cases, except one in a quarantine facility in Thimphu, were reported since Friday.

As more and more people are tested in Phuentsholing, the question on every mind is why a community transmission in Phuentsholing despite having a strict Standard Operating Procedures (SOP) at the Mini Dry Port (MDP) has occurred.

On August 11, Phuentsholing reported the first local transmission case when a 25-year-old loader at the MDP tested Covid-19 positive. Another 12 loaders tested positive the next day. All of them were the primary contacts of the first case. Two positive cases, the primary contacts of the Phuentsholing case, were detected on August 18 in Paro. The most recent case of primary contact testing positive was the 35-year-old man on August 23 in Thimphu in a quarantine.

As of yesterday, there are 30 positive cases, all primary contact of the first case. Another seven positive cases were detected outside MDP during the active surveillance.

The SOP developed for the mini dry port and Regional Revenue and Customs office (RRCO) has come under scrutiny with people blaming the loaders for not following the SOP and concerned authorities for not implementing it strictly.

Prime Minister, Dr Lotay Tshering during a press conference on August 12, claimed that understanding the risk loaders had, their movement was contained and limited their interaction. “Their movement was strictly restricted between the dry port and their hostel.”

Describing Phuentsholing’s case as a classic case of people’s behaviour and “uptake of personal responsibilities,” an official from the health ministry said that all primary contacts are not the contact of the index case (the 25-year-old loader).

The official said primary contacts are also people who were associated with the RRCO dry port, meaning those who were working at the port apart from the loaders. The health ministry’s update on the positive cases mentions every positive case as a primary contact of the Phuentsholing case.


SOP was followed

Considering the safety and prevention of a community spread of Covid-19, all the 143 loaders working at the two customs ports in Phuentsholing, shifted their base to a school when the five cases were reported in Jaigaon, adjacent town to Phuentsholing in June.

The loaders, mostly unemployed youth or those who lost jobs because of the pandemic, were not allowed to mix among the general public. They stayed in the school, cooked on their own, and their movement between the school and the ports were monitored.

Every morning at eight, a bus picked them and dropped them at the ports. In the evening, the bus dropped them back to the school. This was done recognising that there was a high chance of the loaders contracting the virus while coming in direct contact with trucks coming from India.

Bhutanese drivers were also given a secluded area where they waited until the loads were transhipped and were not allowed to mix with others.

It can never really be established that SOP was not followed. Measures were put in place. However, people may have sneaked out,” an official said.


Primary contacts

Prime Minister Dr Lotay Tshering admitted that despite having an SOP in place, the implementation failed miserably. However, he said that the primary contacts that the health ministry mentioned in its updates did not necessarily mean the primary contact of the loaders.

Lyonchhen explained that the detail of the positive case is not shared because sharing their personal detail was not important. “The health ministry mentions that the person is a primary contact of the Phuentsholing case, but never mentioned it’s a primary contact of loaders or others working at the port,” he said.

“The primary contacts could be those working at the RRCO, other workers at the MDP and other office bearers,” he said.

Lyonchhen shared that the 25-year-old man had gone on leave to meet his family sometime earlier this month. “After returning, he was screened for the virus by which Phuentsholing was already doing community surveillance before the lockdown. He tested negative.”

Many primary contacts had also tested negative, including those whom he had met while on leave. “This means he may have contacted or was infected after he had returned to the work station,” Lyonchhen added.

Lyonchhen said that although an SOP was in place, there were other mobile individuals who visited the MDP and contacted people at the port.

“One of the positive cases is a woman who works at the MDP. She was free to go home and could have possibly shed the virus from outside. Those who fell under the SOP protocols were monitored while there were others that the SOP didn’t cover.”

Primary contact would also mean the primary contact of those positive cases detected outside the port during the mass surveillance.

“We had carefully managed for the last five months because of the SOP and this time we got the virus through a small window where we were able to identify everyone,” Lyonchhen said. “Even at a time of the first outbreak, we’ve tested more than 19,000 in Phuentsholing and only seven tested positive outside MDP.”

Lyonchhen said that it would not be easy to find out the patient Zero or find out who first brought the virus. “It’s still unbelievable that even after a rampant test, many tested negative.”

An official from the Technical Advisory Group said the MDP was an area where all people, from truck drivers to importers to exporters including non-Bhutanese truck drivers, mingled.

“It’ll not be possible to say who got the virus first. Those who come to the RRCO for other work could have also mingled and shed the virus.”

Protocols like wearing face masks, maintaining physical distance and washing hands were in place, but the official said that they were not followed. “It’s still not being followed even when Phuentsholing is declared a red zone and under lockdown. This was noticed while going to collect samples during mass surveillance.”

“It’s a combination of factors and a series of events that took place leading to a local transmission. This is why we have several primary contacts in other places because they had visited and met people who worked or were at the MDP.”

Meanwhile, the threat of full-blown community transmission in Phuentsholing is almost dropping down to the pre-lockdown level, according to Lyonchhen.