Yangchen C Rinzin
Please tell us honestly, where have you been last week?
Can you remember the places and people you met?
Did you travel by taxi or bus?
There is a barrage of questions as information becomes crucial when somebody test positive for Covid-19. With key information, the spread of the virus could be curtailed as they are traced, quarantined and tested.
Behind this crucial task of tracing contacts are 41 officials called as the Covid-19 Surveillance Team that was formed in March soon after the first positive case in the country was detected. The team trace people that a positive case may have come in contact with two weeks before the onset of symptoms and during the duration of the illness. They also investigate the source, contain and prevent future outbreaks, monitor situations, advise testing and quarantine, liaise with other institutions to arrange testing and quarantine of suspected cases.
Started with seven members in March, it became 17 members in April and merged with the surveillance and quarantine team in July, which became 20. Each dzongkhag has a surveillance team with health workers, officials of the drug regulatory department and Bhutan Medical and Health Council.
Understanding the risk, a National Surveillance team with experts from the Bhutan Narcotics Control Authority, Bhutan Red Cross Society (BRCS), KGUMBS, Royal Bhutan Army, and Royal Bhutan Police (RBP) was formed. Based in Lungtenphug, it is also the command centre for all the local teams.
The team now has 41 members.
As of September 1 more than 1,333 primary contacts and more than 976 secondary contacts were traced concerning the outbreak in Phuentsholing and the two cases in Gelephu.
Officials from the team said the additional members have been helpful, as the transmission in Phuentsholing increased the workload.
Divided into two shifts, the team starts work by 8:45am and goes until 10pm. “However, if the situation demands, both teams come to the office and work together. Like many, we also do not go home.”
Involving the police in the tracing team, officials said, had been a masterstroke in tracing contacts. Some primary contacts of the first case in Gelephu could be traced only after involving the police.
“The police have been helpful from the beginning, especially in tracing contacts, and their presence has made it easier for coordination and active contact tracing,” he said.
The team also works closely with the local team to build a case history by talking to the person who tested positive, which helps in finding the likely source of exposure and number of people the infected person might have come in contact with.
“People are cooperative, but there have been cases where some became abusive on the phone,” an official said. “The biggest challenge in tracing is the lack of proper address and phone numbers not working or answering. A few positive individuals didn’t want to provide a full history of travel and people they came in contact with.”
As a safety precaution, the team’s first work is to ensure they do not come in direct contact with any cases. All the discussions with the positive or suspected case happen over the phone. In few cases, the team provided SIM cards to those without phone numbers.
After they receive information about a positive case, a member calls up the individual and explains their test result. A hard part is sharing the news of their result. “It is difficult but we have to let them know so that contact tracing is executed as soon as possible,” said a team member.
The team gives them time to relax and compose themselves after the news is broke. Some hang up the phone upon hearing the news, most usually call back or cooperate when follow up calls were made. In a few cases, people called the centre to share information .
There are counsellors with the team and counselling is provided when necessary. “Getting in touch with primary contact is not difficult. However, it is difficult when their phone numbers are out of reach,” said an official.
In some of the recent local transmission cases, it took almost three days to locate the person who tested positive. This is where RBP and BRCS and the taxi drivers, members of BRCS, came handy.
The smallness of the country has also helped contact tracing. “Because our community is small, people know about positive patients and they call us, sometimes requesting us to quarantine them,” said a team member.
Not all contacts are considered as a risk. The people at higher risk of infection are usually those who had face-face contact with a positive case for more than 15 minutes. Others include having physical contact with the positive patient and having unprotected direct contact like being coughed on.
Low-risk contracts are usually those who had face-face contacts or were together in a closed environment for less than 15 minutes.