Her Excellency Lyonpo Dechen Wangmo- the Health Minister of Bhutan, discussed some innovative approaches that Bhutan adopted to deal with the crisis of the Covid-19 pandemic. She gave rare insights on the management of the pandemic and touched upon issues such as digital tracking, global collaboration, tourism and surveillance. Health has been a major concern for everybody in 2020, and many health departments are coming under the scrutiny of the public now.
The King of Bhutan has been at the helm of affairs when it comes to the nation’s approach towards the pandemic. His unconditional love and care for every Bhutanese was reflected in his words during the National Address on 22nd March, 2020 when he told the Bhutanese people that they must exhibit the strength that comes out of their smallness, remain united and support each other. He assured that the government would take responsibility for alleviating any suffering caused to the people by the virus during such exceptional circumstances.
Bhutan adopted the 3 T (Trace, Test and Treat) strategy for combating the pandemic since the very initial days, and rigorously embedded it in its response. All the available national channels and resources were mobilised to ensure the availability of adequate resources such as testing kits, PPE, manpower etc.to effectively implement the 3 Ts.
Trace: Everyone who came from overseas and within primary contact of the positive cases was put under the facility quarantine designated by the ministry of health for 14 days beginning 14th March 2020 and then for 21 days beginning 31st March, 2020. To ensure adherence and comfort, the government fully covered costs such as room and meals. All the designated quarantine facilities are star-rated tourist hotels with amenities that include free internet services. Strong and efficient border control systems were also put in place to reduce the risk of cross-border transmission of the virus. Starting from 23rd March, all international borders of Bhutan were sealed.
Test: Bhutan had adopted an aggressive testing protocol, early on. All individuals who enter Bhutan are tested on arrival and then prior to release from the 21-day quarantine. Every patient who visits the health facilities with flu symptoms is tested for COVID. All frontline workers mending Bhutanese borders and health-workers are being routinely tested every month.
Treat: Every positive case is managed in the hospital where baseline vitals and x-rays are taken.
One of the key interventions in combating the pandemic for Bhutan, has been surveillance. Bhutan began institutionalized Covid-19 surveillance systems at all the POEs beginning January 2020 which was two months before the detection of first cases in the country. The institutionalized surveillance teams operated at both Central and District levels and thoroughly engaged in tracing the primary and secondary contacts of the positive cases and following them up with the 3T strategies. Furthermore, whenever positive cases were reported, extensive surveillance actions were carried out for the high-risk communities to ensure that everybody is traced, tested and treated accordingly.
Bhutan had set up 54 flu clinics across the country to enhance its surveillance of active case findings for Covid-19; these facilities also acted as a buffer to safeguard its health facilities from Covid-19. This intervention was very unique to Bhutan.
Bhutan also developed a druk trace app since the early days of the pandemic to help the surveillance team trace possible contacts of the confirmed cases. Different types of systems were built and put to use, depending on the target population, intensity of risk and the concerned point of contact or authority.
With the increasing number of coronavirus cases globally, it is difficult for Bhutan to determine when to reopen for tourism. The Tourism Council of Bhutan is planning and hoping to reopen tourism early next year around Feb/March 2021, which is the usual time for the tourist season to begin there. A travel-bubble concept is being pondered over to allow tourists from those countries who have manged Covid-19 pandemic well and have no new cases.
India is one country with which Bhutan has always enjoyed exemplary and exceptional friendship in the face of adversity. Government of India has so far, donated important PPEs, Medical Consumables, Medicines and vital testing kits to the RGoB, and also extended exceptional support in the areas of border control.
Moreover, the Ministry of Health in Bhutan has proposed to participate in the clinical trial for Covid-19 vaccines that is being coordinated by the Department of Biotechnology, Government of India. One of the key areas where the two governments will continue to collaborate in the coming times will be Border Control and safe transportation of goods between the two countries.
Amidst this crisis, there is also the possibility of a looming mental health crisis that can not be ignored at any cost. Since the initial days of the pandemic itself, Bhutan had begun to mobilise a National Mental Health Response Team comprising of clinical psychiatrists, clinical psychologists and counsellors for Covid-19. The team has been actively involved in developing awareness and advocacy materials on mental health in the times of Covid-19. Also, as a part of Bhutan’s mental health response to the pandemic, 5 mental health hotlines have been established for counselling purposes.
The health minister believes that Bhutan’s population has been a critical influential factor in public health and epidemiology. Bhutan is blessed with a small population that has made it easier to enforce national interventions and strategies to curb Covid-19 over there.
On April 24, 2020, WHO had launched the Access to Covid-19 tools (ACT) Accelerator, a new global collaboration to accelerate development, production and equitable access to Covid-19 diagnostics, therapeutics and vaccines. With the Accelerator, GAVI, CEPI, and WHO together with multinational and developing countries vaccine manufacturers are working on COVAX (vaccine) Pillars to develop COVAX facilities. It is a global framework designed to ensure equitable and fair access to Covid-19 vaccines and other products, and Bhutan is an active and willing participant of the same.
Like many developing countries globally, Bhutan too is facing the challenge of not having adequate Health Human Resource and medical supplies, but it is doing everything that it can to the best of its capacity.