The Coronavirus (COVID-19) is similar to other infectious diseases that do not have definite treatment and would remain endemic, shared Clinical Microbiologist at the Jigme Dorji Wangchuck National Referral Hospital and Technical Advisory Group for COVID-19, Dr Tshokey.
However, he said the body tries to fight the infection and because of the body immunity and natural cause of the infection, it either naturally subsides or the patient dies.
Additionally, Dr Tshokey said patient would either recover or become chronic carrier; an organism lives in a patient’s body forever in diseases like HIV/AIDS and hepatitis B and C.
“The anti-hepatitis and anti-HIV/AIDS drugs do not kill the virus but it maintains the viral load to certain limit where it does not harm the body,” said Dr Tshokey.
Additionally, Dr Tshokey said the COVID-19 is a typical example of flu with same virus family and due to natural cause of infection the virus multiplies rapidly reaching the peak and goes down in specific time.
Bhutan has 31 total cases of COVID-19 of which 25 cases are active, six have recovered including two Americans that flew back to their country and 11 in de-isolation.
COVID-19 positive patient in isolation ward, treatment and de-isolation
International reports hasve confirmed the rising numbers of asymptomatic positive COVID-19 person, said Dr Tshokey.
With no fever, cough, nose block, or diarrhea, a person can transmit the disease. However, if the coronavirus patient shows symptoms, then we can de-isolate, he said.
Asymptomatic patients, Dr Tshokey said have no treatment and they are kept under observation along with the blood test, chest x-rays (to assess the damage in the lungs), electrocardiogram (ECG) and temperature monitoring. However, if a patient is not able to take food, he or she is provided glucose.
For symptomatic patients with fever and cough but without other risk factors, he said daily monitoring is carried out to take rapid action if the patient has rapid complications.
For those who have mild symptoms with high risks, like diabetes or hypertension or old age, an anti-malarial drug Hydroxychloroquine, antiviral drug Lopinavir-Ritonavir combination is provided, he said.
Those patients with underlying medical conditions are then classified into pneumonia with risk factor and those without risk factor, said Dr Tshokey.
Moreover, he said the high risk factor with severe and a patient suffers from Acute Respiratory Distress Syndrome, a respiratory failure, a person may require ventilation depending upon the vulnerability of getting super infection from COVID-19 positive.
Super imposed infection is one where one gets pneumonia from COVID-19 and additional pneumonia from bacteria.
Those infected from COVID-19 may not require antibiotics but those who have super imposed infection require so.
He also mentioned that there is a lot of confusion in other countries as mild asymptomatic positive patients are not admitted to the hospital and are asked to self-isolate at home. He doubts that it could be the cause of the local transmission.
We are taking a zero risk approach, we admit everyone whether symptomatic or asymptomatic COVID-19 positive patient, said Dr Tshokey.
Additionally, he said Bhutan has protocol that tests are done after seven days of admission for asymptomatic, if the result is positive then testing is done every 48 hours until one recovers or are confirmed negative.
If negative, after 24 hours repeat test then he or she is negative then de-isolated and is shifted to the de-isolation hotel, he added.
However, patients who are symptomatic are kept under observation and re-test is done only if the patient is symptom free for three days adding that if the chest x-ray show abnormal lungs then patient has to show improvement for three days, said Dr Tshokey.
If the result is positive than testing is done every 48 hours and if negative, he is retested every 24 hours and follows the procedure as mentioned earlier.
The other countries practice two approaches where if the patients are asymptomatic for three days, they are asked to self-isolate at home and the other approach is similar to Bhutan.
He feels that most of the countries are making mistakes by sending positive patients home. He said in Bhutan COVID-19 patients sent out are negative where the de-isolated patient is kept in hotel for two weeks and if the test comes negative, they are sent home.
Moreover, the recovered patients are asked to self-isolate for one to two weeks at home as precautionary measure.
Recovered patients test positive
There are arguments in the scientific community that report recovered patients testing positive for the COVID-19, said Dr Tshokey adding that latest reports confirmed that it is neither re-infection nor re-activation of the virus that has been dormant.
Reactivation of the virus means that the virus has not left the patients’ body but the virus count has been low and when a recovered patient is exposed to the COVID-19, it causes re-infection, he said.
“The latest conclusion from the studies and report suggest that the fragments of the virus would be still present in the body of the recovered person (shedding some fragments of the virus), that are not infectious,” said Dr Tshokey.
Moreover, he said that the polymerase chain reaction test is sensitive and explicit that detects any virus particle in the patient’s body.
He also said that a survey conducted in Wuhan, China found out that only 2% to 5% of the recovered patients have developed antibodies but it is not clear how long they would be protected and that still a large population is susceptible to infection.
There are many debates whether 100% of the recovered patients develop antibodies and some studies show that 5 to 6 of 100 infected people may not develop antibodies, said Dr Tshokey.
“We need antibodies to fight against the infection,” he said.
“All do not develop antibody, even if they develop antibody, we are not sure whether this antibody is enough to prevent future infection, even if they prevent future infection for how long that is not clear because the infection is new.”
Thukten Zangpo from Thimphu