COVID-19 pandemic in Bhutan
The COVID-19 pandemic in Bhutan was a part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The virus was confirmed to have reached Bhutan on 6 March 2020, when a 76-year-old American tourist who had travelled from India tested positive for COVID-19.[2]
The King of Bhutan addressed the nation on 22 March 2020, telling citizens "As a small country with a small population, we can overcome any challenge we are faced with, if the people and the government work together."[3]
The country subsequently implemented strict containment measures, and was able to largely stamp out the outbreak.[4] Bhutan currently has the lowest case fatality rate for COVID-19 at 0.05%, which is significantly lower than the WHO's global case fatality rate of 4.34%, and lower than SARS of 2003.[5][6] However, the transmission has been significantly greater.[5][7]
Background[edit]
On 12 January 2020, the World Health Organization (WHO) confirmed that a novel coronavirus was the cause of a respiratory illness in a cluster of people in Wuhan City, Hubei Province, China, which was reported to the WHO on 31 December 2019.[8][9]
The first case of COVID-19 in Bhutan: the case report[edit]
In Bhutan, the index case was a 76-year-old American man who had entered Bhutan as a tourist via India. During his first two days in Bhutan, he sought the medical attention for a minor illness of which the symptoms included bloating, loss of appetite, diarrhea, and fatigue. On his fourth day in Bhutan, he was diagnosed as a case of COVID-19 and was admitted at the Jigme Dorji Wangchuk National Referral hospital. Initial chest X-ray revealed mild bilateral patchy infiltrates, and he was started on oseltamivir, ceftriaxone, and doxycycline, and was kept in respiratory isolation on supplemental oxygen.[10]
Over the days of hospitalization, the patient’s oxygen requirement gradually worsened; his white blood cell (WBC) count and C-reactive protein (CRP) continued to increase. Point-of-care ultrasound revealed worsening B lines. Then the patient was put on lopinavir and ritonavir and the antibiotics were switched to meropenem and vancomycin. However, he continued to maintain a low-grade fever. Computed tomography of the chest revealed diffuse ground-glass opacities consistent with acute respiratory distress syndrome (ARDS). On the fifth day after diagnosis, the patient had to be intubated and was placed on a ventilator for respiratory support.[11]
He also received a three-day course of 0.5 g/kg (40 g daily) of intravenous immunoglobulin (IVIG) and underwent prone positioning for ARDS. By the next morning, his oxygenation status improved, and 48 hours after the first dose of IVIG, the patient’s WBC count and CRP had decreased. The patient was evacuated to his home country after eight days of treatment and significant clinical improvement in Bhutan. His recovery went well, and was extubated seven days after evacuation. Fifteen days after his diagnosis, he no longer required oxygen therapy and rehabilitative therapy was initiated.[12]
