Case Report: The First Case of COVID-19 in Bhutan

• Published in: The American journal of tropical medicine and hygiene 2020-06, Vol.102 (6), p.1205-1207
• Main Authors: LeVine, Shankar, Dhakal, Guru Prasad, Penjor, Tshering, Chuki, Pem, Namgyal, Kesang, Tshokey, Watts, Melanie
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Antiviral Agents - therapeutic use; Betacoronavirus - drug effects; Betacoronavirus - pathogenicity; Bhutan; Case reports; Contact Tracing; Coronavirus Infections - diagnostic imaging; Coronavirus Infections - drug therapy; Coronavirus Infections - immunology; Coronavirus Infections - pathology; Coronaviruses; COVID-19; Humans; Hyperlipidemias - diagnostic imaging; Hyperlipidemias - drug therapy; Hyperlipidemias - immunology; Hyperlipidemias - pathology; Hypertension - diagnostic imaging; Hypertension - drug therapy; Hypertension - immunology; Hypertension - pathology; Immunocompromised Host; Immunoglobulins, Intravenous - therapeutic use; Lung - diagnostic imaging; Lung - drug effects; Lung - pathology; Lung - virology; Male; Pandemics; Pneumonia, Viral - diagnostic imaging; Pneumonia, Viral - drug therapy; Pneumonia, Viral - immunology; Pneumonia, Viral - pathology; SARS-CoV-2; Tomography, X-Ray Computed; Travel; Treatment Outcome; Ultrasonography; United States
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.20-0259

The initial cases of novel coronavirus disease-19 (COVID-19) in a country are of utmost importance given their impact on healthcare providers, the country's preparedness response, and the initial molding of the public perception toward this pandemic. In Bhutan, the index case was a 76-year-old immunocompromised man who had traveled from the United States and entered Bhutan as a tourist. He presented initially with vague gastrointerestinal symptoms and later a cough. His atypical presentation led to a delay in diagnosis, but ultimately he was isolated and tested. On confirming the diagnosis of COVID-19, the patient was isolated in a separate hospital with a dedicated medical care team. All contacts were traced and quarantined. The patient's respiratory status deteriorated despite broad-spectrum antivirals, antibiotics, and intensive supportive care. He required intubation and was given a trial of intravenous immunoglobulin to modulate his likely aberrant immune response. Subsequently, the patient's clinical status improved, and after 8 days of hospitalization, he was transferred out of the country, where he recovered. This was a learning experience for the treating medical staff, the government, and the people of Bhutan.