Survival Analysis of Symptomatic COVID-19 in Phuentsholing Municipality, Bhutan

Abstract

COVID-19 is a disease that is caused by a highly transmissible and pathogenic novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). All of the COVID-19 positive cases in Bhutanese travellers returning via the Phuentsholing point of entry, the local population, and Indian nationals were isolated in the Phuentsholing COVID-19 isolation ward, Bhutan. This study aimed to identify the risk factors for developing symptoms among COVID-19 positive patients in this ward. A retrospective cohort study was conducted using the data regarding COVID-19 positive cases in the Phuentsholing COVID-19 isolation ward from 28 May 2020 to 31 May 2021. The Cox proportional hazards regression model was used to identify the risk factors of developing COVID-19 symptoms. There were 521 patients in the study; 368 (70.6%) were males and 153 (29.4%) were females. The mean age was 32 years (with a range of 1–78 years), and 290 (56.0%) reported at least one symptom. The median length of isolation was eight days (with a range of 3–48 days). The common symptoms were: cough (162, 31.0%), fever (135, 26.0%), and headache (101, 19.0%). In the multivariable Cox regression, vaccinated patients were 77.0% (p = 0.047) less likely to develop symptoms compared to those who were not vaccinated. The front line workers and the mini-dry port (MDP) workers were 15 (p = 0.031) and 41 (p < 0.001) times more likely to be symptomatic compared to returning travellers. The young and economically active population group was most commonly affected by COVID-19. The presence of risk factors, such as being front line workers, MDP workers, or not being vaccinated against COVID-19, meant that patients had a higher probability of developing symptoms of COVID-19.

Risk Factors of Symptomatic COVID-19 in Samtse District, Bhutan

“…In this study, the common symptoms were fever, cough, and headache. These findings were in agreement with other studies, where commonly reported symptoms were fever, sore throat, headache, cough, and myalgia ( 19 , 24 , 28 ). COVID-19 tends to be more severe in adults and the elderly with devastating health outcomes in immunocompromised and patients with co-morbidities ( 26 , 29 ).…”

“…A study on the work-related COVID-19 in six Asian countries including Hong Kong, Japan, Singapore, Taiwan, Thailand, and Vietnam reported “drivers and transport workers” contributed upto 18% of the COVID-19 burden ( 37 ). A similar finding of a higher risk of reporting symptoms among people working in the transportation services was also reported in Phuntsholing Municipality in Bhutan ( 24 ). Loaders tranship the goods entering Bhutan, from Indian vehicles to Bhutanese vehicles.…”

“…Hence, understanding the clinical and demographic characteristics of COVID-19 and identifying risk factors for symptomatic COVID-19 will be useful for future prevention and management of cases. However, there are limited studies on the clinical manifestations and their associated risk in Bhutan ( 24 ). The findings from this study will be useful in addressing this gap and provide evidence for the region-specific COVID-19 disease profile.…”

The COVID-19 vaccination campaign in Bhutan: strategy and enablers

“…The coronavirus disease 2019 (COVID-19) in Bhutan was first confirmed on 5 March 2019, in a 76-year-old tourist [ 2 ]. Subsequently, there were sporadic cases and localized outbreaks in different parts of the country [ 3 ]. As of 15 September 2021, there were 2,596 confirmed cases and three deaths in the country (Fig.…”

“…A large volunteer workforce, known locally as Desuups ( www.desuung.org.bt ), came forward to facilitate the organization of vaccination rounds and other activities to control COVID-19 [ 3 ]. Founded by the Fifth King, Desuup trainees undergo a value-based personal development program to encourage volunteerism for community services and play an active role in building the nation.…”