The coming storm
THG warns the battle against Covid-19 is a marathon, not a sprint
Despite the relatively low number of new coronavirus cases in Thailand, hospitals are already reaching capacity in dealing with patients that need intensive care unit (ICU) treatment and ventilators, says Boon Vanasin, chairman of Thonburi Healthcare Group (THG).
The country has just 200 ventilators that can trap air without spreading the virus, and most of them are in use. The three main hospitals in Bangkok specialising in Covid-19 treatment are already full, one of which is Bamrasnaradura Infectious Diseases Institute.
"The Chulalongkorn team came here yesterday with people from Siriraj Hospital and said the beds they provide for coronavirus patients are already full," Dr Boon said. "Even university hospitals are full with only 100 new infections a day, even in Bangkok, which has a lot of facilities. Anything more than 100 patients a day, we are in trouble."
He estimates the actual number of infections at as much as 40 times higher than reported, as 80% of people with the virus do not show symptoms. This means about 200,000 people could have the virus and not know it.
The number of tests in the country remains low compared with the figures in developed countries such as South Korea and Singapore. Thailand has administered more than 30,000 tests and recently increased tests to 1,000 a day.
But while the government administers free tests, it will only test those with a fever or who are showing symptoms. An elective test from a private hospital costs upwards of 6,000 baht, beyond the reach of the average Thai.
A cheaper but still accurate test will take 3-4 months to develop, Dr Boon said, adding that cost is the main factor hampering increasing testing.
"Of course it is expensive, but one sick person can cause as many as 250 people to get infected," he said. "If every day they infect two, you can multiply that."
When the government administers testing, patients are divided into three categories. Patients who test positive with no symptoms are sent home to self-quarantine. Patients displaying symptoms are labelled a person under investigation (PUI) and monitored at a hospital until they no longer show symptoms. Patients with a severe reaction to the virus are sent to the ICU.
About 5% of new patients are sent to the ICU and require ventilation, usually 3-4 a day, depending on new infections. Dr Boon estimates 95% of private hospitals are unequipped to deal with these seriously ill patients and will have had to prepare facilities months in advance.
In his view the ideal amount of new infections per day would be 20-30, a level at which Thailand's healthcare infrastructure could accommodate patients that need intensive care.
On Tuesday the government reported 34 new coronavirus cases and one death.
Dr Boon worries most about upcountry, where facilities lack specialised equipment such as negative-pressure ICU rooms and high-end ventilators. Without such equipment, air pumped into patients' lungs by ventilators can spread through the room and the hospital, putting healthcare workers in danger.
"I get a lot of calls from doctors upcountry who are scared," he said. "They have no protection, no rooms, no treatment. Actually many of them want to quit. We must rush supplies to them."
Dr Boon said locales popular with foreigners have had it the worst, such as Koh Samui, Pattaya and especially Phuket.
MARATHON, NOT SPRINT
Dr Boon gives the government an overall rating of B+ for being "a bit slow". Despite warnings, the government did not close down major businesses before it was too late, enabling an event at Lumpini Stadium on March 5 to go ahead, which accelerated the spread of the virus.
The government should have put a plan in place to make sure workers in Bangkok did not return to their hometowns after the city was shut down, he said. As a result of the lack of clear planning, thousands of workers returned home and to neighbouring countries, possibly carrying the virus with them.
"The next two months are critical in terms of which way we will turn," Dr Boon said. "But so far so good."
He said the outbreak must be contained before July and the start of the rainy season, a time when people are more likely to get sick with other viruses such as the flu and common cold, and are more susceptible to spreading the coronavirus.
The battle against Covid-19 may last as long as 18 months if it continues to replicate and a vaccine is likely years away from completion, said Dr Boon.
"It is more of a marathon than a sprint," he said.
THG plans to spend 150 million baht to expand the number of beds in its ICU from 20 to 32.
The company is also offering drive-thru Covid-19 testing at Thonburi Bangsue Hospital and Thonburi Bamrungmuang Hospital for 6,000 baht per test. THG has tested about 1,000 people so far and found six positives.
THG is the third largest private hospital company in the country, with 3,000 beds at 18 hospitals in Thailand, and four overseas.