Living in the coastal province of Phetchaburi, 40-year-old office worker Samerpron Sangwasee had received one shot of AstraZeneca before testing positive for Covid-19 two weeks later. Her hometown had a large cluster of cases and she is also overweight, which put her in a high-risk group. She spent two days trying to enrol for home isolation through crmsup.nhso.go.th.
"Initially, I had a sore throat and a fever of 38C. I went to the hospital and the doctor advised me to do a Covid-19 test. However, due to the long queue, I returned home and did a rapid test instead. When the result was negative, I returned to the hospital and had another test done. There were so many Covid-19 patients in the queue, so getting admitted to hospital was difficult," Samerpron recounted.
"The registration process for home isolation was quite confusing, so I had to figure out the process through the internet and the help of my friends. Two days after registering, a doctor from Nakhon Si Thammarat's Sichon Hospital called me to check on my symptoms and gave me a 300 baht voucher to order a meal from an online delivery service and favipiravir for five days. After that, no one followed up on my symptoms during isolation."
Soon, she became fearful of death due to body pains, diarrhoea and the loss of taste and smell, so she sought alternative Thai-style herbal therapy, which was conducted by Wat Srakaew in Nakhon Pathom.
"As I had a serious case, a specialist team from Wat Srakaew came to my home to diagnose my symptoms. They provided me medicine produced from Thai herbs such as fah talai jone and kot chula lampha which can help reduce fever, nourish the kidneys and lungs, heal inflammation and eliminate toxins. The temple has joined hands with a group of volunteer doctors to monitor patients. For two weeks, I had to update my temperature and symptoms twice a day through Line. They also offered tips on how to take care of myself based on Thai-style traditions. I owe them for providing good treatment," Samerpron said.
This is one of many examples that shows how difficult it is for Covid-19 patients to get treatment, especially when the number of daily infections is crossing 20,000. Currently, nearly 100,000 Covid-19 patients are in home isolation and authorities are racing against the clock to save lives.
A health worker prepares a home isolation medicine kit while another carries out a teleconsultation. Photos: Varuth Hirunyatheb
The Medical Services Department is responsible for drafting home isolation measures, while the National Health Security Office and Bangkok Metropolitan Administration have partnered with private clinics, public health centres and hospitals around Bangkok to ensure patients can access healthcare services and medicines as quickly as possible.
"We have expanded several platforms to help patients register for home isolation thanks to collective efforts by the National Health Security Office, Bangkok Metropolitan Administration and other local authorities," said Somsak Akksilp, director-general of the Medical Services Department.
"Hospitals and healthcare centres should instantly register patients for home isolation if they test positive and have mild symptoms. Those using an antigen test kit or PCR test at home can call the National Health Security Office's 1330 hotline or scan a QR code to submit their names, Covid-19 test results, and identification number. The system will send an SMS to confirm registration. There are now 3,000 to 4,000 phone lines thanks to the co-operation between Bangkok's 50 district offices."
Basically, the system will pair patients with a hospital or clinic where doctors screen for disease and offer treatment before delivering some medical supplies and critical medicines such as thermometers, oximeters, favipiravir and fah talai jone to patients' homes. Then, a team of doctors or nurses will conduct teleconsultations twice a day to monitor symptoms and make sure patients receive three meals each day.
"According to the Medical Services Department's guideline, each hospital or clinic is allowed to set up their own platform to monitor and communicate with patients. They will consider when and what sort of medicine patients should be provided," Somsak said.
"Due to a shortage of fah talai jone, favipiravir is being used as the primary option. Patients with symptoms like cough, diarrhoea, fever, loss of smell and taste should receive medicine within four days. If their symptoms get more serious, they will be sent to a hospital."
The workload may be an obstacle because each healthcare institution needs to manage its own system. To help the patients from Hotline 1669, the Medical Services Department previously set up a virtual hospital where a group of 10-15 medical workers looked after 500 patients and prepared relief kits.
Each kit contained essential medicines, including 14 surgical masks, red bags, a thermometer, an oximeter, five days of favipiravir, antipyretics and a guidebook to educate patients on how to care for themselves at home. The department provided patients with three meals a day for a period of two weeks. This highlights the hard efforts of medical staff.
A health worker prepares a home isolation medicine kit while another carries out a teleconsultation. Photos: Varuth Hirunyatheb
"Because most locals live alone in condominiums, Bangkok is ideal for home isolation. Villagers in provincial towns, on the other hand, are more likely to live in big families with no separate bedrooms. Therefore, they should be placed in community isolation or sent to a field hospital. At the same time, if the entire family has been infected, it's ideal for family isolation," Somsak said.
Office worker Pornapar Wongchaonimit and her family reside in Bangkok's Klong San district, where the fresh market became the site of a superspreader event. After her 72-year-old mother developed a fever and body aches, her family purchased a healthcare package and a mobile laboratory came to their house to test them. Two days later, she found that her mother was diagnosed with Covid-19.
"My mum had already received one AstraZeneca dose. After receiving the result, we opted to contact Hotline 1333 and register for home isolation rather than send my mom to a field hospital. My mother was matched with a clinic in Chamchuri Square within 24 hours and a nurse provided teleconsultation twice every day through Line. They delivered us a kit that contained an oximeter, a thermometer, antipyretics, cough suppressants, antihistamines and oral rehydration salt powder, plus three daily meals. My mother didn't need to take favipiravir because her symptoms were mild," Pornapar recounted.
"One week later, my sister tested positive and got a sore throat, fever and lost her sense of smell. She registered for home isolation and was connected with Nakhon Si Thammarat's Sichon Hospital. She spoke to a chatbot to provide updates about her condition but received no answer when she had certain inquiries. The hospital only sent her favipiravir and a voucher to order daily meals. Fortunately, her symptoms were also mild and a nursing team from the clinic, who was caring for my mother, provided her with some guidance."
