On the road back to normalcy

With the government planning to label Covid-19 endemic, the risk of new variants and lack of proper care is still a concern

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Anchalee Woratai, 79, lives alone in a small room. Her daughter and niece died years ago, but their photos still hang on the wall. Piles of clothes, bottles and food containers are neatly squeezed into a confined space. Anchalee was able to make her own way until she caught the coronavirus.

Then hospital staff told her to wait for drugs at home. Days passed, but they didn't turn up and her condition worsened. A dorm caretaker eventually contacted a group of volunteers for help. Anchalee, now being treated at a field hospital, is one of those who have been left behind despite the country's transition to a post-pandemic future.

After two years and three months of fighting Covid-19, the government has unveiled its plan to declare Covid-19 endemic by July and return to normal life. Public health measures will be gradually eased. Under its scenario, the number of new cases should decline from late next month.

Medical experts, however, have weighed in on the road map, expressing concern that the possibility of mutation will prolong the pandemic and therefore impact vulnerable people, including senior citizens and marginal groups.

Chance of unrelenting outbreak

Dr Thiravat Hemachudha, chief of the Thai Red Cross Emerging Infectious Diseases Health Science Centre, said given the pattern of the outbreak, an endemic status is possible because Omicron is highly contagious, and the incubation period and disease don't last long. However, there are exceptions.

"If Thais aren't healthy, they will be more vulnerable than other nationals. If they develop critical symptoms, the pandemic will last longer than just another three to four months. If that is the case, it will increase the chance of viral mutations as well. It is also possible that new strains will break through the Test and Go scheme."

The Department of Medical Sciences has already sent more than 2,000 samples for genetic sequencing. It found that Omicron crowded out all predecessors, with BA.2 subvariant at 68% and BA.1 subvariant at 32%. However, four cases were suspected of being the BA.2.2 subvariant, pending confirmation. This subvariant has already been detected in Hong Kong and the UK.

Other strains are also stoking public anxiety. Dr Wasun Chantratita, head of the Centre for Medical Genomics at Ramathibodi Hospital, Mahidol University, played down the chance of local transmission of Deltacron, except that it comes from other countries. However, the new subvariant of Omicron that merges BA.1 and BA.2 should be closely followed.

"Basic data from the genetic code shows that it can spread faster than BA.2 by 126%, but it remains to be seen how it works in the real world," he said. "We should monitor it to see whether it will lead to the sixth wave. Given the combination, its transmissibility beats other variants, but its severity remains unknown."

The World Health Organization has recently tracked Deltacron, but has not yet designated it a variant of concern nor officially named it. Researchers believe it is a single, hybrid variant that combines genes from Delta and Omicron. It isn't more transmissible than its parental viruses. So far, it has been detected in Europe, the UK, the US and South America.

Impact on elderly patients

If the pandemic is prolonged, it will impact vulnerable populations. Dr Anutra Chittinandana, president of the Royal College of Physicians of Thailand, said the majority of inpatients are now elderly people with underlying conditions because exposure to coronavirus makes them more vulnerable. Moreover, less than one-third of them have received booster shots.

"Don't let your guard down even though the Public Health Ministry announced its plan to declare Covid-19 endemic. The severity of the coronavirus is at an endemic level for those fully vaccinated only. It is still critical for the unvaccinated. Please take serious precautions," he said.

Dr Supat Hasuwannakit, president of the Rural Doctors Society, said "the current stage of the coronavirus is unofficially endemic" because people have already dropped their guard. At the same time, hospitals are mainly offering outpatient services under self-isolation service, but a large number of patients have no access to the public health system.

"It is possible that the real figure of infections is around 100,000 per day, according to authentication data of the National Health Security Office. Hospital beds are limited and reserved for severe cases. Those most at risk are elderly patients who have chronic diseases and develop mild symptoms for the coronavirus because they can get worse in the outpatient under self-isolation service," he said.

The Public Health Ministry has launched outpatient services under a self-isolation scheme to ensure a post-pandemic transition. Dr Kiattiphum Wongrajit, permanent secretary for public health, said 95% of cases are now either asymptomatic or mild, making hospital care unnecessary.

Under this scheme, patients get prescription drugs depending on their condition, a transfer between facilities, and a one-time follow-up call in 48 hours. The cost of food and medical tools is not included. They should stay at home for seven days and monitor their symptoms.

Mountain of unreported cases

"Those who have no access to the public health system come from financially disadvantaged backgrounds," said Nantapong Panmas, a co-ordinator for Tonkla-Asa, a group of volunteers who are delivering free drugs to patients in Bangkok and adjacent provinces. It has grown to over 3,200 in just a month after its inception.

"While some can't call the 1330 hotline, others are left waiting for delayed response until they get worse. Many are also turned away from hospitals. They are asked to wait for drugs at home, which fail to turn up. The outpatient under self-isolation service doesn't work."

Born of inaccessible healthcare services, the group is working around the clock to offer basic drugs, except favipiravir, to patients free of charge because quick treatment will help prevent transmission. It is expanding the team to cope with the growing number of cases.

Nantapong agrees that "the coronavirus should be labelled endemic, but the government hasn't paved the way for it". It has failed to equip people with the right knowledge and implement the outpatient under a self-isolation scheme, which is good in theory, but not in practice because hospitals are unable to offer timely treatment.

"I think there are a large number of unreported cases as people test themselves and seek help from us instead of counting on the public health system," he said.

"If a country has a lot of volunteers, it means that the welfare system is poor. Despite having the resources, the government is absolutely indifferent."

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