Covid self-testing came way too late

Covid self-testing came way too late

People spend the night outside Wat Phra Sri Maha That in Bang Khen district as they wait to get tickets for free Covid-19 testing earlier this month.  Varuth Hirunyatheb
People spend the night outside Wat Phra Sri Maha That in Bang Khen district as they wait to get tickets for free Covid-19 testing earlier this month.  Varuth Hirunyatheb

Since last week, Covid-19 antigen test kits have become available in chemists nationwide.

The availability of self-test Covid kits, once banned by the state, reflects the latest policy to deal with the healthcare sector meltdown after Covid cases skyrocketed.

A public health ordinance gazetted on July 12 made over-the-counter sales of this medical device possible this week.

The long awaited Covid-19 self-test kits are welcome as they will allow people to get tested easier and faster.

Previously, people who suspected they had the coronavirus mainly had RT-PCR tests -- a much more reliable testing method, yet time-consuming and costly.

People must seek approval and get registered by health professionals; the testing takes 24 and 48 hours to get a result. Despite being relatively less reliable, the antigen test kits will make Covid testing faster and more affordable.

People can take a test at home and, if positive, they can get an RT-PCR test at hospital. For the antigen test kit, it takes take less than 30 minutes to get a result and each test kit costs about 300-500 baht. RT-PCR tests cost about 3,000 baht.

Covid-testing in Thailand has proceeded at a glacial pace -- about 10,000 tests daily according to the Public Health Ministry this month.

The limited testing capacity caused many people to wait in long queues and sleep overnight in front of government testing stations.

Demand for tests will increase even more, especially in the Bangkok metropolitan region, where nearly half of the national new cases have been reported.

At the weekend, the Covid case tally in Thailand passed 10,000 cases daily for the first time. Yesterday, the tally went up to 11,397, with a death toll of 101.

The current figure would have been unimaginable last year when Thailand performed exemplary work in controlling the pandemic.

This is thanks to its strong healthcare networks developed over the past 40 years, and the introduction of Universal Health Coverage that provides free healthcare to nearly 100% of the population.

But testing and vaccination, which involve technology, are the country's major hurdles at the moment.

Along with poor leadership, the rigidity of the Thai bureaucracy discourages the government from making fast decisions to adopt new technology.

Since last year, doctors and civil society groups have called on the Public Health Ministry and the government to approve the use of antigen test kits, without much success.

Their move was prompted by the discovery of highly contagious variants such as the UK and South Africa strains.

Though an antigen test kit is less reliable than an RT-PCR test, it has a great benefit in providing early screening to people. It alerts them to act faster to put themselves in isolation or seek medical assistance.

This helps health officers identify cases more quickly and, in return, reduce the chances of infected people spreading the disease.

However, the Public Health Ministry ignored their call. State doctors and ministry executives cast doubt on the reliability of antigen test kits and people's inability to use them properly.

Meanwhile, governments in other countries such as Singapore decided to decentralise Covid tests to the public in a bid to reduce the workload on public health personnel.

Without the ministry's approval, the use of antigen test kits was close to an illegal act. The policy impeded Covid testing and tracking ability.

Some civil society groups could not import large quantities of antigen test kits for home use even though it is the most practical tool for searching new cases in crowded Bangkok slums.

Medical staff at state hospitals couldn't buy the test kits because it would violate the government's procurement law, which prohibits the purchase of items and services outside approval lists.

The recent surge of Covid-19 cases pushed the Public Health Ministry to eventually give a green light to the medical device.

The National Health Security Office, which had long waited for the approval, did not hesitate to start a mass testing programme in Bangkok.

If it had happened earlier, the capital might have alleviated the ravages of the current coronavirus wave.

The bureaucracy's rigidity and flexibility, as well as its regulations, might look like a minor matter to some.

But it can make a huge difference if some restrictions are lifted to make the pandemic emergency response more efficient and effective.

In fact, Prime Minister Gen Prayut Chan-o-cha announced an emergency decree that gives him and his government the power to lift any regulations during the crisis. But this power is not addressed enough.

I believe a lack of vision and overconfidence are part of the reason. The government didn't pay enough attention to the possibility of encountering new Covid-19 strains while withholding the decision to improve testing coverage.

Another reason is deep-rooted in political culture. Allegations that the procurement regulation has been breached is a tool used by politicians and government officials to persecute their opponents.

It reproduces a decision-making process that aims to protect decision-makers rather than protect the public's interest.

During the pandemic, most officials, including Gen Prayut, were inclined to make decisions based on what the regulations allowed, not on what the situation required.

Lifting some regulations can be a game-changer in several areas, including the procurement of mRNA vaccines.

Last year when Pfizer and Moderna vaccines were launched for emergency use, I learned from some public health officials that the government's procurement regulations created a barrier for purchasing.

The procurement must involve comparing product prices and quality, to ensure the state buys from a supplier that offers the lowest price.

This criterion can't apply to the purchase of newly developed vaccines that involve high investment in research and development -- and only a few companies can provide that. Undoubtedly, speeding up testing and mRNA vaccine procurement are strategies that will get Thailand through the crisis.

This can only be achieved if the government is prepared to make the right decision in the public interest despite any political risk.

Paritta Wangkiat is a Bangkok Post columnist.

Paritta Wangkiat


Paritta Wangkiat is a Bangkok Post columnist.

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