The fast-spreading Covid-19 pandemic must be matched with an equally quick response to curb it, tagged with the all-important "what next" question, according to the Rural Doctors Society (RDS).
It has been an arduous seven days for teams of doctors hailing from the provinces who have knocked on the doors of communities most prone to Covid-19 in Bangkok and conducted tests on residents.
The RDS team has joined medical and public health authorities and civic groups to offer the tests, believing they are instrumental in flattening the Covid-19 curve.
The pandemic has logged in more than 20,000 daily infections in the past several weeks with fatalities surging past 200 on some days.
Tests cut transmission
The upswing in new infections was in part attributed to mass testing rounds in the capital where more Covid-19 sufferers have been identified and removed from households and referred to field hospitals or hospitals. Many with few or no symptoms were kept in isolation at home for treatment. The tests have been useful in limiting the transmission and the RDS decided to help out.
Dr Supat Hasuwannakit told the Bangkok Post the society has participated in mass testing in Bangkok twice, first between July 21-23 and the second round from Aug 1-10.
In the first round, the RDS discovered 16% of 30,000 people tested were infected. "We figured then that we needed to come back," he said. The team spent two weeks preparing for the second round of testing.
The society recruited medical volunteers, who also work as full-time state officials, and got in touch with the public health permanent secretary to seek assistance. The volunteers were issued a letter from the Public Health Ministry recognising the mass testing work as an official duty. The ministry also paid for the volunteers' travel and accommodation expenses.
The teams were split into 10, each with 40 volunteers and they worked alongside 200 medical teams from the Bangkok Metropolitan Administration (BMA). In addition, more public health volunteers were also sent from various provinces by the vanload.
Armed with antigen test kits (ATKs), the volunteers performed a test on 150,000 people in Bangkok. The kits were procured with the support of the National Health Security Office (NHSO).
Accountable procedures
The RDS has devised its own system of auditing which became essential after being allocated the kits for use in testing.
The audit was aided by a computer program which recorded the expenses associated with testing procedures. At least 300,000 sets of ATKs were given out by the Public Health Ministry to support the campaign.
Next, the RDS was provided with antiviral drug, favipiravir, to be dispensed to mild-symptom patients. The drug was supplied by the Public Health Ministry. Also, fa talai jone (green chiretta) medicinal herb was handed out.
According to Yongyot Thammawut, the deputy public health permanent secretary, 3,509 people who were tested were given fa talai jone and 8,939 favipiravir.
Dr Yongyot said the medical workers who performed the tests, also known as Comprehensive Covid-19 Response (CCR) teams, managed to cover 100 communities including crowded areas and condominiums. He admitted infections remained a serious concern.
Meanwhile, the RDS coordinated with the BMA to have people who tested negative for the virus vaccinated. "Vaccines were delivered to communities for on-site inoculation of elderly people who were bed-ridden," Dr Supat said.
The RDS teams carved out a goal of testing residents in at least 30 locations a day. However, they were not familiar with the communities and had to consult civic groups or local advocates on how best to arrange the testing. The groups chaperoned people, assisted with registration and the reading of test results, and put out word to residents about the test. Dr Supat, however, insisted that tests alone could not be expected to rein in infections.
What next?
He said there must be answer to the "what next" question. After a test returns a positive result for residents, communities must be adequately equipped to care for them.
Food and water must be delivered to patients in the home isolation programme. With the virus prevalent, what plans the communities have in store to contain transmission also must be put in place.
There is also the question of whether the communities are willing to set up their own community isolation centres to look after the sick themselves pending referrals to proper medical facilities.
"It doesn't end with a test. Basically, the communities must be self-supportive in managing the isolation programme. Tests would prove futile if they confirmed infections with no further plan to deal with them," Dr Supat said.
After testing, each community draws up a list of residents with Covid-19. It pinpoints how many sick residents live in the neighbourhood, and where, which allows specific areas to be sealed off.
Dr Supat said many communities he went back to test in the second round reported a significant drop in infections. The Makkasan community, for example, saw 10% of those tested contracting the virus, as opposed to the 20% in the first round.
But the numbers may not tell the whole story. In fact, the mass infections had built up herd immunity. "It's not very encouraging to learn that immunity had risen not because of the vaccine but as a result of heavy infections," he said.
However, the second round of testing has served as a lesson for the volunteer teams. They knew they had to hand out medicine immediately to those tested positive. Elderly residents and those with underlying illnesses free of Covid-19 were also vaccinated straight away. It is part of a "one-stop-service" model. "Prompt action can really be helpful," he said.
Dr Supat added a tough challenge now was to find beds in hospitals for the critically ill. Also, some people might not avoid the virus for long when family members with whom they live under the same roof come down the Covid-19.
Raising the red flag
One community in central Bangkok was quick to reach out to the RDS to save the 100 families living there.
Naraset Boonyawan, leader of the Northern Talad Chalermlok community in Ratchathewi district, sounded the alarm which caught the RDS's attention. Mr Naraset is also volunteer of the Sen Dai (Thread) charity group. It is one of the communities on the mass testing radar.
"We are happy with the project because it is one-stop service. The sick are treated with medicine and at-risk people are vaccinated. They don't need to wait around and hope to be lucky in securing beds in hospitals," he said.
The NHSO is rolling out at least 8.5 million ATKs this month. Most will be distributed to "dark red" zones where the outbreak is intense, including Bangkok and its vicinity.
Dr Jadet Thammathat-Aree, secretary-general of the NHSO, said chemists and clinics will be the main channels for distributing the kits. Easy availability can mean the difference between life and death. According to NHSO, 11% of Covid-19 cases have been discovered using ATKs. A total of 71,777 cases were reported to the office, of whom 49,467 are entering the home isolation programme in Bangkok.
