EXCLUSIVE: Coronavirus 101: Thailand’s first lesson

The country’s top epidemiologist and Deputy Chief of the Department of Disease Control Dr. Tanarak Plipat talks to Bangkok Tribune about the disease’s threats and how the country has handled it

A newly emerging disease is not necessarily infectious, but if it is also infectious, it can pose a much challenge not only to public health systems, but also to social settings and functions, like what the novel Coronavirus or COVID-19 is doing to almost all of the countries around the world at the moment.

In Thailand, the virus first touched down here in mid January when one visitor had travelled from Wuhan in China and was diagnosed later as being infected with the virus. And since, it has been battling with the virus, which spread out of Bangkok to upcountry around mid March before being suppressed to the point that the number of new local cases was down to one digit and zero for the first time yesterday (18 new reported in Songkhla’s detention center). The so-called “New Normal” way of living has at the same time been instructed to help ease some restrictions imposed against the citizens.

One of the country’s top epidemiologists and Deputy chief of the Department of Disease Control Dr. Tanarak Plipat said although COVID-19 belongs to the same Coronavirus family as SARS or MERS, but each virus is different, just like an individual who possesses different qualities and characteristics.

How it affects the pattern of an outbreak depends largely on their distinctive qualities and their epidemiological capacities to “spread” and to “kill”, he said.

Compared with SARS (Severe Acute Respiratory Syndrome) which emerged and spread during 2002-3 and MERS (Middle East Respiratory Syndrome) which spread in 2014, the Coronavirus has a relatively lower mortality rate (1.4% here as estimated in March (3.4% worldwide by WHO), compared with around 10% of SARs and 3% of MERS).

But it has a higher transmission rate, with one person being able to infect two new persons on average, according to Dr.Tanarak who helps direct the COVID-19 Control strategic team of the department.

“It’s the nature of a newly emerging infectious disease that can cause such a pandemic, largely because it’s new and unprecedented.

“The problem with this virus is the fact that it can infect a number of people following its transmission capacity. As there are a great number of people falling ill because of the virus at the same time, the death rate may follow, as well as the needs for intensive care units and other public health measures,” said Dr. Tanarak.

Modern settings

It’s now widely accepted that social settings and functions in modern times have a role in contributing to the pattern of the virus’s outbreak.

Dr.Tanarak said the Coronavirus disease is in fact is not complicated, when compared with other critical diseases including HIV, which concerns social norms, stigma, and discrimination deeply.

Its infection risk increases as people tend to come into contact to one another easily following modern settlements and movements, something that cannot be easily controllable, he said.

To cope with such the unprecedented outbreak and challenge, the Public Health Ministry activated its Emergency Operations Center since the beginning, where epidemiologists and disease control officers keep tracing and investigating cases and formulating data to support policy making as well as public health interventions and other social supportive measures, including social distancing.

The initial strategy of the country since it was first hit by the virus was case screening and surveillance among the travellers from China, slowing down the transmission, and prolonging the “Phase 2” of the infections, a limited transmission phase, under which local cases can still be traceable. That had lasted until the country was hit by the first few cluster cases in mid March, when super spreading took place afterwards and the virus spread out of the city of Bangkok to upcountry.

Dr.Tanarak explained that epidemiologically, an outbreak can be dealt with in different levels depending on public health and disease control intervention capacities.

The first and most extreme scenario is eradication, under which the World Health Organization defines it as “permanent reduction to zero of the worldwide incident of infection”. Dr. Tanarak simply puts it; a disease wipe-off, like a case of smallpox, which was wiped off from the world since 1979.

The second scenario is elimination, which WHO addresses it as the reduction to zero of the incidence of disease or infection in a defined geographical area. And the last scenario is disease control which means a reduction in the incidence, prevalence, morbidity or mortality of an infectious disease to a locally acceptable level. 

The Coronavirus, Dr. Tanarak said, is mostly in a control period, under which countries are trying to put it under control.

He said he did not think countries are foreseeing eliminating or eradicating the virus. One critical factor is the fact that there are too many asymptomatic cases which are pretty much elusive in societies.

“Eradicating this disease is still much a theory,” said Dr. Tanarak.

Knowledgeable society

And there is a lot to do with modern social settings. 

To control this virus requires large-scale social interventions, something rarely seen in other diseases.

To date, countries infected with the virus have enforced different degrees of interventions, from specific restrictions to lockdown. These, in turn, have affected the economy, resulting in much more complicated situations for governments to deal with.

Dr. Tanarak said modern settings and functions are not wrong, and if people look into history, other pandemics such as Spanish Flu also had its own settings.

What is more critical is public awareness and a level of knowledge in society to keep up with a disease so that people are able to protect themselves from it in the first place.

“We have a saying that healthy society is knowledgeable society. Society that survives a disease is society that people have knowledge and understanding enough to know how to behave in times of an outbreak so that no one will have to enforce rules upon them to do or not to do things to be safe.

“And that social responsibility as a whole as well as collaboration will follow. For example, we don’t have to have anyone instruct us to work from home if we know why and how to do it.

“Unfortunately, one problem that we have in our society is we tend not to use knowledge to guide through a crisis, and I don’t know whether we don’t really know or we are just ignorant, careless, or arrogant.

The society that will survive and live on during this pandemic and every one can have a way out somehow is the society which is knowledgeable and collaborative,” said Dr Tanarak.

To be able to control the Coronavirus disease does not depend only on public health interventions, but also how people behave, Dr.Tanarak pointed.

Considering the current situation, it’s likely that the virus can resurge every time the guard is down or people become incautious.

Asked if this virus will be around for some long time, Dr. Tanarak said; “It’s possible… that it will be with us.”

So far, Thailand has literally finished the first round of the outbreak, as the number of new local cases dropped to zero yesterday.

The government has eased some restrictions from Sunday on, while instructing people to lead a “New Normal” way of living, with their guards still much remaining in place.

But only in the first few days of the easing of the restrictions, people have loosened their guards in many areas, flocking out for holidays and for alcohols, prompting worries among public health officials already that the virus will resurge sooner than expected.