Medical staff take care of a severe case in one hospital in the city. Credit: DMS

Widespread Covid-19 community infection detected as ICU beds in Bangkok near limits

Senior medical experts from leading hospitals and medical institutes have stepped out to warn the public as well as the government via their FB pages to take serious action against the spread of Covid-19 in the capital now as the infection pattern is shifting towards community transmission_or face the fourth wave of the outbreak

The worrying infection trend has been observed among the experts from Siriraj Hospital, Chulalongkorn Hospital, as well as the Royal College Physicians of Thailand for a week or so and they have agreed on the shifting pattern of new daily infection cases, which is suggesting widespread community transmissions especially in Bangkok and its peripheries, the epicentre of the third wave of Covid-19 infection. Some have started to call this the fourth wave.

According to Assoc. Prof. Dr. Nitipat Jiarakul, chief of Siriraj Hospital’s Division of Respiratory Disease and Tuberculosis and President of the Thoracic Society of Thailand under Royal Patronage, new daily infections cases from local transmissions have been climbing up over the past week or so and this is accounted for 10% increase from the previous week.

Besides infections among children, which clinically suggest community transmissions, the elderly or people with chronic diseases are also among the infected patients, which again suggest the same infection pattern. As the number of these groups of patients has accumulated, it has, in turn, placed a burden on medical capacity, which has become stretched so thin to the point of breaking down.

The noted doctor conceded that the situation especially in state hospitals has reached the ceiling of the medical capacity as medical staff cannot stretch their hands to take care of more incoming patients with severe symptoms any further. Medical facilities such as ICU beds and ventilators are also running out.

“If we allow more severe cases to occur, we may have to turn some hospital space or room, which does not fit for taking care of them to receive them, but that could mean compromises in treatment for both Covid-19 patients and patients with other diseases in hospitals. And without up-to-standard treatment, transmission risks among medical staff and other patients could arise as a result,” said Dr. Nitipat.

Medical staff take care of a severe case in one hospital in the city. Credit: DMS

Dr. Nitipat contributed the shifting trend of Covid-19 infection in the capital to the Delta variant and ineffective control of the spread of the virus among labours in the city as they work in a number of businesses in the city from small to large industry and are regularly in contact with communities.

Clin.Prof. Adune Ratanawichitrasin, deputy head of the Communications Unit of the same hospital has observed a similar trend as he plotted the graph back to last month and learned that over the past week or so the new daily cases from local transmissions have been climbing up, in addition to the stably high active case finding cases.

What is worrying about this is the fact that cases from active case finding mean they were immediately detected and separated from others in the same communities, thus reducing the chances of further infections. However, the local transmission cases were generally reported by hospitals, meaning patients may not have realised they had been infected with the virus and may have spread it to others in their communities already, the doctor pointed.

The doctor projected that the number would rapidly increase over the next four or seven days, which are the incubation period of the virus.

“ I must say that the trend is worrying as the number of cases has not shown any decline yet while we are having more cases coming in. This will add the pressure to our existing medical capacity, which has already been stretched thin as hardly ICU beds left to take severe cases,” said Dr. Adune, who made a plea to the government to look into the issue immediately before it’s too late.

Credit: RCPT’s President AM Dr. Anutra Chittinandana

RCPT’s President AM Dr. Anutra Chittinandana, who has also plotted the graph and observed a similar trend, said he was particularly concerned about severe cases because they indicate death rates and the medical capacity, under which patients with severe symptoms generally need extensive medical care and staff.

According to Dr. Anutra, Covid-19 severe cases and those relying on ventilators during the third wave had increased around three times and four times respectively over the two weeks after Song Kran long holiday before remaining steady for a while. But over the past ten days, the number of severe cases has been climbing up from around 1,200 to 1500, and those with ventilators over 400, suggesting the full capacity of the devices.

Medical staff, on the other hand, have reached their capacity limit and could hardly extend their hands to take more patients with severe symptoms, the doctor said.

So, he warned the public members to protect themselves at best not to be infected with the virus because finding ICU beds could become problematic by now if falling severely ill.

“It’s a marathon game. We have no idea who would get out of the game first; doctors or patients. Or if there is no break during the game by a commentator, maybe both of us would pass out,” said Dr. Anutra.

His institute earlier issued a warning on the government’s plan to reopen the country within the next 120 days following concern about the situation.

According to the statement, the institute pointed directly to the stably high number of severe cases in hospitals, which it said could collapse the medical capacity if there were the fourth wave of the outbreak and more infectious variants brought in from overseas following the reopening of the country.

So, it requested the government to come up with effective and practical disease control measures to ensure disease control capacity to deal with the future spread of the virus.

Covid-19 vaccines are being administered to the target groups at Bang Sue Grand Station. Credit: Public Health Ministry

It also recommended proactive case finding be in place as well as swift restrictions if needed. Law enforcement, it further recommended, must be proceeded strictly to ensure disease control effectiveness especially against risky activities including labour smuggling, gambling, and others.

The government must come up with efficient vaccine acquirement and distribution to ensure transparency. This must not fall under any political intervention or influence, it stressed. The government, it suggested, must give more importance to disease control than economic revival and should come up with concrete measures to receive visitors.

Last but not least, this kind of policy should be reviewed before the deadline arrives, the RCPT called for.

Read: PM sets to reopen the country within 120 days despite hurdles in vaccine deliveries and distribution

Dr. Thiravat Hemachudha, head of the Thai Red Cross Emerging Infectious Diseases Health Science Centre at Chulalongkorn Hospital, wrote in his regular column, Mor Hunsa last week, saying the reopening of the country would be the country’s turning point.

He shared his similar observations that hospitals and ICU beds were fully filled with severe cases already. Up to 20% of new daily infection cases would need to receive treatment in hospital, and this was the number that should get serious consideration, he pointed.

The more severe cases increase in hospital, the much further high number of cases outside hospitals is. And this, he added, helped assess the medical capacity the country has nationwide whether it is ready to receive cases.

Makeshift Emergency Room in upcountry. Credit: Public Health Ministry

 ICU beds near limits

According to the Medical Services Department, the number of new daily infection cases in Bangkok and its peripheries has continuously increased beyond 1,000 for more than two months, resulting in accumulated cases in hospitals, especially those relying on ventilators (the Red List).

As of Monday, 409 beds for patients in the Red List (those relying on ventilators) have been occupied, leaving only around 20 available. Meanwhile, 3,937 patients with moderate and severe symptoms (the Yellow List) have also been occupying beds, leaving only around 300 available, revealed Dr. Somsak Arksilp, the department’s Director-General.

“Following the situation, under which our beds are running out while new cases keep increasing every day, the medical capacity in the city and its peripheries is seriously worrying,” said Dr. Somsak, who added his department would try at best to address the issue.

Dr. Taweesin Visanuyothin, the spokesperson of the Center for COVID-19 Situation Administration (CCSA), said during the press briefing yesterday that the CCSA had discussed the situation and learned about the trend.

It had also learned about the doctors’ recommendations but at this point, it has opted for the specific focus of  “Bubble and Seal” measure to control the spread of the disease as it has to take effects on workers and further transmissions into account in case that workers have to leave infected work areas.

The CCSA, he added, has been working on medical facilities limits with the Bangkok Metropolitan Administration to address the problem and would work more closely with private hospitals to try to increase the medical capacity. A few approaches could be case transfers out of hospitals among some existing mild or moderate cases (the Green list) to enable more space for severe cases, expansion of existing facilities, and others said Dr. Taweesin.

The number of new daily infection cases over the week remain stably high, surpassing 3,000 and 4,000 alternately, and severe cases beyond 1,500. As of today, the new daily infection cases is reported at 4,108 while severe cases are at 1,564.

Dr. Nitipat suggested the government lockdown Bangkok for seven days and prohibit movements of people out of Bangkok to clear the backlog and prevent further transmissions. Even so, he said, the measure could not yet guarantee that the problem would immediately be resolved as it would take some time before taking effect.