Post-lockdown roadmap takes shape

NOTHING TO SEE HERE: A man sits alone on a bench in Siam Square, a popular shopping district in Bangkok which has become almost empty since lockdown measures were ramped up to prevent the spread of Covid-19.

Experts are weighing in with opinions on how the country should move forward after the government signalled its intention to begin easing restrictions on movement and businesses at the end of this month if the number of coronavirus cases continues to fall.

On April 3, the government imposed a nationwide curfew, banning people from leaving home between 10pm and 4am until the end of the month, in an effort to control the spread of the disease. On Friday, Centre for Covid-19 Situation Administration (CCSA) spokesman Taweesilp Visanuyothin said the government in coming days will discuss allowing some businesses, for example, barbers, mobile phone and appliance shops, general stores and banks, to reopen, albeit with special measures in place.

However, talk of lifting the lockdown has raised concerns over the possibility of a new wave of infections after Singapore last week reported a fresh surge in locally transmitted cases. Many are asking what steps Thailand should take to mitigate against this happening.

STRATEGIC TESTING UNDER WAY

Speaking with the Foreign Correspondents' Club of Thailand (FCCT) on Friday about how Thailand is tackling Covid-19, Tanarak Plipat, the deputy director-general of the Disease Control Department, answered calls for the scaling up of testing for coronavirus among the general population.

"I am not saying that we are not going to do the tests, but I am trying to tell you we want to test where we can find cases. We want to test [areas] strategically," he said.

Dr Tanarak said the reopening of the country will come in tandem with the strategic testing of three groups of people in the 44 provinces that have not reported cases for the last 14 days.

"We have to look for cases of pneumonia and influenza-like illness. If there are any clusters, we are going to test the local population. If we find positive cases, we are going to test the larger population as well. The other group is a certain number of walk-in patients who miss certain criteria for testing. We want to test some of them to see how many we have missed," he said.

However, Dr Tanarak said testing will focus more on the eight provinces that have recorded the most infections, including Bangkok, Phuket, Chon Buri, Chiang Mai and four others in the deep South.

"If we have new cases coming in and see clusters, we will expand our testing in those targeted areas. For example, if we know there is a cluster of coronavirus-like illness in a department store and patients test positive, we may test everybody in the area to know the extent of the outbreak. We also plan to do sentinel surveillance among patients with coronavirus-like illness," he said.

When asked about when and how to lift the lockdown, Dr Tanarak said the government will take into account the number of coronavirus cases and trends.

"The 44 provinces which have not reported any cases in the last 14 days may start to relax rules. High-risk establishments may reopen later. When we relax the social measures, we will step up public health, literacy and personal hygiene initiatives.

"We will keep everybody informed and encourage these activities; for example, working from home and leaving home only when necessary. People should keep in mind that it is not a good time to go out and hang around in crowded places," he said.

The limited availability of testing kits has also heightened fears of a post-lockdown breakout due to patients with mild symptoms and asymptomatic carriers.

Dr Tanarak agreed with the possibility but said testing everybody today does not guarantee they will not be infected tomorrow.

"In theory, if you want to find all the infected people, you have to test everybody, every day, for 14 days. I don't think any country can do that. However, doing extensive testing helps, although it does not guarantee [anything]," he said.

Dr Tanarak said authorities are hoping that an antibody test can enhance screening capacity at an affordable price.

"Although it may say much about the current prevalence of the disease, it will give us a rough idea of what happened and how many people have been infected in the country.

"At the moment, we are working with several labs to develop the antibody test. As yet, none have been approved commercially. But I would like to ensure that even for the research scale, if it shows high validity and reliability, we are going to use it," he said.

When asked about pool testing in which samples are combined and examined together, Dr Tanarak warned there is a risk of dilution affecting the amount of virus that can be detected.

"If your testing procedure is not really good, you can miss positive results. However, we now having a sensitive test and pooling samples to see whether it works or not," he said.

While 40% of Thai research institutions are now working towards developing a vaccine, Dr Tanarak said favipiravir has shown some efficacy in treating patients, but it must be administered at an early stage.

"Doctors at Bamrasnaradura Infectious Disease Institute compared the results of those treated with favipiravir against those treated differently. They observed that patients given favipiravir had a shorter duration of fever and viral shedding," he said.

THREE KEYS TO TAKE CONTROL

Khate Sripratak, cardiologist and president of the Chest Disease Institute's medical staff organisation, said it is still unknown when effective vaccines for Covid-19 will be developed. However, the three keys to getting the outbreak under control consist of quick detection, quick medication and personal protection.

"In 2009, we saw an outbreak of severe flu, but we were able to control it. We learned that people survive as long as we are able to test early and treat aggressively. These steps lessen the death rate," the doctor said.

He said the government must look for ways to make sure that favipiravir, which is the only effective drug for treating Covid-19, is on hand to treat patients as soon as possible.

"However, citing limited supply as a reason not to start therapy with the drug until after a patient has developed pneumonia has proven not to be of clinical benefit," he said.

"The government must find a greater supply."

But it is people themselves who remain the key, Dr Khate said: "People must still wear face masks and remember to keep social distancing, washing hands often and maintaining sanitary habits.

"Each lockdown costs all of us time and money. Therefore, before easing the measures, the government must make sure it has an effective and feasible plan.

"Otherwise, the infections and deaths will rise and we will have to start the lockdown all over again, and people's confidence will plunge."

ADAPTING TO A NEW NORMAL

Meanwhile, Anunchai Assawamakin, a pharmacology lecturer at Mahidol University's Faculty of Pharmacy and adviser to the Minister of Public Health, said the public and private sectors should come up with a new model to ensure social distancing in the aftermath of the lockdown.

"They should assess risks and readiness for disease control in every activity. For example, restaurants and fitness centres may have to reduce the number of customers and divide staff into two separate groups. However, boxing gyms, gambling dens, entertainment venues and pubs should suspend services for now. Public health inspectors should be on duty to make sure people don't break the rules," he said.

At the same time, medical personnel cannot let their guard down, believes Mr Anunchai, who warns that hospitals must ramp up their efficiency in testing every case and tracing every contact.

"They should provide specific areas for those under observation and with mild symptoms to reserve patient beds for severe cases. They should also improve RT-PCR [reverse transcription-polymerase chain reaction] and rapid tests to prepare for any new wave of infections. Therefore, local healthcare systems should be well-equipped to monitor and treat their own cases," he said.

Mr Anunchai said the government should ease restrictions province by province in line with zoning -- red, yellow, and green -- depending on the scale of infections in certain areas.

"Although yellow zones with sporadic and traceable infections can relax controls, green zones with new infections can still be re-marked as red spots. Accordingly, communities should work with governors and public health officials to reduce the risk of relapse."

Meanwhile, Viroj Na Ranong, research director at the Thailand Development Research Institute, said the development of an effective vaccine may take more than two years and that wait may transform our lives dramatically. Among those changes will be the growth of digital technology which allows people to work from home and do business online.

"Despite concerns over access to new technology, many Thais have been able to register online for the Chim Shop Chai campaign and the coronavirus cash handout. In the next two years, demand for smartphones will increase and push the growth of 5G. The government should promote this sector and ensure public access at affordable prices. It will also pave the way for distance learning," he said.

However, Mr Viroj said the transitional period will see a decline in the tourism industry because foreigners and locals will travel less.

"Social distancing requires businesses to adapt and shoulder higher financial costs, for example, airlines, public transport and restaurants may be forced to discontinue or resize. The government should consider providing subsidies to affected businesses."