Community-based isolation a solution for managing healthcare challenge

Two-thirds of the nearly 10,000 new daily cases reported in Thailand are concentrated in the region. The influx of patients at hospitals has left medical professionals and health workers fatigued. Hospital beds are fully occupied, forcing new patients to wait longer to be admitted. Some patients have even died at home, unable to obtain hospital care.

We are genuinely sorry about their loss and feel the suffering of people who have had to deal with illness and death in the last one and a half years.

But we also believe that there is light at the end of the tunnel. We see the solidarity of people who have put in great effort to help and comfort others. Many have come up with solutions to fill the gaps in the health system.

One of the solutions that we recognise is the collaboration among multi-stakeholders in Bangkok to initiate "Home Isolation" and "Community Isolation" programmes.

This involves individuals, local communities, civil society groups and hospital operators providing care and assistance to Covid-19 patients with mild symptoms. The programme helps patients reach out to physicians or medical staff via video calls, medical devices and medicine delivery services.

The programme not only helps prevent the spread of the coronavirus, especially in households having several members living together in a limited space, it also helps reduce crowding at hospitals, allowing medical staff to focus on critical cases.

This idea has not come out of the blue. It is based on data and the communities' observation of the high prevalence of mild-symptom patients among those who tested positive.

As of June 4, around 19,430 hospital beds in the Bangkok metropolitan region were occupied by Covid-19 patients. Only 65 of those were critical cases. Bed occupancy increased to more than 29,000 in early July, with around 1,140 severe cases, after the highly contagious Delta variant spread throughout the region.

These numbers show that hospital beds are largely occupied by patients with mild symptoms, many of whom don't require to be admitted to a hospital. They can recover at home if they can get rest and take medicines properly. In addition, health experts have found that the ratio of patients with mild, moderate, and severe symptoms is at 80:15:5.

Aware of this data, Rajavithi Hospital, for example, piloted home isolation care for 18 patients last month. Doctors closely monitored them via video calls. Hospital staff delivered medicines and meals to their homes every day. Most of them have recovered now, proving that home isolation is possible and effective if we can ensure a good monitoring system.

On the other hand, community isolation is a collective approach in which local communities turn communal buildings such as temples and community halls into isolation facilities.

The Institute of HIV Research and Innovation (IHRI) is a frontline organisation that helps many local communities in Bangkok manage the facilities and set up a patient monitoring system, in collaboration with non-governmental organisations such as Human Settlement Foundation and Duang Prateep Foundation.

The IHRI staff has trained community leaders to look for high-risk persons, distinguish the severity levels of Covid-19 patients, and provide them proper care. Equipped with knowledge, each community leader has formed a Covid-19 working group and transferred that knowledge to the group members.

The IHRI team has also connected this working group with medical staff at Piyavate Hospital, whose staff dispatch mobile X-ray vehicles and medicines to the communities. Physicians from the hospital arrange video conferences with patients once every three days.

If their condition worsens, hospital staff will send an ambulance to pick them up and transfer them to a hospital facility to get intensive care.

Community isolation is a bottom-up solution that empowers local communities to fight the pandemic, while ensuring healthcare access to Covid-19 patients amid the tight healthcare resources.

Its success is recognised by the Public Health Ministry, the NHSO and the Bangkok Metropolitan Administration, and has been adopted at the policy level.

From July 12, asymptomatic and patients with mild symptoms in Bangkok will be placed in home or community isolation under close monitoring of medical staff from hospitals or community clinics partnering the NHSO.

There are 204 clinics located across Bangkok. Each can look after 200 patients. Meanwhile, the community isolation model is in the process of expanding into 23 communities across the capital.

The NHSO will cover expenses of medical services and provisions given to Covid-19 patients under this programme, including RT-PCR and rapid antigen tests, laboratory service, patient transfer, mobile chest X-ray service, daily meals, medical devices, and personal protective equipment for medical staff.

On behalf of the NHSO, I want to thank all parties involved in creating this community-based solution to fill the gap in Bangkok's health system that serves more than 10 million people.

I want to emphasise that this programme does not leave patients to their fate at home. It helps patients get faster access to physicians, treatment, and medicines via virtual consultation and home delivery services. It is much better than leaving patients in uncertainty while waiting days and nights for hospital beds.

In the time of crisis, we see the strength of all stakeholders in the health system. We will engage them, empower them and trust them. As long as we collaborate, we should be able to get through the crisis together.