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Case study: Thailand had the world's first coronavirus case outside China - Disaster avoided

Thailand had the world's first coronavirus case outside China.

Here's how it avoided disaster.

Thailand is emerging as another success story in the COVID-19 pandemic.

Source ABC News by SE Asia correspondent Amy Bainbridge and Supattra Vimonsuknopparat

At the time, there was intense speculation the virus could ravage South-East Asia. But Thailand — along with Laos, Cambodia, Myanmar and Vietnam — have all had low case numbers despite dense populations and many direct flights to China.

Tanarak Plipat, who is the deputy-director general of the Department of Disease Control and has been at the forefront of Thailand's response to the coronavirus, says the country was considered high risk because of travel from China.

"Put it this way, we know that there were a lot of travellers from China — especially from Hubei Province and at the beginning of the epidemic," Dr Plipat told the ABC. "They thought we were the highest-risk country because of how many tourists from Hubei province travel to Thailand."

An army of volunteers helped with Thailand's success.

In March, Thailand declared a state of emergency. People were told to stay indoors and curfews were put in place. Businesses were ordered to close and there was a growing nervousness about what lay ahead with the fast-spreading virus.

But instead of locking herself indoors, health volunteer Aksorn Boosamsai went to visit neighbours in Klong Toey — the largest slum in the centre of Bangkok.

"I was scared ... but I think helping the community is one of my duties," the 52-year-old told the ABC.

Mrs Boosamsai is a Village Health volunteer, an army of predominantly female, community-minded workers with basic medical training.

While they are frequently called upon outside of pandemics, the strength of the volunteers has proven to be valuable amid the spread of COVID-19.

They have helped triage cases, sending people with symptoms to medical clinics for testing, and dispelled rumours and misinformation about coronavirus.

"During the peak in March and April, I went to visit the community every day," Mrs Boosamsai told the ABC, adding she first made sure to take precautions against being infected.

"I gave them food, masks, hand gel and taught the villagers how to wash their hands," she said. The volunteers are an important part of an impressive suite of measures that Thailand has drawn upon to keep confirmed COVID-19 cases to just over 3,000.

There have only been 58 deaths so far from the virus.

Among other things, the team of mostly women were responsible for helping to enforce quarantine when people travelled between provinces or back from overseas.

They also visited areas considered vulnerable to outbreaks — including jails, border communities and migrant communities — and provided important public health information in local communities.

James Wise, a former Australian ambassador to the country and author of Thailand: History, Politics and the Rule of Law, said the Village Health volunteers were "enormously important".

"The key factor is they were well prepared for it," Mr Wise said.

"[The volunteers] work closely with the local communities and then once coronavirus comes along you've got an army of foot soldiers who can be quickly briefed on the coronavirus and then can go out into the communities, spread information, dispel misinformation and check people's symptoms. And that's what they did."

How coronavirus first emerged in Thailand

Thailand's initial response was not textbook perfect.

As the virus quickly spread in Wuhan, Thailand did not at first block international flights. The first case arrived in Thailand on January 8.

The country has about 13 million Chinese tourists a year, and early on some citizens on social media accused the Government of putting tourism profits ahead of public health.

There was also outrage after a major muay Thai match at Bangkok's indoor Lumpini Stadium on March 6 led to more than 100 coronavirus cases.

And there was also confusion around the availability of masks, quarantine measures and the specifics of lockdown restrictions.

"They are minor missteps if you have a look at the statistics," Mr Wise said.

"Thailand has still done very well when it comes to the health side of things. I think the missteps have not been all that serious."

Cultural factors and lessons from SARS key to successful strategy

What has helped Thailand manage well so far is it has drawn on systems that have been developed and refined after experiences with SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome).

Those systems include sophisticated airport screening and a large network of highly trained health professionals across the country.

"[It's] so many things, not just one thing," Dr Plipat said.

The first of those key measures involved the Communicable Disease Control Unit, which is made up of about 1,000 teams distributed all over the country, including about 100 teams that can investigate dangerous pathogens.

"We called those teams in to make sure they were alert," Dr Plipat said.

"The second thing we were able to do very quickly was ... call in again all the hospital staff from every province to make sure they knew how they could detect cases and how they could prevent outbreaks in the hospitals.

"When we activate our system, everybody knows what to do."

Dr Plipat said there was also "very good collaboration" from Thai people, who all pitched in, took precautions and followed the advice of health officials.

Mr Wise added Thailand's excellent public health system proved its strength and cultural factors also helped.

"Thais are pretty quick if they're feeling unwell, or think they're going to be exposed to people who are unwell, they immediately put on a mask," Mr Wise said.

"There are some more general things as well. When [Thai people] greet each other, they don't shake hands, they don't kiss. [Instead] they bring their hands together in front of their face and bow gently.

"So it's almost built-in social distancing in the way that they go about their normal lives."

Experts wary of underestimating impact of virus

However, Dr Plipat said he was extremely cautious not to celebrate any success too soon.

"We are still very cautious and the Prime Minister himself also said this," he said.

"We all know this virus can cause very minor symptoms and some of them [people infected] might not have any symptoms at all."

Dr Plipat said the aim for health officials now was to maintain active surveillance of the virus.

That includes trying to identify anyone who might have COVID-19, even those who have minor symptoms.

A big part of this strategy is testing. "Currently we test more than 7,000 per day, or a little more than 50,000 per week," Dr Plipat said.

"To me, I think that is a reasonable amount of testing we perform, although some might want us to do even more."

"I think we will plan to do surveillance as best we can."

Along with maintaining active surveillance, the economic recovery is set to be difficult.

Mr Wise says while Thailand has managed to deal well with the health crisis, the Government, like those everywhere, is "going to be vulnerable to criticism" when it comes to rebuilding the economy.

"It's very hard to get this right," he said.

The Thai Government has announced a range of packages to stimulate the economy.

With the virus causing severe stress and strain on society, many people have lost their jobs.

There will also be challenges ahead for the Village Health volunteers. Some are already receiving training on how to detect people whose mental health is suffering, and to refer them on to experts for treatment.

With the difficult period ahead, Mrs Boosamsai will be there to help.

"I am glad that I am a part of giving knowledge to the community to protect themselves, and to help my country, even it is not a big part, only in my community," she said.

"I feel proud that I am a part of helping the country and Thai people."

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