Thailand's Covid-19 Crisis: A Tale in Two Parts

Abstract

Thailand's Covid-19 Crisis:A Tale in Two Parts Gregory V. Raymond (bio) By October 2021, Thailand had recorded over 17,000 deaths from Covid-19, and its target to have 70% of the public double-vaccinated was still months away.1 Like other countries, Thailand's Covid-19 story has had many chapters with twists, turns, and setbacks on the journey to "return to normal," and the myriad individual experiences of hardship and suffering among its most economically vulnerable populations will probably never be told. Partly because of its high reliance on tourism, Thailand—the second-largest economy in Southeast Asia and one of the more prosperous states there—will likely emerge from the pandemic as one of the worst-hit regional states by Covid-19. The Health Impact and Response to Covid-19 in Thailand Covid-19's health impact in Thailand was initially mild but changed dramatically in 2021. In fact, 2020 and 2021 offer a tale in two halves: the first showing the strength of Thailand's healthcare and disease-prevention infrastructure, and the second revealing weakness in planning for worst-case scenarios. Before the pandemic, the Johns Hopkins University rated Thailand as sixth in the world on pandemic preparedness.2 Over several decades, Thailand has created a decentralized health administration system that is capable of acting locally with autonomy, flexibility, and—due to prior experience of epidemics such as Severe Acute Respiratory Syndrome (SARS) and avian flu—effectiveness. When Covid-19 reached Thailand in January 2020, the system needed no direction from the national government. At the village level, Thailand's 1.04 million well-trained village health volunteers [End Page 10] swung into action, each reaching out to their ten to fifteen assigned households with relevant information on the virus.3 These volunteers managed close-contact cases, monitored individuals in quarantine, and manned checkpoints. At the municipal level, local governments also acted ahead of the national government, inviting local civil society groups to bid for funds in support of health projects, such as those that taught citizens to make masks and alcohol-based sanitizer and trained high school students in hygiene.4 These measures, together with restricting inbound international travel, bringing patients into facilities rather than keeping them at home, and closing all but essential businesses, were effective in containing the initial strain of the virus. By the end of September 2020, Thailand could claim that after 3,559 cases and 59 deaths, the only infected people were those who remained in quarantine.5 Tedros Ghebreyesus, director-general of the World Health Organization, was impressed, stating that, "Thailand's response to Covid-19 offers a powerful example of how investment in public health and all-of-society engagement can control outbreaks of deadly diseases, protect people's health, and allow economies to continue functioning."6 Sadly, this success in 2020—built on effective contact tracing, community compliance, and comprehensive social distancing measures—was not sufficient to arrest the spread of new variants of Covid-19 that emerged in 2021. Thailand experienced reasonable success in containing its second wave of Covid-19, which started at the end of 2020 among migrant workers at a seafood market in the province of Samut Sakhon on the outskirts of Bangkok. But with the third wave, which started in April 2021, the country entered a more desperate and dangerous struggle against Covid-19. This wave began its spread from the Krystal Club, an upscale nightclub frequented by politicians and diplomats. It thus initially spread among Thailand's elite, and soon there was a marked increase in daily cases and deaths.7 By May, Thailand was experiencing [End Page 11] five thousand new cases a day, as many as it had experienced in the whole of November 2020.8 The more infectious Alpha strain initially fueled the April 2021 surge, and its spread puzzled Thai virologists, who wondered how community transmission had occurred despite Thailand's border controls, quarantine system, and testing protocols.9 But worse was to come, because the even more infectious Delta strain was detected in Thailand by June.10 By July, Delta was the dominant variant in the country, with new cases reaching over ten...