Authors: Siriphan Sasat, Aree Sanee and Peter Lloyd-Sherlock
The evolution of the pandemic in Thailand up to early May 2020
The first reported case of Covid-19 in Thailand was in mid-January 2020: a 61-year-old woman returning from China. Later that month, the first confirmed case of community transmission was reported: a taxi driver who had frequent contact with foreign visitors. Initial restrictions on social contacts were quite limited and large gatherings were sometimes still permitted (including a Thai boxing stadium event on 6 March). This led to a rapid increase in the number of daily reported cases, which peaked at 188 on 22 March.
Since early March, a series of government measures have been rolled out, including bans on large gatherings for sporting events or other purposes and the closure of bars and restaurants. These measures coincided with a rapid fall in the numbers of reported daily infections. By 7 May the total number of reported cases stood at 3,004 and deaths attributed to Covid-19 at 56. In the light of this apparent success in keeping the pandemic in check, some lockdown measures are now being gradually relaxed.
Residential long-term care in Thailand before the pandemic
A detailed study on care homes in Bangkok, based on fieldwork conducted in 2019 is available here.
The study notes that there is no unified government register or list of care homes, which means that information about the sector is very limited and unsystematic. The city of Bangkok contains two government-run care homes, with a combined capacity of 350 people. These government homes operate to some extent as shelters for indigent older people and do not admit people with pre-existing functional impairments. A small number of care homes are also operated by NGOs and religious organisations. However, the care home sector is dominated by private for-profit providers. Some of these run expensive facilities comparable to those in high-income countries. But there is also evidence of rapidly growing numbers of more informal, small-scale facilities. According to local key informants:
“There are thousands of them. You can find them at every corner of Bangkok.” And “There are places set up by non-experts who lack professional knowledge… It’s unclear who is responsible for registration or control.”
Responsibility for care home regulation is divided across different government departments and there are no official standards or service guidelines for the sector. Private providers for-profit organisations are, theoretically, under the regulatory authority of the Ministry of Commerce for tax purposes. Draft guidelines have been developed by the Ministry of Public Health, but are yet to be made into law.
Pandemic preparations in care homes
The fieldwork, analysis and drafting of this paper were completed before the onset of the Covid-19 pandemic. Nevertheless, many of the findings have direct implications for responses to this new challenge in Thailand’s complex residential long-term care sector.
The limitations of state regulation and the absence of effective information and quality assurance systems have hampered the development of effective policy responses. Independently of the fieldwork conducted for this paper, in late April 2020 informal discussions were held with a small number of staff and directors in public and private residential facilities. In all private facilities, interviewees commented that no government guidance or advice for care homes had been made available to them. In the absence of guidance in Thai, several had resorted to translating guidance provided in English from the World Health Organisation and other sources. At the time of these interviews, private care home respondents reported there had been no specific contact with government agencies about the pandemic. In early May, the first set of official guidance was provided to government-run providers, but, to our knowledge, this has not been shared with NGOs or privately-run care homes.
In the absence of official guidance or support, the care homes we spoke to were taking matters into their own hands by adopting a number of emergency measures. Directors were acutely aware of how much the pandemic has affected care homes in high-income countries, where regulations, facilities and standards are generally much better.
Immediate responses have included, in some cases: improvements to hygiene, temperature screening, asking staff to move into the facility and to refrain from leaving, and postponing resident visits to hospitals and health centres. Respondents informed us that they had very little access to PPE or other protective equipment and that the situation was becoming increasingly tense and stressful for both the staff and for the residents.
To date, despite these concerns, there has not been a single reported case of Covid-19 infection in a care home anywhere in Thailand. There are, however, no grounds for complacency and it may well be just a matter of time until this situation quickly changes. As is true in many developing countries, past and ongoing policy neglect of residential LTC providers have left their residents and staff in an acutely vulnerable position
Note: The first Thai guidance for COVID -19 for care homes was released yesterday (12 May 2020). It is a collaboration between the Department of Health Service Support, Ministry of Public Health, and Department of Older Person, Ministry of Social Development and Human Security.