Point of Entry Screening and Quarantine Systems Enabled Thailand to Control COVID-19

Based on an interview with Dr Rome Buathong, Division of Epidemiology and Division of International Communicable Diseases Control, Department of Disease Control, the Ministry of Public Health

Infectious disease outbreaks are complex emergencies that require clear thinking, precise communication, and coordinated responses. To save lives, many decisions must be made and programs must be urgently implemented, often with limited information. Among the key factors in Thailand’s successful response to the COVID-19 pandemic were the early implementation of screening systems at the country’s points of entry and the establishment of a highly effective quarantine system.   

On January 3, 2020, the Ministry of Public Health activated the Emergency Operations Center and instructed authorities at Suvarnabhumi International Airport to establish special screening points at arrival gates to detect possible cases of the newly emerged disease, referred to at the time as ‘mysterious pneumonia’. Passengers with a fever were flagged, isolated and sent to a state medical facility.

Dr. Rome Buathong, from the Division of Epidemiology and Division of International Communicable Disease Control at the Ministry of Public Health, was in charge of the airport screening process. “It was right after New Year. I can recall that other countries were not interested in the disease. Nobody else was screening passengers because they thought the outbreak was contained in Wuhan. We spent the whole holiday to prepare ourselves for serious actions after the holidays.”, Dr Rome told WHO Thailand.

Dr Rome was tasked with establishing a thermal scanning system to screen arriving passengers. “The point is, how can we detect passengers with very low fever? The thermo scanners have always been scrutinized if they are able to detect anything. Many airports have thermo scanners, but they don’t know how to apply proper protocols. That is why we needed to set up new protocols specifically for this”, Dr. Rome explained. He supervised the installation of thermal screening systems in the nation’s airports and a protocol for managing febrile travelers that were detected by this system.

The first case detected on January 8th had a body temperature of 38.1 Celsius, cold-like symptoms and a runny nose. She was later transferred to Bamrasnaradura Institute of Infectious Diseases and a respiratory specimen was sent to Chulalongkorn Hospital, where Dr. Supaporn Watcharapluesadee, the Deputy Director, conducted genomic sequencing that identified a bat SARS-like coronavirus. The specimen was then sent to the Department of Medical Sciences for whole-genome sequencing. After receiving confirmation from Wuhan University that this was the same virus circulating there, Thailand announced the first confirmed case outside Wuhan on January 13th.  Once Thailand began detecting imported cases, regional countries became interested and the screening protocol was shared. As of 10th December 2020, international points of entry in Thailand have screened a total of 7,440,709 passengers. Out of the total number, there are 3,646 patients under investigation (PUI).

March was the peak month of the pandemic in Thailand and quarantine officials worked day and night as frontline workers to screen incoming passengers at the airports. Infection prevention was crucial at the airport. “Febrile travelers should not be allowed to enter the ‘clean zones’ such as the Immigrations and Customs area, because transmission of the virus could occur and cause other areas, passengers, and authorities to be contaminated. Therefore, establishing zones in the airport was essential. We couldn’t allow the airport itself to become an outbreak area”, Dr. Rome said. Despite having this protocol in place, some passengers did not  always cooperate. For example, some did not accurately disclose their travel history or negotiated that they were feeling well and should be released because they wanted to travel in Thailand and not quarantined at a hospital.

The Ministry of Public Health used an analogy of three layers of strainers in the efforts to detect cases. The airport quarantine and screening functions as the first layer, which may be able to filter some cases while some slip through. The second layer is the hospitals which has a higher capacity and more comprehensive measures of detection. Last but not least is the community level – the finest level of filtration. “No matter what system we have in place, the village health volunteers (VHV) are the best. They know the community inside-out and even keep a roster of who’s been in and out of their village”, Dr Rome said.

Besides the port health quarantine, Thailand also urgently developed a highly effective quarantine system known as State Quarantine, Local Quarantine and Alternative State Quarantine, where Thai returnees and other visitors are tested twice for SARS-CoV-2. Mandatory quarantine has proven to be a powerful prevention measure as many imported cases continue to be detected in the quarantine facilities. As of 10th December 2020, 1,181 cases had tested positive during their quarantine period.

To the visitor, the screening and quarantine process appear straightforward, but it required a great deal of coordination between different government ministries and several pieces of legislation to set up the system. For example, the Ministries of Foreign Affairs, Transport, Public Health, Interior and Defense all contribute to the effort. Dr Rome commented that the Emergency Decree is an essential tool as it facilitates an integrated single command for the Quarantine-Immigrations-Customs (QIC) process. The Emergency Operations Center at Suvarnabhumi Airport is supervised by the Defense Ministry, which acts as the incident commander. Without the Emergency Decree, each Ministry would be working separately, leading to confusion and inefficiency.

Dr Rome aspires to sustain Thailand’s screening and quarantine procedures beyond the COVID-19 pandemic to help Thailand prevent and manage future infectious disease outbreaks. All screening at points of entry facilities should be adequately staffed and funded, and operate under the same standards. Thailand’s experience with the COVID-19 pandemic will help prepare it to continue to safeguard the public’s health in the future.

The story is originally published on WHO Thailand website.