This is how testing for Corona virus is done in Thailand

[jasonsamui55]

Note: this is reposted sticking to facts and where there are opinions, making It more clear that they are my opinions.
 

I have to say that Thailand's policy is utterly ridiculous and I have a very hard time believing they have only 40 cases. It is my opinion that it is much more than that.

 

My wife and children and myself are all foreigners.  We live in a villa in Samui and have a Thai maid who comes to the house every day from 7 until 3.

 

Today the Thai maid came to the house and she was coughing up a lung, her face all red and she said she had a bad fever.  She was wearing a cheap face mask.

 

I told her, using Google translate app as its how we usually communicate anything more detailed than hello and thank you and goodbye, that I am very concerned about the virus and don't want to any chances whatsoever with two young children. It's more important that my kids stay healthy than my dishes get washed and laundry cleaned.

 

I told her to go home, urgently and immediately, and go to the hospital.  I specifically told her to tell the doctor to test her for corona virus and to draw blood and send it to the lab in Bangkok and to stay at home 3 or 4 days until she gets the results, and to not come back to work until she has a certificate of clean health specifically saying she doesn't have the corona virus.
 

So she went to the one public hospital on Samui that can do such testing. She says the doctor asked her if she had traveled to China, HK, Macau, Korea, Japan, Taiwan, the usual suspects.  Of course she said no as she has no money or need for such travels, so the doctor refused to draw the blood to test her.  He sent her home and said she had nothing to worry about.
 

Are you kidding me?  Is this the way things are done in Thailand in the midst of a global pandemic crisis?  Isn't it obvious that one doesn't need to visit those countries to get the virus, especially when 50% of the people walking around this island have originated from or recently been to infected countries.  It’s already here. 3/4th of everybody on Samui is a foreigner and typically has to exit the country every 30 or 90 days.  Wasn’t the first case in Thailand a taxi driver who fought it from driving around Chinese passengers?

 

It is my opinion that there are many more than 40 cases of this is how testing is done here. Feel free to draw your one conclusions.

 

And I think the Thai government is utterly incapable of doing anything about it, and even if they ever grew the brains or balls enough to block a few potential tourists, it's already way too late.  When the rest of the world has been blocking chinese arrivals for 3-4 weeks now, Thailand still hasn't done a damned thing about it. As you can see here https://www.iatatravelcentre.com/international-travel-document-news/1580226297.htm?fbclid=IwAR11pF3UlcxMokiUlwUftMAzHagFe6x1j-gXIx5OZFu3-vazdN5aaR6ko88 , pretty much every country in the world has some sort of travel restrictions on international arrivals, usually from China, but Thailand has none against any country.  Its still a very open door to all.  Incidentally, as you can see on that website, 9 countries now have blocks or quarantines in place against people who have recently come from or visited Thailand.

 

At least China, love it or hate it for its type of government, can actually issue commands from the top down and they are effectively implemented all the way down to the street level and almost immediately.  That's what an authoritative government can do.  In Thailand, whether its a dictatorship or junta or whatever you want to call it, nobody listens to the leaders. They just issue commands from the top and everyone else shrugs them off or ignores them.  This country is about the closest thing one can get to the natural state of anarchy as possible.  Nothing is done about edicts issued from Bangkok, especially in far flung provinces or locations like Samui.

 

But, back to the maid, I thought to myself if the maid is already sick she’ll either die or get better, as those are the only two possible outcomes, so I told her go home and stay home for a few weeks, with salary, until she has no more fever and no more cough. I don't know what else I can do.  I want to be nice to her and protective of her job, especially since she has admirably cleaned up after my kids for a few years now, but I am not going to allow my kids health to be jeopardized also.

Edited February 27, 2020 by jasonsamui55

[Sheryl]

The test (which is not a blood test, by the way, but rather a test of nasal secretions or sputum) is extremely expensive  and very time consuming to perform and it is an utter impossibility to test everyone with flu-like symptoms.

 

Now I agree that the Thai government's criteria are too tight, but no where outside of maybe the epicenter of Wuhan would someone with your maid's symptoms warrant such a test based on that alone. Usual criteria are either a clinically diagnosed viral pneumonia without other known cause (i.e negative for influenza) or flu-like symptoms in a person who has had known exposure to the virus or travelled to an area where the virus is prevalent.

 

The entire health system would crash under the weight of trying to test everyone with flu like symptoms for corona, and it would divert resources away from more important tasks. Especially since there is no particular treatment indicated in the >80% of cases that are mild, and infection precautions are the same as for the flu.

 

Coronavirus does not appear to have any higher mortality than ordinary influenza, which you would also not want your children to get, so keeping them away from anyone with her symptoms makes sense but not because of corona per se (which it is extremely unlikely this woman has).

 

By the way children are the one group of people who seem largely immune to COVID-19.  There have been extremely few cases even among children closely exposed to known cases. The reason for this is not yet understood.

[uhuh]

6 hours ago, Sheryl said:

 

Coronavirus does not appear to have any higher mortality than ordinary influenza

https://en.m.wikipedia.org/wiki/List_of_human_disease_case_fatality_rates

 

Less than 0.1% of people who get influenza A will die from it

3.4 % of people who get Corona virus will die from it

 

We are told that in developed countries it wil certainly be less than these 3.4%

In Lombardy, one of the richest parts of Italy, 9 persons out of 300 died.  That is 3%.

 

 

[WaveHunter]

A new study published in the journal Radiology that I read about in both Science Daily, and also in RSNA (Radiological Society News) compares Chest CT scans with RT-PCR screening (which seems to be the standard protocol right now), and the findings are that CT provides a better diagnosis of Covid-19 than PCR screening.

 

Articles about the study, entitled, "CT provides best diagnosis of Covid-19" can read in Scince News here:  https://www.sciencedaily.com/releases/2020/02/200226151951.htm

 

And in RSNA News here:

https://www.rsna.org/en/news/2020/February/COVID-19-CT-Diagnosis-Study

 

 Basically the study introduction states:

According to the latest guidelines published by the Chinese government, the diagnosis of COVID-19 must be confirmed by reverse-transcription polymerase chain reaction (RT-PCR) or gene sequencing for respiratory or blood specimens, as the key indicator for hospitalization.

 

Correct me if I'm wrong, but I assume this is the same standard used around the world, including here in Thailand, as well as in the United States.

 

The introduction goes on to state:

...However, with limitations of sample collection and transportation, as well as kit performance, the total positive rate of RT-PCR for throat swab samples has been reported to be about 30% to 60% at initial presentation. ...

 

In the RSNA News article, they said that the study from China shows that chest CT scans demonstrates a better sensitivity than the RT-PCR test looking for the actual PCR of the virus (RT-PCR technique).

 

According to the study of over 1,000 patients in Wuhan, Chest CT actually outperformed RT-PCR. (see the RSNA article)

 

The study found that in patients with negative RT-PCR results, 75% (308 of 412 patients) had positive chest CT findings.  Of these, 38% were considered as highly likely cases, with 33% as highly probable bases.

 

What resulted out of that was that 81% of patients with negative RT-PCR results but positive chest CT scans were reclassified as highly likely or probable cases of COVID-19. 

 

I suppose this is what accounted for the huge spike in reported cases that happened a couple of weeks ago in Wuhan.

 

Recent research (click link) found that sensitivity of CT scans for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71%

 

HOW THIS HITS HOME HERE IN THAILAND
I think a perfect case in point of the inadequacy of the PCR test that this study found, is what happened in Bangkok this week with the man that was admitted to BK Hospital and lied about having just returned from Hokkaido in Japan, which is a location of active community infection. 

 

Though he was finally confirmed as positive for the virus this past Monday, for the previous three days he continued to lie about being on Hokkaido Island, so health care workers and other patients were potentially exposed to the virus during this time, and BK Hospital is not at all set up to deal with highly infectious diseases such as COVID-19.  

 

Even though the 30 or so medical workers were tested and results were negative by PCR screening, considering that the total positive rate PCR throat swab screening has been reported to be about 30% to 60% accurate at initial presentation, correct me if I'm wrong but I don't think this is a good indicator that these health workers are truly virus free at all.  BTW, they are currently in self-quarantine. 

 

Besides the fact that 30 health care workers are at risk, even more importantly, all the people that those health care workers came in contact with may also be at risk, and it's going to take a long time to trace them down and test them.  In the meantime, many of them can all be shedding the virus to the general public.

 

The time factor and accuracy of testing is a huge risk.

 

So, "chest CT may be a more reliable, practical, and rapid method to diagnose and assess COVID-19, especially in epidemic areas", according to the authors. 

 

 

Edited February 28, 2020 by WaveHunter

[samsensam]

12 hours ago, uhuh said:

https://en.m.wikipedia.org/wiki/List_of_human_disease_case_fatality_rates

 

Less than 0.1% of people who get influenza A will die from it

3.4 % of people who get Corona virus will die from it

 

We are told that in developed countries it wil certainly be less than these 3.4%

In Lombardy, one of the richest parts of Italy, 9 persons out of 300 died.  That is 3%.

 

 

 

possibly refer to more reputable and reliable news source than wikipedia and a larger sample to draw generalised conclusions, the fatality rate reportedly currently stands at 2% at the epicenter and less than that elsewhere.

 

https://www.theguardian.com/world/2020/feb/27/what-is-coronavirus-symptoms-wuhan-china-pandemic-spread-covid-19

[WaveHunter]

31 minutes ago, samsensam said:

 

possibly refer to more reputable and reliable news source than wikipedia and a larger sample to draw generalised conclusions, the fatality rate reportedly currently stands at 2% at the epicenter and less than that elsewhere.

 

https://www.theguardian.com/world/2020/feb/27/what-is-coronavirus-symptoms-wuhan-china-pandemic-spread-covid-19

Not only that, but in reality, case fatality rate really can not even be quantified with COVID-19 until the epidemic has ended.  You can't merely divide # of confirmed cases by # of deaths due to lag time of incubation period. 

 

A better indication would be number of serious cases in relation to confirmed cases which is the Serious Complication Rate (SCR) because that is what will predict when the healthcare system will be overwhelmed.  THAT is what the real concern is.

 

The SCR for COVID-19 is estimated to be around 20%. It doesn't take a math whiz to figure out how serious that could be if the the number of confirmed cases continues to grow.

 

When there are no longer enough ICU beds for those who need them, the death rate (whatever it turns out to actually be) will escalate dramatically, not due to the virus itself, but rather the inability to treat seriously ill patients requiring ICU care.

 

And you have to remember that most country's healthcare systems are only designed to accommodate known existing illnesses.  Healthcare capabilities are not designed for a major pandemic, if it turns out that this is what we're dealing with.

Edited February 28, 2020 by WaveHunter

[Sheryl]

2 hours ago, samsensam said:

 

possibly refer to more reputable and reliable news source than wikipedia and a larger sample to draw generalised conclusions, the fatality rate reportedly currently stands at 2% at the epicenter and less than that elsewhere.

 

https://www.theguardian.com/world/2020/feb/27/what-is-coronavirus-symptoms-wuhan-china-pandemic-spread-covid-19

 

Correct. Around 0.7% elsewhere in China (i.e. outside Hubei, the epicenter). And these rates will likely drop further when there is a more complete tally on numbers infected including those asymptomatic or minimally symptomatic.

 

 

[Maestro]

Removed a troll post.