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Is Chiang Mai ready? Infectious disease expert gives some answers

Citylife has been trying to interview Dr. Romanee Chaiwarith, M.D. head of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University for about six months. She is a busy woman. We had heard that she is a Dr. House of Chiang Mai and is renowned and internationally respected for her works with infectious diseases. She had been one of our dream interviews for a long time. But we never expected to HAVE to talk to her.

As news of the coronavirus hit earlier this year we stepped up efforts to interview her, but perfectly understand why she was always too busy. Thankfully we got in touch with her today and she kindly passed us on to infectious disease specialist Dr. Poramed Winichakoon at Maharaj Nakorn Chiang Mai Hospital who took some precious time to answer questions from us and our readers.

Citylife: Dr. Poramed, can you tell us who is doing what to combat this crisis here in Chiang Mai?

Dr. Poramed: At the top is the Prime Minister and the government who are setting policies. Then there is the Public Health Office in Bangkok which gathers information from public health offices nationwide. Here, the Chiang Mai Public Health Office (CMPHO) is in control of coordination between all parties, from hospitals – private and public – to airports and enforcement through to communications. Our Infectious Disease unit, however, are advisors who help supply information and knowledge and support so that those policies can be set.

As to our Maharaj Chiang Mai Hospital, at the top are our dean and director who order policies and we infectious disease experts are their consultants [Ed. find out more about the 60 year history of this excellent hospital in this Citylife article published in February].

Our department has been around for many years and have had a lot of experience with infectious diseases from MARS and the 2009 flu to Ebola. There are doctors here from many disciplines, not just infectious diseases, as when a crisis hits we need to know who to call upon and how to work together. So we have many areas of knowledge, we have pharmacists, we have technicians and of course nurses.

Citylife: Can you tell us about the beginning of when you first heard about this virus.

Dr. Poramed: We were first alerted to this virus which caused pneumonia in December. At the time there were around 40 patients in Wuhan. Immediately we were alerted, as were other teams such as ours nationwide, at the same time as Airports of Thailand (AOT) was, and we all began to prepare.

Citylife: What did you do and when?

Dr. Poramed: Initially we simply initiated our old policies. We started immediately by preparing personnel, retraining, going over procedures, getting our knowledge up to date. We then did a full stock check and went over our procedures over and over, reminding ourselves how to dress, how to act, what to do. It has been a while since MERS so we really focused on our own training. We also began to tweak old procedures as more information came in so that we were responding to this situation in a flexible and focused way. Now we have multiple guidelines and policies in place for all eventualities. It is this knowledge which we pass on to other health care providers, hospitals, government bodies, and the public.

Citylife: Right now the official number for coronavirus cases in Chiang Mai, according to the CMPHO is one person infected. Surely that can’t be right. Do you know how many people are being tested and tell us where and how to get tests?

Dr. Poramed: All information has to come from the CMPHO and if they say that there is one case here in Chiang Mai then that is what I have to say. But as to testing, according to CMPHO policy, all suspected cases in Chiang Mai are to be tested in a separate building at Nakornping Hospital on the Mae Rim Road – the only place officially to test. As far as I know over 300 people have been tested. These are all paid for by the CMPHO and only to suspected cases recommended by physicians. So if you want to test yourself without a doctor’s recommendation then you must pay for it at a private hospital, I have no details on this. All hospitals and doctors have been given as much information as possible by us as to what to look out for and what symptoms a patient must have to recommend them for testing. Patients are being screened nationwide. Every patient who comes through our Maharaj Hospital is screened by doctors who are looking for at-risk people. There is the Upper Respiratory Tract Infection Clinic which has been set up specifically to screen (not test) people who have flus or colds. If anyone is suspected of having coronavirus then they are sent for the test at Nakornping Hospital. As to people who have travelled to high-risk destinations or who may have been exposed to the virus, we have the Nimman Chutima Building which is a dedicated evaluation centre for this group of at-risk people. This is also the building dedicated to quarantines.

Citylife: So what has your team been working on?

Dr. Poramed: Apart from preparing ourselves and working with others to help them prepare themselves, we have also been setting up these two units I mentioned. Then there is treatment.

Citylife: You mean the one patient so far?

Dr. Poramed: [Laughs].

Citylife: If this goes to the worse case scenario, will we be ready?

Dr. Poramed: Hospital beds, personnel and equipment are all being prepared. We have plans for all eventualities. But at this point the messaging is coming from the Bangkok Public Health Office and the aim is not to cause panic so as not to see a rush of people hoarding supplies which could be crucial at a later date.

Now all hands on deck. The treatment team is also ready with many experts. Main jobs now are policy preparation and treatment. For us, it is all about levelling the curve so we can manage resources if and when the time comes.

Citylife: You are obviously limited in what you can tell me, so what can you say to our readers?

Dr. Poramed: I would like to answer your question about what resources we have in terms of personnel, hospital beds, oxygen tanks, etc. But our director of hospital has just said that we will be releasing that information imminently, so I had better not say anything about that here. However, I do want to tell people to be sensible. Don’t panic, there is no use in panicking or hoarding. Thailand is not unprepared. But please just be sensible. Avoid crowds, avoid travelling to at-risk places, and keep washing your hands, all the time! Social distancing and hygiene are the two most important things to be aware of. Right now our strategy is to draw this out for as long as possible so we have a long time to spread our resources out for as many patients as possible. There is also hope that there will be a vaccine at some point. So if we can keep this contained, then it is controllable.