Questions/Answers

The first case of Middle East Respiratory Syndrome (MERS-CoV) was found in June 2015, arrived Thailand by plane from Oman and 176 passengers, cabin crews, taxi driver, hotel receptionist and maids were identified for follow-up from contact the patient. The outbreak led to widespread panic and fear of the impact of the disease. The Ministry of Public Health had to prevent the spread of the disease to the public and stop the epidemic as quickly as possible. In Thailand, there are many types of organizations some structure independent from each other particularly private sector and difference chain of command so there were many complications to follow up all close contact cases such as finding taxi registration numbers from The Department of Transportation, patients’ details from hospitals, communication with patients about treatment, many steps for accessing to a private location such as hotel, apartment, private hospital etc. More complicated tracking for patient care when patient were denied treatment. Contact cases did not want to be quarantined because of loss of employment and related stress. Therefore, the collaboration of all related agencies is important for accomplishment in outbreak suppression such as hospitals, CCTV installation agencies, taxi driver cooperatives and other health agencies. Several agencies including The Thai Royal Police, Bangkok Metropolitan Authority, Airports of Thailand, immigration police, mosques and embassies can help track of relatives and families and contact cases to successfully stop the MERS-CoV virus epidemic for keep people healthy and better quality of life.

The objectives for MERS-CoV virus outbreak stopping are as follows: 1) create a network organization and promote cooperation in surveillance decision-making to control the spread of the MERS-CoV virus. 2) Promote communication to create knowledge and understanding for disease prevention and control 3) People are safe from communicable diseases. 4) Reduce anxiety, panic and fear from the severity of disease to improve people's quality of life. 5) Build trust and confidence in public health for international tourists.

The successful control of the MER-CoV infection in Thailand has been achieved by cooperation between the government, private sector, public and other organizations that are a cooperative organization to monitor, report, prevent, and control the disease. It is difficult to design a system and make decisions on a close contact follow up system because of the multifaceted factors such as difference languages, communication difficulties to understand, but the success of disease control has come from the collaboration between many network organizations such as embassies, religious leaders, airport officials, health control. Airlines provide seating maps. The rapid data reporting system Royal Thai Police Department of Land Transport involved taxi tracking. Hotels and hospitals in Bangkok participated in the preparation of detention facilities and followed up the symptoms of voluntary exposure.

According to the Communicable Disease Act BE 2558, MERS-CoV is a pestilential disease that is 1 of 12 dangerous communicable diseases. The prevention and control of infectious diseases in normal conditions can’t use to effectively control disease. The stage agency that is responsible for health care needs to control the disease not to spread the infection to the community quickly, it is to find out what the disease is and then to monitor the symptoms of all affected people. The key to the success of the mission is to be coordinated, involved in the thinking and decision-making of all sectors. It also promotes people's knowledge, doesn’t discriminate and motivates society to show responsibility for its role in disease prevention and control. In addition to this, the need to point out to the public to see that violence and losses may occur as a result of the disease, for example, outbreaks in South Korea. This approach can effectively control the disease. It can build the confidence of Thailand in economics and tourism. No decline in people's deaths from MERS-CoV in Thailand in line with the United Nations Sustainable Development Goal 3 Good Health and Well Being 3.3 Ending epidemic of disease.

The approach to addressing the epidemic is to encourage the public and the community to have knowledge, understanding and participation, and to strengthen the disease surveillance system. Public health officers must provide opportunities for people to express their views and solve problems encountered in the course of time in a timely manner, by modifying the methods or plans that are appropriate for the religion and culture of the community. Religious leaders and community volunteers built a network organization to engage in the operation requiring trust, commitment and a good relationship with each other. Continuous monitoring will make surveillance of dangerous contagious diseases more effective. Systematic management and provision of emergency response teams is essential to address service issues including the use of the Communicable Disease Act 2558 is required. The case of Thailand has promulgated the Communicable Disease Act BE 2558 to protect people from the spread of serious infectious diseases that could affect people's health. MERS-CoV disease is 1 out of 12 infectious diseases.*As required by law.

Thailand’s first case of MERS-CoV created great anxiety, panic and fear of an epidemic. The gathering of resources and networks for follow-up was initiated when the Department of Disease Control was notified of suspected cases of MERS from a hospital. The Institute for Urban Disease Control and Prevention open the emergency response system meeting with hospital networks, hotels, the airports of Thailand, quarantine officials and airlines to follow up on MERS patients. Hospitals and hotels are provided with detention facilities to treat those who have a fever and report daily information with cleaning information and wearing protective devices. Airport prepare a special airport parking lot for airlines traveling from the Middle East, Royal Thai Police and Land Transport Department cooperated by providing information and tracking taxis that transported the patient. Prime Minister supported budget for follow up that carried out patient care. This follow-up was coordinated with the embassy to track foreign visitors by following Thai visitors and measuring for fever every day and coordinated with regional agencies to follow Thai contacts who returned to their home and Islamic organizations by follow the Thai people who traveled to Umrah in the Middle East.

The mission to follow MER-CoV in close contact is the innovative process of “Medical and Public health”. The system can be used to follow close contact of the MER-CoV virus quickly. This surveillance system can stop spreading the virus to another area and to ensure the people are not illness with MERS-CoV in Thailand. The project in Thailand in line with the United Nations Sustainable Development Goal 3 Good Health and Well Being 3.3 Ending epidemic of disease.

This project was launched for the first time in Thailand and applied from the Ebola surveillance system. Consistent with the mission of the “Health Systems Reform” of Thailand, that means “Development and Pastoral Care for Sustainable Healthy Systems. Thailand can stop outbreaks of MER-CoV because we have cooperation from all networks.

Resources, such as finance 1) Budget of Institute for Urban Disease Control and Prevention (IUDC) were used to supply equipment 2) Budget of Bureau of Epidemiology for laboratory confirmation 3) Government budget for emergency response 4) Budget from donations. Human resource from hotel staff, police, hospital staff and IUDC staffs. We can save budget of medical and public health. Thailand has a policy to promote tourism. We can reduce the revenue from tourism by about US$1 million.

Yes

To stop MER-CoV outbreaks with the power of participation we have transferred to other agencies under of the Department of Disease Control, Ministry of Public Health, through “Show & Share Symposium”. The knowledge such as “How to screen travelers from risk area”, guidelines to contact for high risk MER-CoV close contact, communicate with patients and high risk close contact cases. The project has won The Government Service Development Award in 2017. The practice transfer to networks such as Bangkok Metropolitan and Office of Disease Prevention and Control 1st – 12th for applied and implementation to control emergency infectious disease followed the Communicable Disease Act B.E. 2558 (A.D. 2015)

Social Dimension: Most cases of Middle East Respiratory Syndrome (MERS) were found in Middle East region. The Hajj and Umrah are religious pilgrimages to Mecca, Saudi Arabia. Islamic religious doctrine dictates that every able-bodied adult Muslim who can afford to do so is required to make Hajj at least once in his or her lifetime. That led to collaborate with Islamic religious leader networks for surveillance prevention and control disease by taking the vaccinate, to educated and consult their members and to follow up cases. Economic Dimension: Tourist arrivals in Thailand averaged more than 20 million in each year. If Thailand have MERS case report will affect to travel and tourism receipts. Effective of Emergency Operations Center (EOC) development can decrease time period to follow the risk target group and contact case. Environmental Dimension: To building a Quarantine Center is one of public health policy in Thailand. This place builds for quarantine close contact cases of dangerous communicable disease prevention to transmissible to other persons. They plan to build the quarantine center like as the 3 stars hotel. They will have got comfortable and feel relaxing when stay at this center.

Surveillance and controlling the MERS-CoV disease system was continuously developed. There are many networks such as universities, private hospitals, and government organizations. They practice the Emergency Response Plan with Airports of Thailand Public Company Limited, Airlines, organization of Disaster Prevention and Mitigation, Bamrasnaradura Infectious Diseases Institute and district offices. They are brainstorming to set up an Incident Action Plan (IAP) system for international airports in Thailand. From this model, there were no disease outbreaks or diseases spreading to other people and decreased during time to follow up contact cases from 12 days to 7 days. This operational model requirement put in a standard operation process manual for controlling dangerous communicable diseases of the Department of Disease Control, Ministry of Public Health, Thailand. However, Thailand has a COMMUNICABLE DISEASES ACT, B.E. 2558 (2015) for prevention of people from a serious communicable disease which can spread rapidly to others and MERS-CoV is one of dangerous communicable diseases by law.

Yes

They have evaluated the effectiveness of private networks for surveillance prevention and control of MERS-CoV. This model has been corporate from many networks such as private sector, government sector and civil society sector that they operated tracking patient contact cases and follow cases until the complete incubation period both of active and passive methods. Active method by home visits to investigate cases and passive methods by for asking for their symptoms and collecting the data every day. Thailand’s first MERS-CoV case was in June 2015 and had 176 contact cases and 14 high risk contact cases on a plane to track that they can complete to follow up until all of them had departed from Thailand. The result was found the key to success are collaborating from all relevant sectors. It can decrease the tracking time from 12 days to 7 days and there was no MERS-CoV outbreak or not have MERS-CoV case in the second generation.

Creating a cooperated network is an important factor which helps to prevent and control MERS-CoV outbreaks. From this disease outbreak scenario model, the Thai government may have to restrict travel for foreigners who are at risk and that may affect trust and confidence in public health, the economy and tourism in Thailand and could potentially have an economic impact of over 103 million US$. Thailand can prevent and control the disease without any new cases occurring in the area through communication to achieve knowledge and understanding the prevention and control of MERS-CoV disease effectively. People will be safe from dangerous diseases with no anxiety or fear to have a better quality of life. The cost of tracking for one contact case is around US$605 and if this contact is not monitored and the patient is ill, the average medical expense will exceed US$ 22,000.

Indicators used to evaluate the outcome and impact from the “Stop MER-CoV project” included 100 percent of all patients and close contacts that received follow up and monitoring the symptoms until the incubation period was complete and the government agreed to return. Thailand can stop MER-CoV, we can protect people from fear and anxiety. This project can build trust and confidence in public health, the economy and tourism in Thailand. Stop MER-CoV project is consistent with the “Sustainable Development Goals: SDGs” of United Nations, goal 3 Health and Wellbeing.

The Institute for Urban Disease Control and Prevention has set up guidelines to stop the outbreak of MERS-CoV Disease by establishing an “Emergency Operation Center”, to coordinate the search, collect patients and all contact information for follow-up and monitoring the fever every day until the incubation period has ended. According to the Communicable Disease Act BE 2558, officials can plan and provide budget for compensation, including detainees and staff costs. The process of creating a collaborative close contact follow up networks by encouraging co-operation, monitoring and reporting of information, as the following Communicating network coordinated by providing accurate information to the public and the media. The Department of Health, Bangkok Metropolitan coordinated by finding out who the exposed persons were. The Health Control coordinated by screening travelers from infected areas with information reports. The Embassy coordinated by following travelers who evaded the authorities. The Private Sector or Hotel entrepreneurs coordinated by promote prevention of infection and transmission to others. If suspects reported information to local authorities, Airports of Thailand coordinated by arranging aircraft landing areas, especially flights from countries that are at risk. Airlines coordinated by informing the passenger seat information for the purpose of isolating high risk and low risk groups. Government Hospitals and Private Hospitals coordinated by setting up screening points for disease and extra channels to prevent transmission in the hospital. Drug Stores coordinated by the pharmacists need to collect and report information from travelers in the Middle East who come to buy medication to treat themselves with suspected MERS-CoV symptoms. Religious leaders coordinated by providing knowledge about how to prevent infection by monitoring fever and symptoms. Health Volunteer in the community coordinated by following in communities with travelers that came fro

Operation teams must have knowledge about MERS-CoV. The guidelines stopped a MERS-CoV outbreak and understood the culture of living the lives of patients and contact tracking. The team must have the ability to use language to communicate with the target group in order to agree and cooperate with staff. The cooperation with the embassy will help with any problems with language. The single command operating system makes the operation very flexible. Cooperation from all sectors, people and public health volunteers helped the patients and contact tracking to control the disease. Law enforcement is an excellent tool for dealing with those who do not wish to cooperate. The system follow-up and evaluation must be clear and continuous to rapidly solve the problem. The concept of development focus on creating networks to participate, think, make decisions in new perspectives, resource integration, link data between agencies is based on the needs of the people, don’t discrimination, to extend access to public service and keep people to better quality of life.