Questions/Answers

Since the first medical confirmation of the disease in 2019, the COVID-19 pandemic had global impacted every nation worldwide, including Thailand. In 2020, Thailand, there were a total of 6,884 infected cases and 61 fatalities by the end of 2020. When a new wave of pandemic struck in April 2021, the COVID-19 outbreak spread all over the country effected 19,205 died and 1,883,161 infected (the report of October 2021). During the second outbreak, the number of the infected case had suddenly increased. The infected case rose to more than 1,000 cases per day. Consequently, the government has temporally insufficient resources to provide the medical treatment for people. These need rapid adaptation to cope with disease and health hazards. The Department of Medical Services, as the secretary of National Committee on COVID-19 Medical Services assigned the Princess Mother National Institute on Drug Abuse Treatment, Thailand (PMNIDAT) to take part of the crisis solving. Actually, the main responsibility of the PMNIDAT focused on providing treatment services for people with alcohol and drug use disorder. However, when global, especially Thailand has been confronting with the COVID-19 outbreak. The PMNIDAT promptly responded for crisis situation. Consequently, the initiative on “From Drug Addict Mission to COVID-19 Crisis Alleviation" The initiative aims to provide emergency medical services for people with COVID-19 in Pathum Thani Province, Bangkok and Perimeter Area. The project focused on reducing mortality rate and preventing the further infection in those areas. PMNIDAT set up field hospital with 210 beds for mild symptoms, Cohort Ward with 33 beds for severe symptoms and 200 beds of Home Isolation Service for asymptomatic. The surveillance rapid response of PMNIDAT was impactful achievements in relieving COVID-19 crisis situation in communities. Number of patients and infected persons were equitable accessed to treatment in time.

PMNIDAT had to adjust its role to serve COVID-19 cases from both public sectors and its current drug-addict patients. In no time, having learned from medical experts, the center staffs were informed and able to care for patients. The facilities were adapted to suit the purpose of treating COVID-19 cases. For example, the training building was used as a field hospital, equipped with communication tools to constantly observe patients and arrange medications and supplies. Various technologies and schemes were developed to help patients access medical services, recover emotionally, reduce anxiety, provide an appropriate diet, and follow up after discharge.

PMNIDAT was the first among those under the Department of Medical Services to operate field hospital in the treatment of COVID-19 patients irrespective of gender, race, or nationality. PMNIDAT also helped other hospitals to be able to care for those with limitations, such as bedridden patients, disable patients, patients who are drug addicts, the physically challenged, and the dependent (SDGs 10). PMNIDAT had a total of 2,712 patients under its care. The case fatality rate was 0.3%, reflecting a drop in the mortality rate of those with COVID-19 complications (SDGs 3.4). The COVID-19 patients received prompt treatment and were under close surveillance of the doctors while they were on medications (SDGs 3.8).

The treatment system at PMNIDAT helped ease the COVID-19 crisis, paving way for preventive measures in the treatment of emerging diseases. The measures have been used in rehabilitation centers and hospitals and given rise to the so-called "new normal" medical services such as telemedicine, which relied on online consultation and postage. This reduced traffic and workload of the hospital, saving time and expenditure. In addition, manuals on standard operating procedures to combat epidemics were issued and distributed to field hospitals. A course on how to care for infected addicts was established, and the public was educated on the subject.

There was an establishment of working connections among different departments within PMNIDAT and those under the Department of Medical Services, as well as other private sectors. Advanced coaching and practicing with the medical experts, specifically on the topics related to serving COVID-19 patients, were provided to the PMNIDAT staffs. Standard operating procedures including "Before Action Review" and "After Action Review" were adopted to update on the situation, the standard of medical care provided, and the job responsibilities previously assigned. The procedures also allowed medical teams to act promptly in any case of unforeseen emergency.

The field hospital segregated patients according to the severity of the disease and gender. However, when an entire family was infected, the mother and her children would stay together. The bedridden and the caregiver, and transvestites, whom many would consider vulnerable, were also given a separate isolation area.

In the treatment system of COVID-19 patients, the target patients have been divided into three groups. (1) COVID-19-infected drug addicts who received both drug rehabilitation and COVID treatment.(2) The general public who received medical care and treatment from PMNIDAT, which included scheduled follow-up chest x-rays, tailored medications and diets according to their specific needs.(3) The healthcare providers who worked at PMNIDAT. They strictly observed the 3 P's safety measures, rotating their duties every 14 days to lessen their workload and reduce the risk of disease contact. This group received professional and healthcare benefits including food, accommodation, regular swab tests, hazard pay, and an advanced payment.

The operational guidelines for this task were set up by the board of COVID-19. They are as follows: (1) To set up a field hospital and home isolation care system in accordance with the 4Ps Safety (Patient, Personnel, People and Public) principles. (2) To appoint an expert to train the experienced staff. (3) To provide adequate quality PPE (personal protective equipment) in accordance with industry standards. (4) To design digital gadget in line with the provision of care and prevention of the COVID-19 as per the regulations of social distancing. For example, segregate working zones of the healthcare workers who are at risk of infection and the managerial officers. The lessons deemed as effective were recorded and passed down as guidelines or manuals to help the healthcare providers in taking care of COVID-19 patients. (5) The care of COVID-19 infected drug addicts was a challenge as they would demonstrate withdrawal symptoms, psychological complications, and anti-social behaviors, which also set limitations for the treatment of COVID-19. This group of patients thus required specialized treatments from experienced and expertised medical teams in order to be cured from the disease and the addiction. The drug-addict patients who have been cured of COVID-19 would continue through regular rehabilitation process to recover from the addiction. Patient confidentiality is maintained when taking history in case of relapse. (6) A follow-up on the cases that were discharged from the hospital after 7 and 14 days. This is to provide continuous care; it was observed that 89.75% did not demonstrate any sign of overstressed conditions or anxiety while only 10.25% still needed to medical consultation. (7) An "After Action Review" was performed for further planning on a day-to-day basis.

The major obstacle was the lack of the oxygen pipeline system. Commissioned to care for the rising number of COVID-19 patients, availability of the medical oxygen was the mainstay of the treatment. The tremendous rise in the number of cases at the time resulted in a critical shortage of oxygen supply. Initially, the institute struggled to meet the demand for oxygen supplies and had to resort to renting oxygen tanks from various foundations and private companies. While the oxygen pipeline system was being installed, the instituted successfully sought assistance and cooperation from other hospitals.

The PMNIDAT innovation is demonstrated through the managerial scheme which allowed for job responsibility adjustments of healthcare providers; the crews had previously focused mainly on tasks specified for a drug abuse treatment institute and later had to learn how to provide care for COVID-19 patients. The other hospitals under the Department of Medical Services came forward to help the patient and train the staff to be prepared in coping with a double task.

Drug addiction is a problem every country combats with, just like COVID-19. PMNIDAT is a drug abuse treatment institute that abides by the principle of national and international participation. When PMNIDAT has been assigned the responsibility to help with COVID-19 crisis, we thereby improvise the same principle in helping alleviate the problem.

To observe social distancing in the care of COVID-19 patients, PMNIDAT has set up a control center to monitor communication systems in a "new normal" way. For example, a method of telemedicine, where computer and online applications are used to follow up on patients after discharge, was widely adopted.

The increase in responsibilities at the PMNIDAT, a drug abuse treatment institute attending to COVID-19 patients, demanded cooperative integration of many departments and sectors. They were compelled to share information, seek and offer advice among themselves, and work together to initiate a holistic improvement in the service.The center became an exemplary hospital for the World Health Organization representatives to study in terms of its status as a primary treatment center for COVID-19, the system of which could be improvised and used effectively.

The care system at the PMNIDAT could be used as a paradigm in which different sectors integrate and, with the exchange of knowledge from experts from different fields, come together to resolve problems in the event of an emergency crisis. For example, problems like drug addiction, psychological let down, and the building of a hospital in a short span of time, which could be improvised in cases of calamities like fire, earthquake, et cetera. The idea of home isolation could be used in far-flung areas.

The PMNIDAT field hospital operated with the availability of the followings: 1) Institutional healthcare providers, such as doctors, nurses, pharmacists, medical technologists, social workers, psychologists, and nutritionists. 2) Medical tools and communication devices such as computers, surveillance cameras and handheld transceivers. 3) Transportation for hospital referral in order to receive prompt and timely effective treatment - follow up system to provide consultation and assistance thereafter - system to prevent and eradicate infection in the hospital - budget allotted for various tasks - funds for maintenance, repairs, and security

The keys to success include the followings: 1) Leadership: The head of the institute had the determination to put policy into timely action and managed to set up the field hospital within seven days. With other managerial techniques and evaluation to inspire healthcare providers to achieve the desired outcome. 2) Teamwork The effort of PMNIDAT staff to propel work policies of the Department of Medical Services towards obtaining the objective. 3) Patients were impressed with the moral support they received from a drug addict abuse treatment that is knowledgeable in treating patients physically and psychologically.

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As the spread of the COVID-19 infection is an ongoing public emergency, a formal measure to evaluate the situation is not yet available. Nevertheless, constant attempts were made to assess the work process. The Department of Medical Services has outlined the scheme for the management and treatment of COVID-19, "DMS, The Best for the Most in COVID-19", which includes a shift in the institute’s mission from addict abuse treatment to solving COVID-19 crisis. From the work process assessment, we have identified obstacles and ways to rectify them as well as acquired knowledge and opportunity to make ways for improvement.

From the result of the task: The case–fatality rate of 2712 COVID-19 patients that received treatment from April 22–October 12, 2021, was 0.3%. The satisfactory rate of COVID-19 patients was 91.63%. From the follow-up cases that have been discharged, 89.75% were not stressed and less anxious, and 10.25% had an issue to consult. Hotline numbers were available.

The assessment of the institute’s work process during the COVID-19 missions reflects that: (1) A good management system begins with an overview perspective from the highest executive, who possesses the skills and techniques in good interaction to incite the power of communication directly to the front-liners. So, they work towards the same mission in the same direction, aiming for a certain target. (2) The formation of an academic network under the supervision of an expert would reinforce the sense of security while carrying out any medical or non-medical task. (3) The front liners learnt how to treat, care for, and advise patients in a new normal way, resulting in a good outcome. (4) An effective risk reduction system is essential to protect patients from certain complications that are preventable. This could further improve the health care system of the respective institution. -Implementing safety measures to prevent the spread of infection to healthcare providers and patients -A comprehensive risk management system that can detect and report risks can prevent loss in the workplace to a satisfactory level.

(1) PMNIDAT is a government agency under the Ministry of Public Health's Department of Medical Services. It was commissioned to care for COVID-19 infected drug-addicts and general patients of the same disease. (2) Department of Medical Services supported COVID-19 specialists, medical practice guidelines, and the know-how of emergency management systems. (3) The National Health Security Office funded the care of COVID-19 patients and provided remote-controlled robots to help reduce direct physical contact with the patients, thereby protecting most medical workers. (4) Thanyarak regional hospitals actively participated in caring for COVID-19 patients at the Cohort ward. (5) Specialist hospitals received referral cases that beyond our capability. (6) The Police Department arranged for workforce to safeguard the premises. (7) The local government, Rangsit City Municipality, provided facilities such as mobile lavatories, tents, and beddings. (8) Private sectors including the Mirror Foundation, Siam Cement Group Company, DTAC Communication Company, and True Corporation, offered medical devices and communication tools while donation of food also came from the general public. In the prosecution of the task, meetings were held daily to evaluate the outcome, the problems encountered, and the obstacles that occurred, in order to rectify them and plan for the next day.

Several medical and healthcare organizations nationwide were involved in the amelioration of the COVID-19 crisis. The Department of Medical Services issued a policy to provide treatments for COVID-19 patients in general and drug addicts who are infected with the disease. The Department encouraged the building and extension of "field hospitals" and the arrangement of care system in the event of emergency physicians shortage. This brought about cooperation and coordination among various hospitals under the Department of Medical Services. The PMNIDAT successfully secured supports in the form of consultation and training from COVID-19 experts while the National Health Security Office provided funds needed for the treatment of COVID-19 patients, irrespective of race or nationality. Remote- controlled robots offered by the generosity of King Mongkut’s University of Technology additionally allowed the front-liners to effectively care for COVID-19 patients while reducing direct contact with them, minimizing the risk of contracting the infection.

1) A resilient management system that could timely adapt to various situations is essential to the country’s effective healthcare system. For example, medical personnel at the rehabilitation center are now equipped with knowledge and experiences needed to care for COVID-19 patients. (2) All resources must be used efficiently. When there was a shortage of frontline workforce, the institute sought help from other hospitals under the Department of Medical Services. An active disbursement system and the provision of medical necessities facilitated the prompt treatment provided to COVID-19 patients. In coordination with the Ruamkatanyu Rescue Foundation, an efficient referral system to specialist hospitals helped minimize the fatality rate. (3) Use of cutting-edge digital technology was the key to allow healthcare providers and patients to communicate quickly and effectively without having to maintain physical contact, reducing the risk of contracting the virus. (4) As the COVID-19 is an evolving infectious disease, arduous and continuous research on the subject must be carried out in order to provide healthcare workers with adequate, updated, and effective knowledge to combat the pandemic. (5) Cooperation from all sectors, governmental, private, as well as the general public, is crucial to the improvement of the situation.