Covid-19 blog 15th May May 15, 2020

While many countries are still struggling with the pandemic and strict lock down measures, here in Thailand things appear to be well under control. For over a week now there has been zero to 6 new cases a day, most of whom are repatriated Thais in state quarantine facilities. Lock down rules are being relaxed and traffic jams definitely coming back. New research data are coming out all the time as scientists scramble to find effective treatment and vaccines. Anything with the slightest promise is seized by the media and the public only to be dismissed as false hope. Some early misconceptions about the virus and the disease are having to be revised, cautiously or even reluctantly.

Hydroxychloroquine, remdesivir, and other treatments and cures

Hydroxychloroquine has now been firmly dismissed as a treatment for Covid-19 by the medical community. However if you are a Fox News audience they are still touting it as cure that is being suppressed shadowy dark state figures working with evil Big Pharma. Remdesivir is an experimental antiviral drug related to effective HIV-AIDS treatments and has received emergency approval for use in treating Covid in the US. Data from China has not confirmed its effectiveness however. Even if it does work the effect appears to be small. Meanwhile the president of Madagascar has a herbal cure for Covid that he is selling to other African countries but no-one in the West is taking him seriously.

Children as super-spreaders

One of the earliest measures adopted by many countries to fight Covid was to close schools as children are believed to be potentially super-spreaders of the virus. Children are more likely to show minimal or even no symptom when they catch Covid and it was believed children would bring the virus home from school and infect the rests of the family. This was a reasonable assumptions as children certainly are prone to spreading the common cold and the seasonal flu to their families but there has never been a Covid cluster that was centred around schools. Surveillance and testing data from countries that have carried out extensive testing in children have shown that not only do children suffer much less when they catch Covid, they are for some unknown reason, much more resistant to catching Covid in the first place. A recent article in the British Medical Journal suggests that earlier opening of schools would not have the impact on the disease spreading as was previously thought and that the risk and benefit of keeping schools closed need to be reassessed.

BCG vaccine as Covid prevention

The tuberculosis vaccine or BCG is a routine vaccine in many Asian countries and it was suggested that recipients of this vaccine could have more resistance to catching Covid as the vaccine boosts immune system function. The use of this vaccine in Western countries has been declining for decades now as there are increasing doubts about its effectiveness in preventing tuberculosis. The Americans have never liked this vaccine and US citizens are routinely advised against receiving this vaccine any where, except under certain very rare circumstances. In any case, recent data has  not confirmed that the BCG helps prevent Covid.

Masks or no Masks?

Most countries now advise or require the wearing of masks in public areas but some, most notably the UK, are still not advising it. The reasons cited were (a) that according to the WHO, there was no evidence that that masks prevent the spread of the virus (b) wearing masks could produce a false sense of security and (c) with limited supply, masks should be reserved for health care workers.
This is where scientific language can be misinterpreted. There may be no research data that proves that wearing masks prevents Covid but this is because there has been no proper research done. There is no proof that masks don’t work either.

Covid-19 blog 29th April April 29, 2020

Time to take care of your mental health

The Health Ministry continues to broadcast video update on the Covid situation in Thailand daily. The spokesman who is a doctor, is developing a bit of a fan club for his jovial, optimistic tone. In the last week or so he has been looking even more smug as the numbers are improving. In the last week, new confirmed cases were initially 13 to 15 a day. In the last 2 days there were less than 10 new cases in a day. There was a blip 3 days ago when 50 new cases were found but 40 of them were all detained illegal immigrants at a detention centre in the south. Fatal cases have ranged from 0 to 2 a day in the last week. There are so few deaths the spokesperson has been able to go into detail about each fatal case and they were all elderly people with coexisting health issues. The reason for the very low Covid mortality rate in Thailand is that the majority of cases are among relatively young people.
Can we trust these numbers? Since not that many people have been tested, the real numbers must be higher, but is unlikely be any where near the levels seen in Europe and America. Hospitals in Thailand are functioning as normal with no big surge of admissions and the morgues are not any more full than normal. Other east and south east Asian countries are also showing similar trends of having passed the peak of the crisis. We are all apprehensive about a second wave but  countries like China and South Korea that got on top of things weeks ago seem to be staying on top of things. Lockdown is being eased cautiously in several countries in the region and in New Zealand. In Bangkok  shops are due to open again in a few days, schools not for a while yet. In Bangkok if you had been able to step out, it doesn’t look much like there’s a  lockdown going on at all. There’s a lot of traffic, not the normal bumper to bumper jam but still a lot. Minibuses are crammed with people. Supermarkets are busy and there’s not much social distancing going on, although everyone wear masks and get checked for fever.
Over all I think there are grounds for optimism here in Thailand. The economy is ravaged, but the people are not.

What isn’t being talked about much in Thailand, although there has been warnings in other country, is the mental health impact of Covid-19. There is a serious stigma attached to mental illness in Thai society such that no-one wants to talk about it or acknowledge it. Other countries are reporting rising incidence of depression, domestic abuse, suicide related to the pandemic. Not a peep in Thailand. It is almost as if Thai people are magically immune to mental illness.

I have no idea what is happening outside of my own experience but I can say for sure that there has been a big spike in strange troubling symptoms among children who have come to see me and others who have consulted remotely. These symptoms do not fall into any pattern of common childhood illnesses. Sleep disturbance, sleeping too much, complaints of tiredness, loss of appetite (or increased fussiness with food?), emotional outburst, toileting issues, accidental injuries from inappropriate activities are just some of the things I have been seeing, from toddlers to pre-teens. In nearly all cases, there is nothing to find on physical examination. Indeed many of these children appear joyful when they come to the clinic. What they all have in common is that they have not left the house/apartment at at all for several weeks, and they all have stressed and anxious parents. Children tend to pick up on parental anxieties, and coupled with lack of physical exercise over prolonged period can lead to symptoms which cannot be explained by physical findings. Children are not good at bottling things up like adults and can exhibit physical symptoms from mental stress. Fortunately children are relatively resilient and there distressing symptoms can be ameliorated by parental action, no need for anxiolytics or antidepressant medications. They just need to get out and play, and be surrounded by more positive attitude at home. But how can parents achieve a more positive attitude as worldwide cases approach 3 million with fearful death tolls in America and Europe?

Let’s imagine that here in Thailand cases are under-reported by, 10 to 1. Instead of the official figure of only 300 active cases in the country, there are 3000. That puts your chance of coming across one infected person in Bangkok, a city of 7 million, at roughly 1 in 3000, if all cases are in Bangkok, and not spread out in the country of over 50 million population. If you find yourself in close proximity with 3000 people in a day, may be just 1 of them could have Covid. And what is the likely consequence of you or your child catching Covid? Unless you are old or have serious health problems, full recovery is the norm, and many infected children don’t even exhibit any symptom at all. Life is about balancing the risks we all take every day, from crossing the road, to trying new food, to travelling anywhere. We can never totally eliminate all risks. We cannot live a life so paralysed by fear that we don’t do anything. And if we shut ourselves off from the world, we risk our mental health. It is time now to balance the risk of going out and catching Covid-19, against the mental health risk of a very stressful lifestyle. In either case minimise the risk by wearing mask going out and keeping your distance, and don’t compound stress at home by constantly checking  on how the progress of the pandemic.

Government Covid-19 numbers 23/4/2020 April 23, 2020

Official Thai government Covid-19 numbers for today:

New cases 14
Death 1
Total accumulated cases 2839
Recovered cases 2430
Active cases 399
Between 11th and 17th April in Bangkok metropolitan area 6 cases were identified out of 682 people tested

The present epidemiological trend in Thailand is most cases are young people, with very low mortality rate in this group. Almost call fatalities are among the elderly, many with co-existing serious health issues.

Covid-19 blog #4 22/4/2020 April 22, 2020

More on medical treatment and prevention of Covid-19

The National Institutes of Health (US Health Department research agency) has published treatment guidelines for Covid-19. Here are some key recommendations:

• The panel does not recommend any drug for pre- or post-exposure prophylaxis outside of clinical trials. (This means if you have been in contact with, or are likely to be exposed to Covid-19 patient, there is no recommended useful medicine to take to prevent the disease)
• It does not make a recommendation for specific antiviral or immunomodulatory treatments, as no drug has been proven to be safe and effective. The panel does provide rationale for use of certain therapies under investigation, as well as a summary of studies on these treatments.
• It comes out against use of hydroxychloroquine plus azithromycin outside of clinical trials because of the toxicity risk, as well as against lopinavir/ritonavir or other HIV protease inhibitors because of negative clinical trial results and unfavorable pharmacodynamics. The panel also recommends against interferons and Janus kinase inhibitors.

Basically there is no specific medical treatment that is recommended for use outside of clinical trial or research purpose.

Many patients around the world are being treated with different combinations of these drugs. In China and in Thailand groups have claimed (or reported by the media to have claimed) amazing success in treating Covid patients but the evidence for this success has not reached credible level and has not been emulated elsewhere to the degree that everyone should start to use these treatments.  It is a difficult ethical dilemma as people have argued for “compassionate use” of these unproven treatments but to do so risk causing harm and wasting precious resources. We will almost certainly one day have effective treatment for Covid-19 but it will not come quickly and doctors must not be tempted to use these drugs except under proper research protocol.

We are hearing less about ventilator shortages now that their manufacture is ramping up rapidly. What is not often reported is the mortality rate of patients who are put on ventilators. Estimates are very high, probably above 50% so we cannot be sure how many lives are being saved by ventilators. Personally I only have experience of using ventilators on newborns but I can say that ventilators require skill and experience for proper use otherwise they can be dangerous and can certainly cause lasting, severe lung damage with improper use. Even without a ventilator, 100% oxygen is toxic to the lungs, something that some doctors seem to ignore.

Much more important than getting more ventilators is getting more skilled operators, doctors and nurses, but sadly this cannot be magicked up in a blink of an eye.

Covid-19 blog #3 20/04/2020 April 20, 2020

The global spread of Covid-19 can be tracked at:

https://coronavirus.jhu.edu/map.html

The Health Ministry of Thailand is putting out daily reports which can be seen on YouTube but it is in Thai only. According to official data, for the last 5 days or so about 30 new cases a day are reported, with around 0 to 3 deaths a day. Total number of identified cases in Thailand is about 2800, and most of these cases have recovered. Can these numbers be believed? I don’t know, probably not fully, but what we are not seeing in Thailand is health services being overwhelmed like they are in Europe and America. Chances are most of us don’t know anyone who has been infected, and only hear about cases on the news and social media.

I must confess that in February, I thought that Covid-19 did not seem very much worse than the flu, with severe cases and fatalities among the elderly and those with serious pre-existing health issues. I did not know then that Covid-19 spreads more easily than the flu which is why the spread has been very rapid and can only be slowed down by harsh social measures. The mortality rate also seems much higher than the flu, although this depends on the population group you are looking at.

If you look at the official data in Thailand however, I think I might be forgiven for thinking that the flu and Covid-19 are comparable. I don’t know how many cases of flu there has been this last flu season in Thailand but for sure it must be many times more than 2800. Myself being just one doctor with a modest patient population base would see dozens of flu or flu-like cases every season. So far, I have seen zero case of anyone with symptoms remotely compatible with Covid-19.

What I am continuing to see however, are families being psychologically affected by the fear of Covid-19, and by the consequences of weeks of self-isolation. Even young children are showing signs of being affected by parental stress. While it is wise to be careful and minimise the risk of contracting Covid-19, I think we should all be mindful of the mental health effects of the virus. If all 2800 reported cases are in Bangkok (they are not), and if all of these people are still infectious (they are not), the chance that you will come across one of them in this city of 7 million is only about 1 in 3000, and with sensible precautions the chance of contracting the virus from one of the infected is much lower again. Children, especially, are not meant to be cooped up indoors all day for weeks on end and parents should find a way to let them out and about for 20-30 minutes at least every day, if at all possible. Remember that physical exercise is an excellent stress reliever and your grumpy cranky misbehaving child could become much more their usual self just being out in the sunshine for a short while.

Another important way to reduce stress is to NOT keep reminding yourself how bad things are by constantly reading about the pandemic on social media. Check the news on mainstream media once a day.  This will be enough to keep you informed. While you may feel as many people do nowadays that the MSM is biased and not entirely reliable, most of the time the more reputable MSM do not tend to make up stories.
But they will grab on to any emerging story because the public wants a constant stream of news on the crisis and this can lead to some misrepresentations and misunderstandings, particularly about treatments and cures.

There is a constant, continuing barrage of claims about cures for the Covid-19, and immune-boosting substances of all kinds. These range from the ridiculous like drinking bleach, to promising medicines that are being trialed. While it is wonderful that scientists and doctors all over the world are working flat out to defeat the virus, and while some of their early reports are promising, they are no more than that, early, unconfirmed, unsubstantiated results. The anti-malarial medicine hydroxychloroquine in particular has received a great deal of attention and endorsed by no less than the president of the USA. This has led to huge demands for this medicine of which previously the only experienced users are the very few doctors around the world who were treating malaria. Other drugs being used to treat Covid-19 include antivirals and anti-HIV drugs and while some showed early promise, some just didn’t pan out. The problem is to prove that a medicine is effective and safe takes time and the process is full of pitfalls. Researchers naturally want to prove that their ideas work and this often lead to bias when conducting clinical trials. The gold standard of drug trial is the double-blind trial where neither the patient nor the prescriber know if a patient is receiving the drug being trialed or a placebo. But in an emergency situation such as this the pressure is to use a drug even though the effectiveness is not proven. It is felt that to deny a patient a drug that might work, is unethical.
Here is how confirmation bias rears its head. If the doctor selects younger, less sick patients to receive the treatment, then most of them tend to recover because as we know, relatively younger patients mostly recover from Covid-19. By younger I mean 60 – 70 year olds. The mortality rate rise steeply after this. If a doctor with conscious or unconscious bias select better patients for treatment, then the outcome  will start to look good. Some time lab tests are used to more objectively measure outcome. Lab tests can measure viral load and viral persistence but the process again is subject to bias in who, when, and how samples are collected. If other doctors decide to try the treatment, while remaining sceptical, and then goes on to select weaker patients for treatment since there isn’t much else out there to use, then the outcome can start to look bad. What is known to happen frequently in medical research is that results that seem to indicate a treatment doesn’t work tend to get filed away unpublished, and even if the results see the light of day, and is spotted by a journalist, chances are the story will not get published as people much prefer to read about exciting new treatment than about failed ones.
Eventually the true picture will emerge, and with the huge resources being devoted to finding a cure and vaccine, it is almost certain that we will one day defeat the virus, but it will take time and workers must be careful not to pursue false leads because of over-enthusiasm about a seemingly good idea.

…………… to be continued

Covid-19 blog #2 30 March 2020 March 30, 2020

The situation is changing very rapidly, with new reports and analysis coming in all the time. There are several websites that track the number of cases, the one I use is:

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

The number of cases in Thailand has risen steeply. There are around 20 times more cases than 2 weeks ago which may seem very alarming, but looking at the statistic another way, there  have been 1300-1400 new cases in 2 weeks, and bad as that is, it is not in the same scale as in Europe or America. In Bangkok, a city of 7 million people, or in all of Thailand, about 55 million people, you would have to be extremely unlucky to meet an infected person because the statistical chance is 1:5000 if all cases are in Bangkok, or 1 in 39000 for Thailand as a whole. This is not that 229 people are confirmed recovered from the illness. This is not to say you should not take precautions and minimise your risk. Number of cases will continue to rise. But what this means is since individual chances are very low, we should not get overly anxious or depressed about it. Indeed it is apparent that the effect of the pandemic on mental health is very significant and very severe and we need to keep spirits up any way we can. Talk to relatives and friends often. If you can find uncrowded area get out there and exercise, if you can’t then exercise at home. Apparently sales of home exercise devices have surged. The shops are closed but you can order things online from places like Decathlon.
Children are not immune to anxiety and can express physical symptoms such as fatigue, malaise, headache, loss of appetite when anxious. Having their school routine interrupted and not seeing any friends for many days take their toll on children’s well-being. Keeping children active will help them feel better. They should get out of bed at the same time every morning, and if at all possible spend some time outdoors every day.

Routine health care and vaccination visits

If your child has no health problems, routine check up can be postponed. Most vaccines can be delayed a few months, especially with the schools closed, there is less chance now of catching diseases like measles or chicken pox or seasonal flu than before. Some vaccines however have a time or age limit for administration. Vaccines for infants 4-6 month old should not be delayed by more than 2 months or it may not be possible to complete the course.

Ibuprofen

Ibuprofen (Nurofen, Brufen and numerous other brands) is an effective fever medicine with very good safety record for use in treating fever. When used long term for treating conditions like arthritis, stomach irritation becomes an issue. Patients with kidney diseases need to be careful with ibuprofen. It is not used in people with suspected dengue fever as there is theoretical concern of side effects in this condition, but not because it is known or proven to cause issues. A doctor in France raised concern about the use of ibuprofen in patients with Covid-19 and unfortunately this became overblown in the media. Other experts were quick to point out that there is no known incidence of Covid-19 patient being harmed by ibuprofen, the issue is only theoretical, potential harm in some patients. Some say since there is an alternative in paracetamol/acetaminophen, let’s just use that. But is paracetamol truly safer than ibuprofen? There is no data to support this claim for use in treating fever. It certainly is not as effective as ibuprofen. Some say that ibuprofen could interfere with the body’s immune reaction to the virus. Again this is only theoretical. In any case any fever reducing medicine including paracetamol interferes with the body’s response to infection. It is well known that recovery from some illnesses is faster if fever is not reduced. We mainly reduce fever because of the discomfort we feel when running a fever.

Masks

In Thailand and many other east Asian countries if you do not wear a mask when going outside, you will get funny looks from some people. The BTS now bans people using the skytrain without a mask, and some places may refuse to admit people who don’t wear masks. In Singapore however, people mostly don’t wear them. There is no firm evidence that masks are helpful but tentative evidence that they may help is starting to emerge. Wearing mask shows that at least you care and you are conforming with the local mindset.

South Korea and Japan

People talk about the exemplary response by South Korea to the pandemic and they very much seem to be on top of things and that is very wonderful. Strangely nobody talks about Japan, 300+ million people living on very crowded islands near Korea and China, yet reporting less than 2000 cases, only a fifth of the number in South Korea. I would really like to know how they have done it.

Covid-19 blog #1 28/3/2020 March 24, 2020

It is now over a year since Just for Kids Clinic started.  I am happy to report that the clinic is doing well. I am extremely thankful for all the kind support many people have given me. With your encouragement I will continue to provide the kind of health care that puts children’s health above all, for as long as I am able.

I have been asked about Covid-19 many times every day for a few weeks now. While there is a lot of information on the web, it can be hard to digest, and to separate the fake from the real, or the speculative from the actual, and so I thought I would offer my perspective, and talk about how Covid-19 might affect the younger expat population in Bangkok. I shall be basing most of my opinion not on main stream media news reports, but on published medical reports and data that are aimed at health care professionals.

How badly are children affected by Covid-19?

Children are relatively unaffected by Covid-19, and this is consistent across every affected country. They would have closed schools much earlier if there had been outbreaks centred around schools or if many children have died or had severe symptoms. A recent report from China shows that, of many thousands of children tested who had contact with confirmed cases, they found  170 infected children. Of these 17% had no symptom at all. Almost all the rest had mild symptoms. Only 7 out of the 170 had to be hospitalised in ICU because of their illness severity. All 7 had pre-existing major health issues including leukaemia and immune system disorders. One child died because he had a severe surgical problem on top of his other serious health problems. We do not fully understand why children under 16 are relatively unaffected by Covid-19, but the same is true for some other illnesses like chicken pox and mumps which are relatively harmless in children compared to adults.

What about pregnant women and newborns?

There are very few reports of what happen to pregnant women infected by Covid-19. While we need to minimise the risk in pregnancy and newborns, there is thankfully no report of serious outcomes in this group. One newborn is believed to test positive, presumably through transmission from his mother, but he appearted to have no symptom.

What is happening in Thailand? Should expats leave Thailand?

Thailand was the very first country to report Covid-19 cases outside of China. As of today 24th March, there are 721 confirmed cases, with big increases happening in the last 7 to 10 days. This is only a tenth of the number of cases compared to European countries of similar size. Tiny Luxemburg has more cases than Thailand. Surely part of this and part of the slow rise in confirmed cases is because of lower rate of testing in this country. As testing has ramped up in the last week, confirmed cases are multiplying alarmingly. Is the Thai  government trying to hide the real extent of the disease in Thailand? We cannot know. Certainly the government would like to minimise the impact on the economy and it would surprise no-one if they try to hide the real numbers. While the Thai government does have more power to control the media than Western ones, in fact the government totally owns and has full control of some leading media channels, it would be near impossible for the government to effectively suppress data, not without shutting down the internet and gaining total control of the media, in effect become like North Korea.

It is notable that there has only been 5 (as of 28th March) confirmed Covid-19 deaths in Thailand.

Chances are, expats could become more at risk in their home countries than in Thailand, so it probably isn’t a good idea to flee Thailand to get away from the virus. Expats may feel the need to be near loved ones but it could be doing them more of a favour by staying away and contacting by video calls instead. If things get very bad in Thailand it is very possible that expats could get better and cheaper or free health care at home but that is the only reason I can think of to leave Thailand. With all the flight cancellations and increasingly harsh travel restrictions, it may be difficult to return to Thailand if expats leave.

My child has a fever and/or cough, what should I do?

Young children continue to catch the common cold or the flu or other viral fevers as they commonly do. With social distancing and all the schools closed, fewer children are getting sick compared to normal times. The fact remains that by a very long way, the most common cause of fever and cough in young children is the common cold, followed by seasonal flu. If your child is ill with symptoms of the cold or flu, you should look after him as you would normally do and according to your level of ability and confidence in handling a sick child. You may seek additional advice by telephone from your child’s usual doctor. If the symptoms are worryingly severe, for instance if there is wheezing or breathlessness, high unrelenting fever or exhaustion, you should have her seen by a doctor. It is best to avoid seeing a doctor who you don’t know at all, if your usual doctor is unavailable try to get a recommendation from a friend. During these scary times, even more than usual, there is a risk of being over-investigated and over-treated. You should see a doctor in a clinic or hospital OPD in the day time if possible. Only in a true emergency should you actually go directly to the Emergency Room.

You should of course avoid infecting others with your illness, but this is the normal thing to do for any infectious illness any way.

Should I or my child be tested for Covid-19?

The main question that needs to be asked before performing ANY medical lab test is: what different action would you do, based on the test result? There is no specific, proven  medicine to take for Covid-19 and so you would not or should not get a different medicine to take based on a positive result. But what if you need iv fluid? Intensive care or a ventilator? The indication for needing these more aggressive treatments is based on the severity of symptoms, not on the identity of the viral agent. Therefore you would need a ventilator if respiratory failure develops, regardless of what the causative agent is.
If you test positive for Covid-19, you may well be kept in hospital, in a negative pressure room, until you test negative, and this could take 2 weeks or more. You may not be released even if you have minimal or no symptom at all. I do not know if there is a set policy that all hospitals in Thailand must follow for every identified case of Covid-19. Not long ago, private hospitals did not want to keep Covid-19 cases and would farm them all out to government hospitals, but I believe the government has now put a stop to this practice. Many infected persons do not NEED hospital care, although they need to be isolated. In China many sufferers are cared for and isolated at home, not in hospitals. In the news one young man in Krabi with Covid-19 escaped from hospital, was hunted down and captured by the police, and now faces criminal charges and possibly a jail sentence for his action. It would seem that in Thailand the authorities want to keep infected persons in hospital.

My advice is, you SHOULD get tested for Covid-19 if you have STRONG reasons to believe that you may have caught this virus. This includes compatible symptoms of fever and persistent cough, AND contact with an identified infected person. This means that you have had social interaction with this person, and not happen to live on the same street and may have walked past each other. You should NOT get tested if your/your child’s  symptoms are not compatible with  Covid-19, such as having a runny nose as the prominent symptom, or a rash.

It is of course vitally important to stop the spread of the virus and so testing is important if there is a strong suspicion. However this does not mean every child with a fever needs to be tested. This could overload the system, and there is a risk of a false positive result which cannot be quantified.
There are many, possibly dozens of different tests and test kits for Covid-19 made by very many different laboratories. I have been trying to find out how reliable these tests are and it has not been possible to get a clear answer. Some tests are reportedly 100% reliable, while the makers of many tests say they cannot release the information on their test accuracy at this time, for which reason I do not understand. Worryingly however, some tests, especially the more rapid ones, are reported to have up to 10% false positive rate, that is to say the test can misidentify common-cold causing Corona virus types as Covid-19 agent. This means that if you have no reason to suspect Covid-19 infection, then it is not at all a good idea to get tested in the belief that testing would do no harm.
This is of course my own personal take or bias. The many instances I have seen where people have been harmed by unnecessary medical testing have built up my scepticism over the years. I am sure other doctors will have a different view on this.

What are the treatment options for Covid-19?

There is no specific medicine for treatment of Covid-19. Doctors have tried various medicines including anti-viral, anti-flu, anti-HIV-AIDS medicines, and infamously anti-malarial medicine as touted by the president of the USA. Some treatment successes have been claimed but published data have shown no demonstrable benefit from these drugs. This means that if you are diagnosed with Covid-19, the only appropriate treatment would be the same as any other viral febrile illnesses like the flu. Ventilators are a precious commodity right now. Countries that are being hard hit by Covid-19 are bemoaning the lack of these machines. Ventilators are used when respiratory failure has set in. It is a symptomatic, maintenance treatment, not a curative treatment. The problem with ventilators is that you need skilled operators to use them. Get it wrong and ventilators could cause severe, sometimes permanent lung damage. Patients on ventilators need close, constant care. You can ramp up the manufacture of ventilators, but sadly you cannot do the same with people to operate them.

<<TO BE CONTINUED>>

“Just for Kids” clinic opening on 18th January January 11, 2019

Dear all,

I am happy to announce that the clinic will open next Friday 18th January. The operating hours will be 0900-1200, 1400-1700 daily except Sundays and Thursdays. Appointment can be booked by email or by phone or text to

097 230 3206

I have also agreed to do more clinics at Samitivej Chinatown but only on Thursdays between 10 and 2pm through February. Beyond February I may continue to do clinics there if there is sufficient demand.

“Just for Kids” clinic is opening much later than I had hoped due to the bureaucratic workings of the health ministry. I would have been ready to open weeks ago had I not had to wait for completion of the paper works. Another consequence of this delay is that I cannot easily obtain vaccines through normal channels for several more weeks. If you would like to book your child in for vaccination, it would be helpful if you can say which vaccine is needed, or send me the vaccination record, so that I can ensure availability.

INSURANCE

A frequently asked question is about insurance. As the clinic will be a properly licensed health care facility, it should not be a problem to claim payment from insurance companies. I can either fill in relevant claim forms, or issue medical certificate to enable insurance claim. However it will not be possible for me to directly bill insurance companies for payment. Also please be aware that insurance covers vary, some policies will cover normal check up and vaccines, and some will not. Please check with your insurer about coverage.

MEDICINES

One major difference between medical clinics in Thailand and clinics in western countries is that medicines and medical supplies can be dispensed from clinics obviating the need to take a prescription to a pharmacy. I will carry a range of commonly used medicines that can be dispensed on site. If preferred or for anything not available in the clinic, there are no less than 4 pharmacies in Gateway shopping centre across the road.

FEES AND COSTS

Consultation fee will be around B1500, less if it is something very minor, or more for extended consultations. While this is well above the average fee charged in private hospitals (about B800 for doctor’s fee) in many cases the visit cost will be much lower than in hospitals as I do not prescribe expensive medicines for no good reason, or order unhelpful laboratory tests, or keep children in hospital if they are better off at home. There will also be a service fee of B200 (in hospital clinics usually B300+).
Medicine costs will be comparable to hospital pharmacy costs. Buying medicines in drug stores is usually cheaper than in hospitals and clinics however.
Vaccine prices will in most cases be less than hospital prices, even taking in to account hospital “packages”.
Finally the costs and fees are negotiable! I do not want cost to be the reason for someone not to come and see me.

I hope to welcome you to my practice in the near future. As everything is very new and me and my helpers are not business people, there may be some teething troubles and inefficiencies for which I hope for your understanding.

I wish everyone a happy and healthy new year!

Update 4th January January 4, 2019

Dear all,

The great news is that the Health Ministry officials have inspected my clinic and all was well. However, the ministry only issues clinic licences once a month and this month because of the holidays, they won’t do it until the 15th. This means the earliest I can open is the 16th. It also means that I cannot order in vaccines and certain other meds until the 16th although delivery is usually just a day or two. I can start seeing patients on the 16th except for vaccinations, which will probably have to wait until Saturday 19th.

If you wish to make an appointment please phone/SMS (097 230 3206) or email me.

Due to this unexpected postponement, I will go back to do a few more clinics at Samitivej Chinatown on the 8th, 10th and 12th January if anyone need to see me sooner.

May I wish everyone a great 2019 and many thanks again for all your support.

Dr Olarn

Update 31st December December 31, 2018

Dear all,

Just a few days from now the Health Ministry inspector will visit my clinic and soon after the clinic licence will be issued which means I can open! I do not know exactly how many days but by the 10th of January I should be able to operate. I will make an announcement when I know exactly. I look forward to welcoming you all at my clinic. It is looking very nice, I will post some pictures later on.

I have finished doing clinics at Samitivej Chinatown. For some people, that location is more convenient than Sukhumvit/Ekamai. If this is the case for you please let me know. If there is enough demand I may do half or full day once a week there.

I wish every one the very best for the New Year!