DOH's Response to the First Wave of COVID-19 (Eng)

DOH’s Response to the First Wave of

Thailand Experience



DOH’s Response to the First Wave of

Thailand Experience

DOH's Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Advisors Deputy Director-General
Dr. Sarawut Boonsuk
Dr. Sompong Chaiopanond Public Health Technical Officer, Advisory Level (Nutrition)
Mr. Somchai Tookeaw Director, Bureau of Environmental Health
Mr. Damrong Thamronglaohapan Director, Division of Planning

Compiler
Center for International Cooperation, Department of Health
Ministry of Public Health

ISBN 978-616-11-4582-8

Published by
Center for International Cooperation, Department of Health
Ministry of Public Health
Tel. 0 2590 4280 Fax. 0 2590 4288
Website: cic.anamai.moph.go.th

Amount 150 copies

First edition 2021

Printed at
Beyond Publishing Co., Ltd.

Table of Contents

Executive Summary Page
ii
Preface iv
Introduction 1
Actions Taken by the Department of Health in Response to 3
Emergencies and Public Disasters in Case of COVID-19
Actions Taken During the Initial Stage of the Pandemic 6
Actions Taken in the Course of the Pandemic Through the Easing 13
of Lockdown Phase: Phases 1-6
Achievements and Challenges in the Operations of the Department of Health 36
Lessons Learned from the Battle Against COVID-19 39
Summary 40
Bibliography 41
Appendix 42

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience i

Executive Summary

Coronavirus 2019 (COVID-19) is the most challenging outbreak of a novel disease.
Thailand’s success in controlling the propagation of the pandemic was accredited to
several factors, i.e., leadership of the high-raking executives, prompt responses, effective
and timely plans to suppress and prevent the disease in terms of situation assessment,
case identification, medical treatment, and prevention of the transmission. Importantly,
the success was also thanks to public cooperation. The Department of Health (DOH)
has taken part in operations carried out by different collaborative sectors to an extent
that they were successful in curbing the spreading of COVID-19. As being the sole party
responsible for health promotion and environmental health in Thailand, the DOH was
triggered by the unprecedented outbreak of the disease to adjust and prepare itself to
cope with the situation, and, concurrently, to formulate working mechanisms despite
the limitations imposed by the pandemic. With an aim to ensure responsiveness of
the operations, the DOH has therefore bound by missions on health promotion and
environmental health governance in respect of COVID-19 as follows:
1. Communicate health literacy to the general public, business operators, and
stakeholders to ensure that they possess knowledge and actively and correctly adhere
to hygiene guidelines against the disease.
2. Develop existing knowledge assets on environmental health and hygiene
management dedicated to business establishments into measures and enhance
existing standards to make them clearer and more stringent in response to the pandemic
situation, resulting in a process to establish preventive standards and measures against
the spread of the virus for all business operators and public domains.
3. Enhance confidence and strengthen public, private, community, and people
networks, all of which have built up a robust collaboration to monitor business
establishments and the public, ensuring that they can safely operate their business/activity
while complying with the new normal practices, especially during the lockdown easing

ii DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

phases. This factor is considered the most crucial part of the actions taken by the DOH.
Furthermore, the DOH also serves to provide correct health information. In case there
is misleading health information that may cause improper behaviors, the DOH will
be responsible to take action in response to the issue, commonly referred to as risk
responses, and ensure that the revised information is successfully communicated to the
public domain in order for the public to justify whether the information is reliable and
to perform appropriate behaviors according to their own personal health status.
Even though Thailand could effectively control the first outbreak of COVID-19, the
DOH has still consistently adhered to its core principles in promoting health literacy for
the public to protect themselves, i.e., facemask wearing in public spaces, handwashing,
and social distancing practices. In this regard, the DOH highly expects that these measures
will still be actively followed even when we are in the new normal way of life. That is
because these measures do not only prevent COVID-19, but they will also pertain to
the prevention of all possible diseases in the future for people of all age groups.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience iii

Preface

This present document of DOH’s Response to the First Wave of COVID-19
Pandemic: Thailand Experience was provided to present significant actions on health
promotion and environmental health having been taken by the Department of Health
(DOH) amidst the pandemic of deadly COVID-19 from February through May 2020, and
throughout the easing phases. Here, we have gathered insights of health promotion and
environmental health related works performed by corresponding agencies, both at the
central and the regional level. Based on roles and responsibilities assigned by the Ministry
of Public Health (MOPH), the DOH was to educate the general public, organizations,
and agencies about the pandemic, and ensure that they adhere to hygiene principles
and safety standards specifically applied to each with a purpose to prevent and curb
the spread of the virus, and finally to an extent that Thailand successfully maintained
suppression of the first outbreak.
We wholeheartedly hope that this document will be useful for all agencies
regulated by the DOH and other corresponding bodies as a guidance for further actions
against possible outbreaks of other viruses or diseases in the future.
Center for International Cooperation, DOH
December 2020

iv DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Introduction

COVID-19 is a contagious disease that originates from a recently discovered
novel coronavirus. It first emerged in Wuhan, Hubei, the People’s Republic of China back
in December 2019. As the disease is transmissible primarily between people through
infected secretions, such as droplets generated by coughing, sneezing, mucus, saliva, the
World Health Organization (WHO) declared COVID-19 a “pandemic” and a Public Health
Emergency of International Concern (PHEIC) on March 11, 2020, suggested all countries
have strict surveillance, preventive, and control measures in place.
COVID-19 infection has been reported in all regions throughout the globe with a
cumulative number of patients confirmed on December 14, 2020, at 72,089,758, among
which the death toll has reached 1,610,801. In Thailand alone, as of the same date,
the cumulative number of infected cases was 4,209, among which the death toll was
60. Recently, a moderate number of patients have been found due to infected persons
travelling from neighboring countries. Notably, the infection of COVID-19 is possibly
found in all age groups. The youngest infected patient in Thailand was one-month old
while the oldest one was 91 years. However, on average, the infection has tremendously
impacted the working age population, that is, those aged 30-39 years. In this regard, the
groups that are subject to mortality risk are individuals with underlying disease and the
elderly. Causes of infection are mostly close contacts through contaminated droplets
from humans to humans and from the environment to humans. Therefore, practical
personal hygiene management in prevention of the disease is crucial in mitigating the
transmission of the virus.
The Department of Health (DOH), as a national authority in governing health
promotion and environmental health systems for healthy Thai people, has thus taken
a crucial role in preventing and alleviating the disease transmission by emphasizing
health protection of people in all age groups through well-established environmental
management, starting from the individual level, where people are required to
possess knowledge, be hygiene oriented and adhere to environmental health behaviors.
They must be capable of protecting themselves and their family against potential
contacts with the virus. At the community and local levels, people must be able to

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 1

systematically and effectively perform works in relation to health promotion and
environmental health, as well as to surveil and prevent risk factors regarding health
promotion and environmental health. At the business-establishment level, all
establishments must have environmental health management in place based on
environmental health standards and guidelines in prevention of the transmission of the
disease.
As a consequence, the DOH has formulated key action strategies as follows:
1. Upgrade the actions taken in response to emergencies and disasters of the
DOH in a case that one is diagnosed with COVID-19.
2. Enhance communications and ensure that people have possessed health
literacy.
3. Ensure that all establishments are safe and pathogen free.
4. Strengthen communities and networks on surveillance and health
management.
These are to build confidence on safe daily life of both the public and business
establishments as well as to heighten belief towards the transition from a secured city
reopening phase to paving a solid ground for the new normal stability in order for “Thais
to be safe from COVID-19”.

2 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Actions Taken by the Department of Health in Response to
Health Emergencies and Public Disasters in Case of COVID-19

Action taken by the DOH on environmental health during emergencies or public
disasters is required to establish an operation center for emergencies and public disasters
on environmental health at both central and regional levels to serve as the central
command or the Emergency Operations Center (EOC). Upon the emergence of the
present disease, establishing the operation center is needed to be prescribed by law
or the National Disaster Prevention and Mitigation Plan, B.E. 2558 (2015) by considering
its necessity for establishment, components of individuals, officers, and corresponding
agencies. In respect of the emergency of COVID-19, operations performed by the
DOH integrated between health promotion and environmental health, and therefore
employed a working group model as illustrated in the Structural Diagram of the Emergency
and Public Disaster Responsiveness Working Group on Health Promotion and
Environmental Health, DOH (Order of DOH No. 469/2563, dated July 22, B.E.2563 (2020).

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 3

In structuring the EOC in response to emergencies and public disasters on health
promotion and environmental health, conventional work processes within the DOH
and those of the Ministry of Public Health (MOPH) were mainly considered. Moreover,
the stakeholders have ensured that all possible responsibilities are covered by the EOC.
The EOC composes of the following structures:
1. Incident Commander (IC) is served by the Director-General and the Deputy
Director-General of the DOH who are responsible and authorized to direct, command,
monitor, expedite, supervise, evaluate, and propose solutions for all missions. They
are required to coordinate with external agencies and organizations at the policy
level, formulate targets and objectives of the operations, finalize decisions, elevate,
reduce and shut down operations center. Furthermore, they are the point of report for
health promotion and environmental health related emergencies and public disasters.
Moreover, the IC will appoint, adjust structures, assign responsibilities, encourage, and
support other working groups.
2. Public Information Officer is responsible to monitor news and information
released by media outlets, assess public awareness, provide risk communication plans,
give prompt responses in an accurate and proper manner, provide correct, accurate
and complete information, and coordinate with different mission groups to manage
necessary information. Moreover, the officer will disseminate and communicate
about risks, establish understanding through different channels, as well as produce
communication media, evaluate and summarize operational results in regard to the risk
communications for the IC.
3. Liaison Officer and Secretary are responsible to provide a directory of
coordination network and coordinate with agencies, either under or outside of the
supervision of the DOH, formulate plans to ensure that all commands of the IC have
been satisfied in a prompt and effective manner, facilitate corresponding agencies in
terms of location usage, coordinate for meetings, and designate operating schedules
for each mission group, assist managerial tasks, and ensure convenience of all groups.
4. Safety Officer is responsible to analyze threats, designate personal
protective equipment, prevent and monitor threats, estimate damage or danger caused
to personnel and relevant parties, as well as to structure mobility system and correct
storage procedures, indicate safe areas for humans and resources, indicate hazardous
areas and storage places for hazardous materials and those for contaminant destruction
and disinfection.

4 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

5. Strategic and Technical Advisory Group is responsible to monitor, surveil
and assess the situation and potential risks arising from the situation, collect data and
provide relevant technical databases, analyze and synthetize technical information,
facts, and relevant laws in order to obtain accurate technical insights, propose short,
medium, and long-term measures, as well as operational plans of the DOH pertaining
health promotion and environmental health that are to be executed during
emergencies and public disasters to the IC. The group will integrate their actions with
those of collaborative agencies that are either regulated or not regulated by the
DOH. Moreover, it will monitor, evaluate, and summarize lessons learned subsequent
to its operations based on measures and operational plans for a purpose of further
improvement to cope with the situation.
6. Operation Group is responsible to comply with orders given by the IC,
formulate plans, coordinate, and ensure that the group has been well-prepared and is
primed to provide prompt support once requested. Furthermore, it will conduct field
visits for the implementation of health promotion and environmental health measures
during emergencies and public disasters, ensure preparedness of working process,
equipment, operation support, evaluate group requirements, take actions on site to assist
affected population, and ensure the highest efficiency of each field visit, summarize its
performance and propose to the IC.
7. Finance and Administration Group is responsible to acquire human
resources, budgets, financial support, and supplies, provide personnel support, financial
assistance, and supplies for the Operation Group, perform administrative tasks, keep
record and pay wages based on hours of work, monitor and report the result of budget
reimbursement, summarize financial reports and analyze operational cost-efficiency,
allocate life insurance benefits, make claims, provide care and indemnification in case
of accident or injury, summarize its performance and propose to the IC.
8. Logistics Group is responsible to plan for and analyze risks, manage
transportation flows, materials and equipment in support of the Operation Group.
Moreover, it will ensure that there is always a contingency plan and operation
supporting plan in place. It will distribute, monitor, and assign personnel, materials,
equipment and vehicles based on plans and as deemed appropriate, summarize its
performance and propose to the IC.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 5

Actions Taken During the Initial Stage of the Pandemic

The first and most crucial thing to be concerned is situation monitoring. Thai
public health studies the pandemic situation by learning to understand that COVID-19
is a novel disease, and then makes a set of knowledge from the true understanding to
lead to a simple, uncomplicated and practical practices known as health literacy. The
DOH established an initial set of knowledge referred to as 3R, namely Reduce touching,
Refrain from going to highly populated areas, and Responsibility to take care of one’s
health, and employed all communication means possible. What has been actively and
consistently done by the DOH throughout the pandemic course is the strengthening of
people’s awareness towards wearing fabric masks. The DOH has rendered knowledge to
educate the public that fabric masks are a preventive and practical tool, and to encourage
people to consider an alternative to surgical masks – fabric masks to be specific, in
order to ensure that the former will suffice for medical personnel in our country. This
is an example of success as people are able to access correct, accurate, and practical
knowledge and information.

1. Elevation of communications and promotion of health literacy for the
benefit of the general public consist of:

Encourage Thai people to wear a protective mask against COVID-19:
Sewing Love in Prevention of COVID-19 Campaign

Wearing a mask is a vital preventive measure against directly being into contact
with droplets of body fluid from an infected person. The campaign aims for 2 objectives,
that is, to strengthen awareness of Thai people in wearing a mask in public domains or
in places that are prone to potentially mass infection, and to encourage healthy people
to wear a fabric mask instead of a surgical one to ensure that the latter will be sufficient
for medical use and those in need. The target was that 200 million pieces of masks were
available to Thai people with them being aware and habitually wearing a mask. Due to
the target, the DOH geared up the production of face masks for public distribution, by

6 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

integrating its actions with collaborations of local administrative organizations, launching
campaigns, boosting trends, and educating people about the importance of wearing
fabric/surgical masks. Moreover, it promoted the production of fabric masks and personal
hygiene practices, supporting and promoting networks within the public and the private
sector, groups, associations, and encouraging people to voluntarily contribute their time
to making fabric masks. The DOH has additionally collaborated with media outlets at
all levels in disseminating knowledge and public communications, and conducted field
visits to several communities to demonstrate and educate the locals about wearing
fabric/surgical masks. All communications have been conveyed dimensionally through
the use of infographics, video clips, advertising spots, campaign banners, leaflets, posters,
news images/press release, or broadcasting. With all the efforts, it was found that the
percentage of the population being aware of habitually wearing masks in prevention of
the disease has greatly increased.

The 3R (Reduce, Refrain, Responsibility) measure to promote personal
hygiene practices

The 3R measure objects to equip the public with comprehensive hygiene
practices to protect themselves from COVID-19. The DOH, therefore, designed and
produced educational media for the benefit of the public at the early stage of the
outbreak, which were communicated through different channels, and conducted field
visits to raise awareness of people and ensure they would adhere to correct practices. In
this regard, the DOH has made a visit to a variety of locations, e.g., government offices,
religious places, childcare centers, academia, transport hubs including Bangkok Mass
Transit Authority (BMTA), affiliated buses, taxi, vans, MRT, BTS, airport rail link, and the

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 7

State Railway of Thailand as well as other places that are prone to overcrowding, such as
restaurants, markets, department stores, etc. Subsequent to the visits and demonstration
of the correct handwashing procedure, it was explicitly found that more general people
and civil servants became aware of the handwashing techniques and tend to habitually
wash their hands during the course of the pandemic.

8 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Big Cleaning Week Campaign
Cleaning of frequently touched surfaces in places or areas that are prone
to public gathering or those dedicated for specific services is a key factor to kill any
virus last on the surfaces, which potentially leads to virus transmission. The DOH thus
initiated a campaign to raise awareness and knowledge of area managers, service providers,
and business operators to effectively clean public areas. In this regard, the DOH prioritized
possible risk areas, including transportation hubs, markets, department stores, restaurants,
theaters, stadiums/gyms, schools, primary student development centers, places of
worship, condominiums/flats, etc. Guidelines were tailored to different contexts of
each business establishment to make sure that business managers were able to follow
correct cleaning procedures at a proper frequency. Additionally, further field visits were
made for active demonstration and distribution of educational media for different target
groups. Thanks to the face-to-face workshop with the locals, the DOH could manage to
raise the public confidence towards the prevention of COVID-19.

Raise awareness on “Social Distancing”
The social distancing practice is a public health measure in lessening
interpersonal transmission. The DOH was assigned by the MOPH to serve as the key
responsible organization for the campaign, and it therefore identified 2 aspects of social
distancing, namely 1) routine practices for the general public, and 2) social distancing in
business places for business operators and service providers. Moreover, it also created
instructional media, including infographics, video clips, advertising spots, campaign banners,

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 9

leaflets, posters, news images/press release, and made its presence in the media, as well
as conducted field visits for demonstration and education, which was found that before
reaching the easing phase, people became more aware of keeping distance.

Risk communication and response
Apart from providing accurate information, it is undeniable that, during this
health turmoil of COVID-19, there have been bulks of information coming from countless
sources, among which there are possibly some that could be misleading. This kind
of information is generally referred to as false health information. Hence, the DOH is
responsible to take certain actions known as risk response against the threat of false
information that may bring about incorrect practices. The DOH formulated a system
to ensure that all the responses to those fictitious information have been effectively
communicated to the general public and allow them to justify whether the information
is reliable and to perform appropriate behaviors according to their personal health status.
The pandemic of COVID-19 was truly a crisis which was also indeed a
good opportunity for the MOPH to join forces with collaborative agencies. Here, the
DOH proposed the Risk Response for Health Literacy (RRHL) system in surveilling
and responding to the contagious risks of COVID-19. The proposal to integrate
collaboration of 9 official bodies at the department level, namely the Office of the
Permanent Secretary of Public Health, the Department of Medical Services, the Department
of Thai Traditional and Alternative Medicine, the Department of Disease Control, the
Department of Medical Science, the Department of Health Service Support, the DOH,
10 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

the Food and Drug Administration, and the Government Pharmaceutical Organization,
was approved and resolved by the Editorial Board of the Thai Fights Against COVID-19
campaign. However, the name of the system was later amended to Risk Response for
Health Literacy Center, or “RRHL Center,” with an ultimate goal to ensure that the general
public can optimize their health literacy against COVID-19.
The development of the risk surveillance and response system and mechanisms
executed by the MOPH, and the development of the “RRHL Center”, are an establishment
of collaborative system on the Central Digital Platform which enables officers of all
departments to collaborate in one single platform, as well as to reassign their works to
the working process of the “RRHL Center” as follows:
Step 1: Monitor, verify, and assess news and information. These are processes that
connect to the active work process of the RRHL center. Early in the morning, the DOH
will submit news/issues prioritized based on the risk evaluation criteria on a daily basis,
and log details of the operation system on a website/platform that is simultaneously
accessible by representatives of all departments, regardless of locations and time.
Afterwards, the news and issues will be distributed to corresponding departments
through a reminding system via automatic email which will be directly sent to responsible
coordinators at 8.00 am every day. The email will make a reminder again once a period
of 24 hours elapses, and will stop once the risk in question has been examined and
redirected to the RRHL’s working system for further actions.
Step 2: Formulate a responsive measure. All departments reminded by the
email will verify the risk in the system, analyze and determine a form of response.
Personal information and the device used for the login will be displayed and recorded
to be further used in support of managerial decision-making of the DOH and the MOPH.
Step 3: Designate a responsive operation team in the course of COVID-19.
This phase includes 3 steps, which are reminding the commission of the DOH and the
MOPH on a daily basis to act in response to risks and provide public communications,
reminding through the Line Application group that was dedicated for the RRHL working
group of the DOH, the RRHL Center working group, and the editorial board of Thai Fights
Against COVID-19. All actions taken will be summarized on a biweekly basis, in which
summary there will be numbers of risks and view counts categorized by topics and

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 11

corresponding agencies. Moreover, a summary report of analytic performance will be
proposed to the EOC working group of the DOH on Fridays.
Step 4: Monitor and evaluate performance of the system by monitoring,
examining, and evaluating information and news which referring to the general public
through different channels, and evaluate results to consider whether to what extent
such response has impacted on health or behaviors of the target groups.
The developed system is a piece of innovation that constitutes a working system
through integration of technology, which can be practically implemented by stakeholders
on a step-by-step basis, resulting in outputs and satisfaction of all stakeholders. These
all come with aims to respond to the needs and concerns of people in the media
domain that is not only the mainstream online media outlets in order to eradicate
non-literacy or false information. In this regard, the search performance and COVID-19
risk evaluation in Thailand have been increasing as expected, together with prompt
and clear responses. For example, in case of mask wearing and social distancing, the
platform was accessed by a higher number of readers that corresponded to the stricter
compliance with the recommended practices of the general public. Moreover, this was
a great opportunity to join forces with different bodies under the MOPH and enabled
personnel to learn together about the working process simultaneously on the online
platform. It also obtained objective performance results of which the information and
insights thereof could be leveraged against risk, strengthened health awareness for the
general population and the community, and evidently unlocked Thailand’s potential
to compete the COVID-19 crisis, as of April through June 2020.
12 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Actions Taken in the Course of the Pandemic Through
the Easing of Lockdown Phase: Phases 1-6

The DOH has adhered to 2 areas of operational principles. First, it has
strengthened people’s health literacy on personal hygiene and personal protection
in public domains. People unavoidably come into contact with frequently touched
points; therefore, it is suggested they avoid visiting overcrowded places if possible.
However, as the suggestion may not be practical, people need to realize how to protect
themselves instead. One important hygiene practice is to wash their hands with soap in
the 7 steps of handwashing techniques for 20 seconds, and to habitually wear a mask.
During the pandemic, wearing a mask is compulsory, and it has been employed and
practiced since the outbreak. Second, business establishments are required to improve
their service standards and hygiene practices to align with the disease prevention and
control guidelines. What to be focused is the cleaning of places and surfaces, waste
management, toilet management, and sanitation of the entire public domains, e.g.,
restaurants, fresh markets, convenience stores, sports fields, parks, religious places, and
schools. These are the factors that all stakeholders need to well manage in order to
enhance confidence of the service users towards their safety and hygiene during the
pandemic situation.

1. Encourage Operational Sites to Strengthen Mitigation of Disease-related
Risks

The DOH has focused on operational sites as they are places prone to social
gathering; therefore, it can potentially be settings that promote the intensity and spread
of the virus. Consequently, the DOH has provided guidelines for these operational sites
in pursuance of a series of the Emergency Decree executed in different phases of the
pandemic by the Centre for COVID-19 Situation Administration (CCSA) due to the outbreak
of COVID-19. It is a means to boost confidence of the people towards the use of service
and encourage business operators to provide services that are safe from COVID-19 with
a supportive activity called “Clean Together”. Its major task is to develop a platform to

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 13

support and assist operational sites in evaluating themselves on preparedness. The DOH
also made field visits to demonstrate possible ways to prepare all based on types of
their business and established a public-private network to flourish the existing standards
as follows:
The Development of the Thai Stop COVID (TSC) Platform
Thai Stop COVID (TSC) is the central platform developed by the DOH as a
channel to communicate knowledge, suggestions, and guidelines concerning health
promotion and environmental health for business operators, operational site owners,
public health officials, local officials, and the general public to ensure that they are
able to perform activities or business concurrently with adhering to the implemented
measures that encompass public health, hygiene, and environmental health in
prevention of COVID-19. In addition, TSC also serves as a platform for self-evaluation,
allowing the users to review operational sites, business establishments and public
domains that can accommodate people of all age ranges and ensure their strict
compliance with the disease preventive measures according to the state guidelines. On
this platform, contents are presently divided into 5 sections: Section 1 – Self-evaluation
for business operators; Section 2 – Health literacy test for the general public and a form
to evaluate the operational site from which the user has just used the service; Section
3 – Public health and medical knowledge bank for the general public; Sections 4-5 –
Relevant sources of knowledge for and feedback from the general public. Currently,
the stakeholders are working on development to add the sixth section which will allow
public health and local administrative officials to access performance evaluation. Details
are as illustrated in the following diagram.
14 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

TSC is a web application developed with a purpose to make sure that all
business operators are well-prepared to provide safe services for the public. In the TSC
application, the users can access evaluation forms for different types of business. The
forms are categorized into stages of the pandemic, that is, during the pandemic and
all the easing phases. At present, there are 27 types of business to be chosen on the
TSC platform. In using the application, business operators will be required to study and
practice following the guidelines provided by the CCSA. After that, they will be asked
to complete a self-evaluation form on the platform. If all the criteria are met, they will
be entitled to receive an E-certificate and get pinned on the TSC map. Service users
can review the business they would like to visit and to see whether it complies with
the measures implemented. If not, the service users can provide feedback through
a QR code available on the E-certificate, or access through the pin on the map.
Businesses that do not comply with the measures will be removed from the map until
they manage to remedy the issues and upload a photo as a proof. In the next step,
the DOH will collaborate with its associated networks, e.g., the Ministry of Interior, the
Ministry of Education, to integrate information for developing, monitoring, tracking, and
reviewing each business.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 15

Since the launch of the web application, the cumulative number of locations
from which the users access, as of September 18, 2020, was 98,217 (including business
establishments, e.g., markets, restaurants, department stores, gyms, etc., and public
domains, e.g., schools, child development centers, etc.). Among the aforementioned
number, there were cumulatively 46,318 business establishments/operational sites
allowed by the CCSA to operate their business during the first through fifth phases, but
with strict adherence to the implemented measures required.
16 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

The insight obtained from self-evaluation of the business establishments on
their compliance with the preventive measures in the wake of COVID-19 allowed the
DOH and the MOPH to realize whether which locations do not adhere to the measures
on hygiene, cleanliness, and disease prevention. For example, the measure that requires
both service providers and users to wear masks, provision of handwashing facilities or
sufficient hand sanitizer, correct waste management, etc. Moreover, it also enables the
DOH to formulate health promotion and environmental health measures in an appropriate
and timely manner.
In addition to what stated above, there was a rapid assessment and
randomized survey conducted in a short period of time between May to July 2020 to
implement active surveillance. An evaluation was based on types of business/activities
allowed to operate by an announcement of the CCSA with 5 key measures, including
1) cleaning frequent touchpoints; 2) compulsory mask-wearing; 3) handwashing;
4) 1-2 meter social distancing; and 5) alleviation of overcrowding. Moreover, a guideline
manual for rapid surveys and analytic methods was published to guide on analysis of
the insight obtained from each business/activity in order for corresponding organizations/
health centers to be able to independently utilize the data in an accurate manner,
and to be used as a guideline to conduct surveys in upcoming phases. Further surveys
will focus on businesses that are possibly subject to risk exposure, monitoring from the
TSC platform or any potential threats of businesses/activities arising in such area. The
results of business/activity assessment on their compliance with the measures indicated
that the businesses have well cooperated in providing handwashing stations and hand
sanitizers, as well as prioritizing mask-wearing. However, certain measures still need to
be focused, including the alleviation of overcrowding, social distancing concerns, and
cleanliness of frequent touchpoints. Business establishments that need to be stricter in
complying with the measures are markets, restaurants, etc.
Quarantine Management during COVID-19 Situation
The management of environmental health and health promotion within the
quarantine areas started from gathering data of the organizational structure, managing
of the state quarantine facility, coordinating and reporting to each Alternative State
Quarantine (ASQ) hotel commanders in charge prior to work, coordinating with associated
networks in regard to responsibilities to be carried out within a locality (health personnel
under the supervision of the DOH, the Department of Medical Services, the Department
of Mental Health, district offices/provincial health offices, environmental departments,
waste disposal companies), evaluating general conditions of the ASQ hotels in terms

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 17

of the environment, evaluating hotel staff, providing meetings with hotels’ executives
and managers, making requirements and guidelines on environmental health in order
to prevent the spread of virus, adjusting work processes, developing work systems,
such as waste management, management of wastewater prior to being discharged from
the quarantine sites, and cleaning of accommodation rooms, common areas, and the
environment. Moreover, it also concerned sanitary management of consuming water, as
well as promotion of work equipment, such as free chlorine test kit, red garbage bags,
cleaning agents and disinfectants. Performance results were followed up and reported
daily performance to each ASQ hotel commander. A summary of each empowering visit
and reports were also presented to the commanders as well.
Provision of a Manual for the Operation of the Health Literacy

Communication Team on COVID-19
In establishing the EOC in response to emergencies and public disasters on
environmental health, the DOH has been primarily concerned on the nature of the
conventional system within the DOH and the MOPH, once deliberately considered, it
assigned the entire responsibilities to the operation center in response to emergencies
and public disasters on environmental health. The roles within the EOC in response to
emergencies and public disasters on environmental health are segmented into:
1. Incident Commander (IC)
2. Public Information Officer
3. Liaison Officer
4. Safety Officer
5. Strategic and Technical Advisory Group
6. Operation Group
7. Finance and Administration Group
8. Logistics Group
In this regard, the operation group is responsible to receive commands from
the IC, plan, coordinate, prepare itself, and get ready to provide support once requested.
It has conducted field visits to take actions on the health promotion and environmental
health issues during emergencies and disasters, verified preparedness of work process,
equipment, work support, evaluated requirements of itself in support of the general
public, and affected population. It has arranged field operating systems and summarized
performance results based on each role assigned, which were later proposed to the
IC. The operation team therefore provided a “Manual for the Operation of the Health
Literacy Communication Team on COVID-19” which was to be considered a guide and
18 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

work direction for the team that was composed of officials from several agencies within
the DOH and to ensure that they were effectively trooping towards the same direction
and adhered to the same standards.
Field Visits for Preparations of Each Business Operator
The DOH has been in collaboration with the MOPH in providing 97 topics
of technical practices and measures in different phases, i.e., prior to the execution
of the Emergency Decree (29 topics), during the execution of the Emergency
Decree (38 topics), and the easing phase 1-3 (32 topics). In order to ensure that
all practices are concrete, practical, and suitable for people’s livelihood, the DOH
therefore required both central and regional bodies to conduct field visits for
demonstrations to ensure that all businesses do align with the measures set forth
by the CCSA. Concurrently, the businesses were also educated on how to make
themselves accessible through the TSC platform. These agencies have conducted
field visits to promote the disease preventive measures in markets/restaurants,
religious places, children centers, schools, gyms, theaters, public transportation hubs,
condominiums, flats, department stores, quarantines, highly populated areas/construction
areas, and workplaces. In this regard, the topics focused on during the field visits were
major and support measures as announced by the CCSA and the application of business
measures. The total number of visited locations was 510, among which included fresh
markets, restaurants, department stores, supermarkets/convenience stores, barbers,
beauty salons, golf fields, hotels, filming locations, etc.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 19

2. Strengthen Associated Networks and Public Participation in Surveillance
and Health Management

The DOH has established collaborations between associated networks, whether
they are from the public, private, or community sector, e.g., those from the business/
commercial sector, tourism sector, sports sector, in terms of health, disease preventive,
and socioeconomic aspects, in order to formulate measures together. This has shown
that all sectors have simultaneously voluntarily contributed to a safety standard for the
benefit of the general public. In this regard, the DOH has served as the intermediary and
facilitated all stakeholders in getting prepared, rather than being an examiner, as well
as providing surveillance and identifying key issues to upgrade the disease preventive
measures.

Activities to Develop Health Management and Environmental Health for
Highly-Populated Urban Areas

The DOH, in collaboration with the Ministry of Social Development and
Human Security (MSDHS), had conducted field visits to strengthen community spirits.
Especially in the dimension concerned by the DOH was to empower communities in
terms of disease prevention as well as community health promotion for people in all
20 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

age groups amidst the pandemic situation. The DOH therefore organized the “Community
Solidarity Against COVID-19” activity, by joining hands with the “MSDHS Helps All
Communities to Fight Against COVID-19” program initiated by the MSDHS, to make its
presence in communities to render assistance on health concerns and prevention of
COVID-19. Vulnerable groups in highly populated areas in 286 communities within Bangkok
Metropolis were surveyed between April - May 2020, focusing on 5 aspects, namely
consumption/central kitchen, financial support, profession/earnings, household and
health. The DOH had made visits to each community and distributed knowledge regarding
COVID-2019 prevention, as well as providing surveillance and holistic health analysis in
order to propose to the MSDHS and the communities to consider improvement of health
management. The “Community Solidarity Against COVID-19” activity has contributed to
several key outputs, including community empowering forms/guides to promote good
health and safety from COVID-19 with an expectation that all community members
will be healthy and strong against the disease. Moreover, it also conducted a survey on
health status based on each age group and impact caused by COVID-19 in 5 voluntary
highly populated areas in Bangkok, namely Lhung Flat Ruam Pattana Community in Lak
Si District, Mha Lhong Community and Wat Rat Satthadham Community in Phra Khanong
District, Aue Arthon Hua Mark in Bang Kapi Disrict, and Aue Arthon Ruam Klao 2 in Lat
Krabang Distirct. Furthermore, it worked hand in hand with 3 communities, including
Lhung Flat Ruam Pattana Community in Lak Si District, Aue Arthon Hua Mark in Bang
Kapi Disrict, and Aue Arthon Ruam Klao 2 in Lat Krabang Distirct, to formulate proactive
plans. All actions taken above have been developed into health and environmental
health management guidelines dedicated to the urban areas of Bangkok Metropolis
during this pandemic crisis and healthcare, as well as environmental health guides for
the benefit of good health.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 21

In addition to highly populated areas, other vulnerable groups that the DOH has
actively focused on are early childhood group and school age group as the impact of the
spread of COVID-19 led to the lack of social and health opportunities, such as access to
medical and public health services, nutrition, education, etc. Hence, it is a focal point
on which the DOH is currently actively work with the Ministry of Education, the Ministry
of Interior, and the MSDHS in order to get prepared for the reopening of educational
institutes and nursery centers.
22 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Activities in Prevention of the Spreading of COVID-19 within Schools
The DOH, in collaboration with the Department of Disease Control, the
Ministry of Education, and associated networks, has published a “Practice Manual
for Schools in Prevention of COVID-19” to prepare all schools for the reopening in
6 dimensions: safety with the reduction of the spread of virus, health literacy, disadvantaged
children inclusiveness, welfare and protection, policy, and financial management, and
6 key measures to prevent the spread of COVID-19 in schools including 1) having thermal
and symptom screening measures before entry in schools; 2) wearing a fabric or surgical
mask at all time while in the buildings; 3) providing sufficient handwashing facilities with
soap or hand sanitizer; 4) ensuring at least 1-2 meter interpersonal distancing; 5) cleaning
frequent touchpoints; and 6) lessening congestion by not organizing an event prone to
social gatherings. In this regard, the MOPH, in collaboration with the Ministry of Education
at the area level, has randomly visited schools in all educational areas throughout the
country in order to empower and follow up on the performance evaluation based on
the compliance with the preventive measures against COVID-19 within schools.
The DOH had visited target schools in Bangkok with an aim to empower and
monitor the adherence to the preventive measures against COVID-19 at schools and to
review whether they had monitored hygienic environmental health based on the new
normal practices. These schools, St. Andrews International School, Darunsikkhalai School
for Innovative Learning, Baan Nhong Yai Border Police School, and International Bangkok
School, Nonthaburi, were considered good models for other schools.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 23

Additionally, the MOPH has collaborated with the Ministry of Education and
its associated networks in providing a “Surveillance and Tracking Manual and COVID-19
Encountering Plan at Schools” which served as a practice guideline for a potential second
outbreak of the disease in order to ensure that all responses will be in alignment with
the preventive measures against the second wave of COVID-19.
Provision of Knowledge about Adherence to Hygiene Principles within

Religious Places
The DOH, by the Bureau of Elderly Health, has visited and educated people
in regard to compliance with hygiene principles in prevention of the spread of COVID-19
at several religious places. The activities include sharing of COVID-19 knowledge to curb
the infection rate and the spread of the disease, demonstrating handwashing techniques,
mask-wearing procedures, making of homemade hand sanitizer, fabric masks, cleaning
methods for personal hygiene and venue/religious places, setting up screening stations at
the entrance as deemed appropriate for people who visit the places, as well as providing
hand sanitizer, such as alcohol gel, at the entrance of the religious places. There are
also guidelines for those in charge of religious places and environmental health in
religious places, guidelines about taking care of themselves to monks, priests, Imams,
ritual performers, and building awareness of visitors in taking care of their own health.
Besides, it also provides educational materials to communicate about the prevention
and the spread of COVID-19 in forms of health informative posters for monks in order
for them to prevent the spread of COVID-19, manuals for events of ritual performances
and traditional activities in regard to the prevention of COVID-19.
The DOH had attended a meeting with the Sheikhul Islam Office to discuss
preventive measures against the spread of COVID-19 that would be employed during
religious activities in the Ramadan month as guidelines for Muslims. Moreover, the DOH
had made empowering visits to Borom Racha Kanjanapisek Anusorn Temple (Leng Nayi
2), Buddhapanya Temple, Rajabopit Temple, Sathira Dhammasathan in Bangkok to render
advice on health and hygiene practices, almshouse management, food distribution and
receiving, and provision of screening stations.
24 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Additionally, it also offered knowledge and workshop in respect of the
outbreak of COVID-19 to the monastic students at Mahachulalongkornrajavidyalaya
University, Wang Noi District, Phra Nakhon Si Ayutthaya. The DOH further offered surgical
masks, fabric masks, alcohol sanitizers, and hand sanitizing gel, as well as knowledge
about COVID-19 and practices against the infection by prioritizing the “3R” measure.
The DOH demonstrated 7 steps of handwashing techniques, surface and touchpoint
cleaning, homemade sanitizing gel making, fabric mask sewing method, and correct
facemask wearing and disposing methods. The activities were held bilingually, that is,
in Thai and English.

Implementation of Health Safety Standards in the Events of Sports
Activities and Different Types of Physical Exercises

Based on the easing measures implemented to places for physical activity
or gyms which require all settings to strictly adhere to hygiene practices and comply
with the preventive measures against the spread of COVID-19, the DOH has formulated

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 25

practice guidelines to ensure compliance with the major control measures and the support
measures on physical exercises, healthcare, and recreation activities to prevent the
spread of COVID-19. There are criteria to evaluate the compliance with the preventive
measures against the transmission at those places, and a manual in regard to the easing
measures for gym and sports business in phase 4 of lockdown easing, together with the
Ministry of Tourism and Sports, based on types of establishments as follows:
1. Parks, public activity platforms/spaces, sports utilities, except the outdoor
space
2. Outdoor gyms and sports fields
3. Gyms and sports fields that are located in a department store or in an
enclosed building
4. Outdoor and indoor swimming pools
5. Indoor sports fields, gyms
6. Service locations and dancing schools, or the like
7. Places for water-based sports
All business operators are required to have a registration system before and
after one visiting their place by using an application developed by the government,
which is “Thai Chana”. Moreover, they are required to provide a handwashing facilities
with soap or 70% alcohol gel, or disinfectants, in service areas, including toilets, shower
rooms, and changing rooms in an amount that is sufficient to visitors. Social distancing
markers need to be placed to indicate a proper distance for sitting or standing in queue.
Slots of services must be well-organized through a queue management system for service
users to secure their preferred slot of time beforehand to reduce overcrowding. There
should also be personal disease protective equipment provided, such as surgical masks
or fabric masks, face shields, for all staff. In the case where a stadium is installed with
air-conditioning, the owner needs to ensure that air flowing has been well maintained.
Social distancing markers should be provided at service spots, such as cashier, reception.
The DOH had made an empowering visit and monitored compliance with the
easing measures against the spread of COVID-19 to tennis establishments or tennis
businesses at the Lawn Tennis Association of Thailand (LTAT) under the Royal Patronage,
Chaengwattana Road, Bang Pood Subdistrict, Pak Kret District, Nonthaburi; a gym business
26 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

at the gym room of the Department of Health, Building 6, 2nd Floor, the DOH, MOPH,
Tiwanon Road, Talat Kwan Subdistrict, Mueang District, Nonthaburi; and the 1st track
of the 2020 Track Cycling National Championship for “Queen Sirikit” Trophy, which
was organized in a closed system (no audience) at Velodrome, Hua Mark, Bangkok.
Moreover, there were also assessment for surveillance of the spread of COVID-19 in the
competition of “Run Rayong” at Suan Sri Meuang, Rayong, in order to strengthen
confidence and boost the economy, a cycling activity “Safe Cycling Trip to Rayong” at
the Sports Stadium of Rayong, and “New Normal Monstration Match: Rayong Kick Off!,”
a “new normal” football match with limited numbers of audience in Rayong.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 27

Execution of the Amazing Thailand Safety & Health Administration
Standard (SHA)

As CCSA has eased the disease preventive measures, it has defined guidelines
that will be considered common norms for each type of business and activity with health
concerns and additional social and economic factors in mind in order for the public
and busines operators to be able to familiarize themselves to the preventive measures
against the disease and to enable more travels. In terms of domestic tourism, the MOPH
and the Ministry of Tourism and Sports have collaboratively developed and upgraded
the Amazing Thailand Safety & Health Administration (SHA) standard with a purpose to
formulate a health safety standard to be used as a guideline for all business operators,
which helps boost business establishments in the tourism industry and prepares them for
further improvement. All operators are required to adhere to the new normal practices,
which are currently considered a compulsory standard for all business operators, service
providers, and service users. The practices indeed strengthen confidence of tourists,
and create a positive image for Thailand’s tourism industry, as well as mitigate the
spread of COVID-19. In this regard, there are 10 categories of businesses and activities
eligible for the SHA standard, including 1) restaurants/street food vendors, 2) hotels and
accommodations, conventional venues, 3) recreational and tourism sites, 4) transportation,
5) tour business, 6) beauty and wellness, 7) department stores and shopping centers,
8) sports for tourism, 9) organization of activity/meeting/theater, and 10) souvenir stores
and other shops.
The DOH has collaborated with the Tourism Authority of Thailand (TAT) in
providing the SHA Manual. The criteria on hygiene and environmental health including
air quality management within buildings, management of waste, toilets, food sanitation
in hotels, restaurants, etc., are adapted with the 5 key measures for COVID-19 prevention
to tailor to each business, including rendering technical advice or suggestions in regard
to the execution of the SHA standard.
28 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

The MOPH by the DOH, in collaboration with the TAT, organized an award
event to grant SHA Standard certification to business establishments that had passed
the SHA Standard. There were more than 500 business establishments, among which
were the Grand Palace, in the category of “Recreation and Tourist Attraction,” Paragon
Department Store, Siam Center Department Store, Siam Discovery Department Store,
ICONSIAM Department Store, MBK Center Department Store, and Siam Wellness Group,
hotel and tourism business operators in Rayong, hotel and tourism business operators
in Samui, and business operators in Bangkok. In addition, there was a grant of certificate
of honor to food business operators in Phuket as they had played an integral part in
upgrading the tourism industry through health security potentials, safe tourism, and good
hygiene. The certificates of honor included Clean Food Good Taste Standard, Healthy
and Clean Phuket Restaurant Standard (Thumb Up Health), GREEN & CLEAN Hospital
Standard, HAS Standard, and SHA Standard. The execution of health and safety standards,
based on 3C (Care, Clean, Clear), supported tourists and provided guidelines for
evaluating the establishment under the Thai Stop COVID policy, the “preparedness for
the reopening of Phuket” policy, the “development of food and environmental sanitation
and anti-COVID-19 measures in order to strengthen confidence of tourists and to boost
the Thai economy,” and the “development of food and environmental sanitation
management system in tourism areas”. In term of transportation, the executives of the
DOH and those of the TAT had maintained close supervision over Nakhonchai Air bus
transfer services after the easing measures in accordance with the empowering project
and campaigns held against the spread of COVID-19.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 29

Provision of Health Safety Standards in the MICE Industry
The DOH, the Ministry of Tourism and Sports, and its associated networks,
have collaboratively developed health safety criteria and standards to suppress the
spread of COVID-19 within the MICE industry, composed of meetings, incentives,
conventions, exhibitions, and events, and have also formulated plans to drive the criteria,
standards, and developed innovation or novel forms of event organization. This shift
aims to upgrade the health standards of the national MICE industry and to strengthen
confidence of tourists and business operators. There is a collaborative framework and
roles to prepare for the reopening of businesses and events in respect of tourism and
sports, including formulation of key criteria and measures in order to be a guide for all
agencies, or relevant events. Moreover, they also have communicated and disseminated
knowledge, infected situation reports, and preparedness measures against the pandemic
to its associated networks and the general public. They have jointly approved measures,
guidelines for business operations and organization of events in line with directly
responsible government agencies. Moreover, there are surveillance, supervising, and
30 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

monitoring measures to prepare all for another wave of the pandemic and the outbreak
situation, and to supply information to relevant agencies. They have communicated
to establish mutual understanding with event organizers to arrange events by strictly
adhering to the active measures, visited target groups to empower people and evaluate
compliance with measures of the organizers, and rendered advice, as well as randomly
conducting surveys on behaviors of attendants to review whether they have complied
with the existing measures.
Regarding performance results, there have been 3 practice guides in regard to
health/SHA, 1 work manual for the MICE industry, 16 meetings with organizers and field
visits, a summary of attendee behavior surveys, and a qualitative performance summary.
Based on field visits to conventions, fairs, exhibitions, music festivals and concerts, all
the venues aforementioned have adhered to the implemented measures, both prior
to and during the actual event. There have been a range of new product and process
innovation emerged in many localities, both from technological approaches and local
wisdom. For example, hands free door openers, counter shields, temperature detecting
robots, eye temperature scanners, disinfecting tools, e.g., ozone sterilizer, UVC sterilizer,
sterilizer box, online/streaming work management, etc.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 31

3. Technical Seminar on Exchange of Best Practices for COVID-19
Prevention and Control in Thailand, the People’s Republic of China,
and Singapore; PP&P: Opportunity in the COVID-19 Crisis

The DOH had organized a webinar about “PP&P: Opportunity in the COVID-19
crisis” as part of the 13th National Health Promotion and Environmental Health Conference:
The Battle of Thai Against Crisis, Thailand on May 20, 2020. Dr. Wu Jin, Director-General
Shanxi Provincial Health Commission of the People’s Republic of China and Dr. Shawn
Vasoo, Clinical Director, National Center for Infectious Disease of Singapore, were invited
to exchange their expertise on COVID-19 prevention and control. In this occasion, the
DOH was honored by Mr. Anutin Charnvirakul, Deputy Prime Minister and Public Health
Minister, to give a speech on the success of actions taken to prevent and suppress the
spread of COVID-19 in Thailand.

The success of Thailand in monitoring the spread of COVID-19 was thanks to
a key factor, that was, the collaboration of all the population, who had strictly followed
official guidelines and advice. There were campaigns that encouraged Thais to stay
home called “Stay Home, Stay Safe,” “Stay Home for Medical Personnel,” and “Social
Distancing”. People expressed their generosity and supported one another by donating
medical equipment while the healthy had used fabric masks instead of surgical masks
in order to ensure that surgical masks sufficed for medical personnel. Moreover, they
also donated money, foods, and necessary items to the affected people. Thailand, with
32 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

collaboration of all sectors, could eventually adjust itself to the new normal era
with toleration, sharing spirits, strong personal and public health concerns, avoiding
highly-populated areas, strictly practicing social distancing, wearing facemasks, and
regularly washing hands. These are aimed to limit the possibility for another outbreak
and to ensure a solid ground of the new normal society, health literacy against COVID-19
among Thais, and turning the crisis into health security and sustainable economy.

The success of the People’s Republic of China in taking the COVID-19
pandemic under control was by normalizing preventive and disease control measures.
International research institutes believed that COVID-19 tended to further coexist with
human beings for a lengthy period of time; therefore, the normalization of the preventive
and disease control measures could be both a high-priority mission and a long-term
strategy. It was a gradual shift of pandemic prevention and controlling models, from
dimensionally prevention and control to professional ones, from emergency measures
to normalization, highlighting multiplication of cost-profit efficiency with aims to tailor
a deep-rooted mechanism that integrated responding approaches to emergencies and
normalization of disease control. In this regard, it would further center its attention on 6
aspects, namely 1) normalization of preventive and controlling strategies, 2) enhancement
of nucleic acid tests, 3) implementation of the “4 Fast” measures, including fast
detection, fast reporting, fast quarantine, and fast treatment, 4) amplification of
potentials of hospitals in preventing and controlling the infection in medical institutes,
5) adherence to the safety-first principle according to the technical roles of prevention

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 33

and controlling, and 6) integration of innovation to different measures. This could greatly
magnify disease preventive and control efficiency. For example, it encouraged people
to use mobile applications called “Health Code” and “Travel Code” in order to ensure
safe and well-managed travels of people, installed smart thermal detectors and security
doors in hospitals and transport hubs, which improved accuracy of thermal detection, etc.

The measures employed by Singapore to control and prevent COVID-19
were composed of health and treatment system measures. There was an establishment
of an organization responsible to provide care for recovered infected patients.
Its disease screening measures had been heightened, especially in groups of workers and
elderly care. Plasma from completely recovered COVID-19 patients had been obtained
to be used as part of the treatment. In terms of public health measures, it focused on
disease screening examination. When there was a person testing positive, he/she would
be required to undergo a quarantine. Moreover, an application had been employed to
track infected patients, and monitor Singaporeans who were under self-quarantine or state
quarantine. Apart from the measure that highlighted face mask wearing, Singapore’s
government also distributed face masks to every single one of its population. Additionally,
there were public policy measures such as work from home policy, and temporary closure
of workplaces, schools, etc., except locations that were required to be open. The measures
described earlier were called Circuit Breaker, which were to make sure that people
would leave their houses only when necessary. Concurrently, financial measures were
executed as the economy had been adversely affected by the situation. The Government
34 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

therefore provided financial support to every population. Based on the current situation,
Singapore still could not curb the lockdown; however, it would gradually ease strictness
of other aspects along with further implementation of public health measures and public
policy with a purpose to encourage and launch campaigns to strengthen awareness on
handwashing, mask wearing, and social distancing, consistently.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 35

Achievements and Challenges in the
Operations of the Department of Health

Achievements

The DOH has played an integral part of the overall operational success achieved
by the MOPH and the Thai Government as being a key driver in boosting public hygiene
and sanitation management in business establishments. Looking back to the early stage
of the pandemic, February through May 2020, changes and improvement can be noticed
as follows.
Firstly, the DOH has promptly adjusted to the situation, reorganized work
structures, plans, budgets, and emergency management by establishing the EOC of the DOH,
in which the Director-General of the Department serves as the Incident Commander (IC)
for formulating commanding mechanisms and a novel form of work organization in
support of unpredictable changes. The pre-pandemic working models were also
suspended and implemented dynamic approaches towards new responsibilities in
response to the pandemic of COVID-19. In addition, it has established work strategies by
defining a mutual goal, as well as closely supervising, monitoring, and communicating
commands and performance results.
Secondly, the DOH has gathered a team of technical experts from different
agencies, reviewed literatures from local and international journals to provide guidelines
that are tailored to each phase of the pandemic situation. Furthermore, it has aligned
the tasks of the technical team with the overall framework of the MOPH to ensure that
all advice and guidelines go in the same direction, reducing perplexity of the people and
enhancing confidence in taking actions against the disease and improve their personal
hygiene.
Thirdly, the DOH has developed health literacy mechanisms for the general public,
ensuring that they can manage to fathom the disease, through different forms of media,
including online, on air, and on ground infrastructures, in proactively providing onsite
demonstrations of protective practices to the locals, specifically on risk communication
and responses through the Risk Response for Health Literacy system (RRHL). All of these
actions have been taken to ensure that the population has obtained facts and correct
36 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

information, and to develop educational key messages and guidelines that are
fine-tuned in regard to their actual livelihood and surrounding contexts, which could
also be indeed carried out independently by the general public.
Fourthly, the DOH has implemented surveillance mechanisms, focusing on public
hygiene and compliance with disease preventive measures of different public and private
sectors, especially within business establishments. The mechanisms include rapid and
online surveys to evaluate preparedness and to prepare all corresponding agencies at
all levels.
Fifthly, the DOH has migrated its operations from analogue to digital by adopting
the Thai Stop COVID (TSC) platform as the major tool to create relationships and manage
all networks, especially in part that concerns the national economy and the business
sector that wished to continue its operations. TSC is a tool that prepares business
establishments for service management, activity organization that is publicly acceptable,
and for not being a source of transmission.
Lastly, the DOH has consolidated collaboration and strengthened the associated
network in terms of health practice improvement and implementation of protective
measures at the individual, community, and business level. All stakeholders are
allowed to take part in the operations and support actions taken by local administrative
organizations. These are deemed a highly integral part in the operations to suppress and
prevent the transmission of the disease.

Challenges

Owing to the novelty of the disease, obtaining knowledge about COVID-19
has been a frustrating task due to the lack of both efficient preventive and practical
innovation. One of the actions that was expeditiously taken by the DOH was the rendering
of advice to the general public on COVID-19 that the disease did not spread specifically
within certain localities, but indeed transmitted throughout the country and could be
infectious to all regardless of their nationality, religion, and profession. Therefore, the
general health guidelines were not sufficient. People demanded for more information on
what to be best practices for individuals with different lifestyles. In this regard, this matter
is not limited to only the practices to be complied by all people, but it also involves
the surrounding environment and communities where people make use of services.
The DOH is thus required to render guides and suggestions for businesses, activities and

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 37

establishments at every stage of the pandemic, including the easing phases, to ensure
that public activities, and those of the economy and the society can practically operate
and will not be a potential cause of the transmission.
The challenges of the DOH as an academic department with a mission of
health promotion and environmental health are how to deal with health illiteracy
and make the public fathom the disease to lessen fears and anxiety. It is required to
publicize proper guidelines that are tailored to specific contexts of each community in
terms of personal hygiene, and sanitation measures for businesses, activities, business
establishments, in order for the businesses to persist amidst the pandemic and to
mitigate the transmission of the disease.
However, one challenging factor is that when the domestic transmission is
mitigated, people potentially become less focused on the existing measures. As a
consequence, it is then a responsibility of the DOH to employ strategies that can maintain
a strict adherence to the disease prevention measures and prepare all sectors, including
the public, for the new normal of healthy life. While other countries are still in an intense
fight against the uncontrollable disease, the DOH, as the governor of health promotion
and environmental health systems, will put its greatest efforts to ensure that Thailand
can economically and socially overcome the situation.
38 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Lessons Learned from the Battle Against COVID-19

The outbreak of COVID-19 is a significant lesson learned by Thailand and the
entire world. COVID-19 is an emerging disease that rapidly spreads. There are several
concerns that still cannot be explained by academic knowledge, leading to a great fear
of the unknown, bafflement, anxiety, and panic of the entire society. The DOH hence
shifted its work priority, highlighting the use of digital technology as a mode of work.
Moreover, as the DOH could not make a visit to every single community due to disease
exposure and inability to provide face-to-face training, it has created a platform called
Clean Together, or commonly known as Thai Stop COVID (TSC). It is a tool to be used by
the DOH itself, the general public, business establishments, and associated networks, to
provide/obtain knowledge, communicate, enhance standards, and track the progress for
a purpose of surveillance because everything is accessible through the online platform.
In this regard, the platform is initiated at the provincial level, but is later employed at
the national level. Even though its performance may not be considerably effective, it
has formed a new work model for the personnel under the DOH, encouraging them to
work side by side with the general public and simplify official work procedures.
Based on the overall performance of the DOH in coping with COVID-19 since
the early stage of the outbreak in January 2020, we have found an important fact that,
in achieving any measure, social solidarity is key. Only public mechanisms exercised
through law execution, or the use of medical and public health innovation may not
be the final answer for Thailand. The way all sectors are enthusiastic and determined
to collaboratively solve the problems is a lesson that all have learned from this crisis
mitigation.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 39

Summary

The transmission of COVID-19 triggers the DOH to adapt itself to the situation as
being the government body that is responsible for health promotion and environmental
health of Thailand and concurrently requires to establish work mechanisms against the
pandemic restrictions to ensure that all actions taken have corresponded to the situation
taking place. The DOH’s missions are to promote health and monitor the environmental
health system during the pandemic of COVID-19, which has been consistently carried out
since the early stage of the outbreak, through the phase of community transmission and
the easing phase. The DOH educates people and all stakeholders with practical health
knowledge to ensure that they will possess health literacy and be able to reasonably
adhere to health practices in prevention of the disease. Moreover, it also improves the
existing standards to ensure its clarity and responsiveness to the pandemic situation,
contributing to awareness among business operators and all public domains in having
preventive standards or measures in place to prevent the spreading of virus, strengthening
confidence and the foundation of all associated networks in monitoring activities carried
out by business establishments and the general public for their own safety and health
in the new normal era.
The DOH has taken part in several operations of different agencies which have
joined forces to successfully curb the first outbreak of COVID-19. However, there are
still challenges in preventing this disease, as the pandemic situation of other countries
are still out of control and cannot be effectively suppressed. It therefore still requires
surveillance and strict adherence to the new normal practices for the safety of all.

40 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience

Bibliography

1. Thailand’s Experience in the COVID-19 Response, The Ministry of Public Health.
August, 2020.

2. Joint Intra-Action Review of the Public Health Response to COVID-19 in Thailand
20-24 July 2020, WHO Thailand.

3. Development of Surveillance and Response Systems and Mechanisms for Emergency
Risks to Establish Health Literacy During the COVID-19 Crisis, Amphorn Chanthaviboon,
Saichon Khloi-iam, Wimon Roma, Kingphikul Chamnarnkong, Public Health Journal,
Year 29, Vol. 5, September-October 2020.

4. Operational Manual of the Coronavirus 2019 Related Health Literary Communication
Team, The Department of Health.

5. Operational Manual on Surveillance and Response Operations to Communicate About
Risks, The Department of Health.

6. Performance Summary Report on Health Promotion and Environmental Health During
the COVID-19 Crisis, The Department of Health.

DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience 41

Appendix

1. Multimedia for Education and Suggestions on Routine Practice Guidelines During the
Pandemic of Coronavirus 2019, http://covid19.anamai.moph.go.th/th/.

42 DOH’s Response to the First Wave of COVID-19 Pandemic: Thailand Experience