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De Padua Durante AC, Lacaza R, Lapitan P, Kochhar N, Tan ES, Thomas M. Mixed effects modelling of excess mortality and COVID-19 lockdowns in Thailand. Sci Rep 2024; 14:8240. [PMID: 38589527 PMCID: PMC11001903 DOI: 10.1038/s41598-024-58358-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
Accurate mortality data are critical for understanding the impact of COVID-19 and learning lessons from crisis responses. But published statistics risk misrepresenting deaths due to limited testing, underreporting, and lack of subnational data, especially in developing countries. Thailand experienced four COVID-19 waves between January 2020 and December 2021, and used a color-coded, province-level system for lockdowns. To account for deaths directly and indirectly caused by COVID-19, this paper uses mixed effects modelling to estimate counterfactual deaths for 2020-2021 and construct a monthly time series of provincial excess mortality. A fixed effects negative binomial and mixed effects Poisson model both substantiate other studies' estimates of excess deaths using subnational data for the first time. Then, panel regression methods are used to characterize the correlations among restrictions, mobility, and excess mortality. The regressions show that mobility reductions modestly curbed mortality immediately upon imposition, suggesting that aversion of non-COVID deaths was a major aspect of the lockdowns' effect in Thailand. However, the estimates are imprecise. An auto-regressive distributed lag model suggests that the effect of lockdowns was through reduced mobility, but the effectiveness appears to have varied over the course of the pandemic.
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Affiliation(s)
| | - Rutcher Lacaza
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines
| | - Pamela Lapitan
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines
| | - Nishtha Kochhar
- Department of Economics, Georgetown University, Washington, USA
| | - Elaine S Tan
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines
| | - Milan Thomas
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines.
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Tuangratananon T, Rajatanavin N, Khuntha S, Rittimanomai S, Asgari-Jirhandeh N, Tangcharoensathien V. Governance, policy, and health systems responses to the COVID-19 pandemic in Thailand: a qualitative study. Front Public Health 2024; 12:1250192. [PMID: 38584930 PMCID: PMC10996397 DOI: 10.3389/fpubh.2024.1250192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/12/2024] [Indexed: 04/09/2024] Open
Abstract
Background Since 2020, Thailand has experienced four waves of COVID-19. By 31 January 2022, there were 2.4 million cumulative cases and 22,176 deaths nationwide. This study assessed the governance and policy responses adapted to different sizes of the pandemic outbreaks and other challenges. Methods A qualitative study was applied, including literature reviews and in-depth interviews with 17 multi-sectoral actors purposively identified from those who were responsible for pandemic control and vaccine rollout. We applied deductive approaches using health systems building blocks, and inductive approaches using analysis of in-depth interview content, where key content formed sub-themes, and different sub-themes formed the themes of the study. Findings Three themes emerged from this study. First, the large scale of COVID-19 infections, especially the Delta strain in 2021, challenged the functioning of the health system's capacity to respond to cases and maintain essential health services. The Bangkok local government insufficiently performed due to its limited capacity, ineffective multi-sectoral collaboration, and high levels of vulnerability in the population. However, adequate financing, universal health coverage, and health workforce professionalism and commitment were key enabling factors that supported the health system. Second, the population's vulnerability exacerbated infection spread, and protracted political conflicts and political interference resulted in the politicization of pandemic control measures and vaccine roll-out; all were key barriers to effective pandemic control. Third, various innovations and adaptive capacities minimized the supply-side gaps, while social capital and civil society engagement boosted community resilience. Conclusion This study identifies key governance gaps including in public communication, managing infodemics, and inadequate coordination with Bangkok local government, and between public and private sectors on pandemic control and health service provisions. The Bangkok government had limited capacity in light of high levels of population vulnerability. These gaps were widened by political conflicts and interference. Key strengths are universal health coverage with full funding support, and health workforce commitment, innovations, and capacity to adapt interventions to the unfolding emergency. Existing social capital and civil society action increases community resilience and minimizes negative impacts on the population.
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Affiliation(s)
| | | | - Sarayuth Khuntha
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Salisa Rittimanomai
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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Jirapanakorn S, Witthayapipopsakul W, Kusreesakul K, Lakhotia D, Tangcharoensathien V, Suphanchaimat R. All-cause excess mortality among end-stage renal disease (ESRD) patients during the COVID-19 pandemic in Thailand: a cross-sectional study from a national-level claims database. BMJ Open 2024; 14:e081383. [PMID: 38272543 PMCID: PMC10824030 DOI: 10.1136/bmjopen-2023-081383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES COVID-19 infection increased nephrology-related risks and mortality rate among end-stage renal disease (ESRD) patients. The pandemic also disrupted essential healthcare services. We aim to explore all-cause excess mortality among ESRD patients who were members of the Universal Coverage Scheme (UCS), the largest public health insurance scheme in Thailand covering citizens who are not employed in the formal sector, including children and older persons. DESIGN A cross-sectional study. SETTING We retrieved the dataset from the UCS claims database-electronic health records used for processing healthcare expense claims from medical facilities of all UCS members. This database links mortality outcome to civil registration. We employed the WHO's excess mortality methodology using pre-pandemic data to estimate expected deaths during the pandemic period (March 2020 to August 2022). PARTICIPANTS This study included ESRD patients from across Thailand, covered by the UCS. PRIMARY OUTCOME MEASURE Excess deaths are the difference between predicted and reported deaths. RESULTS Over a 30-month period of the pandemic, the total number of all-cause excess deaths among ESRD patients was 4966 (male 1284; female 3682). The excess death per 100 000 ESRD patients was 3601 (male 2012; female 4969). The relative excess death was 5.7% of expected deaths (95% CI 1.7%, 10.0%). The excess deaths were highly concentrated among patients aged 65 and older. CONCLUSION ESRD patients are significantly more vulnerable to pandemic-related mortality than the general population. Health systems' capacity to contain the pandemic at varying virulence and maintain essential health services for ESRD patients might be related to the size of excess deaths at different periods. The observed excess deaths highlight the importance of established strategies to reduce all-cause mortality such as rapid vaccine rollout for ESRD patients and sustaining dialysis and other essential services for older patients and other high-risk groups.
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Affiliation(s)
- Sutham Jirapanakorn
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Woranan Witthayapipopsakul
- International Health Policy Program, Nonthaburi, Thailand
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Divya Lakhotia
- International Health Policy Program, Nonthaburi, Thailand
| | | | - Rapeepong Suphanchaimat
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
- International Health Policy Program, Nonthaburi, Thailand
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Bonnet F, Camarda CG. Estimating subnational excess mortality in times of pandemic. An application to French départements in 2020. PLoS One 2024; 19:e0293752. [PMID: 38241216 PMCID: PMC10798530 DOI: 10.1371/journal.pone.0293752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/18/2023] [Indexed: 01/21/2024] Open
Abstract
The COVID-19 pandemic's uneven impact on subnational regions highlights the importance of understanding its local-level mortality impact. Vital statistics are available for an increasing number of countries for 2020, 2021, and 2022, facilitating the computation of subnational excess mortality and a more comprehensive assessment of its burden. However, this calculation faces two important methodological challenges: it requires appropriate mortality projection models; and small populations imply considerable, though commonly neglected, uncertainty in the estimates. We address both issues using a method to forecast mortality at the subnational level, which incorporates uncertainty in the computation of mortality measures. We illustrate our approach by examining French départements (NUTS 3 regions, or 95 geographical units), and produce sex-specific estimates for 2020. This approach is highly flexible, allowing one to estimate excess mortality during COVID-19 in most demographic scenarios and for past pandemics.
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Affiliation(s)
- Florian Bonnet
- Institut national d’études démographiques (INED), Aubervilliers, France
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Anupong S, Chantanasaro T, Wilasang C, Jitsuk NC, Sararat C, Sornbundit K, Pattanasiri B, Wannigama DL, Amarasiri M, Chadsuthi S, Modchang C. Modeling vaccination strategies with limited early COVID-19 vaccine access in low- and middle-income countries: A case study of Thailand. Infect Dis Model 2023; 8:1177-1189. [PMID: 38074078 PMCID: PMC10709621 DOI: 10.1016/j.idm.2023.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 08/17/2024] Open
Abstract
Low- and middle-income countries faced significant challenges in accessing COVID-19 vaccines during the early stages of the pandemic. In this study, we utilized an age-structured modeling approach to examine the implications of various vaccination strategies, vaccine prioritization, and vaccine rollout speeds in Thailand, an upper-middle-income country experiencing vaccine shortages during the early stages of the pandemic. The model directly compares the effectiveness of several vaccination strategies, including the heterologous vaccination where CoronaVac (CV) vaccine was administered as the first dose, followed by ChAdOx1 nCoV-19 (AZ) vaccine as the second dose, under varying disease transmission dynamics. We found that the traditional AZ homologous vaccination was more effective than the CV homologous vaccination, regardless of disease transmission dynamics. However, combining CV and AZ vaccines via either parallel homologous or heterologous vaccinations was more effective than relying solely on AZ homologous vaccination. Additionally, prioritizing vaccination for the elderly aged 60 years and above was the most effective way to reduce mortality when community transmission is well-controlled. On the other hand, prioritizing workers aged 20-59 was most effective in lowering COVID-19 cases, irrespective of the transmission dynamics. Lastly, despite the vaccine prioritization strategy, rapid vaccine rollout speeds were crucial in reducing COVID-19 infections and deaths. These findings suggested that in low- and middle-income countries where early access to high-efficacy vaccines might be limited, obtaining any accessible vaccines as early as possible and using them in parallel with other higher-efficacy vaccines might be a better strategy than waiting for and relying solely on higher-efficacy vaccines.
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Affiliation(s)
- Suparinthon Anupong
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Tanakorn Chantanasaro
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Chaiwat Wilasang
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Natcha C. Jitsuk
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Chayanin Sararat
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Kan Sornbundit
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Ratchaburi Learning Park, King Mongkut’s University of Technology Thonburi, Ratchaburi, Thailand
| | - Busara Pattanasiri
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Department of Physics, Faculty of Liberal Arts and Science, Kasetsart University Kamphaeng Saen Campus, Nakhon Pathom, 73140, Thailand
| | - Dhammika Leshan Wannigama
- Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, Japan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
- Biofilms and Antimicrobial Resistance Consortium of ODA Receiving Countries, The University of Sheffield, Sheffield, United Kingdom
- Pathogen Hunter’s Research Collaborative Team, Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Mohan Amarasiri
- Laboratory of Environmental Hygiene, Department of Health Science, School of Allied Health Sciences/Graduate School of Medical Sciences, Kitasato University, Kitasato, Sagamihara-Minami, Kanagawa, 252-0373, Japan
| | - Sudarat Chadsuthi
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Department of Physics, Faculty of Science, Naresuan University, Phitsanulok, 65000, Thailand
| | - Charin Modchang
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Center for Disease Modeling, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
- Centre of Excellence in Mathematics, Ministry of Higher Education, Science, Research and Innovation, Bangkok, 10400, Thailand
- Thailand Center of Excellence in Physics, Ministry of Higher Education, Science, Research and Innovation, 328 Si Ayutthaya Road, Bangkok, 10400, Thailand
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Tangcharoensathien V, Vandelaer J, Brown R, Suphanchaimat R, Boonsuk P, Patcharanarumol W. Learning from pandemic responses: Informing a resilient and equitable health system recovery in Thailand. Front Public Health 2023; 11:1065883. [PMID: 36761120 PMCID: PMC9906810 DOI: 10.3389/fpubh.2023.1065883] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The third quarter of 2022 saw COVID-19 cases and deaths in Thailand reduced significantly, and high levels of COVID-19 vaccine coverage. COVID-19 was declared an "endemic" disease, and economic activities resumed. This paper reviews pre-pandemic health systems capacity and identifies pandemic response strengths, weaknesses and lessons that guided resilient and equitable health system recovery. Robust health systems and adaptive strategies drive an effective pandemic response. To support health system recovery Thailand should (1) minimize vulnerability and extend universal health coverage to include migrant workers and dependents; (2) sustain provincial primary healthcare (PHC) capacity and strengthen PHC in greater Bangkok; (3) leverage information technology for telemedicine and teleconsultation; (4) enhance and extend case and event-based surveillance of notifiable diseases, and for public health threats, including pathogens with pandemic potential in wildlife and domesticated animals. This requires policy and financial commitment across successive governments, adequate numbers of committed and competent health workforce at all levels supported by over a million village health volunteers, strong social capital and community resilience. A strengthened global health architecture and international collaboration also have critical roles in establishing local capacities to develop and manufacture pandemic response products through transfer of technology and know-how. Countries should engage in the ongoing Inter-government Negotiating Body to ensure a legally binding instrument to safeguard the world from catastrophic impacts of future pandemics.
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Affiliation(s)
- Viroj Tangcharoensathien
- International Health Policy Programme, Ministry of Public Health, Nonthaburi, Thailand,*Correspondence: Viroj Tangcharoensathien ✉
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