The Delta variant, the fourth wave of the COVID-19 pandemic, caused a sharp surge in hospitalizations and deaths in July 2021, Thailand. Because to population density and insufficient immunization, Bangkok and the Metropolitan Region(BMR) were the epicenters. The Thai government switched from inpatient care to home isolation due to the massive outbreak.

Methods

A retrospective cohort study was conducted. A-MED Telehealth identified all BMR COVID-19 patients in the home isolation program (HI) between July and December 2021. On September 20, 2022, the National Civil Registration database evaluated patients. The Cox proportional hazard model determined 28-day mortality and its determinants. During the study, BMR had standard health systems and COVID-19 crisis response task force services. The Royal College of Family Physicians of Thailand and the Thai Red Cross Society supported Fammed CoCare (Tangerine Clinic), which was part of the HI crisis response task force.

Results

The overall number of participants was 90,861. In July, the first month of HI protocol implementation, Fammed CoCare treated up to 50% of patients. Average age was 37.28±18.96 years. Half of the participants were men. Asymptomatic, mild, urgent, death, resolution, and other administration are the initial symptoms(42.80%,29.50%,1.20%,0.01%,0.70%,and 9.30%). Andrographis paniculate, favipiravir, and corticosteroids were administered(8.70%,23.00%,0.53%).

The 28-day mortality rate was 55.80%. The independent factors were increasing age(HR,1.12;95%CI:1.11-1.14), male(HR,1.75;95%CI:1.28-2.39),increasing BMI(HR,1.05;95%CI:1.01–1.08),Mild symptoms(HR,1.55;95%CI:1.04–2.30),Urgent symptoms(HR,2.66;95%CI:1.52–4.65),Delayed assessment(HR,0.86;95%CI:0.78–0.95),increased O2 saturation(HR,0.89;95%CI:0.85–0.92),increased temperature(HR,2.26;95% CI:1.43–3.58) after adjusted for all factors and corticosteroid prescription.

Conclusions

Managing patients during the COVID-19 pandemic requires timely adaptation. Early on, conventional health systems should collaborate with the HI crisis response task force for COVID-19 patients to form multidisciplinary teams. In this situation, the various COVID-19 lessons learned guided outbreak management systems.

Public health implications

Standard health systems and a crisis response task team will be used to prototype pandemic prevention and control. Early crisis response necessitates a well-supported team, which is how future disasters will be handled. Furthermore, due to COVID-19, telemedicine should reinforce the chronic care model. Finally, the Thai government's healthcare staffing will be influenced by population density.