Outbreak Investigation: A public bus driver in Bangkok who was died from COVID-19, 14-15 April 2020

Abstract

Background: The Division of Epidemiology, Department of Disease Control (DOE) was notified from Institution for Urban Disease Control and Prevention (IUDC) about the dead case of lab-confirmed COVID-19. A joint investigation team (JIT) was conducted to confirm the diagnosis and the outbreak, to identify the close contacts as well as the active cases, to know the risk factors and to recommend the control measures.
Methods: The descriptive study was to reviewing medical records and other related documents, tracing the closed contact, finding the active case, and interviewing various group of people. Laboratory study was performed by RT-PCR for SARS-CoV-2 among those high-risk contacts. The environmental survey was conducted at the bus terminal as well as in both hospitals where the patient got treatment.
Results: A 52-years-old Thai female, worked as the public air-conditioned bus driver, mainly presented with myalgia on 17 March 2020. Afterwards, her illness was not improved. She still worked and joined the parties many times. Her last party was held on 26 March 2020, which was the most suspicious source of disease spreading, because one of the attendants had got sick from COVID-19 before attending the party. Five days after the party, she developed high fever. She was diagnosed as lab-confirmed COVID-19 at a hospital. All the last party attendants were diagnosed as COVID-19. For the environmental survey, the canteen and the waiting area at the bus terminal were sometimes crowed. Both hospitals that she got treatment had well-prepared services due to response to COVID-19 situation.
Recommendations: We recommended 1) each community develop the surveillance and warning system when social distancing is not followed 2) the bus company provide the recreation area at the bus terminal, strengthen the sanitation programs among the employees, set the fever screening points for the employees before start working each day, set up the partitions between the bus driver and passengers, improving air flow inside the bus, frequently cleaning inside the bus, limit the number of passengers, design the seats in order to reduce the exposure of disease, encourage all passengers wearing mask during the trip, and use the bus automatic payment system.