An investigation of the first confirmed coronavirus disease 2019 (COVID-19) case in Nakhon Si Thammarat Province, Thailand, March 2020: a multidisciplinary approach

Abstract

Background: Coronavirus disease 2019 or COVID-19 is an emerging disease, caused by SARS-CoV-2 virus. large-scale transmission of COVID-19 have occurred since March 2020. Nakhon Si Thammarat Public Health Office was reported on March 3, 2020 that there was a probable COVID-19 case admitted to Tha Sala Hospital, Tha Sala District, Nakhon Si Thammarat Province. The case investigation was conducted during 3–16 March 2020 in order to confirm the diagnosis and existence of the outbreak, to describe epidemiological characteristics, to identify the source and mode of transmission, and to provide appropriate disease prevention and control measures.
Methods: A descriptive study was conducted by reviewing medical records and interviewing the case and involved person. Contact tracing and active case finding by using the definitions of case and contact of the Department of Diseases Control. We collected upper respiratory tract specimens from the patient under investigation (PUI) and high risk close contact and subjected to detect SARS-CoV-2 by Reverse Transcriptase Polymerase Chain Reaction technique. Environment study inside the houses and his visited places were also performed.
Results: There was a confirmed case of COVID-19. He was 21–year–old, Thai Shia Muslim student. His onset was on 26 February 2020 while he was in Tha Sala District, Nakhon Si Thammarat Province, Thailand. He just came back from Islamic Republic of Iran where the outbreak was still ongoing and there was a previous confirmed case in his school. The students usually directly contacted each other by hands touching and then touching their own faces (Islamic greeting). There were other 2 PUIs among his low risk close contacts and 153 high risk close contacts. However, SARS-CoV-2 virus was not detected in the PUIs and all high risk contacts. We found that the case mostly visited the places with open-air setting.
Conclusions and discussion: The first confirmed COVID-19 case of Nakhon Si Thammarat Province was Thai-Muslim student who just came back from Islamic Republic of Iran, where the outbreak was still ongoing. He was likely to be infected before returning to Thailand. The transmission may be occurred during Islamic greeting. A multidisciplinary approach was applied in the investigation and disease control There was no more case. The explanation may be the case had practiced a good personal protection during his travels, he was promptly admitted and isolated in the hospital as well as the effective close contact tracing. However, Thailand should strengthen the surveillance among passengers entering the country.