Table 6

Snapshot of surging health infrastructure capacity measures implemented in six Asian countries

IndonesiaSingaporeSouth KoreaThailandThe PhilippinesVietnam
Surge capacity of treatment, isolation and quarantine facilitiesTo augment existing government hospitals, police and military hospitals become designated referral hospitals while other hospitals were urged to convert up to 40% of general wards to COVID-19 wards. An online platform that shows hospital bed occupancy was initiated. To rapidly increase capacity, Jakarta transformed its Asian Games Athlete’s Village into a COVID-19 makeshift hospital and quarantine facility. As traditional facilities get overwhelmed, ferries and ships were converted into floating isolation facilities in September 2021 to accommodate mild cases. All along, hotels were also used as self-isolation centres.A 330-bed purpose-built facility which could increase to 500 beds was used to house patients since 2020. During the first wave, large venues such as convention halls were repurposed to community isolation facilities. Hotels also became facilities to isolate close contacts. The Delta wave brought an upswing in numbers needing isolation and community care facilities, renamed as community treatment facilities were set up to absorb cases that still require medical attention, particularly for the elderly and those with comorbidities. As hospitals reached capacity in the third quarter of 2021, the Home Recovery Programme was rolled out, augmented by telemedicine services. Private hospitals were also engaged throughout to boost overall health system capacity.In early 2020, non-clinical amenities were converted into COVID-19 community facilities so that capacity for non-COVID-19 related services can continue. Concurrently, secondary and tertiary private hospitals were also engaged to add to the existing pool of dedicated COVID-19 hospitals while general hospitals were also transformed into respiratory split hospitals that could effectively segregate patients with respiratory symptoms with those that do not, limiting nosocomial transmission. As vaccination rates increased by the end of 2021 with more people suffering from milder symptoms or becoming asymptomatic, home isolation and recovery was promoted.Hospitels (hotels repurposed as special hospitals) for cohort wards and keeping recovered patients were created at the outset. Military forts were also used as field hospitals for spare capacity. Exhibition halls and stadiums were also converted into field hospitals to expand overall capacity in 2020. As the fourth wave hit, home isolation was permitted in Bangkok, whereby doctors will communicate with patients remotely and food and medicines will be supplied at their doorsteps in a bid to relieve the strain placed on isolation facilities brought about by the Delta variant. Private hospitals were also engaged throughout the pandemic.Selected government and volunteer private hospitals were designated as COVID-19 referral hospitals based on overall capacity and availability of human resources and appropriate infrastructure. In August 2020, One Hospital Command Centre was also launched as a coordinating centre for health facility referrals. Local Government Units identified and furbished provincial, city, municipal and barangay facilities that may be used as isolation facilities and to assist the Department of Tourism in identifying hotels and other similar establishments to be utilised as quarantine facilities. Simultaneously, government buildings, stadiums and event venues were repurposed for isolation usage. As the Delta variant caused an exponential surge, coupled with a sluggish vaccination drive, more health facilities were required in mid-2021 which came in the form of a request for more funds through the Health Facilities Enhancement Programme. Private hospitals were also engaged and reimbursed for providing service by PhilHealth.To cater to the swelling cases from the first wave, large scale infrastructure including schools and stadiums, were converted into temporary COVID-19 hospitals. In mid-2021, as the country faced a huge wave derived from the Delta variant, more field hospitals were installed by military forces. Home isolation was also permitted for mild and asymptomatic cases with monitoring by local health commune centre staff. The government had been urging private hospitals to take on more COVID-19 patients since mid-2021 as public hospitals were overwhelmed due to the Delta wave.
Surge laboratory and testing capacitiesAt the beginning, all samples were sent to MOH appointed labs in Jakarta, resulting in slow processing of samples. As the pandemic progressed, testing became more decentralised. By mid-2021, Indonesia had almost doubled the total no of laboratories authorised for testing. As cases remained high through 2021, private laboratories were also engaged to provide drive-through and home-based testing.Singapore had an existing national public health lab performing PCR testing during the first stage of the pandemic. In May 2020, the Testing Operations Centre which aggregated national demand and centrally manage allocation of capacity was formalised. By Mid-2020, as caseloads persisted, private GP clinics were engaged as Swab and Send Home clinics for more testing and surveillance in the community. To further meet demand, large scale quick test centres were set in October 2021 to performed supervised self-swabs while there was an increased emphasis on self-testing at home as all households were issued with RAT test kits.Tests were initially centrally performed at the Korean Centre for Disease Control and subsequently scaled up to regional labs. Test kits were rapidly approved for use and sent to regional health centres at the start of 2020. Private sector labs were also partnered to augment government testing capacity. Concurrently, South Korea rolled out its innovative drive-through and walk-through testing to align with its aggressive national testing strategy.Private labs were mobilised and certified by the Department of Medical Sciences under its ‘one province-one laboratory- 1-day reporting’ policy, ensuring sufficient testing capacities within all provinces. Thailand has a total of 500 government and private sector labs under its Laboratory SAR-CoV-2 Detection Network in 2022 after rapidly expanding capacity since the first pandemic wave.The Research Institute for Tropical Medicine (RITM) was the lone laboratory conducting PCR tests in March 2020. To rapidly surge lab capacity, the Asian Development Bank and the Department of Health (DoH) convened Task Force T3, a private-public taskforce aimed at expansion of PCR capacities. It identifies the most urgent requirements for the set-up of PCR labs at priority hotspots. As waves continue to hit the Philippines, RITM and DoH continue to accredit more labs to join the National COVID-19 PCR Laboratory Network. By the end of 2021, licensed public and private COVID-19 testing laboratories numbered 287. Some private facilities implemented drive-through testing. The Philippine Red Cross also introduced saliva-based PCR testing in January 2021, whose results were retroactively included in official reports through a DOH policy in June 2021.Since the first wave, Vietnam had been exponentially expanding its lab testing infrastructure, splitting the amenities between screening labs and confirmatory labs throughout all provinces by mid-2021. Many private laboratories that are qualified in terms of equipment and human resources have been authorised by the government as well. Mobile container labs that could provide up to 2000 tests per day were also deployed.
  • GP, general practitioner; MOH, Ministry of Health; RAT, rapid antigen test.