Thai boys may face health issues outside of cave
MAE SAI, Thailand — Eight boys rescued from Tham Luang Cave are happy and in good condition but remain in quarantine and will stay hospitalized for a week because of the risk of rare infections, doctors said Tuesday.
Doctors were conducting a battery of tests on the boys, and X-rays showed that two might have pneumonia. All of them were being treated with antibiotics and received vaccinations, including for tetanus and rabies, said Thailand’s permanent secretary for public health, Jesada Chokedamrongsuk.
“This morning, all eight are in good health, with no fever and in a good mood,” Jesada said. “They miss their home and they are happy.”
Medical specialists who are not involved in treating the boys said that while the risk of serious infection is low, they could face other short- or long-term complications, including post-traumatic stress disorder.
The 12 boys, ages 11-16, and their soccer coach had been trapped in the cave since June 23. A team of foreign and Thai divers began extracting them Sunday, starting with four of the older boys. Four more emerged Monday, and the four remaining team members and their coach were rescued Tuesday afternoon.
Like the rescue itself, the close medical attention from one of the government’s highest-ranking doctors underscores the unusual nature of the mission to save the youths and their coach.
The boys are in different stages of recovery after more than two weeks in the dark cave. The first group out has been able to adjust to normal lighting, but the latter ones are still wearing sunglasses, Jesada said.
All are being kept in the same room at Chiangrai Prachanukroh Hospital, the main hospital in Chiang Rai province.
Also joining them in quarantine will be four Thai divers who stayed with the boys for more than a week after their discovery in a flooded cavern, said Dr. Thongchai Lertwilairatnapong, the public health doctor for Thailand’s northern region.
That includes an army doctor, Lt. Col. Phak Lohanchun, who was seen in video clips treating the boys’ cuts and abrasions.
The four divers face less risk than the boys, however, because they were never malnourished and spent less time in the cave, experts said.
Relatives of the first four rescued boys have been allowed to see them through a window, and a similar visit will be arranged for the others after doctors give their approval, the head of the rescue operation, Narongsak Osottanakorn, said Tuesday.
Prime Minister Prayuth Chan-ocha visited them Monday when he came to check on the rescue operation.
Although the likelihood of serious infection is small, specialists said they were taking precautions in case the boys acquired a rare disease while stuck in the cave.
One danger is getting an infection from bats or rodents they might have encountered underground. The boys reported seeing no wildlife in the flooded cavern where they took refuge, but doctors were still concerned.
“We don’t have experience in this kind of deep cave, but they said they didn’t see any bats or animals,” Jesada said. “Bats can lead to several diseases.”
The hospital has sent the boys’ blood samples to a Bangkok laboratory that specializes in emerging infectious diseases.
One danger is Nipah virus, a disease that can be transmitted to humans by bats through bites, among other possibilities, said medical specialists who are not involved in treating the boys.
Potential symptoms range from headaches and fever to, in severe cases, acute respiratory failure or even death.
A 2005 study reported that Nipah virus is present in Thailand. However, an infectious-disease doctor who works in the country’s north said there had been only three major known outbreaks worldwide — in Malaysia, India and Bangladesh.
The risk that any of the group has Nipah virus is extremely low, he said, in part because the cavern is so deep inside the Tham Luang Cave network that bats would probably avoid it during the rainy season.
Martyn Farr, a cave explorer who lives in Wales, agreed, saying he doubted that bats would be there at this time of year because they are “intelligent creatures” who are capable of flying long distances and would not want to be hemmed in by floodwaters, as the boys were.
Dr. Eileen Soon, a general practitioner in Singapore and the medical adviser for the Singapore Mountaineering Federation, said that while the incubation period for Nipah virus is generally four to 14 days, she did not expect the boys to be quarantined for that long if they did not exhibit any signs or symptoms of the disease.
Soon said the boys might also be at risk of contracting other infections, including leptospirosis, a bacterial disease that is carried by rodents and can be transmitted through water, and histoplasmosis, an infection caused by a fungus that dwells in soil containing bat excrement.
“However, these infections are either not contagious, meaning human-to-human transmission is not possible, or transmission may be extremely rare,” she said in an email.
Relatively minor ailments — minor scrapes, for example, or bacterial infections picked up from contaminated water — could become a problem for the boys because their immune systems have probably been compromised during their ordeal, medical specialists said.
“When you’re balancing and moving along an irregular-floored tunnel and you slip or stumble, the first thing you’ll do is put your hand or arm out onto the nearest bit of wall,” Farr said by telephone. “And those walls, in caves, can be very sharp.”
However, Phak’s treatment of the boys’ cuts and abrasions after he arrived at the cave should have reduced that risk.
Beyond physical ailments, Soon said, the boys could eventually experience anxiety, panic attacks, recurrent nightmares, phobias or other symptoms of post-traumatic stress disorder.