How did Covid slip through Taiwan’s ‘gold standard’ defences?
"Island state went 253 days without a single local case but now the number of cases is rising sharply
A worsening coronavirus outbreak in Taiwan has raised urgent questions about how the virus slipped past the island’s “gold standard” defences, and if it can quickly return to a zero-Covid life.
In 2020, the island state of 24 million people was producing extraordinary numbers: fewer than 1,000 cases, about 90% of them detected in recent arrivals, zero infection leaks from quarantine, a death toll of 12, and 253 days without a single local case.
On Friday, the numbers turned when health authorities reported 29 local cases, followed by 180 on Saturday, 206 on Sunday, and 333 on Monday. Most are in the north, with large clusters in Taipei city and New Taipei city, where testing stations have reported 10% positivity rates. About 91% of Taiwan’s total local caseload has come in the past four days.
The outbreak began in late April, connected to flight crews from the national carrier, China Airlines, and a Taoyuan airport Novotel, which was hosting both quarantining flight crews and Taiwanese flight enthusiasts who had booked in as part of a domestic tourism promotion. Both the airline and hotel have since been fined.
The first cases were reported in two pilots on 20 April. Ten days later, the Central Epidemic Command Centre (CECC) announced an investigation into “the possible risk of transmission” among staff who had quarantined at the Novotel in the previous two weeks. The cases confirmed fears about the government’s decision to steadily relax required quarantine time for flight crews, down to just three days by mid-April with a mandated period of self-monitoring of their health. By the time of the investigation many crew members had checked out and some were later found to have visited public venues while infectious, in breach of the rules.
Dr Chiou Shu-ti, former health commissioner of Taipei, said authorities were “playing with fire” by relaxing the requirements while being “complacent” with testing of arrivals.
By early May, 18 airline and hotel employees and 11 family members had tested positive, and soon cases emerged in counties without a known link to the airport or hotel. By Monday, there were cases in nine cities or counties, all reportedly the same UK variant of the virus.
In response, the national and local governments have announced caps on gatherings, the closures of some businesses, public venues and schools, reduced non-Covid medical services, and tighter border restrictions. Residents are urged to increase hygiene and avoid travel. But the measures vary across Taiwan, and even the stricter rules in Taipei and New Taipei don’t come close to a full lockdown.
Taiwan’s health minister, Chen Shih-chung, acknowledged his intent was to allow businesses – including indoor dining – to keep operating, saying: “The spirit of level three is to reduce the risks of coronavirus spread, to reduce the scale of any gathering.”
Dr Chiou, who said her history as a one-time political candidate had coloured responses to her advice, warned authorities against following the mitigation strategies of the UK or US instead of aiming for elimination. She called for an immediate nationwide quasi-lockdown (with government financial support for workers) and then mass testing.
“The [CECC’s] restrictions will slow down the transmissions, sure… but if they don’t get to zero then after they relax the curve will go up again,” she said.
She said Taiwan had been “stupid” in focusing testing on people who presented with symptoms and also had a travel history or connection to a confirmed case, rather than one or the other. As of Monday, rapid testing was only established in Wanhua, meaning there were potentially many more cases undetected.
“Everyone knows that Covid-19 can spread before the onset of symptoms,” she said.
Chiou pointed to three recent mass travel events that could contribute to a spread but would not be detected yet: the 8-9 May mother’s day weekend, last weekend’s high school entrance exams, and students returning to their home towns after universities switched to remote learning on Sunday.
Hassan Vally, associate professor of public health at Melbourne’s La Trobe University, said after 16 months it still wasn’t proven exactly what worked in terms of lockdowns but short sharp ones could be very effective “if for no other reason that they just buy you a bit of time where things don’t get worse while you assess the situation”.
Vally said Taiwan had the “gold standard” of responses in the beginning, and the high community cooperation with non-mandatory requests to stay home was a huge plus.
“It’s effectively a lockdown without enforcing it,” he said. “The answer will probably be revealed in the next seven days.”