COVID19 outbreak continues in Taiwan as the government struggles to contain it

Taiwan’s Central Epidemic Command Center confirmed that Taiwan reported 312 new local coronavirus cases on Friday, making it the seventh day in a row that Taiwan has recorded more than 100 cases in a single day. However, the epidemic alert in Taiwan remains at level three, and Taiwan’s Health Minister Chen Shih-Chung stressed that the country is definitely not raising its level of alert to level four, which would mean a total lockdown.

Among the confirmed cases announced on Friday, 107 cases were associated with the Wanhua area in Taipei and 73 cases were related to the Wanhua tea parlor cluster. Chen emphasized that since all counties across Taiwan have raised their alert level to level three, the whole country should coordinate their disease prevention standards, the statements they make, and steps that they will follow in order not to cause social chaos.

Chen also held a video conference with the U.S. Health Department Secretary on Friday morning. Chen said he told his U.S. counterpart that the outbreak is becoming more serious in Taiwan and that Taiwan urgently needed vaccines. He said he hoped the U.S. would support Taiwan. The U.S. Department of Health’s Office of Global Affairs tweeted that it would support Taiwan in obtaining vaccines.

However, with millions of doses of vaccines yet to arrive in Taiwan and community outbreaks continue to pop up across Taiwan, some experts think there are other steps that Taiwan should do in order to prevent the current outbreak from worsening.

Is it time to impose any form of lockdown?

Yaneer Bar-Yam, President of the New England Complex Systems Institute in the U.S., suggested that in order to avoid seriously disrupting social activities, countries may have to act the strongest initially. “You have to pay the price of the initial disruption of social activity but that has the least social disruption over time because it only lasts a short period of time,” he said.

“If you did it on the first day, as soon as you see there is a problem and you take action, then it’s the smallest action that you will have to take. The longer you wait, the bigger the action that you need to take.”

Bar-Yam said since Taiwan is now one week into its worst local outbreak since the beginning of the global pandemic, it almost surely needs a two-week lockdown instead of a lockdown that only lasts several days. “There may be the need for an additional week of lockdown in a few places, but that should be enough,” he said.

“What you want to do is to take the areas where you would have the most time and you do intensive testing, then that shortens the time that you have to impose the restrictions. It’s all about acting fast and acting strongly in the best way possible. How long you wait for dictates the magnitude of the effort that is needed.”

However, Minister Chen in Taiwan said on Friday that the current state of the outbreak hasn’t met the criteria of raising the pandemic alert to level four, since it requires Taiwan to report more than 100 cases for 14 days in a row and more than half of the cases need to have unidentifiable sources of infection. He claimed that the government can usually find the sources of infection for most of the current cases within two days.

Should Taiwan enhance its testing capacity?

Taiwan has been setting up testing stations across different communities over the last week, but it has yet launched a community-level mass-testing in hotspots like Wanhua District in Taipei. Chen Shih-Chung said on Wednesday that those with contact histories with infected patients, have recently been to a hotspot and have started to show symptoms should be tested.

On the other hand, those who have contact histories with infected patients and have recently been to any hotspots but have no symptoms should be quarantined for 14 days and go to get tested when they start to show symptoms. Those without contact histories with infected patients, who haven’t recently visited hotspots or haven’t shown any symptoms don’t need to be tested.

Bar-Yam thinks that it’s important for Taiwan to increase capacity to do testing rapidly and to quarantine when in doubt, which includes contacts or any kinds of symptoms. “There are ways to identify cases that are beginning to show symptoms, including fever and oxygen saturation, and there are other tests that are possible, like CT scans,” he said.

“If you can’t test enough, you quarantine based on symptoms. You verify the results later. The false-negative issue is important because even the PCR test has about a 30% false negative. One has to interpret the negative result cautiously and continue to take any symptomatic indications as being indications of the disease. People being quarantined need to be quarantined for 14 days even if they are asymptomatic.”

Bar-Yam points out that the main thing is to over-quarantine so that if there are any cases, they will be prevented from transmitting even if you can’t verify that they have the disease. “The main thing is to systematically prevent transmission because there are enough cases that asymptomatic individuals will be transmitting them that’s undermining the efforts to stop the outbreak,” he said.

Should citizens start to get their second dose of vaccine when the number of vaccines is limited?

So far, Taiwan only has the COVID19 vaccine from AstraZeneca and it has been rolling out the 300,000 vaccines received prior to the current outbreak. It received an additional 400,000 doses of vaccines a few days ago. However, with a limited number of vaccines, Taiwan is facing the dilemma of whether to allow more citizens to have their first doses of vaccines or to allow those who have scheduled their second doses of vaccines to be vaccinated on time.

Bar-Yam thinks that how to best ration Taiwan’s existing number of vaccines depends on the time frame. “It has been demonstrated that a delay in the second vaccine is not harmful to the development of immunity, and the first vaccine shot is helpful,” he said.

“The main thing is that the available vaccines should be used but they can’t be relied upon in the context of this outbreak in Taiwan. Vaccines can help, especially since medical workers are always at high risk.”

Bar-Yam said while vaccines are powerful tools that can help amid an outbreak, but they also have their unique strengths and limitations. “Thinking about them as part of the overall thought is better than thinking about them as the response, which is one of the challenges in terms of what people are doing around the world,” he said.

Taiwan’s Health Minister said on Friday that so far, not too many citizens have received the second dose of their vaccines, and he emphasized that waiting until the 12th week to receive their second doses of vaccines wouldn’t lower the effectiveness.

This piece was first published in Mandarin on DW’s Chinese website.