What are the key factors that might have caused the worst COVID19 outbreak in Taiwan?

Over the last week, Taiwan suddenly added more than 1000 local coronavirus cases, forcing the government to issue a series of emergency guidelines to cope with the rising number of local cases. Experts think that after more than a year’s success in containing the virus, Taiwan may be lagging behind in acquiring key knowledge to deal with the variant that is now circulating within Taiwan.

Question: Over the last year, Taiwan has been praised as a COVID19 success story around the world, but a large number of local cases emerged over the last week. What do you think might be the causes of the spike of local cases?

Chi Chunhuei: The underlying cause is very complicated. Taiwan has done well since the beginning of the outbreak by strictly guarding the border while domestically following a strict guideline of mask-wearing and maintaining social distancing. This allowed Taiwan to have no local cases by mid-April 2020.

From then until December 2020, Taiwan had no domestic coronavirus cases. The successful control quickly led Taiwanese people into what I called post-pandemic mode, largely living a very normal life. At the same time, Taiwan’s economic lifeline remains very important while it was strictly guarding the border.

Taiwan had to continue to maintain its business transaction especially export and therefore, to accommodate the commercial flight, the command center had relaxed the quarantine requirement for pilots and flight attendants. The origin of the current outbreak remains not 100% sure.

The CECC is still trying to do extensive contact tracing and try to link all the cases. While we don’t have a final answer yet, most likely, the whole outbreak originated from China Airline’s pilots. We don’t know from there.

Question: Health authorities in Taiwan said the British variant is the main cause of this latest wave of COVID19 outbreak. Do you think Taiwan has the experience to cope with the challenges posed by the more transmittable variant?

Chi Chunhuei: In late January, Taiwan experienced an outbreak at the local hospital in Taoyuan and that was the first time Taiwan encountered the new variant from the US. That variant was already more contagious than the original coronavirus. Most Taiwanese people’s experience of dealing with the pandemic was based on their experience dealing with the first wave of the pandemic from last year.

Unlike most countries around the world, they didn’t have the experience of dealing with the variants, including the B117 British variant. This time, through the China Airline pilots, the variant was introduced to Taiwan. Most government officials and the general public have very little experience dealing with the B117 variant so they were shocked at how fast the variant spread.

After some pilots violated the government’s quarantine protocols, the variant was leaked into the community. They not only infected their family members, the variant was also spread into the community through them and their family members. Since Taiwan has enjoyed normal life for nine to 10 months, the CECC no longer required stringent safety protocols.

This offers the British variant to spread quickly in Taiwan. Given Taiwan’s success in containing the virus during last year’s first wave, the general public and the government somehow neglected the need to catch up with the new knowledge the world discovered over the last year.

Question: What are some of the new knowledge that Taiwan failed to acquire through the international communities’ experience in combating COVID19 over the last year?

Chi Chunhuei: One particular vital new information that most people in Taiwan up to now ignored was that the vast majority of transmission was done by people with no symptoms. Taiwan largely relied on measuring temperature in schools, public places, or MRT stations. If there are cases, you may only catch about 10% of them through measuring temperature.

The vast majority of people become highly contagious from the moment that they are infected through the first two days of them showing symptoms. On average, the infected people remain contagious for a period of 10 to 12 days. The vast majority of those infected by coronavirus are contagious while they are not showing symptoms and once they have symptoms, they will usually be contagious for another two to three days.

Measuring temperature is largely useless but perhaps they do that to satisfy the public to show that they care. Between 60% to 80% of the spread of the virus was done by asymptomatic patients. Taiwan needs to quickly adjust the preventative measures and I think the move to raise the level of warning to level three by Taipei City and New Taipei City is a very accurate move.

Based on the experience in the US, roughly around 40% of the people who have been infected are asymptomatic. But being asymptomatic doesn’t mean that they are not contagious. For the 60% of the people who eventually develop symptoms, another 40% or so will have mild symptoms. Only about 20% or less are those who will develop more severe symptoms and about 10% of them will require hospitalization.

Altogether, adding up the asymptomatic patients and the pre-symptomatic patients are responsible for most of the spread of the virus. It’s extremely difficult to contain the virus once it’s in the community, which is why in many parts of the world when they were at the height of the outbreak, the only way to prevent it from worsening is through some forms of lockdown.

Now we have the vaccine. Earlier, I was urging that Taiwan needs to step up its effort in developing a domestic vaccine as well as obtaining international vaccines. Unfortunately, in this case, Taiwan seems to become the victim of its own success. Since Taiwan was so successful, most of the government officials and the general public didn’t feel the urgency of getting vaccinated.

If we use an arch as an analogy for Taiwan’s COVID19 prevention, in the first half of the game, Taiwan did really well by a very strong defense. In order to win the game, they need to launch an offense in the second half, and that is vaccination.

Question: What will be the necessary measures that Taiwan needs to take in order to successfully contain the latest outbreak?

Chi Chunhuei: Taiwan needs to quickly contain the outbreak, and by quickly, I think they need to vaccinate the high-risk groups. Also, one unfortunate thing in this development was that I look at statistics, up until the current outbreak, there was only a little bit more than 40 pilots among China Airline were vaccinated. Compared with its competitor Eva Airline, over 200 of their pilots have been vaccinated.”

Had those pilots been vaccinated, Taiwan may not be in this outbreak at all. Pilots and flight attendants are high-risk groups for Taiwan. Even though Taiwan has nine to 10 months without domestic cases, the groups that are most likely going to bring in the virus are the pilots and flight attendants. They were given an expedited, shortened quarantine, while all visitors are subjected to more strict quarantine.

Within the next two weeks, I think the strict indoor gathering regulation is the number one priority for now and that includes limiting the number of people gathering indoors to wear masks. I think most Taiwanese people are now refraining from going to restaurants or department stores or using public transportation.

I have confidence in most Taiwanese people that they can stick to the regulations during this pandemic.

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