Amid heightened public alarm as Taiwan registered its first case of suspected community transmission of COVID-19 on Feb. 19, a young foreign national arriving at Taoyuan International Airport reported a sore throat. Quarantine officials immediately escorted the traveler from the fever screening station to the testing station.

The tests would quickly deliver an answer as to whether the disease-causing virus, scientifically called SARS-CoV-2, has set foot on Taiwan with newly arriving travelers. They are Taiwan’s first line of defense against the virus.

                               

The Battle Against Community Transmission is on

According to World Health Organization (WHO) statistics, the number of confirmed COVID-19 cases outside China rose from 132 cases to over 1,200 cases in the first three weeks of February.

During the SARS (severe acute respiratory syndrome) crisis in 2002, the respiratory illness spread across five continents in nine months. In contrast, it took COVID-19 only five weeks to reach four continents. In Japan, South Korea, Singapore, Thailand and Vietnam health authorities are fighting a close battle against person-to-person transmission in a community setting. Taiwan might not be able to escape such a scenario either.

Today, viruses appear frequently, they are transmitted faster and affect more people from day to day.

Decisive Battle Front 1: Cruise Liners

Fear to get infected onboard or when going ashore

Within just two weeks 621 people aboard the Diamond Princess were confirmed to have contracted COVID-19, which means every hour, two persons tested positive for the virus. As the more than 3,700 passengers and crew began to evacuate from the vessel to return to their home countries, governments saw themselves confronted with the new challenge of the virus spreading across borders.

Kentaro Iwate, an infectious disease expert of Kobe University who went aboard the cruise liner to help evacuate patients, posted a video on the internet alleging that there was no clear distinction between infected “red zones” and infection-free “green zones” onboard. Describing the situation as “completely chaotic”, Iwate said “I was so scared of being infected because there was no way to tell where the virus is.”

In quarantine, Iwate said in a phone interview with CommonWealth Magazine one day after his video went online that the Japanese authorities’ reaction had been slow because the nation lacked a specialized agency dealing with communicable diseases comparable to the Taiwan Centers for Disease Control (CDC). “The Japanese government bureaucrats do their job according to established procedure but they cannot think about counter measures on the spot,” Iwate said.

Source: GettyImages

While the cruise ship business has seen a rapid boom in recent years, infectious disease prevention measures have not kept pace.

Washington-based industry organization Cruise Line International Association (CLIA) forecast more than 30 million cruise ship passengers worldwide for 2019. Passengers on Japanese cruise ships hit a new high of 320,000 travelers in 2018, generating economic value for Japan worth at least 300 billion Japanese yen.

We can only wait and see whether there will be another spike in infections aboard cruise ships in the coming weeks.

Decisive Battle Front 2: Trade Fairs…International Meetings Breed Super-spreaders

With 91 total confirmed cases Singapore ranks fifth as of Feb. 25 on the list of countries and territories outside China in terms of number of confirmed CoVID-19 cases, throwing the city state into a dilemma.

Ranked top Asian city for meeting by the International Congress and Convention Association (ICCA) in 2018, Singapore has built a remarkable hospitality industry supply chain in recent years by hosting large-scale conferences, trade shows and exhibitions. The emergence of the novel coronavirus is rocking the industry to its foundations as congresses and other large international events are postponed or cancelled.

Source: GettyImages

The 34^th International Conference of Alzheimer’s Disease International (ADI), originally scheduled to be held from March 19, is just one example.

More than 1,300 participants had registered for the conference, even more than for the previous meeting in Chicago two years ago. Organizer ADI said in an announcement that the conference is being postponed to December due to the novel coronavirus situation.

Steve Walsh, the first confirmed case in Britain, had picked up the virus when attending a large-scale sales conference in Singapore. Following a vacation stopover in France on his way home to Britain, he infected a total of eleven people, becoming Europe’s first super-spreader.

For fear that more super-spreader could emerge, many international meetings have been cancelled in Singapore.

During the SARS crisis, Singapore injected US$230 million into the most hard-hit sectors such as airlines, gastronomy, retail and other service industries.

This time, Singapore’s Prime Minister Lee Hsien Loong predicted in an interview with a Singaporean newspaper earlier this month that the local economy will take a hit and that the economic impact will be worse than during the SARS epidemic.

Source: GettyImages

Decisive Battlefront 3: International Students

With the beginning of the new semester, a large number of students will return from abroad, presenting a challenge for disease prevention on campuses

According to U.N. statistics, a total of 900,000 Chinese students were studying abroad in 2017. Regarded as the saviors of the tertiary education industry facing declining revenues, the once highly welcome students are now met with caution and panic. There is widespread fear that virus carriers could be among the large numbers of students returning from China.

In the decade between 2006 and 2016, the number of Chinese students in the United States increased five-fold to 320,000 people. In South Korea, the country with the highest count of confirmed cases outside of China, Chinese nationals account for 44 percent of foreign students at colleges and universities. The South Korean government has no other choice but manage the more than 70,000 Chinese students by splitting them up into smaller groups when they return from winter break in March.

South Korea’s Yonhap news agency reported that the South Korean education ministry asked colleges and universities in mid-February to advice the 50,000 Chinese students who have not yet returned to take a leave of absence amid the coronavirus outbreak. As many as 9,000 of the 20,000 Chinese students who have already returned to South Korea are still placed under a 14-day quarantine period.

The number of Chinese students in Taiwan has already declined from 42,000 students five years ago to around 30,000 last year. Yet Taiwan still has to address a few difficult issues such as how to deal with Chinese students who are not able to return to their schools in Taiwan due to the current ban on entry of all Chinese nationals.

With a spreading virus on their doorsteps, nations are asking themselves: should they go into lock down, sacrificing economic interests to prevent importing cases, or keep their borders open and focus their resources instead on the treatment of the critically ill to minimize lethal outcomes?

Japan and Singapore have made different choices.

Source: GettyImages

On Feb. 1, Singapore prohibited the entry of travelers who had visited China in the previous 14 days. The city state also temporarily halted issuance of visas to Chinese travelers. Five days later, Taiwan introduced 14-day home quarantine for arrivals with a recent history of travel to China, Hong Kong and Macao. 

Although more than 60 countries around the globe restrict visits by travelers from China, Japan, which receives nearly 10 million visitors from China per year, still keeps its doors to most Chinese tourists wide open.

Many believe that Japanese policymakers are aware that without the Chinese visitor contingent, they won’t be able to meet the government’s target of “40 million foreign visitors in 2020.” 

In contrast, Taiwan’s relations with China are in a freeze. Last July, Taiwan saw 320,000 arrivals from China, but that figure had dropped to just 100,000 in December when COVID-19 emerged. This means that while Taiwan had fallen far behind Singapore (270,000 Chinese tourists) and Japan (710,000 Chinese tourists) in terms of tourist arrivals, its transmission risk had also decreased markedly.

Experts believe that SARS-CoV-2 will mutate into a new strain of influenza that might lead to new outbreaks every year. Given limited medical resources, Taiwan cannot just depend on its medical personnel to cope with outbreaks of virulent infectious diseases. Preparations need to be made long-term and call for nationwide efforts.

**Safeguarding Taiwan

Hospitals are only the first line of defense, how can the entire population join the battle?

Epidemics put human nature to test. Taiwan has gone through several epidemics including enterovirus and swine flu (H1N1 virus flu) outbreaks, which forced the island to compensate for limited resources with creativity and tenacity not seen elsewhere.

In early February, the Ministry of Health and Welfare recruited border quarantine volunteers. Within just two weeks 600 people had applied for the posted 100 unpaid jobs.

Retired registered professional nurse Yang Min-li is one of them. The 54-year-old began to work as a volunteer nurse a few years ago. After an explosion at the Formosa Fun Coast water park in June 2015 that killed 15 and injured almost 500 people, she treated burn survivors. “Although I have left the first line, I always keep the Nightingale Pledge in mind,” Yang says with pride.

Wearing a volunteer vest and a surgical mask, Yang is responsible for checking information provided by arriving travelers before they reach the fever screening station.

She once came across a Taiwanese traveler who admitted that he had flown to Tokyo from Wuhan before returning to Taiwan a few days later. “In that moment I was very scared but I couldn’t let it show, so I maintained a safety distance of more than one meter. Luckily, we were both wearing masks,” says Yang.

After escorting travelers to the quarantine station, Yang quickly discards her mask and gloves, and washes her hands to reduce the risk of viral contamination. “We must not cause panic because there were still many people waiting in line in the back,” she explains.

It is first of all panic that allows viruses to gain control over humankind. While globalization brings economic affluence, it also allows viruses to spread around the globe faster than ever before. 

Whether Taiwan will be able to contain the extent of the damage from the current outbreak as much as possible does not hinge on the concerted effort of doctors and nurses alone but also on the personal commitment of every one among us. We must not let down our guard. 

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Translated by Susanne Ganz
Uploaded by Sharon Tseng