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切換側邊選單 切換搜尋選單

Secret Weapons from the SARS Experience 

How Taiwan Fights COVID-19

How Taiwan Fights COVID-19

Source:Chien-Tong Wang

Taiwan has been relatively effective in combating the novel coronavirus that is quickly spreading around the world. But that success has not happened in a vacuum. Many of the country’s disease-fighting measures originate from the SARS crisis nearly 20 years ago.

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How Taiwan Fights COVID-19

By Cathy Chiang
From CommonWealth Magazine (vol. 692 )

Hidden in Taipei’s Nangang District is the Centers for Disease Control’s (CDC) Center for Research, Diagnostics and Vaccine Development, commonly called the Kunyang Lab. This old six-story building holds the keys to detecting bacteria and viruses that attack Taiwan’s national territory.

Kunyang Lab – Answers in Just 4 Hours

The structure’s underwhelming exterior belies the importance of the mysterious lab it houses, which has emerged as a key weapon in the government’s efforts to combat the global coronavirus outbreak. It can currently test roughly 300 samples a day, more than any other lab in Taiwan.

When the SuperStar Aquarius cruise liner was allowed to dock in Keelung in early February, the Central Epidemic Command Center (CECC) took saliva samples of 128 passengers considered most likely to have the coronavirus and rushed them to the Kunyang Lab. There, the lab’s 25 workers went to work and delivered their verdict within a matter of hours – all samples tested negative. That enabled all of the Taiwanese passengers on the ship (accounting for 1,709 of the 1,738 passengers) to disembark that same day.

That efficiency is no coincidence. Taiwan is at the global forefront of developing its own test methods.

                               

On Jan. 10, China announced the genome sequence of the novel coronavirus (now called COVID-19 by the World Health Organization). Six days later, Germany announced it had developed a test reagent that the WHO recommended be adopted.

By Jan. 13, however, the Kunyang Lab had designed and successfully tested specific primers and probes based on the novel coronavirus’ genome sequence that were needed to perform the tests identifying the virus in humans. Prior to releasing the genome sequence, China had been using a test method that took up to a full day to get results, but the Kunyang Lab’s new method reduced that time to four hours.

The SARS Experience

The CDC itself was the product of a major enterovirus epidemic in Taiwan in 1998 that resulted in 78 deaths, which led to the consolidation of Taiwan’s preventive medicine, epidemic prevention and quarantine agencies into the disease control agency.

The Kunyang Lab was set up in 2001, with Su Ih-jen named chief scientist. When the SARS crisis hit two years later, Su became the CDC’s director-general.

In 2003, the watershed moment of the SARS crisis was the handling of one patient at Taipei Municipal Ho Ping Hospital surnamed Tsao. Her three samples all tested positive at Kunyang Lab for the SARS virus, but the SARS task force under the Department of Health (at the central government level) made a major misjudgment. It concluded she did not have the virus because she had no history of coming in contact with SARS patients or visiting China, Hong Kong or Macau, a key standard for SARS used by the WHO at the time, according to Su.

That led to a cluster infection at the hospital that forced it to be shut down with patients and medical workers quarantined inside. Ultimately, the Ho Ping Hospital cluster led to 150 confirmed SARS cases and 35 deaths.

“I always stressed ‘science evidence.’ It is the main basis for all epidemic prevention decisions. One’s experience can only serve as a reference. In the end, you still have to ask where the laboratory evidence is,” Su said two years ago in a speech recalling the SARS crisis.

That painful lesson has since been learned, as test results are now the final arbiter in determining infectious cases.

As the current coronavirus outbreak spread, for example, the CECC announced that beginning on Feb. 17 it would expand its testing program, requiring all visitors who entered the country within the previous 14 days who developed suspicious symptoms to be evaluated by a doctor and tested for the disease.

As an advisor on infectious diseases to the government, Infectious Disease Society of Taiwan President Huang Li-min says that even if a person does not have a travel history or suspected contact with a coronavirus patient, “if a patient looks off, that patient should be tested.”

The Honing Process

Taiwan’s epidemic prevention system has been sharpened with each successive bout with a new infectious disease.

The year after the SARS outbreak, major revisions were made to the Communicable Disease Control Act that included measures now considered standard practice in Taiwan, such as the institution of the CECC, the statutory requirement that people not hide their contact or travel history when seeing a doctor, and the implementation of airport and port quarantines. 

The Rise of ‘Virus Detectives’

Another change that went relatively unnoticed was the introduction of the American epidemiology system.

In the 1995 classic movie “Outbreak,” Dustin Hoffman plays a “virus detective” who travels all over in an exhaustive search for the source of a deadly virus, a part modeled on epidemiologists with the United States Centers for Disease Control and Prevention.     

Philip Yi-chun Lo, the incumbent deputy director-general of the CDC who has served as the CDC’s chief medical officer, recalls how that aspect of Taiwan’s epidemic control efforts evolved from the SARS crisis. 

He said American specialists with the CDC who came to Taiwan during the SARS outbreak advised then President Chen Shui-bian to imitate the U.S. CDC by creating a team of epidemiologists consisting of pediatricians and infectious disease and epidemic prevention specialists. It was only after this that the act governing Taiwan’s CDC was revised, leading to the inclusion of epidemiologists in the public health system starting in 2005.

Source: Cathy Chiang

Taiwan’s CDC currently has 24 epidemiologists. Among the best known is Huang Wan-ting, the CDC’s chief medical officer, who often appears at CECC press conferences with Health and Welfare Minister Chen Shih-chung. 

Lo and her have been to the U.S. CDC for its Epidemic Intelligence Service that offers training in investigating infectious diseases.

Su Ih-ren said that at one point only seven of the 800 employees at Taiwan’s CDC had backgrounds as physicians or dentists, and when an outbreak occurred and the CDC sent people to investigate and discuss the cases with doctors, they would often be looked down upon. 

Su recalls what a huge challenge it was to recruit doctors to work in epidemic prevention. Public health physicians were paid only NT$70,000 a month, and the busy and potentially dangerous workplace environment they operated in were anything but appealing. So during his time in office, Su dramatically increased the pay level of CDC physicians to at least the level of prosecutors and judges.

The Ministry of Health of Welfare has said its epidemiologists now make at least NT$100,000 per month and senior physicians can make more than the NT$190,000 a month earned by the health and welfare minister.

The high salaries are not hard to justify. These high-risk physicians stand eternally on the front lines fighting often unknown bacteria or viruses, and they have been fully involved in every one of the more than 30 confirmed cases of novel coronavirus reported so far in Taiwan.

In the high-profile handling of potentially infected passengers on the SuperStar Aquarius cruise ship or the charter flight that brought Taiwanese home from Wuhan – the epicenter of the coronavirus outbreak – it was these physicians dressed in full-body protective gear who conducted health checks or took samples for analysis. They were busy until the test results were known.

“While investigating epidemics, two types of people are targeted – we need to look upstream for the source of the infection, and look downstream tracking down people with whom confirmed cases came in contact,” said one epidemiologist.

Taiwan’s only coronavirus death to date offers a clear example of this. Epidemiologists quickly went to the hospital that treated the patient to find out when the patient was admitted to the emergency ward, where his bed was, whom he came in contact with, and the time at which he was sent to the intensive care ward. 

People with whom the deceased came in close contact with also had to be tracked down and have their samples taken. The “virus detectives” eventually found that a family gathering, including the man who would later die, triggered a cluster infection. Even the seating plan of that meal and the relationship between the family members who were there were all recorded in minute detail to help clarify how the infection spread.

Source: Chien-Tong Wang

More Negative-pressure Rooms per Capita than Japan 

Taiwan’s experience with the SARS epidemic in 2003 and the H1N1 swine flu scare in 2009 has had another positive effect – a high density of negative-pressure rooms used to isolate highly contagious patients that is far higher, for example, than Japan, known for having the highest medical standards in Asia.

There are currently 1,100 beds in negative-pressure isolation rooms in Taiwan, compared to 1,870 beds in Japan, which translates to 40 beds per million people in Taiwan against only 15 beds per million people in Japan. 

The Department of Medical Affairs under the Ministry of Health and Welfare is sometimes called the epidemic war room, keeping track of the number of intensive care rooms and negative-pressure isolation rooms in Taiwan. The department’s director, Shih Chung-liang, said there were still 581 empty beds as of Feb. 17, which he described as sufficient. Even patients only suspected of having the coronavirus can be isolated in negative-pressure rooms and kept there until their tests come back negative, he said.

Shih said his department has prepared five different scripts depending on how the coronavirus outbreak develops, and adjustments will be made as necessary.

“When you go in battle with the troops, the worst thing is not having a plan,” Shih said. In the future, if there is a noticeable increase in suspected infections that starts to put pressure on hospitals’ normal operations, a centralized response will be adopted. Taiwan’s 21 hospitals designated as isolation hospitals for communicable diseases would be used exclusively to handle patients, leaving other facilities to operate normally.     

Were the epidemic to get even worse, the government would designate more than 100 hospitals around Taiwan as isolation hospitals and then in the next stage it would ask medical facilities to postpone surgeries that are not emergencies and use those resources to treat coronavirus patients.

In the final stage, if there are so many patients that they are paralyzing hospitals, patients with only mild symptoms or who are being observed will be moved outside the hospital and sent to quarantine facilities used to shelter evacuees from Wuhan in early February. That would allow the hospitals to focus on more serious cases.

Preventing an epidemic is much like going to war. Helped by the experience and knowledge it has amassed over the past two decades, Taiwan has been able to quickly and flexibly respond to the coronavirus epidemic, but it may have to further adjust course if global challenges continue to mount.

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Translated by Luke Sabatier
Uploaded by Sharon Tseng

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