♦ Updated daily ｜Taiwan’s Covid-19 Outbreak

In 2021, Hong Kong’s response to COVID-19 was at least as successful as Taiwan’s. But this year, disaster struck. On January 8, Hong Kong reported its first local untraceable COVID-19 cases in 3 months. Less than 10 weeks later, half of Hong Kong’s entire population had likely been infected with COVID-19. The number of deaths has been even more staggering than the number of cases. 

Adjusted for population, many of Hong Kong's daily death totals have been higher than the worst days experienced by the US during the pandemic. For example, on March 15, Hong Kong reported 228 COVID-19 deaths in a 24-hour period. Adjusted for population, this would be equivalent to Taiwan suffering 718 deaths in a single day. 

Recently, Taiwan’s domestic COVID-19 cases have spiked significantly, reaching 216 on April 5, 2022, and unfortunately, the conditions that led to Hong Kong’s 2022 COVID-19 crisis also describe the current situation in Taiwan, setting the stage for a surge in COVID-19 deaths.

(Source: Chase W. Nelson) ♦ Updated daily ｜Taiwan’s Covid-19 Outbreak

Hong Kong’s huge spike in COVID-19 deaths has been driven by its large number of unvaccinated seniors. As of April 1, roughly 50% of total Hong Kong “Fifth Wave” COVID-19 deaths, or 3,852 out of 7,732 deaths, is among Hong Kong residents 80 years and older who are completely unvaccinated. Even accounting for recent vaccinations, as of April 1, around 42% of Hong Kong residents 80 years and older have yet to receive even a single vaccine shot. In turn, Hong Kong’s Department of Health has estimated a case fatality rate of 12.12% for people in this age group who have had one or fewer vaccine shots. By comparison, last summer, when Taiwan went into “soft” (level 3) lockdown, Taiwan’s overall case fatality rate (all ages) exceeded 5% and the case fatality rate for those over 70 years exceeded 20%. 

The larger the population of unvaccinated seniors, the larger the risk of deaths, and unfortunately Taiwan has a very large population of unvaccinated seniors. As of March 29, 22.9% of people 75 years and older were completely unvaccinated. Based on Taiwan’s 2020 population data, this suggests there are 186,000 people 80 years and older who are completely unvaccinated.

If border controls remained effective, unvaccinated seniors arguably would face a low risk of COVID-19. However, Hong Kong’s 2022 situation is a warning about what may occur when Omicron ultimately sneaks past border controls and enters Taiwan, as it likely already has. 

After all, Hong Kong’s COVID-related border controls were arguably stricter than Taiwan’s, for example originally requiring a 21-day as opposed to a 14-day hotel quarantine. Hong Kong residents are also comparably diligent at wearing face masks. However, Omicron still broke through Hong Kong’s defenses. 

Meanwhile, Taiwan recently started loosening border restrictions. As of March 7, incoming travelers only need to quarantine for 10 days and Premier Su Tseng-Chang said on March 31 that Taiwan still intends to open the country gradually.

Given the above, it is reasonable to assume Taiwan’s entire population will eventually be exposed to COVID-19, as is occurring across much of the globe. In turn, if we assume the group of completely unvaccinated 80+ year-olds suffers a fatality rate equal to that of Hong Kong (12.12%), this implies a potential ~22,000 COVID-19 deaths, or 26.5 times Taiwan’s total number of COVID-19 deaths to date of 853.

(Source: Ming-Tang Huang)

The above estimate only accounts for unvaccinated people 80 years and older. But there could also be a considerable number of deaths among slightly younger unvaccinated people as well. Following the same methodology as above for Taiwan’s 75-79 age group, if we apply the currently reported Hong Kong unvaccinated fatality rate of 3.2% for this group, this suggests an additional ~4,400 COVID-19 fatalities among unvaccinated 75-79 year-olds. 

We recognize Hong Kong’s estimated fatality rate may underestimate the total number of COVID cases, as it would not include undetected or unreported cases. However, even if the total number of unreported cases is, for example, three times the number of reported cases, which would reduce the death rate by 75%, this would still imply a potential ~6,800 deaths among Taiwan’s unvaccinated seniors.

Research clearly suggests vaccination significantly reduces the COVID-19 death rate. The US CDC finds that an unvaccinated person is 14 times more likely to die than a person who has had two vaccine shots, and 20 times more likely to die than a person who has had two vaccine shots plus a booster. In other words, a three-shot vaccination cycle could reduce the deaths among the currently unvaccinated by 95%. 

Unfortunately, convincing still unvaccinated seniors to start the vaccination process has been glacially slow. From March 1 to March 15, the percentage of 75+ year-olds who had received one shot increased by only 0.2%. In response to stagnating vaccinations, the CECC approved an NTD500 incentive for seniors who receive a vaccination shot, with the program running from March 10 to April 10. However, in the first two weeks following implementation of this program, the 1st shot vaccination rate for the 75+ age group increased by only 0.4%.  If we consider the pace of vaccinations over the most recent four weeks, it would take over 1.5 years for the single-shot vaccination rate of 75+ year-olds to reach 90%. 

While Taiwan’s overall vaccination rate appears quite high, Taiwan’s senior vaccination rate is lagging major peers. The vaccination rate for those 80 years and older is around 95% in Singapore, and around 90% in South Korea. Even in the US, whose overall vaccination rate is lower than in Taiwan, the two-shot vaccination rate for people 75+ is 85.7%, above Taiwan’s 70.9% for the same age group.

The low vaccination rate among seniors is admittedly a known issue. Local commentators, scientists, and even the CECC has spoken out for the need to increase the vaccination rate among seniors, but outside of the recently announced NTD500 vaccine incentive, there seems to be limited discussion over measures to persuade unvaccinated seniors to get vaccinated. This suggests there may be limited awareness about the potentially huge scale of COVID-19 deaths among unvaccinated seniors. 

Going forward, I believe that the government must place the highest priority on reducing the number of unvaccinated seniors. From my own observations as a concerned citizen, I feel the government could consider additional measures including:

Shifting focus from overall vaccination statistics to those for seniors, as this is the population most as risk from COVID-19.

Raising public awareness, not only among unvaccinated seniors, but also among their younger relatives (children, grandchildren) about the significant difference in risk for the vaccinated vs the unvaccinated, e.g. the fatality rate faced by unvaccinated seniors could potentially be over 10%, while vaccination plus booster could reduce this risk by 95%.

Raising public awareness that if and when a large COVID-19 outbreak occurs in Taiwan, there may very likely not be enough time for the unvaccinated to gain the full protection of a complete vaccination plus booster cycle before being exposed to COVID-19. 

Increased efforts to make receiving vaccinations shots as convenient as possible. For example:

Setting up a system whereby anytime a senior citizen visits a hospital for any reason, their vaccination status is automatically checked and if the senior citizen is unvaccinated (1) the attending physician, regardless of department, is alerted and trained to encourage the senior to receive a vaccination; and (2) the hospital has a system for making it possible for the senior to receive a vaccination right on the spot as conveniently as possible (e.g. nurse comes to that clinic and provides vaccination without any additional wait, registration, filling of forms, visiting another section of the hospital, etc.).

Implementing and proactively promoting at-home vaccination for all seniors, as well as for other mobility-impaired individuals. Hong Kong only relatively recently announced plans to provide at-home vaccination for residents with mobility issues, after already enduring two months of the current crisis.

The Taiwan government and the residents of Taiwan have done a tremendous job for over two years working together to reduce the health risks of COVID-19 while maintaining a growing economy. 

However, Taiwan is not yet free of preventable danger. Hong Kong’s recent experience is a clear warning that a rapid reversal in the COVID-19 situation, even worse than what occurred last summer, threatens a large number of lives. 

For now, Taiwan may still have time to reduce the risk of incurring over 20,000 preventable COVID-19 deaths. But once widespread community spread of COVID-19 occurs, it will very likely be tragically too late to help the majority of our most vulnerable elders.

The author was formerly Head of Taiwan Research at a major global investment bank. He is using a pseudonym because his views may conflict with his terms of employment. 

 (This piece reflects the author's opinion, and does not represent the opinion of CommonWealth Magazine.)

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