By Sahana Shankar & Ray Jhang
As the widespread transmission of COVID-19 rages on, more and more efforts are spent on harnessing detection, medication, and prevention strategies for the disease. Armed with the lessons learned from combating the 2003 SARS outbreak, Taiwan is silently playing a prominent role in the current crisis.
When the COVID-19 outbreak in China was reported in December 2019, Taiwan was predicted to be at high risk owing to its close physical proximity (81 miles), and regular travel and economic ties to the mainland. Another risk factor was the lunar new year holiday, the largest annual exodus when Chinese travelers visit Taiwan and Taiwanese expats (approx. 850,000) who work or live in China come home. Despite these challenges, Taiwan has done well to keep the victims low, thanks to the effective prevention and intervention policies that were put in place after the SARS crisis.
The key to Taiwan’s success in handling the situation so far must be attributed to:
- Early action to introduce and monitor quarantines and
- Simultaneous integration of big data from its National Health Insurance (NHI) records, immigration, and customs databases to identify potential cases
- Extensive communication and outreach campaign to inform and alert citizens of risks and preventive measures
- Affordable and trusted healthcare system.
In 2003, Taiwan suffered the largest number of SARS death rates outside China and Hong Kong which led to the formation of the National Health Command Center (NHCC) to mount a rapid, concentrated and effective response to future health emergencies. It helps that Dr. Chen, Chien-Jen, then health minister and current Vice President is an epidemiologist. He helped institute a program and infrastructure to enable interagency cooperation, recruitment of relevant experts and updated SOPs in hospitals across the island. Audrey Tang, Taiwan’s digital minister has spearheaded an awareness campaign online, using artificial intelligence (AI) and digital information to inform citizens about the real-time availability of facemasks across pharmacies, debunking fake news and providing updates on the outbreak. Chen, Shih-Jung, Taiwan’s current Health Minister has been at the forefront, personally supervising the operations and communicating with the public regularly, with news conferences.
Taiwan has managed a strict control on the COVID-19 spread, with a total of 67 cases, with 1 death (as of March 16, 2020). Taiwan Centre for Disease Control (CDC) was on high alert and started screening passengers arriving from Wuhan as soon as China notified the World Health Organization (WHO) of the outbreak. The Central Epidemic Command Center (CECC) was convened on January 20, 2020, to discuss epidemic management by imposing strict travel restrictions. Between January 20 and February 24, the CECC developed and implemented a 124-point action plan including, border security, case identification, quarantines, fighting fake news, public education, and economic policies for businesses and companies.
As the fourth country to purify the contagious COVID-19-causing SARS-nCoV-2 virus at the end of January, research groups across Taiwan joined forces to collaborate on various diagnostic and therapeutic research avenues. A second virus line was soon purified in another lab, showing subtle differences implying the evolution of the RNA virus. After attaining the virus line in the lab, research teams in Academia Sinica followed up with the development of the antigen in a mere 10 days. One of the candidate drugs, Gilead Science’s remdesivir is under validation and production by scientists at the National health research institute (NHRI). With the complete viral genome sequence, purified virus line, and new antigens in hand, according to the NHRI, the next steps, would be:
- Development of a vaccine
- Obtaining effective medication agents
- Building an epidemic model, and
- Generation of a disease-related database.
Currently, four vaccine development strategies are simultaneously implemented. A peptide vaccine, recombinant vaccine, DNA, and subunit vaccine are to be generated using existing knowledge and research infrastructure. Though the expected time frame for an optimized vaccine is a few months away, the resulting scientific literature and protocols shall be worthwhile not only for COVID-19 but also for the ever-changing family of coronaviruses in the future. Aside from vaccines, there are plans for serum preparation for those with severe infections. Milligram-scale production of 97% pure remdesivir has been achieved and can be scaled up for larger doses, once authorized by Taiwan FDA. Existing drugs and molecules are used for antiviral tests quickly and several drug screening projects are underway.
With an ever-increasing number of people flocking to the hospitals for tests, new and faster testing kits and monoclonal antibodies are also being developed by taking advantage of the COVID-19 antigen. Academia Sinica recently announced a rapid immune test, capable of testing samples within 15 to 20 minutes.
Since the government and research institutes have formed task forces to address these issues, validation, certification, and approval of new technologies are not expected to be caught in unnecessary red tape.
Screening and isolation of possible virus carriers were introduced early in the game and strictly performed. Long before the first case was reported on January 21, 2020, awareness and preventive measures were in place. Travelers could report their travel history and health symptoms online via QR code. Effective resource allocation ensured enough medical and safety supplies. To prevent panic and hoarding, the government banned the export of medical masks and rationed the buying of face masks to 2 per week which is now relaxed to 3 per week. SMEs have also stepped up to produce more face masks. All public places, schools, offices and MRT stations (metro) are equipped with required anti-viral cleansers.
Measures such as AI to proactively identify people with respiratory symptoms from the NHI database and to monitor those under quarantine, imposing fine upon its violation, retesting negative cases, regulation on travel, special clinics for those who have contracted the virus or have a travel history to China and real-time transparent reporting have all helped in recruiting citizens as responsible allies to combat the crisis.
Taiwan’s National Health Insurance covers 99% of the population and affordable healthcare ensures everyone reaches out to medical facilities when they are ill. Ironically, since Taiwan is not a member of the WHO, it emphasizes preparedness for healthcare emergencies at a much higher scale than other countries, learning well from the SARS outbreak. It has well-trained public health officials across hospitals, biomedical companies willing to collaborate with government institutes to develop supplies and technology. Top officials in the government have constantly addressed the public to ensure correct information distribution. The public trusts the government’s ability to handle the crisis and are willing participants in the additional safety and precautionary measures of temperature testing, frequent hand wash and close monitoring of friends and family for symptoms.
By being experienced, careful and proactive, Taiwan has geared up for the fight and has shown impressive results. At the same time, most public health and government officials are aware that the battle is only half won and needs continued co-operation among public and private players to declare victory against COVID-19.
Editor: Rajaneesh K. Gopinath, Ph.D.
- Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. Published online March 03, 2020. doi:10.1001/jama.2020.3151
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