Preparing in advance for COVID-19

Taiwan won global acclaim for the advance measures in response to the outbreak of COVID-19.

Measures includes “epidemiological surveys”, “border control”, “effective monitoring, testing, tracing, and investigation mechanisms”, and “triage measures for mild and severe cases”.

The effort of Taiwan’s Center for Disease Control is critical to the success of preventing and containing the spread of the epidemic.

An early response to COVID-19 pandemic
Taiwan has won global acclaim for the many advance measures it has taken in response to the outbreak of the 2019 coronavirus disease (COVID-19). These measures are widely regarded as being critical to Taiwan’s success in preventing and containing the spread of the epidemic.

At the end of December 2019, the Taiwan Center for Disease Control (Taiwan CDC) learned from online sources that at least seven cases of atypical pneumonia had occurred in the Chinese city of Wuhan. On December 31, Taiwan sent an email to the WHO contact resource under the International Health Regulations (IHR) mechanism to request further information from WHO. In addition, the email discreetly referred to the disease as atypical pneumonia and noted that patients had been isolated for treatment. From these statements, public health professionals should have been able to deduce that there was a strong possibility of human-to-human transmission for this new disease.

From that point, Taiwan acted swiftly, activating border quarantine measures on December 31 under the assumption that there was a real possibility of human-to-human transmission. In fact, Taiwan was the first country in the world to conduct onboard screening of passengers arriving on direct flights from Wuhan and to require arriving travelers to fill in a health declaration.

The President announces efforts to prevent and control the epidemic
When discussing the potential economic impacts of COVID-19 and government contingency measures on January 30, 2020, President Tsai pledged to fight the pandemic as if fighting a war. She said the government would secure domestic medical supplies and disease prevention resources, and make every effort to control and contain COVID-19.

The effort of Taiwan’s Center for Disease Control
In order to ensure comprehensive security measures regarding disease prevention and to remain vigilant against this epidemic, the Taiwan CDC formulated a plan based on past experience from international epidemics including the H7N9, Ebola, MERS and Zika outbreaks.

The plan consists of two phases depending on global epidemic situations. The first phase, “Preparedness Planning,” is activated when suspected cases of COVID-19 have been reported in neighboring countries but without ongoing community transmission. The second phase, “Contingency Planning,” is activated subsequent to the first phase, during an ongoing, spread of epidemic.

1. Preparedness Planning:
A. Continuous epidemiological surveillance and risk assessment
B. Implementation of border quarantine
C. Inventory checking of medical supplies and equipment
D. Strengthening risk communication
E. Enhancing testing and diagnostic capabilities
2. Contingency Planning:
A. Continuous epidemiological surveillance and risk assessment
B. Tightening border quarantine
C. Solidifying the Healthcare System
D. Allocation and management of medical supplies and equipment
E. Enhancing testing and diagnostic capabilities
F. Constant risk communication
G. Community-based epidemic prevention
H. Epidemiological investigation
I. Development of international collaboration

Overall, the key aspects of Taiwan CDC’s advance efforts include:
1. Epidemiological surveys and border control
(1) Phase 1 border control: preventing the spread of COVID-19 from China
(2) Phase 2 border control: preventing the spread of COVID-19 from other countries
2. Effective monitoring, testing, tracing, and investigation mechanisms
3. Triage measures for mild and severe cases

The establishment of the Central Epidemic Command Center (CECC)
Pursuant to a legal basis, on January 20, 2020, level 3 of the Central Epidemic Command Center (CECC) was established by the Taiwan CDC to integrate all resources of the administration. On January 23, 2020, level 2 of the CECC was established as a direct response to the first domestic case of COVID-19, confirmed on January 21, 2020. Dr. Shih-Chung Chen, the Minister of Health and Welfare, served as the commander to coordinate and mobilize resources from a cross-ministry perspective. On February 27, 2020, level 1 of the CECC was established due to the worsening of the global epidemic situation. Dr. Shih-Chung Chen continued his role as the commander, as designated by the Premier.

Taiwan was the first country in the world to establish a command center of this kind in response to COVID-19. The CECC’s work includes evaluating information gathered as part of epidemic monitoring practices; formulating and promoting response strategies; and consolidating and integrating the resources, equipment, and personnel needed to support this response. The CECC also deals with a wide range of epidemic control measures, including daily press conferences, education and outreach, prioritizing the use of mass media, border entry and exit restrictions, home quarantine, liaison and cooperation with international organizations, airport and seaport controls, the expropriation of transportation, the cleaning and disinfection of public environments, worker safety and workplace sanitation, and the prevention and control of communicable diseases common to humans and animals. Listed below are some important measures which the CECC has taken:

◆Surveillance and Laboratory Diagnosis:
The community surveillance system has been implemented since February 16. Starting April, patients with pneumonia should be reported to health officials and are subject to related screening and testing; persons with fever/respiratory symptoms, an abnormal sense of smell, diarrhea, and with history of travel, contact with COVID-19 patients or clusters should be reported to health officials, as well as prioritized for sample collection for further laboratory diagnosis.
In order to have samples tested quickly, the government has improved its laboratory diagnosis capacities from 12 laboratories for 520 cases per day, to 37 laboratories for 3,900 cases per day.

◆Border Control:
From December 31, 2019 to January 23, 2020, Taiwan implemented onboard quarantine inspection of direct flights from Wuhan, China, and promoted related prevention measures among other travelers.

Since February 7, passengers arriving from China, Hong Kong and Macao (including those transiting through these areas) have been required to fill out a “Novel Coronavirus Health Declaration and Home Quarantine Notice” and be under home quarantine for 14 days. Starting from March 19, foreign nationals have been prohibited from entering Taiwan, and home quarantine measures have been expanded to include arriving passengers from all countries. From March 24, the transit of airline passengers through Taiwan has been suspended.

◆Control of Community Transmission:
Individuals exposed to contact with confirmed cases will be isolated at home for 14 days. Local health agencies will monitor people in home isolation to check their health twice a day. If they develop symptoms, health agencies will place them in the hospital in isolation. Due to the increased number of individuals under home quarantine, the Tourism Bureau has implemented a subsidy plan for hotels to provide rooms for people subject to home quarantine. Furthermore, social distancing measures were announced on April 1.

◆Stockpile and Allocation of PPE and Other Medical Supplies
In order to ensure enough Personal Protective Equipment (PPE) for medical workers working on the frontlines to protect themselves, the government implemented a ban on the export of medical masks from January 24 to June 30, 2020. The government has also helped allocate a mask to every citizen through purchase at pharmacies by using their National Health Insurance cards. Moreoever, an online ordering mechanism for a name-based quota system has been set up for people unable to make purchases from pharmacies.

Sources: Taiwan CDC and the MOFA website

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