Prevention and Control of COVID-19 in Taiwan
- On January 2, 2020, the response team of Taiwan CDC was set up to respond to the mystery pneumonia epidemic in Wuhan, China.
- On January 20, 2020, level 3 of the Central Epidemic Command Center (CECC) was established to integrate resources of the administration, the academic, medical, and private sectors to fight against the 2019 novel coronavirus (COVID-19). Dr. Jih-Haw Chou, the Director-General of the Taiwan Centers for Disease Control (Taiwan CDC) served as the commander
- On January 23, 2020, level 2 of the CECC was established due to the fact that the first case of COVID-19 was 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, including the ministries of interior, transportation, foreign affairs, economics, labor, education, environment, etc. as well as private stakeholders to fight against COVID-19.
- On February 27, 2020, level 1 of the CECC was established due to the global epidemic situation getting worse. Dr. Shih-Chung Chen, the Minister of Health and Welfare was appointed by the Premier as the commander to coordinate and mobilize resources from across ministries and private stakeholders to fight against COVID-19.
- The Communicable Disease Control Act was stipulated in Taiwan to prevent and control infectious diseases. Furthermore, if any infectious diseases cause great impacts on national security, social economy and human health or impose heavy burden on our healthcare system, the Enforcement Rules of Disaster Prevention and Protection Act can apply to the above-mentioned affairs and related matters.
- According to the Communicable Disease Control Act, Taiwan CDC classified COVID-19 as a Category 5 communicable disease on January 15, 2020, to strengthen surveillance and containment of COVID-19. It helped urge the public and medical facilities to take notice of the disease and take necessary precautionary measures to decrease risk of transmission.
- In addition, a Special Act for Prevention, Relief and Revitalization Measures for Severe Pneumonia with Novel Pathogens was adopted on February 25, 2020, to respond to the coming crisis.
- On December 31, 2019, when we were notified of mystery pneumonia cases in Wuhan, China, we began to implement relevant prevention strategies, including surveillance and laboratory diagnosis, border control, control of community transmission, medical system response and preparedness, stockpile and allocation of Personal Protective Equipment (PPE) and other medical supplies, as well as health education and disinformation management.
- Surveillance and Laboratory Diagnosis:
- We began to identify people who developed fever, cough or other acute respiratory symptoms and who had a past 14-day travel history or close contact with the above mentioned people. They are all required to report to the health authorities and provide a laboratory specimen for further laboratory diagnosis.
- The scope of surveillance has been expanded according to the developments of epidemic situation. Reporting requirements for COVID-19 was updated based on the latest findings on the disease. Starting April, patients with pneumonia and persons with fever/respiratory symptoms, abnormal sense of smell or diarrhea and with history of travel, contact or cluster should be reported to health officials and be subject to specimen collection for further laboratory diagnosis. Additionally, the community surveillance system has been implemented since February 16. Thus, suspected cases who do not meet the disease reporting criteria can be screened and tested through the above-mentioned surveillance system.
- The standard diagnostic method is using nucleic acid tests, a molecular biology technique for testing. In order to have specimens tested quickly, we have improved our laboratory diagnosis capacities from 12 laboratories for 520 cases per day to nearly 50 laboratories for around 6,000 cases per day.
- Since 2003, standard operating procedures have been implemented at Taiwan’s airports including reinforcing fever screening of arriving passengers, screening suspected cases through inquiring about their history of travel, occupation, contact, cluster and conducting health assessments.
- 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, arriving passengers 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. Since February 11, arriving passengers have been required to fill out the novel coronavirus health declaration form. Who should be placed in home quarantine is subject to change based on the epidemic situations in other countries. 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 in response to global epidemic developments. In order to stop the spread of COVID-19 through air transport, the transit of airline passengers through Taiwan has been suspended starting from March 24 to decrease the cross-border movement of people and to reduce the risk of disease transmission.
- Since February 16, 2020, travelers with mobile phone numbers provided by telecom operators in Taiwan have been able to use a Health Declaration and Home Quarantine E-System (Entry Quarantine System) by scanning the QR Code while waiting at the check-in counter. Travelers can complete the health declaration form online while waiting for their flights or upon entry. The health declaration pass will be sent to travelers’ mobile phone via SMS upon arrival in Taiwan. After that, travelers will get faster immigration clearance by showing the health declaration pass. Therefore, travelers can complete health declaration and get faster immigration clearance with 4 simple steps: scan the QR Code, fill out the form, get a health declaration pass via SMS, and show the pass on their mobile phones.
- Control of Community Transmission:
- People who had contact with confirmed cases will be isolated at home for 14 days. Local health agencies will contact 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.
- In collaboration with telecom companies, we have launched an electronic security monitoring system to identify the location of people in home quarantine or isolation by detecting mobile phone signal connecting to the cell tower. If the system detects a person leaving a designated quarantine site, causing the phone signal to move away from the nearest cell tower, the person and the civil affair bureau worker responsible for the person will receive a notification via SMS. The responsible worker and the police will check the person’s location immediately. Violators not following the regulations will be fined or forcibly placed to prevent possible spread of disease.
- During the 14-day period of home quarantine or home isolation measures, individuals may not go outside. Therefore, on March 1, central and local governments worked closely to implement plans for providing services for home quarantined/isolated individuals. Each local government has set up centers for COVID-19 consultation and support services, the measure of daily follow-up calls as well as standard procedures for related services and assistance to people for transport arrangements, medical care arrangements and household services, including settlement planning for people without a residence, meal delivery, garbage collection and consultation
- Due to the increased number of individuals under home quarantine, the Tourism Bureau has implemented a subsidy plan for hotels which collaborated with the government to provide rooms for people subject to home quarantine. Each hotel offering rooms for those subject to home quarantine can receive a subsidy of NT$1,000 per room per day from April 1 to July 31.
- During the early stage of the global COVID-19 outbreak, schools in Taiwan had delayed opening for two weeks after which there was no large scale of school closure. In order to protect students from COVID-19 infection, the Ministry of Education has announced rules for the suspension of classes, prepared and allocated medical supplies to the schools. In addition, schools are required to monitor students’ health conditions, maintain environmental disinfection, and follow up on the activities which teachers and students have participated in. As of now, only one school has been closed for 14 days due to two confirmed cases.
- Social distancing measures were announced on April 1 to encourage the general public, in phases, to maintain social etiquette and observe social distancing and thereby reduce the risk of community transmission of COVID-19, which continues to spread across the globe. Other related guidelines and recommendations, including those for mass transportation, enterprises, large-scale public gatherings, large commercial sites, community management, and establishment and management of quarantine hotels, were also issued.
- Medical System Response and Preparedness
- Taiwan CDC established the “Communicable Disease Control Medical Network” (CDCMN) after the SARS outbreak in 2003. The CDCMN identified 6 districts in Taiwan, and under the network, one response hospital in each district and county/city was designated to be responsible for isolation of the patients with Emerging Infectious Diseases (EID). The government would provide subsides to the response hospitals to supply their isolation facilities and provide training courses. In addition, the local government was allowed to designate appropriate hospitals located in the county/city as the isolation hospitals. As of now, 134 response and isolation hospitals have been designated in Taiwan.
- During the COVID-19 pandemic, 161 medical facilities were designated for collecting specimens. Of which, 134 response and isolation hospitals have been designated for treatment of confirmed mild cases of COVID-19 while 52 regional hospitals or medical centers have been designated for treatment of severe cases.
- According to the nosocomial control guidelines, hospitals are subject to identify two separate entries for emergency and hospitalized patients. Medical staffers are required to take care patients by a separate area and group. COVID-19 patients have been settled on the specific ward or area to avoid nosocomial infection.
- Stockpile and Allocation of PPE and Other Medical Supplies
- Lesson learned from SARS, we had accumulated a pre-stockpile of N95 respirators, surgical masks and protective gowns for medical and public health personals in response to the emergency crisis according to the Communicable Disease Control Act.
- In order to ensure enough medical masks for medical workers working on the frontlines to protect themselves, the government has also implemented a ban on the export of medical masks from January 24 to May 31, 2020. In addition, government funds and military personnel have been used to increase mask production as well as to assist manufacturers in acquiring equipment to boost capacity.
- The increased production of medical masks has been distributed not only to the frontline healthcare workers but also the general public for personal protective measures. Therefore, the government has helped allocate a mask to every citizen through purchase at pharmacies by using their National Health Insurance cards. Furthermore, an online ordering mechanism for a name-based rationing system has been set up for people who are unable to buy from the pharmacies. Members of the public can order masks online, pay by credit card/ATM transfer and get the masks from convenient stores, such as 7-11 or FamilyMart. Due to the increased mask production, every citizen is able to purchase more masks now. From April 9, adults are eligible for 9 masks, and 10 child-size face masks are allowed for children every 14 days.
- Supply the public with 75 percent alcohol and arrange for the alcohol to be sold at National Health Insurance (NHI)-contracted pharmacies, convenience stores, supermarkets, and hypermarkets.
- Continue to prepare the stockpile of PPE, including isolation/protective gowns and N95 respirators, for medical and public health personnel to protect them from COVID-19 infection.
- Health Education and Fighting Disinformation
- The CECC has conducted daily press briefings chaired by the commander to release COVID-19 related information to the public. Mass media such as Television, leaflets, posters and radio as well as social media such as Facebook, Line and Twitter have also been extensively used for public education. These announcements included when and where to wear a mask, the importance of hand-washing and the danger of hoarding masks, to prevent them from becoming unavailable to frontline health workers.
- Taiwan CDC has also collaborated with the National Police Agency, the National Communication Commission and the Bureau of Investigation to fight disinformation which might interrupt or affect our response measures to COVID-19.
- Loosening Epidemic Prevention Measures
- We are planning to gradually start international commercial exchanges with persons who wish to enter Taiwan for humanitarian reasons or essential business activities, whereas necessary quarantine and management measures are still imposed. Entry and quarantine measures for foreign nationals have been updated as below:
- (1)Foreign nationals may apply to enter Taiwan for reasons other than tourism and regular social visits.
- (2)Hong Kong and Macao residents may apply to enter Taiwan for special humanitarian reasons or emergency situations; to fulfill contractual obligations; as part of internal transfers within multinational enterprises; when they are the spouse or child of an R.O.C. national and possess an R.O.C. Resident Certificate; for commercial and trade exchanges; or when they hold an R.O.C. Resident Certificate related to employment, investment, or entrepreneurship.
- (3)Foreign nationals and Hong Kong and Macao residents who have received permission to enter Taiwan, when checking in with the airline for the flight to Taiwan, must present an English-language certificate of a negative COVID-19 RT-PCR test taken within three days of boarding (except Alien Resident Certificate holders). They must also undergo a 14-day home quarantine period and observe other relevant epidemic prevention measures upon entry into the country.
- (4)From June 25, transit passengers are allowed at Taiwan Taoyuan International Airport with thorough route and monitoring measures in place to prevent coronavirus spread. However, related restrictions are put into place to minimize the risk of infection posed by transit passengers:
- i.Transit flights from or to China where COVID-19 continues to spread are excluded from the plan;
- ii.Transit passengers are required to fly with the same airline (only Taiwan’s China Airlines and Eva Air and Hong Kong’s Cathay Pacific are included in the transit plan, and the list of airline companies permitted will be reviewed based on the pandemic situation and implementation of the project.);
- iii.Transit passengers are required to leave Taiwan within eight hours.
- (5)From June 22, short-term business travelers are allowed entry and can apply for shortened home quarantine periods if such travelers meet all the conditions listed below:
- i.Those who are allowed entry according to the announcements of the CECC;
- ii.Those whose duration of stay doesn’t exceed three months;
- iii.Business travelers who enter the country for business activities, such as goods inspection, after-sale services, technical assistance and training, and contract signing;
- iv.Those who arrive from low- and middle low-risk countries/regions announced by the CECC and have no history of travel to other countries in the last 14 days before boarding the flight to Taiwan. Those from low-risk countries/regions may apply for taking a COVID-19 test on the 5th day of their stay while those from middle low-risk countries/regions may apply for taking a COVID-19 test on the 7th day of their stay. If the result is negative, they will be allowed to practice self-health management.
- Considering the low risk of community transmission in Taiwan, we are gradually loosening certain restrictions as below:
- (1)Adjustment to mask distribution policy: Starting from June 1, masks not requisitioned by the government will be open for domestic purchase or export. The current quota (9 masks per 14 days for adults and 10 masks per 14 days for children) under the name-based rationing system will remain in place to ensure universal access to masks for every citizen and to stabilize the price of masks.
- (2)Restrictions on visits to hospitals and long-term care facilities were eased, allowing each patient to have two visitors once per day and allowing each resident of long-term care facilities to have at most three visitors (children included) once per day, respectively.
- (3)New lifestyle movement for disease prevention: the CECC started to ease restrictions on domestic activities or gatherings in phases in May. For instance, applications for the lodging sites in national parks can be accepted from May 7th, and each regular season game of Chinese Professional Baseball League (CPBL) can be attended by at most 1,000 spectators from May 8th.
- (4)As Taiwan continues to record no new indigenous cases, which indicates no community transmission in the country, we have expanded the scale of loosening epidemic control measures. However, we still urge the general public to observe personal preventive precautions. More specifically, the general public should follow personal precautions but it would not be necessary to impose restrictions on the number of people allowed in a place when they eat out or attend social activities.
- Although Taiwan is not a member of the WHO, as a responsible member of the international community, Taiwan CDC has reported confirmed cases of COVID-19 to the WHO. Taiwan has also shared information on the epidemic situation, travel and contact histories of patients, border control measures with other countries, such as Japan, Republic of Korea, Singapore, Malaysia, the Philippines, the United States, Canada, Italy, France, Switzerland, Germany, the United Kingdom, Belgium and the Netherlands through the IHR mechanism.
- As globalization spurs the speed and frequency of the spread of infectious diseases more than ever before, a crisis anywhere may easily and soon become a problem everywhere. Taiwan will continue to collaborate with other countries in fighting against COVID-19. However, we have only been participating in a few activities organized by the WHO, such as attending the Global Research and Innovation Forum online and several clinical and infectious control teleconferences. At these kinds of events, we were unable to fully elaborate on how we have responded to the COVID-19 epidemic with the international experts in person. We will be able to contribute more and share our experience with WHO members and international professionals if Taiwan could participate in the WHA and COVID-19 related technical meetings of the WHO.
Updated on 2020/7/9