The novel viral pneumonia (officially called COVID-19) started since December 2019 in Wuhan, Hubei province of China. Fever was the main clinical symptom. Some would also experience breathing difficulties with X-ray findings of infiltrative injury to both lungs. The cause of this novel pneumonia belongs to a class of virus called coronavirus. Other significant diseases such as SARS also belong to the coronavirus family.
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Coronavirus (CoV) is an enveloped virus which gives its name from the crown-like spikes seen under electron microscopy.
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Coronavirus infection among humans primarily involves the respiratory tract, including symptoms of general upper respiratory infection like nasal congestion, rhinorrhea, cough, and fever. However, infections caused by SARS-CoV, MERS-CoV, and COVID-19 (SARS-CoV-2) tend to be more severe than other strains of human coronavirus, with some cases developing severe pneumonia and even respiratory failure.
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Apart from those transmissible to humans, other specific strains of coronaviruses are also known to infect animals such as bat, pig, cattle, turkey, cat, dog, and ferret. Case reports of animal-to-human transmission have also been reported.
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Certain strains of coronaviruses are zoonotic, which means they are pathogenic in both humans and other vertebrates. Most human coronaviruses are transmitted through direct contact with body secretions or respiratory droplets from infected individuals. Some strains of coronaviruses cause diarrhea among animals and can be isolated from animal feces; as a result, they are also transmitted through direct contact with feces of infected animals.
Severe Acute Respiratory Syndrome (SARS) virus, which first emerged in 2002, was likely associated with human exposure to infected animals such as civets or bats. Middle East Respiratory Syndrome (MERS) virus, which first emerged in 2012, has been linked to human contact with camels or consuming camel milk.
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SARS-Cov-2 is a new strain of coronavirus which first emerged in Wuhan, Hubei Province, China back in December 2019. Initially, the World Health Organization (WHO) received reports on December 31, 2019 that Chinese authorities have identified a novel viral outbreak involving over 40 patients in Wuhan, Hubei Province, China. This was a previously-unknown strain of coronavirus, and the WHO referred to it by the provisional name 2019 novel coronavirus (2019-nCoV). The International Committee on Taxonomy of Viruses (ICTV) then officially named it as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on February 11th, whereas the WHO then officially named the disease caused by SARS-CoV-2 as COVID-19.
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Aside from its origin in Wuhan, Hubei Province, China, where SARS-CoV-2 was first identified, numerous cases have been reported in other Chinese provinces and cities such as Beijing, Tianjin, Shanghai, and Guangdong. COVID-19 has since spread rapidly worldwide, and has been declared by the WHO as a global pandemic. As of April 12, 2020, over 1.77 million cases have been reported in 210 countries and territories, with over 108,000 deaths.
 
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The first confirmed imported case in Taiwan was reported on January 21, 2020, who was an individual residing in Wuhan, Hubei Province, China. As of April 11, 2020, a total of 385 cases have been confirmed in Taiwan, with 6 mortalities reported. There has so far been no evidence of community infection in Taiwan.
 
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When a pneumonia outbreak of unknown origin took place in Wuhan, China in December 2019, most cases could be traced back to Huanan Seafood Wholesale Market, a wet market selling seafood and wild animals. SARS-CoV-2 was detected in environmental specimens from this market; however, the exact source of infection remained elusive.
Besides, epidemiological studies of confirmed cases demonstrated infection among family members and healthcare personnel. As a result, it is highly probable that the risk of human-to-human transmission may be increased through respiratory droplets within close proximity, as well as direct or indirect contact with nasal or oral secretions and body fluids of infected individuals.
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The main clinical manifestations of confirmed cases of COVID-19 are fever, general fatigue, respiratory symptoms, and dry cough, while some of them may even develop respiratory failure. In severe cases, the symptoms could progress to severe pneumonia, acute respiratory distress, or multiple organ failure, and shock. According to available epidemiological data reported so far, most patients eventually recover, but there are still some deaths. Most mortality cases had underlying diseases, such as diabetes mellitus, chronic liver disease, renal insufficiency, and cardiovascular disease, etc.
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There has so far been no approved specific antivirals or other drugs against SARS-CoV-2 infection, though there are several ongoing clinical trials evaluating direct treatments. According to the “Interim Guidelines for Clinical Management of COVID-19 Patients” published by the Taiwan CDC, patients should be given supportive treatment as early as possible and their clinical conditions should be closely monitored. Appropriate medication may be given if necessary.
 
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When travelling to epidemic regions or taking public transportation in those regions, wearing surgical face masks is recommended as a preventive measure, the same as preventing common respiratory tract infections.
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If you have (1) traveled to or lived in epidemic regions during the past 14 days, or (2) been informed by health authorities that you were in contact with confirmed COVID-19 cases, and has developed a fever or respiratory symptoms during home quarantine, you should:
  • Put on surgical face mask immediately
  • Contact the local health bureau, or dial the toll-free Taiwan CDC Infection Control Hotline 1922 for help, and seek medical service as advised as soon as possible.
  • Be sure to inform the doctor of your travel history, occupational or other relevant exposure, and if anyone around you has developed similar symptoms.
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The incubation period is defined as the time between exposure to the virus and onset of symptoms. Based on information released by the WHO and available literature, the incubation period for SARS-CoV-2 is currently estimated to be between 2 to 12 days with an average of 7 days. However, for those who have traveled to epidemic regions or had come in contact with suspected COVID-19 patients, home quarantine is still mandatory to prevent possible disease spreading.
 
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Taiwan CDC routinely updates all the latest information regarding the evolving domestic COVID-19 epidemic situations, and provides detailed recommendations for prevention measures. Please refer to https://www.cdc.gov.tw/En/Bulletin/List/7tUXjTBf6paRvrhEl-mrPg for further details.
 
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Coronaviruses are not readily isolated from tissue cultures. Real-time polymerase chain reaction (RT-PCR) is the primary choice for testing coronaviruses in humans, which can also aid in determining the epidemiology and evolution characteristics of the virus.
 
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After the SARS outbreak in 2003, Taiwan has been routinely screening for fever on all inbound international transportation at ports of entry and conducting quarantine assessments on the travel history of fever individuals. In response to the COVID-19 epidemic which first originated from Wuhan, China, the Taiwan Central Epidemics Command Center (CECC) has been constantly strengthening international epidemic surveillance as well as border control measures. To minimize the risk of any community outbreaks, passengers presenting with fever at international and Mini Three Links ports of entry are required to clarify any travel history to Wuhan and undergo comprehensive health assessment to evaluate the need of on-the-spot compulsory transfer to hospital (medical evacuation). For inbound travelers with upper respiratory symptoms who do not meet the criteria of compulsory transfer to hospital, they are required to complete the “Communicable Disease Survey Form” and receive “Notification of Compulsory Quarantine for Arriving Passengers with Suspicious Symptoms.” This is aimed at strengthening quarantine measures at ports of entry and to improve understanding of COVID-19 among the general public, while protecting domestic security at once.
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During the visit, you should:
  1. Adopt personal protective measures, wash your hands frequently with soap, and always wear a face mask.
  2. Avoid high-risk public places such as live animal markets and local hospitals
  3. Avoid contact with live animals or animal carcasses
  4. Avoid eating raw meat or eggs
  5. If you develop flu-like symptoms (e.g. fever (body temperature≧38℃), cough, etc.), put on a surgical mask and seek medical attention immediately
When returning to Taiwan:
  1. Inbound travellers with fever or other flu-like symptoms should inform the airline staff and quarantine inspectors at ports of entry.
  2. If you develop those symptoms after returning home, dial the toll-free Infection Control Hotline 1922, put on a surgical mask and seek medical attention immediately. Inform doctors of your travel history, contact history, and your symptoms.
  3. After seeking medical attention, stay home and rest. Do not leave your home. Avoid or minimize contact with others.
  4. Cover your coughs and sneezes with tissue paper or your upper sleeves.
  5. Continue wearing a surgical mask if any respiratory symptoms persist.
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If you have traveled to or lived in China in the past 14 days, please put on surgical masks and seek medical attention immediately if you develop fever or any respiratory symptoms. When seeking medical attention, you should actively inform doctors of your travel history, occupational exposure, relevant exposure, and whether people around you have also developed similar symptoms.
While there is currently no rapid screening available for COVID-19, you may receive testing for SARS-CoV-2 if indicated by doctors.
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Clean and disinfect high-touch surfaces with bleach three times daily if sharing a bathroom or common spaces with home-isolated/quarantined individuals. Use a 1:100 bleach solution (500 ppm) for furnitures and kitchens, and a 1:10 bleach solution (5000 ppm) for bathrooms and toilets. Change the bleach solution everyday. Check for good ventilation to maintain clean indoor air.
 
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Taiwan CDC has raised the travel notice for Wuhan, China to Level 3 (Warning) on January 21, 2020. Travellers are advised to avoid all nonessential visits to regions with  Level 3 travel notice.
 
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Clean and disinfect high-touch surfaces with bleach once daily. Use a 1:50 bleach solution (1000 ppm) for furnitures and kitchens, and a 1:10 bleach solution (5000 ppm) for bathrooms and toilets. Change the bleach solution everyday. Check for good ventilation to maintain clean indoor air.
 
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A1. During home quarantine, you should:
1. Stay at home or at an accomodation location. You are NOT allowed to travel abroad or take any public transportation.
2. Separate yourself from others in your home as much as possible. All should adopt appropriate protective measures, which includes wearing a surgical mask, maintaining good personal hygiene, and staying a proper distance away from others (1-1.5m).
3. Record your body temperatures and health conditions in detail. You will receive follow up phone calls everyday from health authorities.
4. If any symptom develops, contact the district Public Health Bureau. Follow their instructions to seek medical attention. Do NOT take public transportation.
A2. During self-health management, you should:
1. Rest at home and avoid going out as much as possible. Wear a surgical mask at all times if you are going out.
2. Maintain respiratory tract hygiene and good cough etiquette.
3. Check your body temperature every morning and evening. Record the temperatures and daily activities in detail.
4. If any symptom develops, contact the district Public Health Bureau. Follow their instructions to seek medical attention. Avoid taking public transportation as much as possible.
 
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Home-quarantined individuals are those who have come into contact with COVID-19 patients and are therefore required to stay home for self-health monitoring. They are currently asymptomatic and do not transmit the virus to other people. You do not have to be concerned if you had come into contact with home-quarantined individuals. Simply live as usual.
 
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All patients with COVID-19 are released from isolation and discharged only after they meet the discharge criteria, i.e. three consecutively negative SARS-CoV-2 tests. After discharge, they do not transmit the virus to other people and pose no threat to the community. Please accept them and do not discriminate against them, simply keep on your usual life.
 
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Please refer to the following attachment of “FAQ on the Quarantine System for Entry.”
 
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A: Simply add 15 days to the date of entry. For example, if you arrived in Taiwan on April 1st, you will be released from home quarantine on April 16th (1+15=16).
 
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A: All travellers of Chinese, Hong Kong, and Macau nationality are temporarily prohibited from entering Taiwan. Please refer to announcements of the Central Epidemic Command Center (CECC) for further updates. With respect to entry regulations regarding travellers of different nationalities, please refer to the National Immigration Agency (NIA) official website for details.
 
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A: Currently, all inbound travellers are required to undergo home quarantine for 14 days. The workflow of border quarantine is briefly summarized as follows:
  • Declaration of home quarantine upon entry: Mobile phone users can scan the QR code and enter the “Quarantine System of Entry” to complete online registration. For those without or unable to use a mobile phone, fill out the “COVID-19 Health Declaration and Home Quarantine Notice” form (hereinafter referred to as the “printed Notice”). Travellers should stay honest and report detailed travel history as well as health conditions.
  • Review of home quarantine digital credential/printed Notice: After disembarking the aircraft, travellers with home quarantine digital credential can go through the e-Gate; those with a printed Notice should go through manual procedures of personal information verification, on-site data entry, and formal issuing of the printed Notice.
  • Taiwan CDC quarantine station: Travellers without fever (i.e. no abnormalities on the infrared thermometer) or upper respiratory tract symptoms can proceed to the immigration checkpoint of the National Immigration Agency (NIA), MOI. For those with fever or upper respiratory tract symptoms, please follow instructions and undergo health assessments as well as compulsory quarantine measures.
  • Immigration checkpoint of the National Immigration Agency (NIA), MOI: Review of immigration documents. According to the Communicable Disease Control Act, those who fail to truthfully reveal their travel history and health conditions will be fined.
  • Complete immigration clearance, welcome to Taiwan.
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A: You may apply for a SIM card at the airport. Our quarantine staff will dial the phone number on-site to ensure it is valid and you are always reachable. For those arriving at Taoyuan International Airport, you will receive a mobile phone designated for home quarantine/self-health management follow-up and tracking.
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  • For adults: Use your personal mobile phone number.
  • For children under 18 years of age whose parents are also undergoing home quarantine: The priorities are as follows:
1. Mobile phone number of the father (who is also under home quarantine)
2. Mobile phone number of the mother (who is also under home quarantine)
3. Mobile phone number of a co-resident living with the children (who is also under home quarantine), and specifically note “this number is shared between the co-resident and the children” in the remarks section.
 
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A: Starting from March 19, 2020, all crew members of foreign nationality are temporarily prohibited from entering Taiwan. Crew members of Taiwanese nationality will receive the “COVID-19 Health Declaration and Home Quarantine Notice” from quarantine staff at maritime ports and must undergo home quarantine for 14 days after entering Taiwan. Under supervision of the Maritime and Port Bureau, MOTC, all personnel of the maritime industry must comply with and thoroughly implement the aforementioned regulations.
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A: The same home quarantine regulations are applicable to those flight crews if they have thoroughly adopted appropriate measures both on the flight and during layovers. (e.g. wearing masks and gloves throughout the entire flight, taking designated shuttle services and staying at designated accommodation without going out during layovers, etc.) They are also required to fill out the “COVID-19 Health Declaration Form for Flight Crews Returning from Regions with Level 3 Travel Notice” and report health conditions before going through immigration. Instead of undergoing home quarantine for 14 days, flight crews are allowed to go on duty at an interval of at least 5 days apart. They must report their health conditions everyday and are closely monitored by airline companies. Under supervision of the Civil Aeronautics Administration (CAA), MOTC, airline companies are obliged to effectively implement the relevant measures. If a member of the flight crew presents with symptoms upon entering Taiwan, he/she must undergo home quarantine for 14 days and receive testing for SARS-CoV-2.
For any questions regarding management of aircrew immigration, please contact the Civil Aeronautics Administration (CAA), MOTC via direct line (02-23496144) for further information.
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According to the WHO and Chinese officials, the incubation period of the novel coronavirus between disease exposure to the onset of symptoms ranges from 2 to 12 days (7 days on average). However, 14 days of surveillance is required for those travelling to the regions of epidemic or in contact with infected patient(s) by the virus.
UpdateTime2020/4/10
Apart from those transmissible to humans, other specific strains of coronavirus are also able to infect animals such as bats, pigs, cattle, turkeys, cats and dogs. There were also few cases of animal-to-human infection. Coronavirus can cause infection in humans and other vertebrates. Most types of coronaviruses transmit infection mainly via secretions and droplets. Some infected animals also suffer from having diarrhoea, and the virus present in the faeces can cause further disease transmission.
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There is no vaccine as yet to prevent COVID-19. Prevention is the same as for other respiratory infections including washing hands frequently, wearing masks and cleaning up secretion from the mouth and nose appropriately. Other measures include avoiding crowded places such as markets or local hospitals, avoiding contact with animals and dead animals and avoiding eating raw meat or eggs. Additionally, you should wear masks and attend medical attention immediately when flu-like symptoms occur (such as body temperature ≧38℃, and coughing, etc)
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Currently, there is no targeted treatment for COVID-19. Current treatment aims at supportive care. The anti-viral medications used for SARS have not been proven to help with the novel coronavirus infection. There is no vaccine as yet to prevent the novel (new) coronavirus. Please seek medical attention immediately if you are unwell.
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Please wear a surgical mask immediately and call 1922 or local health bureau if you have been to or resided in the epidemic region affected by the novel coronavirus in the past 14 days, have been identified as a contact of an infected person or have developed fever or respiratory symptoms. When you call for help, please seek medical attention as instructed and provide doctors with detailed travel history and occupational exposure.
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For living environments such as furniture and kitchen, you can apply 1:100 diluted bleach (500 ppm). For bathroom or toilet surfaces, apply 1:10 diluted bleach (5000ppm) to disinfect. You should disinfect once a day with freshly diluted bleach and make sure there is good airflow to maintain good air quality.
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