Complacency, lack of testing behind Taiwan's infection surge

TAIPEI • Until this week, Taiwan's Covid-19 containment appeared to be so effective that virtually no other defences were put in place: few tests, no local surveillance to pick up undetected infection and close to zero vaccination.

Lauded as one of the most successful places in the world at containment, a high level of complacency about the risks had set in among the public and the authorities. Covid-19 seemed to be something happening only in the outside world.

The virus' opening was an ill-fated decision on April 15 to shorten quarantine for airline crew to just three days, as carriers struggled to operate their cargo lines with staff having to undergo 14-day isolation periods.

Infected airline pilots introduced a more transmissible British variant, whose spread was then accelerated through a network of "hostess bars" - places which staff and patrons were reluctant to be associated with, making contact tracing more difficult.

Taiwan reported 267 new infections yesterday, bringing the total over the past few days to 1,291 - a small number in global terms but an astonishing one in a place that, before May 1, had posted just 1,132 cases during the entire pandemic.

The surge from zero to quadruple digits signals that undetected spread was going on for months.

"If they have 300 diagnosed cases, they have 3,000 cases in the community - they just don't know it," said Dr Gregory Poland, a virologist and director of the Mayo Clinic's Vaccine Research Group.

"It's going to require a hard lockdown... and then getting the vaccine out as quickly as they can."

The problem is, there are no vaccines. As in many places that seem to have eliminated the virus locally, Taiwan's inoculation drive is lagging behind European and North American economies, a major vulnerability that could trap it in a stop-start cycle of restrictions.

Taiwan officials yesterday expanded restrictions to the entire island as cases rose, closing recreation venues and entertainment businesses, urging companies to allow staff to work from home and limiting the size of gatherings.

The government is hoping that the measures can help it fend off a hard lockdown, which will be triggered if an average of at least 100 new daily cases is reported for 14 consecutive days and the source is unidentified in half of the cases.

Health Minister Chen Shih-chung yesterday expressed confidence that Taiwan will not enter a hard lockdown, saying that officials are working hard to stay on top of the sources of all new cases.

The virus' most likely route past border defences was the Novotel hotel near Taiwan's biggest airport, Taoyuan International.

While China Airlines crew members were quarantined in one part of the Novotel, another wing was open to the public attracted by cheap staycation deals.

More than 30 of the recent cases have been linked to the airline and hotel. Following the lapse, the government ordered all China Airlines pilots and some flight attendants to undergo 14-day quarantine as a "circuit breaker".

For the Novotel cases, a clear infection chain is yet to be identified.

Covid-19 testing has been quite infrequent, a strategy the authorities justified last year by saying that mass testing would raise the risk of false positives, wasting medical resources - a position counter to global best practices.

Taiwan administered 0.18 Covid-19 test per 1,000 people on Sunday, according to Our World in Data. In Australia, the number is 1.8, while in Singapore, it is 13.1.

Increasing testing will be a key step if Taiwan wants to avoid a hard lockdown, said Dr Gigi Gronvall, a senior scholar at the Centre for Health Security at Johns Hopkins Bloomberg School of Public Health. "Even the use of rapid tests will be able to quickly identify people who are infectious," she said.

Since its lack of outbreak meant Taiwan did not have to keep up with the latest practices in fighting the virus, there were no measures to detect asymptomatic carriers.

The high share of infected people who are asymptomatic is a key challenge and makes containment much harder than with pandemics like the 2003 severe acute respiratory syndrome outbreak.

One way to detect asymptomatic spread is wastewater surveillance, which can pick up traces of where the virus is lurking. Another is routine testing of high-risk populations such as migrant worker communities or nightlife staff.

Many of Taipei's illicit hostess bars are found in the city's Wanhua district, which has become an infection hot spot. Over 2,000 people were tested locally as at Sunday, with a positive rate of 10.8 per cent. A rate higher than 5 per cent indicates the search for people who may have been exposed to the virus is not wide enough.

Bars where patrons pay to spend time socialising with escorts pose a number of virus risks. These establishments tend to have few windows and poor ventilation, while close contact, including sharing drinks or singing together, can allow infections to spread.

Alcohol consumption also makes reckless behaviour more likely, and customers are often reluctant to admit they have visited these clubs, making contact tracing even harder. Hostesses are often reticent about coming forward.

The question now is how Taiwan can get the situation back under control. The virus is running rampant among a population where few people have been vaccinated or previously infected.

As at Monday, just 0.9 per cent of Taiwan's 23.5 million people had had their first shot. It will be hard to ramp up inoculations quickly. Convincing a population that has not felt much threat from the virus to get vaccinated is one issue.

But there is also the supply chain. So far, Taiwan has taken delivery of only 315,000 doses of the AstraZeneca vaccine, with another 400,000 doses due to arrive yesterday. Five million Moderna shots will arrive in the middle of the year, but even that will cover only a fraction of the population.

Officials hope that measures like contact tracing and a population compliant with public health curbs such as mask-wearing can keep spread under control until more vaccines arrive.

BLOOMBERG