TAIPEI - Taiwanese health authorities, once lauded for their handling of the Covid-19 pandemic, have now come under a cloud over their management of a recent surge in cases.

There is increasing concern about lax contact tracing and the mounting death rate, which, according to media reports, included three people who were in hotel quarantine.

The concerns come despite the fact that infections are back to two-digit figures some two months after locally transmitted cases grew by the hundreds each day.

On Saturday (July 10), the island reported 31 local cases, a huge drop from the peak of 535 on May 17.

The death rate, though, has increased significantly, tripling from 1.57 per cent on April 10 to 4.74 per cent now.

A lot of anger has been directed at what is being considered as lax contact tracing, with one notorious case involving a man dubbed the "Lion King" by Taiwanese netizens.

The man, who was an active member of non-profit service group Lions Clubs International, transmitted the virus to many of his friends and family in May.

One of those infected was Ms Yen Tzu-hsin's 66-year-old father-in-law, who had met up with club members frequently even after news of the cluster broke. He tested positive for Covid-19 on May 28, two weeks after the "Lion King" was diagnosed.

"But we never got a call from the authorities like they promised. I had to call and ask about my father-in-law's test results, then my family went into home quarantine," Ms Yen told The Straits Times.

The Central Epidemic Command Centre (CECC) had by then set up testing stations around Taipei and New Taipei City, where Covid-19 hot spots were reported.

But they failed to notify patients of their positive results immediately. Contact tracing, once conducted rigorously and the CECC's proud success story, had become lax, said Ms Yen.

She said she called the CECC's Covid-19 hotline to inquire about quarantine guidelines for those who had come in close contact with Covid-19 patients.

"They told me to just stay at home and wait for the authorities to call for contact tracing and the next steps. I waited for a whole week and had to call them myself again," she said.

But more confusion followed, said Ms Yen.

The Xinzhuang district's health centre, near her apartment, said it was not in charge of contact tracing. It told her to call New Taipei City's Department of Health, which informed her that local health centres were responsible for keeping track of confirmed cases and their contacts.

"They kept kicking me around. I understand that they are understaffed and there are so many cases, but shouldn't the responsibilities be clearly appointed to certain offices?" asked an exasperated Ms Yen.

Meanwhile, reports emerged of three patients, two of them elderly, who were found dead in quarantine hotels in Taipei.

One of the cases came to light after someone claiming to be a grandchild posted on social media that a 70-year-old woman had died in a hotel room on May 24.

In the posting, the writer complained that the authorities did not deploy medical staff at quarantine hotels. The writer also said the old woman had phoned her family members the night before her death to complain about feeling weak and having trouble breathing. Her family called her the next morning but after three hours of not getting a response, they notified hotel staff, who discovered the woman had died.

Asked about the deaths, the CECC said: "We cannot determine and analyse the symptoms and physical changes they experienced for those who had died during at-home quarantine or before they were hospitalised (including those who died there), but experts and foreign studies have said that silent hypoxemia is most likely the reason."

Hypoxemia is a below-normal level of oxygen in the blood, specifically in the arteries.

On May 31, the Financial Times quoted Taiwanese public health expert Su Ih-jen, who has criticised the health authorities' handling of the recent surge, as saying that the CECC had refused to conduct mass testing when Covid-19 cases were still under control.

He also said that its decision to put Covid-19 patients with mild symptoms in isolation wards caused a ward shortage when local clusters began breaking out. Dr Su was head of Taiwan's Centres for Disease Control during the 2003 Sars epidemic.

In Bloomberg's Covid-19 Resilience Ranking, Taiwan fell from fifth spot in early May to 44 as of July 9, a drop that was quickly reported by local media outlets.

Observers say the lack of action, regardless of the reason, could be the reason for Taiwan being unable to keep cases from skyrocketing in May and June.

In confirmed Covid-19 cases, about 40 per cent of patients show no symptoms, while others can take a week or even longer to develop them.

"Both groups are most contagious in the first 10 to 12 days after getting infected. And they tend to go running around because they don't have symptoms," said Professor Chi Chun-huei, a public health specialist at Oregon State University's College of Public Health and Human Sciences.

As the deadlier Delta variant has made its way onto the island, Prof Chi thinks there is not much Taiwan can do, except to keep the public informed on guidelines and to accelerate the vaccination roll-out.

As at July 4, only 10 per cent of the population has received the first dose of a vaccine.

On Thursday, Health Minister Chen Shih-chung announced that Taiwan will partially ease its Covid-19 curbs next week, but will officially maintain its existing alert level until later in the month, as the situation continues to stabilise.

Taiwan raised its alert level to Level 3 in May following the spike in infections, limiting social gatherings, closing entertainment venues, parks and movie theatres, and banning dining in.

Those measures will be partially eased on July 13, but the Level 3 alert will stay in place until July 26, Mr Chen said.