With cases of COVID 19 /New Corona Virus infection and suspected infections rising in the Indian subcontinent, doctors, and the administration is battling a tide with great effort.

Update:Article is updated as on 12th May 2020

In a country with 1.3 billion people, our best chances lie with preventing infection by lockdown and testing more. But are we, even on the right path?

Do we also need a lockdown? Definitely yes.The statistics are giving us hope about that.

If it’s severely affecting the old, maybe only locking down elderly makes sense? The answers are not yes and no and definitely not simple. The young are also getting infected.

But apparently,their fatality rate is lower. While Taiwan, Japan, and South Korea are doing an excellent job of fighting the Covid19 or SARS COVID2, it’s essential to understand their models one at a time. A lot of social media outrage is happening about calling the virus a Wuhan virus and the Chinese virus.

But it’s important to know that many other illnesses like Ebola virus, Zika Virus, Delhi belly have been named after places. This often helps in a better understanding of socio-cultural geographic and climatic reasons behind the origin and spread of such diseases. In times like this, we need data, transparency, and science-backed protocols and international cooperation to fight this menace that the entire world is facing. In this feature, you will be coming along with me to explore what Taiwan is doing right to beat the Chinese virus.

Once upon a time, China decided to create a story about the Wuhan virus, and the rest is history. While we are in uncertain times, there are times when we all think about the what-ifs.

If China had stopped international travel. If China had shared transparent, accurate data about mortality and infection load. If China didn’t stop the whistleblower doctor who lost his life trying to warn the world about this new threat, then the world wouldn’t be in this position today.

Taiwan gives us hope. When I was researching what we should do as doctors to prepare for the COVID19 scare, I had a realization. This time around due to the beautiful thing called world wide web,data, and scientific research from all over is accessible. Something we definitely didn’t have back in 2003 during the SARS epidemic, there were even fewer data, and even then, China was much less than forthcoming. In fact, it may be said they lied by omission.

But our travel and international travel was much less than what it was and we survived. In the recent history of the world in the last 50 years has the world ever faced a pandemic closing lockdown of so many geographical places. Pandemic is serious, and this is what makes SARS COVID2 stand out. Taiwan was a country badly hit by SARSCOVID1, and they learned. They also had one significant advantage that the world didn’t have. They didn’t trust China at all and definitely didn’t rely on China’s data about the virus its transmission or mortality. They also had a contingency plan.

An epidemic task force, the administrative body which was battle-ready after 2003. This body had unique privileges and was a parallel body that would kick into effect in cases of SARS COVID1 repeated itself. They were smart and right, and they were going to find that out in 2019-20 when China presented the world with SARSCOVID2 Taiwan, in fact, even warned WHO (World health organization )about the discrepancy in the data supplied by China. But Taiwan was not a country WHO listens to.They listen to China though.

The apex body is now facing a lot of public outrage about their lack of timely action and not taking China to task about their irresponsible handling of the virus. Taiwan is close to mainland China and was ready for epidemics from China since 2003. As soon as China announced in December 2019 about what was happening, Taiwan started tracking cases, contact tracing testing, and allocating resources for protecting public health.

They collated data from their database of National health insurance with immigration and customs data. This helped them get real-time alerts from patients visiting clinics using their detailed travel history and symptoms. They used new technology like online self-reporting on-flight origin and of travel history in the last 14 days. Persons with low risk according to travel history received health declaration border pass via SMS (short messaging service) on phones for quicker immigration clearance.

Those with a higher risk level were kept in-home quarantine and tracked through their phones to check whether they followed guidelines during the incubation period. (Singapore went one step further with surprise home visits and steep fine for failure to follow rules of home quarantine) Taiwan also actively retested all those who had tested negatively for flu using the national health insurance database again.

National Health Command center was a unified head for direct discussion between the local region and central administration. It included Counter bioterrorism command center, Central epidemic command center (CEEC), Biological Pathogen command Center, Central Medical Emergency operations center Taiwan started screening passengers for symptoms as early as the first week of January 2020. CEEC, under the minister of Health and welfare, was the man in charge, and he coordinated the different ministries to fight this problem.

They also had a stockpile of N95 masks, surgical masks, and negative pressure isolation rooms. They did have challenges like many countries are having, but they have a grip on the problem. Taiwan learned from the i2003 SARS health crisis. It had decided to have a technology system and resources in place for a rapid response if and when the next crisis came. In an emergency, it’s the people and economy which suffer. That’s why Taiwan had a system in place.

What really helped Taiwan?

• Stopping flights from China early.
• Screening all passengers from Wuhan starting on 31st December.
• Extensive contact tracing of confirmed cases
• The manufacturing sector was used early to make masks and PPE
• Food, books, and extra money to those individuals in strict quarantine with apps to follow up for fever symptoms and avoiding movement beyond a certain zone.GPS to be always on to avail the benefits and strict measures in case of fallout Disciplined nation.

The Journal of the American Medical Association talks about 124 actions that Taiwan took to contain COVID 19 cases,even after being so close to China land masss.

But what about India? What can we do? We don’t have a system in place right away. This is where it gets interesting.

Taiwan’s current status as on May 11th 2020 :

440 cases and only 7 deaths in Taiwan and their model is worth following. In spite of not having help from WHO or any standing in WHO Taiwan did best in containing the COVID scare. Even when its facing a second wave its doing well and helping other nations plan strategies to survive the COVID 19 problem.

Restrictions remain in place. But Taiwan believes they are doing good today, but to keep doing good tomorrow and day after precautions are needed until the Global Pandemic crisis is overcome.

Taiwan showed how size of a country doesn’t matter if intent of Government ,common sense and self-discipline of people work together

List of Restrictions still in place in Taiwan include

• Important measures include a temporary ban on foreign visitor and a mandatory quarantine for all arrivals including transit passengers
• Wearing masks is mandatory
• Indoor events with less than 100 people
• Loss of sensation of taste or smell are mandated to be tested
• Epidemic fighting fleet to pick up passengers returning from epidemic areas for easier contact tracing
• Apps used to track face mask buying

Virus mutates and so does response in Taiwan.

Conclusion

India has established a complete lockdown for 21 days, initially and now it’s more than 50 days, with third lockdown ending on 17th March 2020. The lockdown has helped us stall and break the cycle of infection.

It will also help us get ready with more test kits and testing. But we really need more responsible behavior by citizens. Also, self-reporting via WhatsApp or SMS at a local coordinator with our AADHAR numbers about our symptoms and travel history to enable help reaching us faster. We also need N95 masks, more surgical masks, and negative pressure isolation rooms and negative pressure ICU. While the former is easier to manage, the latter two need time.

Will  Taiwan be invited to the World Health Association to meet in May? Watch the fireworks happening. Taiwan has managed the entire CCP virus crisis with amazing alacrity.

They have managed to stop the death march. But China still insists on no place for Taiwan at the world table. When Australia and New Zealand supported Taiwan’s participation, China protested and has started strong-arm tactics. New Zealand and Israel have declared they will emulate Taiwan’s response model to fight Coronavirus.Germany,Denmark have praised Taiwan’s handling of COVID 19 Pandemeic. But China is more interested in stopping Taiwan ‘s recognition, rather than fight COVID19. It is also warning Indian media about disregarding One-China norms while China continues interfering geo-politically in India’s matter. Proxy fights is what China does, this time the World hopefully will stand together.

I believe Taiwan can help.

References:

https://statisticsbyjim.com/basics/coronavirus/

https://jamanetwork.com/journals/jama/fullarticle/2762689/

https://www.orfonline.org/expert-speak/covid19-made-in-china-pandemic-63531/

Age-structured impact of social distancing on the COVID-19 epidemic in India
Rajesh Singh1, ∗ and R. Adhikari1, 2, †
1DAMTP, Centre for Mathematical Sciences, University of Cambridge, Wilberforce Road, Cambridge CB3 0WA, U

Taiwan Is Exporting Its Coronavirus Successes to the World

https://healthpolicy.fsi.stanford.edu/news/how-taiwan-used-big-data-transparency-central-command-protect-its-people-coronavirus