Taiwan has now been taken off the World Health Organization's (WHO) list of areas with recent cases of local transmission of SARS. As the first wave of this summer's global epidemic comes to an end, it is worth examining the successes and failures of our efforts at each stage of the SARS epidemic curve and consider what direction our efforts should take in the future.
There were three major shortcomings in the first stage of the epidemic (November last year to early April this year) -- the period when the newly emerging infectious disease was the least well understood.
First, the best opportunity for learning about the epidemiology of SARS came in November last year when the disease had just began to spread in China and media reports that the public was scrambling to buy vinegar were followed by the peak of the epidemic's curve in Guangdong Province in February. It is unfortunate that authorities in Taiwan didn't work proactively to gather accurate information about the epidemic or put in place any epidemic prevention measures.
Second, at daily meetings of the Taiwan SARS Advisory Committee, most of the time was spent trying to discern between "probable" and "suspected" SARS cases at an individual level so that a more far-sighted public health vision was lacking.
Third, and most importantly, although several different infectious disease surveillance systems had already been established in Taiwan, their sensitivity to newly emerging infectious diseases was low. They were completely dependent on the vigilance of doctors and personal enthusiasm for public health.
During this initial period of the epidemic, three other aspects of the response were handled well. These include, first, paying close attention to the WHO's daily SARS briefings and responding immediately beginning in mid-March. It was fortunate that the son of the first index case was an employee of the Center for Disease Control and thus close cooperation was achieved to prevent further transmission.
Second, the Department of Health subsequently established the SARS Advisory Committee for the purpose of allowing the daily number of SARS cases to be transparent and having scholars provide the most updated information on international research findings to clarify the state of the epidemic.
Finally, in this period, apart from two small clusters of SARS cases, the majority of probable cases were related to people's travel histories and manifested in a "sporadic" distribution. Rapid quarantining of patients prevented the spread of the disease.
By the middle period of the epidemic, between mid-April and mid-May, clinical symptoms of SARS were already reasonably well understood. The etiologic agent of the new coronavirus pathogen was discovered, and its molecular diagnosis became feasible. This was the best opportunity to understand the epidemic scientifically.
Unfortunately, medical personnel had a low awareness of the epidemic and their day-to-day training in preventing the spread of infectious diseases was insufficient. Therefore, the majority of cases were associated with hospitals, and outbreaks appeared in one hospital after another. In addition, public health policy at that time failed to make medical personnel feel safe and secure in a timely manner.
The media reported the status of the epidemic far more rapidly than epidemiological investigations by government officials took place, and hourly television news reports on the grieving relatives of medical personnel who died caring for SARS patients as well as the daily increasing number of cumulative cases created a public panic. This was the chaotic period of Taiwan's SARS epidemic.