Taiwan’s 24th COVID-19 case, confirmed on Wednesday last week, is a woman who has not traveled overseas in the past two years. The 19th confirmed case was a taxi driver who had also not been overseas recently and was possibly infected by a Taiwanese businessman returned from China riding in his car.
Whether the source of infection for the 24th case was from overseas has yet to be determined by the Centers for Disease Control. On Friday last week, the 25th and 26th cases were confirmed — the granddaughter and daughter of the woman.
These cases mean that Taiwan has to be prepared for the eventuality that from this point on, the spread of the coronavirus might be happening within the nation itself: Taiwanese might already be facing community infection.
There are two conditions for determining whether infections are not coming from overseas and constitute community spread.
The first is the inability to trace the source of an infection and that it cannot be linked to a case from overseas.
The second is that the number of cases whose source cannot be traced gradually increase, to the extent that they exceed the number of cases from overseas.
The emergence of community spread within Taiwan will necessitate changes in how the government responds. In addition to preventing infected people from entering the nation, authorities would have to shift their focus to crisis management.
That means reducing the effects of, and damage caused by, community infections to the medical system, the economy and the general public as a whole.
The most important method to contain the crisis at that point is medical triage: the prioritization of treatment based on a person’s condition. The main reason for this is that COVID-19 differs from SARS and Middle East respiratory syndrome in that it is more virulent, but less deadly, so that a considerably high proportion of infected people show only minor symptoms. Therefore, triage is the best way to deal with community spread of this coronavirus strain.
If community spread does occur, in addition to the preventive measures, the government could also consider setting up anti-epidemic clinics. Anyone, even if they have no apparent travel history or contact with an infected person, could go to one of these special clinics if they develop a fever or breathing difficulties. The doctors at the clinics would formulate their treatment strategy based on each patient’s symptoms, and advise them to stay home from work or school for five days to a week.
This kind of patient, with only minor symptoms, would not strictly need to be tested for COVID-19 infection: testing every single person with even the slightest symptoms would place an undue burden on medical resources.
Hospital outpatient clinics, emergency rooms and admissions should be reserved only for the provision of medical treatment to higher-risk cases or for more serious cases of infection, including quarantine and tests.
The triage approach is the best way to ensure Taiwan avoids hospital-related infections.
The coronavirus crisis in Taiwan is at a turning point. The public must be on high alert and be prepared for the eventuality of community spread if the damage from the virus is to be contained. With appropriate triage, hopefully after a certain period of time community immunity would be achieved, and the number of new cases will decrease.
Chiu Cheng-hsun is a professor of pediatric infectious diseases at Linkou Chang Gung Memorial Hospital.
Translated by Paul Cooper
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