On Feb. 14, American physician-scientist Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases of the US National Institutes of Health, announced that the number of people infected with COVID-19 is expected to increase and the epidemic is going to continue for an extended period.
He added that the public health systems in countries around the world have to ensure that comprehensive preparations are in place to prevent community transmission of the disease.
That same day, the US Centers for Disease Control and Prevention issued its Interim Guidance for Preventing the Spread of Coronavirus Disease 2019 (COVID-19) in Homes and Residential Communities.
According to epidemiological characteristics, three categories of people are at a heightened risk of infection of SARS-CoV-2, the COVID-19 causing agent: relatives, household members and intimate partners in close contact with those infected; caregivers in a non-healthcare setting and medical professionals; and people who have been in an enclosed environment with laboratory-confirmed SARS-CoV-2-infected persons.
For this reason authorities in Taiwan now require that these three categories of people must comply with isolation or quarantine rules: They, as well as those infected and people who have been in contact with them, should be isolated.
In addition, people with a history of travel or transit in affected areas, such as China, Hong Kong and Macau, and other areas with community transmission, should be quarantined and tested for the virus, and those who have returned to Taiwan from affected areas appearing to be SARS-CoV-2-negative, must enforce “self-management of health” measures at home for 14 days, and can only return to their normal routine after receiving three negative test results, to avoid secondary transmission.
The Central Epidemic Command Center (CECC) has announced that as of March 1, local governments have to implement their carer service programs for people in home quarantine and home isolation to ensure that they receive the physical, psychological and medical care assistance they need during the 14 days.
However, should the epidemic develop into community transmission, the focus will shift from containment to mitigation.
Taiwan has a lot of large religious gatherings, such as Matsu festivals, and at this stage the efforts to retard community spread need to focus on three things: risk communication, surveillance and community drills.
First, we would recommend the establishment of community risk communication channels: Each member of a community needs to be aware of proper epidemic mitigation concepts and behaviors, such that they do not become novel coronavirus “transmitters.” This will require reinforcing communication within the community to reach a consensus on how the epidemic prevention efforts are best implemented.
At an individual level, people should record their daily movements and whom they come into contact with, and whether they might have experienced case clusters, so it would be possible to trace the source of an infection.
Fear and prejudice will break trust within society, and this will lead to flaws in the epidemic prevention efforts. It is of paramount importance to avoid witch hunts of infected people. There will need to be a centralized communications channel and designated spokespeople to make announcements within a community, as well as a consultation mechanism, to prevent rumors from spreading or the stigmatization of SARS-CoV-2-infected individuals.
Second, it is important to take an inventory of, and expand, resources and personnel in each community. There should be a delegation of tasks, with specialists, such as community pharmacists, clinic doctors, public health nurses and caregivers assisting with surveillance within the community, so that SARS-CoV-2-positive people with mild symptoms or who are asymptomatic are detected quickly.
At the same time we should also keep an eye on high-risk groups — such as elderly people or people with multiple chronic comorbidities, as well as COVID-19-like symptoms manifested by their family members and neighbors, and people they have been in contact with — and measure their level of hygiene awareness, not simply relying on passive surveillance by local clinics.
District and sub-district leaders, community workers, members of civic groups and temple volunteers should offer their services to help care for and support the community, and address shortfalls and blind spots in epidemic prevention efforts, such as ensuring that vulnerable and disadvantaged groups, illiterate people, those who do not understand Chinese and those who cannot use the Internet get timely assistance.
Third, there should be regular epidemic prevention drills in the community. There has long been a lack of cohesion between specialist resources and community workers, neither have there been organized, regular epidemic prevention drills, and the current situation presents an opportunity to establish community and household guidelines to address this. This will enable experts and community support systems to form a robust response mechanism so that the members of communities throughout the country will be more prepared to deal with the threat of the current and future infectious diseases.
In the deployment of medical and caregiver resources, once the number of COVID-19 confirmed cases in a community rises, hospitals should prioritize caring for patients with more severe symptoms. Recovering patients or those with relatively mild symptoms can be treated in solitary quarantine at government-commissioned army barracks, dormitories or other temporary shelters or detention centers. It is imperative that infected people be in one-person rooms and not allowed shared spaces to avoid cross-infection, and to stop emerging or mutated virus strains that might have greater transmissibility, higher viral replication capability or more virulence from getting into the community and exacerbating the situation.
In addition, the fatality rate among elderly people and those with multiple comorbidities is high, so the health of elderly people living in long-term care institutions of all types, and their staff and visitors, including family members, should be monitored closely to prevent transmission clusters.
It is not a question of whether community transmission will occur; it is more a matter of how soon. Government at all levels must immediately establish comprehensive community-based infectious disease prevention networks engaging in the provision of risk communication, surveillance mechanisms and epidemic prevention drills to mitigate the virus’ spread, in addition to linking regional command systems in northern, central and southern Taiwan; Kaohsiung, Pingtung County and Penghu County; and Hualien and Taitung counties. The central government should set up community epidemic prevention networks superior to those in other, more advanced, countries, and the public must be unified and vigilant until this crisis is beaten back.
King Chwan-Chuen is a professor at National Taiwan University’s Institute of Epidemiology and Preventive Medicine and a consultant for the Taiwan Promoting Public Health Association; Wang Liang-Yi is an assistant professor at National Cheng Kung University’s Department of Public Health; Chen Yi-Yeh is secretary-general of the Taiwan Promoting Public Health Association; Chan Hsiao-Yun is a project specialist of the Taiwan Promoting Public Health Association; and Yen Muh-Yong is an infectious diseases doctor in the Department of Disease Control and Prevention, Taipei City Hospital.
Translated by Paul Cooper
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