After striving to contain the Omicron variant of SARS-CoV-2, Taiwan finally saw its first day of no local cases in more than two months. As a result, the government is expected to start lifting COVID-19 restrictions, but such easing must be done in stages, without repeating Hong Kong’s mistakes.
Despite a two-dose COVID-19 vaccination rate exceeding 70 percent, Hong Kong is facing its worst outbreak of the pandemic. The territory’s experience shows that having two shots only reduces the number of severe Omicron cases, but provides little protection against infection.
Many people in Taiwan regard the nation’s vaccination coverage rate as the decisive factor for lifting restrictions, but this is a dangerous view. Even with three doses of one of the most effective vaccines, Moderna, there is still a 20 to 30 percent chance of breakthrough infections. About 30 percent of the fully vaccinated people in Taiwan received AstraZeneca’s COVID-19 vaccine.
Authorities should continue promoting vaccination, but there are still many older people who are unwilling to receive even a single dose. As long as this group remains vulnerable, Taiwan could become the next Hong Kong.
Hong Kongers wear masks as much as Taiwanese do, which shows that once the pandemic spreads, masks alone are insufficient to curb the spread of the Omicron variant. Wearing masks is only effective when there are few cases, meaning that even if only sporadic new cases pop up, masks should remain mandatory. Unless there are no local Omicron cases in Taiwan for 14 consecutive days, people should wear masks in public.
Taiwanese should consider themselves lucky that wearing masks can still curb the spread of COVID-19 before a situation gets out of control.
Mandatory quarantine for arrivals has been shortened to 10 days, which should not cause concern, as the incubation period for the Omicron variant is only three days, making the quarantine period long enough to detect positive cases. Shortening mandatory quarantine to seven days would be the beginning of the real test. Fourteen days times 0.6 (the incubation period of the Delta variant of SARS-CoV-2 is five days) is 8.4 days, longer than the seven-day quarantine, which raises the possibility of COVID-19 reaching communities.
There are two ways to avoid community spread of COVID-19: testing and contact tracing.
In East and Southeast Asia, where better COVID-19 controls are in place, the pandemic curves are flatter and longer than in the US and Europe. The curves of countries such as India, the Philippines and Vietnam have already peaked and are in decline.
The reason for the high number of positive cases entering Taiwan from those countries is that polymerase chain reaction tests can come back positive more than 20 days after someone is no longer contagious, meaning that the tests only reflect a person’s COVID-19 status a month earlier.
By the time the positive rate falls to a certain threshold, the probability of COVID-19 spreading in a community might not increase even if the mandatory quarantine is shortened to seven days.
With shorter quarantines, the government should increase the speed and capacity of contact tracing, which aims to find and isolate potential COVID-19 spreaders as soon as possible.
As Taiwan’s effective reproduction number (Rt) is about one, lifting COVID-19 restrictions in one area creates a security hole. Therefore, improving other areas of epidemic prevention — such as with more effective contact tracing — would be needed to balance the Rt value.
Should shortening mandatory quarantine cause an increase in cluster infections, local governments would have to carry out contact tracing at lightning speeds — potentially covering thousands of people — to ensure COVID-19 containment.
With decreasing Omicron cases overseas and improved contact tracing in Taiwan, quarantine could be gradually reduced and replaced by intensive testing after entry until quarantine is no longer required for entry. After opening for business travelers, tourists visiting Taiwan and Taiwanese nationals visiting abroad would then be allowed.
During the process, communities must be closely monitored for signs of outbreaks, and should they occur, restrictions would have to be restored back to previous levels.
Lifting COVID-19 restrictions at this stage applies only to the Omicron variant. Should new variants emerge, everything would have to go back to square one and measures reconsidered. Epidemic prevention measures and COVID-19 restrictions might be difficult and seem harsh, but they are much better than having to face overloaded hospital mortuaries.
Shen Cheng-nan is a physician.
Translated by Lin Lee-kai
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