The controversy over the unfortunate, but avoidable incident at Taiwan Taoyuan International Airport involving Hong Kong actor Wong He (王喜), an inbound passenger from the UK who had a nosebleed during a nasal swab for a COVID-19 test, highlighted many aspects of pandemic management.
Undoubtedly, mandatory tests at the airport prescribed by the Central Epidemic Command Center should be followed, but no medical process should involve a level of force such that the person bleeds. The gentle sample-taking procedure does not warrant shoving a long stick deep inside the nasal passageway in an intimidating, unprofessional way.
The health worker was certainly at fault, but this is not to blame them, given the tremendous pressure frontline health workers are under and the tight timeline for the entire process of taking a sample, sending it to the lab and obtaining the result in an hour before the passengers can be allowed to proceed further.
However, Wong’s shock and his celebrity status could mean negative domestic and international publicity, denting Taiwan’s image. The incident might not be unique to Taiwan, as transit passengers across the world have more or less the same bitter experience when it comes to COVID-19 mandatory testing at airports. However, it could deter foreign travelers from coming to Taiwan, and such incidents are certainly avoidable.
A dissection of this unfortunate incident is not the aim here, but in light of it, I wish to bring in a new perspective in COVID-19 pandemic management, given the experience of other countries, specifically the Indian state of Maharashtra, with a population of 110 million. I am from Mumbai, and have direct exposure to and experience in pandemic management in Maharashtra, and only recently moved to Taipei on a research fellowship. Mumbai, with a population of 20.21 million, was at the epicenter of the first and second waves of the COVID-19 pandemic in India. The city can be compared with the population of Taiwan, which is 23 million, just 25 percent of the population of Maharashtra.
The success story of the Dharavi slum in Mumbai, which has been applauded by the WHO and the UN, is worth referring to here. Dharavi, Asia’s largest slum, with a population density of more than 277,136 per square kilometer, is spread over just 2.1km2. When the first case of COVID-19 was reported on April 1, 2020, the entire nation felt that the epidemic would spread like wildfire, but a multipronged approach involving the whole state, local agencies and local communities, with a single-minded focus on the four Ts (trace, track, test and treat) helped in achieving the unimaginable success of total control with minimal loss of lives and controlled positive cases. Dharavi, once a coronavirus hotspot with 8,233 cases in the first wave, is, as of March 25, free of COVID-19. Mumbai recently achieved a 100 percent vaccination rate among targeted age groups.
As of April 2, Maharashtra is free of disease prevention regulations and wearing masks is optional. Domestic and international travelers are allowed in and out of the state, even without mandatory polymerase chain reaction tests and quarantine, although a double vaccination certificate is required. The risk of an unknown virus looms large, with a daily average reported case load of 128 and active cases of 870.
However, over the past three or four months, the data establish a clear trend of declining positivity and death rate across the age groups in new COVID-19 cases. The positive part of evolving data patterns encouraged state authorities to withdraw all restrictions on entry, movement, testing, quarantine, gatherings and functions. As a result, near normalcy has been established in the state, which is reflected in Mumbai airport’s passenger handling, like in pre-COVID-19 times, reaching 90,000 daily. As a precaution, appropriate behavior involving social distancing, wearing masks, using sanitizers and washing hands in general is encouraged and promoted by local health authorities.
Taiwan’s cautious approach to the pandemic has been vindicated in fewer COVID-19 deaths and infections in the two years since the WHO declared a pandemic. The fresh wave of infections in Taiwan, with daily cases increasing in the past couple of weeks, is a matter of concern, but seems to be under control, although specific reasons for cluster infection might be critically explored to further contain it. Still, the data on new cases, critical cases out of newly reported cases and COVID-19 deaths is comforting.
Since October last year, there have only been seven COVID-19 deaths; this year, only five moderate or severe cases have been reported. Almost all reported new cases are Omicron variants of SARS-CoV-2. Research and experience have established that Omicron variants BA.1, BA.2, BA.1.1 and XE or any other recombinant variety of Omicron is not life-threatening, although they are highly transmissible. The WHO has said that vaccines are exceptionally good at preventing serious disease and death, although less effective at preventing infection and transmission of Omicron.
Like other countries, COVID-19 precautions and strict border controls once had a place. Now, new infections are under control, and Omicron variants have been researched and studied, with the WHO comparing it to the flu. The US, the UK, India and many other countries have recognized the need for transition from pandemic to endemic. Accordingly, despite the infection load, they have withdrawn pandemic restrictions and declared living with COVID-19 to be the new normal. Countries that have put vaccination at the center of their fight have already reached pre-pandemic normalcy.
Globally, despite the existing infection load, countries have opened up to foreign travelers with no restrictions like quarantine (home, institutional), testing and reporting. The Taiwanese population is well vaccinated, thereby bolstering general public confidence in the government’s disease management.
At present, Taiwan is carefully placed on three grounds. First is the high vaccine coverage of targeted groups, with continuous increases in the vaccination outreach program that covers most population groups, especially booster shots to the vulnerable elderly and young people, using innovative ways to achieve maximum vaccine coverage.
Second, critical cases are few and the number of COVID-19 deaths has stabilized at one or two a month from September last year.
Finally, an excellent health infrastructure has been set up to meet any future exigencies, along with an impressive digital monitoring system of the disease. Taiwan is comfortably placed in critical COVID-19 parameters like infection rate and its criticality, and the death and vaccination rate compared with many countries that have already opened up, including India and Maharashtra. However, it is no longer clear what Taiwan is waiting for. Is it not time to quickly recalibrate strategy and declare normalcy?
Adopting the idea of “living with the virus” or the “New Taiwanese Model” promoted by Premier Su Tseng-chang (蘇貞昌) could include three pillars in a new revised strategy. First, vaccinations; second, the four Ts; and third, gearing up existing public health infrastructure and additional capacity to cater to unforeseen future demand for medical attention.
The suggested new model of calibrated opening up might take care of the potential risk to vulnerable groups, as the carefully planned response system would concurrently address the challenges arising out of the implementation of the new model. The government should allow international travelers to enter the country as per normal, as in pre-pandemic times. Placing too many COVID-19 restrictions on visitors limits travelers’ access to Taiwan’s people, culture and cuisine, denying them an enriching experience, which is unfortunate because as tourists and visitors they are the ambassadors of goodwill for Taiwan.
Rajagopal Devara is a Taiwan research fellow at National Chengchi University, and has served in different policy level positions in Maharashtra, India, with experience in COVID-19 management.
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