The number of confirmed cases of COVID-19 in Taiwan has dipped below 10 daily, but the nation must not let down its guard, Vice President Chen Chien-jen (陳建仁), a geneticist and epidemiologist who led the nation in its battle against the 2003 SARS outbreak, said in an interview with the Liberty Times (sister newspaper of the Taipei Times), adding that healthcare experts might have to wait until the end of next month before drawing a definite conclusion about the development of the pandemic.
LT: In a Facebook post on March 23, you estimated that it might take at least another two months before the COVID-19 pandemic slows down. Could you elaborate?
Chen: It is a tough task to predict when the pandemic might wind down. It depends on each nation’s efforts to contain the virus. Even though the vast majority of Taiwan’s more than 300 confirmed cases are imported, if the world continues to burn, Taiwan will get burned, whether it likes it or not.
Photo: Tu Chien-jung, Taipei Times
It is apparent that the US and Europe have underestimated the transmission rate, and the outlook for those countries is gloomy.
They likely need to at least place some cities in lockdown, as Wuhan did. People need to practice social distancing as much as they can.
A number of nations have said that they will lock down their cities for three to four weeks. As I see it, that will probably not be enough.
It took Wuhan two months before its lockdown was lifted. It claimed to have achieved this solely by practicing social distancing, putting people in home quarantine and avoiding assemblies, without any medication or effective protective measures, but the international community has cast doubt on the actual number of confirmed cases in China.
With the number of cases increasing worldwide, South Korea has made it through the peak of an outbreak. It spared no effort in combating the virus and conducted mass screenings.
Yet even with that, it took South Korea two months before the spread slowed, so Taiwan and the rest of the world need to keep their guard up for a little while longer.
LT: Are you concerned about China lifting the lockdown on Wuhan and allowing workers to return to the workplace?
Chen: The world cannot fully understand the severity of the outbreak in China without Chinese authorities thoroughly investigating how many people have contracted the virus. Some asymptomatic cases and those with mild symptoms could have recovered without ever being tested for the virus.
As there is no information on the size of the population that was sampled, all other nations should beware of the lockdown on Wuhan having been lifted.
China should have done two things before lifting the lockdown on Wuhan. First, it should have tested people displaying mild symptoms for the virus and, second, it should have tested for the virus across all demographics to ascertain how many people were carriers.
Asymptomatic people and those who have recovered can be tested for antibodies to see how many of them have recuperated and how many carriers appear healthy.
China must ascertain whether asymptomatic carriers can infect others. Otherwise, asymptomatic carriers and carriers with mild symptoms could trigger a second outbreak in Wuhan, which would put the entire world in grave danger.
LT: Is it suspicious that the numbers of confirmed cases in the US and Europe are soaring, while the number in China has flattened?
Chen: Many experts and specialists have likely expressed the same doubt over the accuracy of numbers published by China. Chinese authorities have sparked many doubts by repeatedly changing the rules on when a suspected case should be reported.
Not only did China fall short of effectively containing the virus, but the WHO has been criticized by many for its slow response. Declaring the pandemic a public health emergency of international concern (PHEIC) on Jan. 31 was way too late.
Wuhan has a population of 66 million and has a major Chinese airport. Over the Lunar New Year holiday, Wuhan alone had 41 air routes to 47 countries operating daily, hence the possibility that the virus would spread.
Some had warned against these potential dangers. An academic at the Johns Hopkins Institute had predicted the spread of the virus via international air routes.
The WHO is responsible for issuing a PHEIC and should have heeded such warnings, but it waited until Jan. 31 to raise the alarm. This is partly the reason for the US and Europe’s initial negligence regarding the disease, which aggravated the pandemic.
LT: The WHO’s response to the pandemic has been criticized as putting politics ahead of the disease and you have also accused the organization of doing too little, too late. Amid calls for WHO Director-General Tedros Adhanom Ghebreyesus to step down and for the organization to reform, what are your thoughts on how reforms could be implemented at the WHO?
Chen: First, I must defend the WHO. The WHO is one of the organizations that we vigorously pushed for the UN to establish in the post-World War II era, along with Japan and the US.
During the SARS epidemic, it sent people to Taiwan despite opposition from some countries, and allowed then-Centers for Disease Control Director Su Yi-jen (蘇益仁) to attended a meeting. The WHO has done good work in the past, a fact that we should cherish and defend.
The WHO should return to being an organization led by medical professionals and not by politics, as disease and sickness are often transnational affairs that respect neither political parties nor political machinations.
Reforms should start with the director-general and from there, medical professionals should begin to be appointed to the organization’s members. I hope that nations worldwide consider expertise first and politics second when nominating individuals to the organization.
LT: Could international collaboration expedite the projected schedule for testing kits, medication and vaccines currently set at three months, six months and a year-and-a-half respectively? If so, what kind of collaborations can we expect to be promoted?
Chen: Both of Taiwan’s principal vaccine labs are working to develop vaccines for SARS-CoV-2. As vaccines have to undergo three separate phases, even with animal clinical trials, they take longer to develop. Because vaccines are ultimately delivered and injected into humans, it is best to be safe.
At present, testing kits approved by the US mostly look at the level of antibodies, not the virus.
Based on the development of testing kits at Academia Sinica and the National Health Research Institute, an expedited review process, and kits with a sensitivity rate of 80 percent, or even 70 percent, being allowed to pass review, it is entirely plausible that rapid testing kits could appear on the market within three months.
There are many medications that claim to be effective against SARS-CoV-2, but most of the clinical trials for these drugs were too hastily organized, lowering their credibility.
Clinical trials require a sufficient number of patients, a fact that Taiwan is overcoming by participating in clinical drug trials in the US and other countries.
The nation’s public health has always been great and we demonstrated this by exterminating malaria in Taiwan, and introducing better hygiene and sanitation for women and the young.
Since the SARS epidemic, Taiwan has suggested, through its participation in APEC, that a multilateral health unit be established. We could work on selling this idea more.
Second, Taiwan is a part of the Global Cooperation and Training Framework, together with the US and Japan, and about 25 to 30 countries have visited Taiwan for seminars and lab work. This platform is also one through which Taiwan could make significant contributions to the global health sector.
LT: SARS-CoV-2 experts are saying that could end up being seasonal, like influenza. With your imminent return to academia after you step down from the position of vice president on May 20, what suggestions can you offer President Tsai Ing-wen’s (蔡英文) administration in its second term?
Chen: The government has many important tasks ahead of it. Should the outbreak worsen in Taiwan, resulting in local cluster infections, or if it becomes like the flu, Taiwan needs the tools to deal with it.
First among these are rapid testing kits. At present, all people undergo mandatory 14-day home isolation upon passing through customs, and should they exhibit symptoms, they are diagnosed at medical centers — defined by the Ministry of Health and Welfare as medical institutions, on a grade above regional hospitals.
Should COVID-19 become like the flu, patients would not need to visit medical centers, but would visit local clinics, like they do for the flu.
If the pandemic goes the way of the flu, baseline medical personnel must have the ability to rapidly diagnose and cure their patients. Therefore, it is imperative that clinics have testing kits and medication available.
Translated by Sean Lin and Jake Chung
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