Epidemic in Taiwan: The number of confirmed cases remains high, experts say quick fixes and prolonged epidemics have their own advantages and disadvantages and need to be fully prepared – BBC News 中文

Professor Lu Chunqi, dean of the School of Public Health at the University of California, Berkeley, analyzed that since 2022, about half of Taiwan’s new crown deaths have come from patients who have not been vaccinated against Covid-19. Therefore, “the sooner Taiwan achieves universal vaccination, especially the fastest Vaccinations and boosters for vulnerable people, the fewer hospitalisations and deaths,” he told the BBC.

According to the data from the Ministry of Health and Welfare of Taiwan as of the end of April this year, the proportion of people with mild disease in Taiwan currently accounts for about 99.75%.

Chen Shizhong, commander of Taiwan’s Central Epidemic Command Center (CDC), estimated that the peak time of confirmed cases may occur on May 20 after the Poo Mikron variant of the virus entered the entire Taiwanese community. Some analysts also said that the current epidemic variables are still there, so it is difficult to predict the peak time.

In the face of the surge in the number of confirmed cases of the new crown in Taiwan, Taiwan’s current approach is not like Shanghai’s strict closure of the city, nor is it like Hong Kong’s ban on indoor dining at night, closing gyms, bars and other public places.

At present, Taiwanese people go out as usual, but many elementary schools and kindergartens have announced the suspension of classes.

However, the surge in the number of confirmed cases has also created scenes of chaos, especially in the emergency rooms of major hospitals in northern Taiwan.

According to Taiwan media reports, most of the people who crowded the emergency rooms of large hospitals are not severe or even have no symptoms, but they flock to the emergency room because of anxiety. The reason is that Taiwan still needs to be confirmed by PCR testing before it can be officially regarded as a confirmed diagnosis. This also caused a large number of people to flock to the hospital for PCR testing. Among them are many people who have purchased new crown medical insurance, because they need to have a PCR test to confirm the diagnosis before they can claim.

The chaotic emergency rooms and hospitals are full, crowding out other emergency patients who really need to seek treatment, and medical staff are overwhelmed and fall ill. In addition, there are still cases where Taiwan’s rapid screening reagents are still unavailable, resulting in widespread public grievances.

Accordingly, Taipei Mayor Ko Wenzhe apologized for deleting the NT$2.8 billion budget for rapid screening reagents last year. The Taiwanese government has also urgently cooperated with hundreds of community hospitals or clinics across Taiwan to allow people to go for PCR tests.

In her 30s, Miss Koo (a pseudonym upon request), who has worked in Taipei for many years, told BBC Chinese that she had mild symptoms after being diagnosed by quick screening at the end of April, but was “tired” by the complicated and contradictory procedures. She said that because she was diagnosed first after traveling with her counterpart, after she was informed, she was diagnosed after quick screening because of mild symptoms. She originally wanted to isolate herself at home, but at that time, the Taiwan government stipulated that she must also go to the PCR line for testing.

She criticized that this is not to let people who go to PCR tests “go out and spread the virus”. Miss Koo’s doubts are one of the most important debates in Taiwan facing the Omikron epidemic.

Taipei Mayor Ko Wenzhe criticized the central government for asking people to pass a PCR test to be diagnosed, which is unwise and a waste of medical resources.

Chen Jianren, former vice president of Taiwan and current academician of the Taichung Academy of Sciences, explained that any screening test has its sensitivity, specificity, false positive rate and false negative rate. According to epidemiological studies, “the prevalence of the disease determines the positive predictive value.”

Chen Jianren, who is also an epidemiologist himself, said that according to years of research and statistics in various countries, the so-called “positive predictive value” will vary significantly with the prevalence of the epidemic. For example, when the prevalence rate is 50%, it can be as high as 95%; At a prevalence of 10%, the positive predictive value was 68%. “At a prevalence of 1%, the positive predictive value is only 16%, in other words, only one of the six people who screen positive is actually sick.”

Therefore, Chen Jianren believes that if home quarantine is opened, the prevalence of home quarantine objects is higher than that of the general population, so quick screening positives can be used to replace PCR diagnosis, but it is not suitable for other groups with lower prevalence rates. He called for the use of rapid screening for diagnosis in ethnic groups, regions and time periods with high prevalence rates.

Faced with the rapidly rising number of confirmed and critically ill patients, Taiwanese President Tsai Ing-wen said last Friday (May 6) that Taiwan is expected to obtain about 100 million doses of rapid screening reagents, and “the supply will become more and more stable.” She also asked local governments across Taiwan to set up community screening stations, expand PCR testing power to local areas, and plan to cooperate with grassroots clinics. The Taiwanese government also announced last week that if people are positive after rapid screening tests and confirmed by medical units, they can be regarded as confirmed cases. The new regulations will be implemented from May 12.

Tsai Ing-wen called for the cooperation between the local government and the central government to show that Taiwan’s epidemic prevention model is changing in the fight against the mutant virus.

Wang Zhihong stressed that what Taiwan should do now is to fight guerrilla warfare. He told the BBC that after Omicron has spread in the Taiwanese community, epidemic prevention is no longer under the unified control of the Taiwanese central government in the past. He believes that, based on the experience of epidemic prevention in the United States, to simulate the disease and resources, the Taiwan command center needs feedback from hospitals in various places. The process is that the hospital goes to the local government, and the local government reports to the command center, but there is often a gap in numbers or time, and sometimes it is slower. In addition, there are also issues such as how local and central governments define “lack or sufficiency” of medical resources, all of which are challenges brought by Omicron.

Wang Zhihong said that with the arrival of local elections at the end of the year in Taiwan, the outbreak of the epidemic is indeed a test of whether the local government and the central government can truly cooperate and become a decentralized partnership. The central government provides transparent and clear guidance, and the local government does cooperate. Implementation, such as how to dispense rapid screening reagents, etc.

But in fact, the local and central governments are out of sync in epidemic prevention, and the public is also very aware of it.

Ms. Gu gave an example. After the quick screening showed a positive result, she went to the PCR test site and filled in her personal residence information. Instead, the system notified the health unit of the place where she had left for 20 years to contact her. Two days later, the Taipei City Health Bureau, where she had lived for many years, contacted her.

After that, another central epidemic prevention unit called a “care phone” to ask about her symptoms. Miss Gu told the BBC: “I am a mild case, and I need so many different units to call, and the unit in charge of isolation has not contacted me yet… A simple job that requires 4 people to do, and they have not notified each other… …Actually, if you don’t see the whole system process clearly, everyone will think that the grass-roots civil servants are inefficient and innocent.”

Miss Koo believes that medical manpower is wasted in these complicated and even impractical systems.

In Taitung, which has the lowest vaccination rate in Taiwan, Julie, a citizen, also told BBC Chinese that she believed that the epidemic in Taitung was not transparent at the beginning, “they don’t announce how many people have been diagnosed within themselves. The chief was diagnosed with the diagnosis and a member of the congress was diagnosed, and then there was no post. It seems that these cases were mixed in the case of another township, so we didn’t know that Taitung City was so serious, we thought it was another township (Chenggong Town) .”

However, both Ms. Gu and Julie said that they were not as worried about this wave of epidemic as they were when the Delta epidemic hit last year. The only thing they worried about was the health and safety of the elderly or children. Taiwan’s Minister of Health and Welfare Chen Shizhong announced on May 5 that the Pfizer Children’s Vaccine is expected to arrive in Taiwan on May 12. The first batch of 777,600 doses will be available on the 20th at the earliest.

Wang Zhihong analyzed to the BBC that in the face of Omikron, Taiwan’s first method is to make the number of confirmed cases rise rapidly, and then it will decline rapidly. It will come down, but this will cause many people to die, because medical resources cannot keep up, especially the elderly or patients with chronic diseases will be in critical condition, and the number of beds or medicines in the hospital may not be enough.

The second method is to flatten or lengthen the diagnosis curve. But that would delay the outbreak longer, but also give hospitals time to prepare beds, ventilators or medicines. But to flatten the curve, mitigation strategies are needed, including requiring people to reduce activities, possibly increasing the number of working days from home, avoiding crowds, considering MRT or mass transit restrictions, and paying attention to indoor dining.

Wang Zhihong suggested that Taiwan needs to quickly simulate what it needs now: “Singapore has made a model very early, so the simulation is very successful. When they started to divert, they almost prepared the medical resources they needed. Hong Kong wants to get rid of it. The zero route, the result can’t be cleared, there is no way to clear it at all. Taiwan needs to take some time to think about what it can do now to reduce the mortality rate,” he told the BBC.

Taiwan’s Vaccine Policy Advisory Committee member and the attending physician of the Pediatric Infectious Diseases Department of National Taiwan University Hospital, Li Bingying, analyzed in the Taiwanese media “Treasure Island Network”. Referring to the development of the epidemic situation in various countries, the peak number of confirmed diagnoses has ranged from appearance to decline for about 3 to 5 months, and Taiwan has not yet arrived. The number of confirmed cases peaked. He called on Taiwan’s medical institutions to take precautions. Li Bingying also said that referring to the experience of the H1N1 flu, three years after the first pandemic, the peak period of infection still appeared, but the peak wave weakened each time. Weakening: “As most people become immune, the number of infected people will gradually decrease, but as long as there is an epidemic, it will still cause a considerable number of severe cases and deaths.”

Professor Lu Chunqi of the University of California, Berkeley analyzed that, according to data from the Taiwan Command Center, as of May 4, less than half (43.7%) of Taiwan’s Covid-19 beds were in use, and most of the confirmed patients were asymptomatic or mildly ill. Currently home care. He observes that Taiwan’s hospitals are taking a sensible tiered care approach to maintain hospital bed capacity: “As long as the Taiwanese people and government don’t panic and continue to take a scientific approach to the COVID-19 outbreak, which is expected to peak in the next 2-3 weeks, I think Taiwan will There is no need to lock down the city,” he told the BBC.