October 13, 2020
9:00 – 10:00 UTC+8
The COVID-19 is affecting 213 countries/territories and infecting 25,655,400 cases globally as of September 1, 2020. Taiwan is a crowded country and close proximity to China, the epicenter of COVID-19. Nevertheless, it is one of the few countries with the lowest number of cases (20 per million population) and 396 of 488 cases (81%) were imported from abroad. Given the continual spread of COVID-19 around the world, understanding the actions that were implemented in Taiwan and assessing the effectiveness of these actions in preventing a large-scale epidemic may be instructive for other countries. Besides, healthcare personnel are at the front line of care and are exposed to occupational hazards that place them at risk of infection. The US CDC reported on August 31, 2020 that more than 149,195 healthcare personnel had been infected with COVID-19 with 670 deaths. In this 45-min talk, I will explain Taiwan’s national policy and how we implement in daily practice at hospital level. The goal was to contain community transmission and achieve zero tolerance for COVID-19 infections in healthcare personnel and no outbreak in the hospital. COVID-19 occurred just before the Lunar New Year. Taiwan quickly mobilized and instituted specific approaches for case identification, containment, and resource allocation. Guidance or policy were announced and adjusted timely. Border control to prevent importation include health alert/restriction/ban and entry restriction. Community surveillance and epidemiological investigation, hand hygiene, universal masking or social distance, risk-based home isolation/quarantine/health self-management, policies toward schools or mass gathering aimed to contain community transmission. The government addressed the issue of disease stigma and compassion for those affected by providing food, frequent health checks, and encouragement for those under quarantine. Case definition, SARS CoV-2 RNA PCR targeting testing and enhanced screening program, contact tracing, patient divergence and transfer, isolation of the sick and quarantine of those at risk aimed to protect healthcare settings. The government also took an active role in resource allocation, including surge capacity of mask production and rationing its distribution. Information technology was integrated for risk assessment and containment. For more stringent control and avoid intentional deny important epidemiologic history, the personnel information for oversea travel and contact of confirmed cases are integrated with the National Health Insurance database. From hospital perspective we initiated or upgrade infection prevention and control measures early and timely risk-adjusted, integrated national and institutional policy/practice which includes control at the source, control along the path, control at the person level, etc. In addition, we used a hospital-wide web-based health surveillance integrated with a risk-based management algorithm and molecular testing of asymptomatic healthcare personnel. In conclusion, Taiwan effectively delayed and contained community transmission by leveraging experience from 2003 SARS epidemic, prevalent public awareness, a robust public health network, support from healthcare industries, cross-departmental collaborations and advanced information technology capacity. However, the challenge remains in the context of COVID-19 moving in a borderless world. We must act and act together locally and globally.