Taipei, Taiwan – After 18 months of successfully keeping COVID-19 at bay, Taiwan is now facing a surge in cases after an outbreak was discovered in mid-May.
From just 1,200 cases and a handful of deaths among the island’s population of 23 million, the number of confirmed cases had reached more than 11,000 by Tuesday and the death toll had risen to 308.
The self-ruled island was widely praised last year for its effective response to COVID-19, which included strict border controls and contact tracing. Now, as they grapple with life under lockdown for the first time, many in Taiwan are wondering what went wrong.
Six months ago, Al Jazeera interviewed Chen Chien-jen, Taiwan’s former vice president and health minister who rose to fame during the SARS (severe acute respiratory syndrome) outbreak nearly 20 years ago, about why Taiwan had been so successful in fighting COVID-19.
This week, we spoke to the epidemiologist again, over Zoom, about the island’s sudden change in fortunes.
Chen says the outbreak is partly the result of “prevention fatigue” as people let down their guard.
Hospitals that were supposed to have dedicated COVID-19 and isolation wards had begun using them for other patients and the health system was unprepared for the sudden surge in coronavirus cases, which have been traced back to a group of airline pilots, he said.
For Chen, the first two weeks of the outbreak “were a disaster”.
The interview has been edited for length and clarity.
The COVID-19 situation in Taiwan has suddenly become very serious. What do you think went wrong?
Dating back to April, we started to have this British variant B117 imported from other countries and as you know B117 is a highly infectious virus. The second important characteristic is it causes a lot of asymptomatic and mild cases.
It started from China Airlines and Novotel employees, then transmitted to New Taipei City and the Lions Clubs, and then transmitted to Yilan and it finally got to Wanhua’s adult entertainment venues, the so-called “tea houses”.
On May 15, before our Central Epidemic Command Centre (CECC) announced the Level 3 (semi-lockdown) alert, President Tsai Ing-wen called a meeting and invited me. (I said) thousands and thousands of people will be infected this time.
How do you think the current epidemic procedures are going?
In the first week of May 15, every day we had around 500 to 600 people infected and my former boss asked me: Is that good enough? I said I cannot say if that’s the peak. But fortunately for the first seven days, it’s 500-600 cases, and the second week is 400 to 500, and then 300 to 400. Now it’s 200 to 300.
That means the epidemic curve has been levelled off through the efforts of Level 3 alert.
So I think it’s a good sign, but (the numbers are) also a bad sign. The disease has become endemic, which means the virus in Taiwan has community transmission and it is very, very difficult to eradicate the virus at all now.
Last February, I had some suspicions and unfortunately, my suspicion was right that COVID-19 is mutating, and it’s becoming flu-like.
The only way Taiwan can have very good containment in this second phase of the pandemic is the increased herd immunity through a nationwide immunisation programme and urge the CECC to try to get the vaccine as soon as possible.
What do you think about Taiwan’s response to COVID-19 six months later?
I think that for the prevention of the pandemic, there are two ways to do it scientifically. The first one is the interruption of the virus transmission. That’s what we were doing in 2020 and it seemed to be very successful.
But there is prevention fatigue, people get tired of it and they somewhat loosen their awareness. So before November 2020, Taiwan played very good first half of the game, but in the second half, we ran short (because) of the vaccine.
I have to confess in the very first two weeks (of the recent outbreak) was really a disaster. Too many people got an infection and too many people rushed out to be tested and community stations were not ready at all and not even the hospitals.
Originally, we asked every hospital to have a designated ward or isolation room for COVID-19 patients, but since there were no COVID-19 cases, all the hospitals thought they didn’t need it so they filled in a lot of patients in the designated isolation rooms.
The situation is quite similar to any country with this surge of patients but fortunately, I would say, after two weeks, the community-based screenings stations were set up and then there were more and more isolation rooms available.
If COVID-19 has become more like the flu, what does that mean for Taiwan?
I would like to share first how we combatted influenza going back to the 2009 H1N1 pandemic.
We did three things: one is very good contact tracing and also home quarantining of infected people. For infected people, when they had very severe symptoms they got a rapid test and immediately and they would get antiviral, the so-called Tamiflu. They didn’t have to do any kind of home quarantine as their viral load went down and they recovered.
At that time, we developed Taiwan’s first domestic flu vaccine and then we used the international and domestic one to immunise people. If COVID-19 is going to become more and more flu-like, in the future, we need a very good and very sensitive specific rapid diagnosis test and a so-called antiviral for really infected people like influenza.
Taiwan is struggling now to get enough vaccines. Why?
As you know, we have an ordered 20 million doses of the vaccine: from COVAX around five million, Moderna five million and AstraZeneca 10 million. The (domestic vaccines) Medigen, as well as United Biomedical, are in phase 2 clinical trials. If their safety and efficacy are good, they might get emergency-use authorisation.
But as you know, although we already have the purchase order with COVAX, the delivery is somewhat delayed and somewhat inadequate. At least we got the 1.25 million (AstraZeneca) donation from Japan and 0.75 million doses of Moderna from the United States. We hope that in June we can vaccinate three million people, and if it goes smoothly with the international vaccine and domestic efforts, we hope in July there will be another six million vaccines available, and in August another six million available.
By the end of August, I hope we may immunise at least 15 million people in Taiwan with (at least) one dose and at that point the epidemic might be contained much better. With some hope and if that’s the case then we are going to return to a new normal life.
What will solve the current crisis?
The only thing we can do is immunisation. We try to get everybody to have resistance to it, and more importantly, the immunisation has to be implemented as soon as possible and on as large a scale as possible. This isn’t only for Taiwan, this is for the rest of the world.
There is a kind of competition in time with virus. If (the) coronavirus is going to keep mutating like influenza virus, then someday, somehow there will be a new variant which the current vaccine cannot prevent in humans at all.
What do you think of the theory COVID-19 may have been leaked from a lab?
According to recent report, there is a piece of the human genome in the COVID-19 virus, and it is really weird. It seems to be genetically modified or inserted by some of the labs and that’s the reason why US President Joe Biden has asked their experts to try to look into it.
Another reason people have their suspicions is when the WHO delegation went to the Wuhan lab, they didn’t get very much information from their visit at all. If there really are human genes in the virus, then we have to figure out how it could be integrated into the virus gene. This is very strong evidence to indicate that in some lab some (researchers) did a laboratory experiment.