I was about to celebrate my freedom after a mandatory 14-day home quarantine imposed by the Central Epidemic Command Center (CECC) on anyone arriving in Taiwan from abroad when I received a text message from the government: “COVID-19 has an incubation period of up to 22 days. Please continue to do self-health management for 7 days.”
While I am no longer confined at home, I must “wear a mask at any time, and avoid visiting crowded places.”
In other words, I was still potentially contagious so I needed to protect those I came into contact with.
I did a lot of thinking during my quarantine, but the “self-health management” during the third week after my arrival in Taipei got me thinking even harder. I was trying to work out the logic.
Because many people infected with COVID-19 are asymptomatic, but can still infect others, anyone is a potential “super-spreader.” Therefore, ensuring that no contagious person is introduced into a country without any local cases since April 12 (almost seven weeks ago) makes sense.
Yet what is the evidence that this “14 plus seven” isolation policy is the only way to go and is it worth the price of its implementation?
The CECC is the most transparent team tasked with keeping COVID-19 under control in a nation of 23.8 million living in densely populated cities. The CECC has made Taiwan the most successful nation in handling the COVID-19 pandemic.
Since reporting its first case on Jan. 21, Taiwan has performed almost 73,000 tests on people with symptoms and contacts of infected individuals. So far, Taiwan has only had 443 cases, with seven deaths.
They accomplished this without a Wuhan-style lockdown, school closure (except for a two-week delay in opening schools after the Lunar New Year holiday), or in-restaurant eating ban.
This compares favorably with New Zealand, held up as a great success with a goal of “eliminating the COVID-19 from the country,” where 1,504 cases with 22 deaths were found in a sparsely populated country of less than 5 million.
Except that more people are wearing face masks, Taiwanese daily life is no different from that of Sweden, but with vastly better results.
Taiwan’s main tools in keeping COVID-19 out are: a travel ban on non-residents, testing of symptomatic individuals and close contacts of positive cases, and quarantining contacts of infected individuals and anyone arriving from abroad.
The CECC keeps track of and publishes the case histories of all positive cases, with updates until they are resolved.
During my quarantine, I examined the last 101 cases (tested positive on or after April 3) and found something interesting.
One-third (36) are crew members of the navy ship Panshih (磐石) that toured Palau in March. Upon returning to Taiwan on April 9, the crew were given shore leave on April 14 and 15, less than a week after arrival, rather than the 14-day quarantine imposed on others arriving from abroad.
A few crew members got sick after returning to Taiwan and tested positive for COVID-19, leading to the testing and quarantine of all 744 members of the three-ship flotilla on the same mission.
Of the 36 who tested positive, 13 were asymptomatic, 13 were symptomatic prior to disembarking on April 14 and the remaining 10 became symptomatic during quarantine.
None of the people they came into contact with in Palau or in Taiwan got sick or tested positive. In other words, they were out and about — but mostly wearing face masks — without infecting the public.
Of the 65 non-navy COVID-19 cases I examined, eight were asymptomatic, but were selected for testing due to close contact with infected individuals; seven were sick after flying on a China Airlines flight from New York City on March 30 with 336 people on board (including five others who tested positive earlier, a total of 12 passengers got sick on this flight); four were sick after traveling on the cruise ship Coral Princess; and six were local cases who got sick from being in close contact with those infected while abroad.
Of the remaining 40 non-navy cases, 20 had symptoms prior to arrival in Taiwan and were tested based on their history, and 20 developed symptoms during quarantine.
The remarkable result of Taiwan’s policy is that there has been no virus circulating in Taiwan for the past seven weeks, period.
Taiwan’s authorities have therefore scheduled to remove most of the remaining restrictions inside the country as of Sunday, including large gatherings and food tasting at supermarkets and night markets.
However, strict border controls are to remain in place indefinitely.
Here is where my thinking and staring at the data during quarantine led me to a different place.
Banning foreign visitors and imposing a 14-day quarantine plus seven additional days of “self-health management” for people arriving from abroad will keep the virus from getting into the community, but the cost is enormous, even for a nation that has not imposed a lockdown.
Based on the latest available statistics, the number of passengers arriving at Taiwan Taoyuan International Airport fell from 2.1 million in December last year to 20,000 in April — a 99 percent drop — while tourist hotel occupancy fell from 70 percent in December to 18 percent in March.
Airlines, hotels, tour operators, convention venues and businesses catering to tourists have been and will continue to be devastated.
If I am still considered contagious after my initial 14-day quarantine, but all I have to do now is to don a mask and conduct business as usual, why have home isolation in the first place?
With only 14 people testing positive — eight of whom were asymptomatic — among the thousands of people who were in close contact with people arriving from abroad over the past two months, and no one testing positive among the contacts of the 36 infected Panshih crew, is home quarantine really necessary?
My conclusion is that the authorities have forgotten the original goal of social distancing — to “flatten the curve” and prevent overwhelming the medical system.
By focusing on the “cases” and zero as the only acceptable number, the scope of the problem is exaggerated, the population is unnecessarily frightened and the economy is wrecked.
From my vantage point, strict border control is unsustainable.
Aggressive contact tracing and making potentially contagious people wear masks, but not isolating them, to protect others will likely do just as well.
That the authorities let me out after two weeks with a face mask means that they believe this is effective in keeping the community safe.
I am happy to protect others from my spit if I am considered a potential (asymptomatic) COVID-19 carrier, but home isolation for two weeks is too harsh and unnecessary for all those arriving from abroad, because current CECC statistics show that more than 99.5 percent are not contagious.
By staying true to the original expert advice of “flattening the curve” and establishing sustainable social distancing guidelines such as mask wearing, the world can get through the pandemic without keeping children out of school or blocking travel for business or leisure longer than necessary.
With any luck, the highly respected CECC will amend its border control policy and I will not be confined to my home at all next time I fly into Taipei.
Pui-Yan Kwok, a physician who also holds a doctorate in chemistry, is the Henry Bachrach Distinguished Professor at the University of California, San Francisco, and director of the Institute of Biomedical Sciences at Academia Sinica. He conducts research in human genetics. He completed his quarantine and self-health management on Friday.
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