The US Centers for Disease Control and Prevention (CDC) has published some results that showed how rare COVID-19 infections are in people who are fully vaccinated with a vaccine approved by the US Food and Drug Administration. As of Tuesday last week, a total of 7,157 breakthrough infections had been reported to the CDC, out of more than 87 million fully vaccinated individuals. This equates to a prevalence of less than 0.00008 breakthrough infections per person, or 0.008 percent.
While these numbers are subject to underreporting, they nevertheless provide convincing evidence that vaccines are not only effective at reducing symptomatic COVID-19 infection, hospitalization and mortality, but they are also effective at reducing transmission among the vaccinated population. US National Institute of Allergy and Infectious Diseases Director Anthony Fauci said in a radio interview that such breakthrough infections are “incredibly rare.” Without infection, it is impossible for the virus to be passed on.
There is mounting evidence that vaccination cuts transmissibility by suppressing viral load and preventing viral shedding. In Israel, a study was conducted to measure the difference in viral load via polymerase chain reaction (PCR) tests between unvaccinated and vaccinated individuals. The study found that while there is no difference between the viral load of SARS-CoV-2 positive unvaccinated individuals and vaccinated individuals prior to 12 days after the first dose of the Pfizer vaccine, the viral load for vaccinated individuals more than 12 days after the first dose was significantly reduced by more than a factor of 3 to 4.5 compared with unvaccinated individuals.
Suffice it to say, for fully vaccinated people who received a second dose on day 21, the viral load was suppressed even more due to the activation of T cells and augmentation of humoral immunity. As viral load is associated with disease, such evidence strongly supports a negative impact on contagiousness by receiving the full vaccine series.
Taiwan has one of the best COVID-19 pandemic responses in the world. As of yesterday, it only had 1,116 cases, with 12 deaths. This exemplary performance has mostly been attributed to a swift lockdown, and a stringent quarantine system for inbound travelers. With the exemption of business travelers from low and medium-risk countries who are required to submit a negative PCR test to end their quarantine after five to seven days, most inbound travelers must undergo 14 days of quarantine, followed by seven days of self-health management, during which time riding on public transportation and visitation of crowded places are forbidden. This system has proven to be successful.
Taiwan on April 1 opened a “travel bubble” with Palau, which has no recorded cases of COVID-19, and with more than half of the population vaccinated. This allows tourists from both sides to skip quarantine, although a negative PCR test must be provided prior to boarding a flight, and visitors must travel in groups. Media reports say Taiwan is also considering forming “travel bubbles” with Singapore, the Philippines, Guam and Hawaii.
I am a doctoral nurse practitioner student at New York University (NYU). I obtained my master’s entry into nursing at Johns Hopkins University. After receiving both doses of the Pfizer vaccine through NYU Langone, I have been allowed to complete my rotations through internal medicine and intensive care units that specialize in caring for COVID-19 patients.
Since the pandemic, I have received twice-weekly COVID-19 antigen tests, which have been consistently negative, despite my high exposure to COVID-19 patients and respiratory droplets of patients who are on ventilators and extracorporeal membrane oxygenation machines. I am highly convinced by the effectiveness of the vaccine. My partner, a skin doctor practicing in Brooklyn, New York, has also received both vaccine doses.
With limited vacation time, the 14+7 quarantine rule makes visiting Taiwan impossible. The major difference between requiring fully vaccinated and unvaccinated people to quarantine for 14+7 days is the immune response. While this varies from person to person, scientific evidence supports that vaccinated individuals can effectively elicit an immune response to suppress viral load, whereas unvaccinated individuals only start developing neutralizing antibodies five to 10 days after SARS-CoV-2 exposure, and therefore allow the virus to accumulate freely.
It is this author’s opinion that the prolonged quarantine time of 14 days, already surpassing the average incubation period of five to six days, is more than sufficient to monitor for such rare cases of breakthrough infection, in the context of practically zero exposure to the virus after travel and landing in Taiwan. It is unthinkable for a vaccinated individual with a negative PCR test at the end of 14 days to miraculously become positive in seven days in the context of zero exposure. For peace of mind, vaccinated individuals can submit a negative PCR test to prove negative infection status at the end of 14 days.
This suggestion is likely to garner an immediate and severe backlash from the Taiwanese community who fear breakthrough infections and breakdown of the pandemic response that the nation has thus far upheld. However, I encourage citizens to look at the evidence and trust in science.
Breakthrough infections can be 100 percent identified by testing vaccinated individuals via PCR tests. On the upside, economic productivity would be enhanced by allowing vaccinated people a shortened quarantine. Is it time for Taiwan to reconsider the 14+7 fortress for vaccinated individuals?
Clare Huang is a doctoral nurse practitioner student at New York University. The opinion reflected in this article is solely her own and does not represent New York University or Johns Hopkins University.
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