Taiwan’s Covid-19 Testing Strategy Divides Public Health Experts

Taiwan’s Covid-19 Testing Strategy Divides Public Health Experts
Photo Credit: Taiwan Central Epidemic Command Center

What you need to know

A canceled press conference on Covid-19 antibody testing is the latest episode dividing Taiwan’s public health experts.

Weeks of debate on whether Taiwan should expand its Covid-19 testing took a dramatic turn on Tuesday. The midterm report of a coronavirus antibody testing program involving 10,000 residents in Changhua, a central Taiwan county, was canceled abruptly the night before its scheduled release.

The testing saga has put Taiwan’s much praised coronavirus response under unusual scrutiny.

The study, led by National Taiwan University’s College of Public Health (NTUCPH), would help determine the true community infection rate in Taiwan and provide guidance for future pandemic policies, according to Dr. Chan Chang-chuan, professor at NTUCPH.

Since researchers launched the testing program in June, they have built up public anticipation in potential findings. But Dr. Chan cited incomplete “administrative tasks” as a reason for the last-minute cancellation of the Tuesday press conference.

In a growing debate over Taiwan’s testing capacity and quarantine policy, the Central Epidemic Command Center (CECC) has had to fiercely defend its Covid-19 strategy against criticism from prominent public health experts and the opposition Kuomintang party.

Health Minister Chen Shih-chung told reporters today that the high-profile study has caused “unnecessary” arguments and urged researchers to explain the delay. He also indicated possible ethics violations in the program.

As new outbreaks are emerging even in countries that had previously contained the virus, Dr. Chan urged Taiwanese authorities to conduct mass screenings on travelers arriving in Taiwan. When several foreign nationals returning to Taiwan tested positive for Covid-19 last month, he warned of “a growing risk of the presence of asymptomatic carriers” in local communities.

There have also been at least eight recent cases of travelers who reportedly tested positive for Covid-19 after leaving Taiwan. While most of these mysterious cases proved to be false positives after further investigation, they raised concerns over whether Taiwan may need to test more.

Internationally, asymptomatic patients have indeed been one of the biggest sources responsible for the spread of coronavirus, Dr. Chunhuei Chi, director of the Center for Global Health at Oregon State University, told The News Lens.

“That’s if they’re not being isolated,” Dr. Chi said. “But Taiwan has done a superb job — probably too strict — of putting every incoming visitor and citizen through a 14-day quarantine.”

He cited a recent controversy in which Changhua’s health officials tested an asymptomatic student who was under home quarantine without approval from the Central Epidemic Command Center. While the student tested positive and was sent to the hospital, the test was “totally useless” from the viewpoint of pandemic control because he was still in quarantine, Dr. Chi suggested.

More recent data indicates that a Covid-19 carrier, irrespective of symptoms, is the most contagious between the first day of infection and the 10th day, he added. If the student was asymptomatic, he would not have been contagious once he was out of quarantine.

“That’s why Taiwan uses a rather conservative 14-day quarantine,” Dr. Chi said.

The Changhua Public Health Bureau is currently under investigation for violating CECC protocols. Several Kuomintang officials and public health scholars, including Chan, have criticized the CECC for overreacting. Chen said that the probe would help authorities understand any loopholes in the current testing policy and that he did not wish to turn this debate into a political issue.

While South Korea and Vietnam have taken an aggressive testing approach, Taiwan never adopted mass testing. South Korea, which is on the verge of a nationwide outbreak, has conducted over 1.8 million Covid-19 tests to date. Meanwhile, Taiwan has only tested slightly more than 170,000 people in total.

Instead of mass screening arriving travelers, Taiwan implemented strict quarantine measures, which require 14-day home quarantine on arrival followed by a 7-day self-health management period. A robust contact tracing system has also helped prevent a major outbreak in the country so far.

Currently, Taiwan only tests incoming travelers if they exhibit Covid-19 symptoms during the mandatory 14-day quarantine. Foreign nationals without residency are required to provide a negative Covid-19 test within three days prior to boarding their flight to Taiwan. Taiwanese nationals and foreign residents would have their specimens collected upon landing.

Despite calls for mass testing, the CECC has repeatedly stated that this strategy is extremely vulnerable to false results and that it would overload Taiwan’s healthcare system. However, the center is open to possible changes upon discussions and scientific consensus.

“As the prevalence of Covid worsens in some countries, [the CECC] may want to consider whether to test all passengers from select countries on top of the quarantine,” said Dr. Tse-min Lin, a government professor at University of Texas at Austin, who believes that more testing could be beneficial under the right circumstances.

“What is important is not testing more for no reason but testing smarter for good reasons.”

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TNL Editor: Nicholas Haggerty (@thenewslensintl)

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