Taiwan has been highly effective in pandemic control, so that there has been almost no community transmission since the beginning. The star of the show has been its border entry quarantine system.
But the current rapidly growing outbreak of community transmission starting from a quarantine breach requires a different approach. There is benefit to learning from the experience of other countries.
New Zealand and individual states of Australia have also been highly successful. Unlike Taiwan, they have had multiple such quarantine breaches. They have, however, developed a method of “snap lockdowns” that limit health impacts and rapidly restore economic activity.
When such breaches occur, as soon as there are a few cases, strong action is taken to rapidly suppress the transmission. Unlike what people have traditionally expected as the last and least welcomed intervention to be used after all else failed, the "snap lockdowns" were done very early when there was only one small cluster with, say, four to five cases, or even just one case of unidentifiable source. It has been shown that the earlier and stronger the action the better. This makes possible a very short disruption.
The lockdowns that New Zealand and the individual states of Australia impose typically last only a few days but enable contact tracing to identify chains of transmission. Once the transmission chains are confirmed to be complete, the lockdown is relaxed. But if there are unidentified chains, the lockdown is extended to two weeks or longer.
In New Zealand, there have been lockdowns that lasted three days, seven days and 20 days. Among states of Australia, there have been multiple lockdowns that took three, four or five days, one lasted 23 days, and the longest one, when the number of cases reached a maximum of 700, lasted over 100 days.
By acting earlier, it is also possible to limit the geographic area of the action, so that just one city, or even just one neighborhood, has to be locked down. Such local action must include travel restrictions so that only essential commuters are moving from community to community.
The snap lockdown uses a “green zone” strategy. When an outbreak occurs, we first define the boundary of the safe regions, and implement the lockdown in the others. In the region under lockdown, transmission is dramatically reduced, and extensive investigation is undertaken to identify existing cases and the chain of transmission. Isolation and quarantine can then be done early, which enables the fastest possible return to normal activity. The investigation can also further identify additional green zones that can return to normal sooner. This is the best way to reduce the impact of the outbreak.
It is also possible to shorten the lockdown by using mass testing. Testing of everyone in a neighborhood with high incidence shortens dramatically the lockdown that is needed by identifying people who are not yet symptomatic.
While every area has unique challenges, during the fall it was demonstrated that these strategies can be successful even in Dharavi, India, one of the world’s most densely populated urban communities.
There is no doubt that shortening the time of action is the best for the economy. The longer an area stays in a non-zero state, the more the impact on both lives and economy.
In all the world, Taiwan, New Zealand, and states of Australia are among the areas least affected by the pandemic both in health and economy. Areas that have allowed the outbreak to grow have suffered much greater harms. It would be tragic if Taiwan would choose to allow this to happen and suffer such death and economic devastation.
The key to avoiding this fate is to use all these powerful tools: lockdown, testing, travel restrictions and contact tracing. This is like using legs and arms in a fight. Tying your arms or legs together is self-defeating. Coordinating them effectively is the way to win.
In Taiwan, now there is a need for at least a two week lockdown in areas where community transmission is currently present, and likely a three or four week lockdown in a few areas that are strongly affected. Any delay will extend those times. By acting fast, the damage can be limited and economic activities restored rapidly.
This article originally appeared in Chinese in The Liberty Times.
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TNL Editor: Bryan Chou, Nicholas Haggerty (@thenewslensintl)
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