No lockdown but intensive contact tracing: Taiwan’s strategy to defeat COVID-19

At Taiwan in 2020, life was quite “normal”. Weddings, parties, concerts, fairs and sports took place. This situation was different from the rest of the world where this “normality” was disturbed by the coronavirus and confinement, face masks and social distancing were the “new” normal.

Solo 11 people have died from COVID-19 in the small island nation 180 km east of China since the start of the pandemic, an impressive feat for a country that has never been confined. With one of the lowest COVID-19 per capita rates in the world, Taiwan received unanimous applause for its handling of the pandemic.

At the start of the pandemic, it was considered a country at high risk for COVID-19 due to its proximity to China and the frequent trips made between the two countries. This, coupled with a 2003 SARS record that was not particularly well managed, forced the Taiwanese government to act quickly to close your borders. January 20, 2020 Created a Central epidemic control coordinate cooperation between different government departments and agencies, and between government and business.

Recently, a new study published in the Journal of the American Medical Association examined in more detail why Taiwan has been so successful in the fight against COVID-19. The authors of the research, from various health institutes and hospitals in Taiwan and the United States, compared the estimated effectiveness of two types of policies in the first few months of the pandemic: case-based measures and population-based measures.

The former include detection of infected people through testing, isolation of positive cases, contact tracing and 14-day quarantine of close contacts. And the second included use of a mask, personal hygiene and social distancing.

The effects of these measures were quantified by estimating the effective number of reproductions (R number), a way to assess the ability of an infectious disease to spread. An R number greater than 1 means the virus will continue to spread and epidemics will continue. An R number less than 1 means that the number of cases will start to decrease.

While previous studies in other countries have simulated what-if scenarios, this work combined drivetrain modeling with detailed actual data to estimate efficiency. The authors collected data on 158 cases between January 10 and June 1, 2020 from the Taiwan Centers for Disease Control. All cases were confirmed by PCR testing. Data referred to local infections, confirmed clusters, and imported cases of people who entered Taiwan before March 21, 2020.

They then compared the results they found in Taiwan with an R of 2.5, based on the estimated equivalent number in neighboring China at the start of the COVID-19 outbreak. The study found that Case-only policies, such as contact tracing and quarantine, could reduce the R-number from 2.5 to 1.53. Containment is the one that has contributed the most to reducing the R number.

the case-based interventions could not substantially prevent person-to-person transmission, but they did successfully reduced subsequent transmission to a third or fourth person, as long as these close contacts are quarantined. For their part, population-based measures, like social distancing and masks, they reduced the R number from 2.5 to 1.3.

The authors concluded that it was the combination of case-based and population-based measures that helped Taiwan contain COVID-19. The combination of the two approaches leads to a number R, estimated by two different methods, of 0.82 and even 0.62. They also found that robust population-based measures were needed to achieve containment, even though the number of circulating infections was low. NOTneither of the two approaches would have been sufficient on its owneven in a country with an efficient public health system and a sophisticated contact tracing system.

Recognizing that all models make assumptions and this analysis is no different, the document confirms that the set of public health measures that we use in a fairly consistent way around the world –To different degrees of temporality and rigor– they were necessary. However, it should be noted that The study results reflect a period when newer variants with higher transmissibility were not an issue.

Taiwan is an island nation capable of controlling the introduction of new cases through border control, and the authors acknowledge the findings of this study may not be fully applicable to other countries. That is why the researchers focused on the effectiveness of case-based and population-based interventions on local transmission, and not on border checks on the number of imported COVID-19 cases.

The authors concluded that intensive contact tracing is not possible when public health systems are overwhelmed. This has never happened in Taiwan due to the success of their strategies. Finally, the document found similar results for the seven and 14 day quarantine and suggests that the detention period could be shortened. Some countries are considering this possibility, including the United States, but to date it has not been widely introduced.

KEEP READING: