Taiwan was a COVID-19-free haven—then the virus snuck back in

January 22, 2021, 10:26 AM UTC

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Taiwan, the self-governing territory off the coast of mainland China, announced on Tuesday that it would cancel an annual festival related to the upcoming Chinese New Year holidays after it confirmed four new COVID-19 cases.

Four new cases would be celebrated as an exceptionally low number in much of the world, but the outbreak represents Taiwan’s largest in months.

Since the onset of the pandemic, Taiwan’s 23.8 million citizens have lived relatively free of coronavirus, recording just 870 cases and seven deaths. Florida, a U.S. state with a population comparable to Taiwan’s, has recorded 1.6 million cases of COVID-19 and nearly 25,000 deaths.

Taiwan’s government was among the fastest in the world to recognize the potential dangers of COVID-19, screening passengers from Wuhan, China immediately after Beijing announced an outbreak of a “pneumonia-like” virus in the city on Dec. 31, 2019. As COVID-19 spread across the globe in early 2020, Taiwan’s Central Epidemic Command Center implemented virus control measures like border restrictions on foreign travelers, mandatory quarantines for citizens returning home, universal mask wearing, and tracing the contacts of confirmed cases. Such actions allowed Taiwan to avoid the draconian lockdowns implemented in other parts of the world.

For 253 days in 2020, Taiwan reported zero locally-transmitted cases of COVID-19. Its success meant that the government was able to largely relax social distancing measures, with citizens free to go to bars, travel around the island, and even attend packed concerts.

But in late December, the streak came to an end. The territory is now battling to contain its a second local cluster, with the new outbreak demonstrating how the virus can slip through the smallest cracks in what seems to be an airtight COVID-19 response system.

Flying in

In late December, a cargo pilot for Taiwan’s EVA Air landed in Taiwan’s capital of Taipei for a short stopover from the United States. At the time, Taiwan mandated that pilots quarantine for three days upon arrival and only get tested for COVID-19 if they were symptomatic.

The pilot claimed that he wasn’t symptomatic and visited with another pilot in Taipei after completing his quarantine. Eight days after arriving in Taiwan, local media reported that the pilot was seen coughing in the cockpit and not wearing a mask on his departing flight to the U.S. After arriving in the U.S., the pilot tested positive for COVID-19.

Two days after he tested positive, Taiwan recorded its first local case of COVID-19 in over eight months. A female pilot who had reportedly been in close contact with the Eva Air pilot tested positive.

Taiwanese authorities, which had conducted contact tracing interviews with the original pilot after he tested positive, later accused him of not being truthful about where he’d gone and who he saw in Taiwan.

In response to the outbreak, Taiwan extended its quarantine policy to seven days for pilots arriving from abroad. Eva Air fired the pilot and said that his actions brought “serious damage to the company’s reputation and image.”

Hospital cluster

The pilot cluster did not spread beyond those two infections, but on Jan. 12, Taiwan’s Central Epidemic Command Center (CECC), the government agency charged with confronting the pandemic, announced two more local cases of COVID-19.

The authorities said that a doctor and a nurse in northern Taiwan tested positive for the virus after taking care of a COVID-19 patient, who presumably imported the virus from abroad. The cluster has since grown to ten cases, involving hospital employees and some of their relatives.

In response, Taiwan has placed over 350 employees at the hospital in emergency isolation for an unspecified period of time. Authorities are now conducting intensive contact tracing efforts involving the infected employees. Taiwan’s army has also reportedly deployed its “chemical warfare troops” to disinfect local markets, fast-food restaurants, and other locations that the COVID-19 patients may have visited.

Dominic Meagher, a visiting fellow at Australia National University who researches COVID-19 responses across Asia, says it’s not surprising the outbreaks in Taiwan stemmed from flight crews and frontline medical workers since they among the most likely to be exposed to the virus.

He says that while places like Taiwan can take extra precautions such as mandating longer quarantines for pilots, it may be impossible to create a perfect COVID-19 response system.

“Unless you have a completely sealed-off country, you are going to interact with the virus,” he said. “No one can have that.”

He said that Taiwanese authorities appeared ready to fill in the cracks as soon as they appeared.

“Even in the most careful places, eventually something is going to go wrong and you have to be vigilant and react quickly when it does,” Meagher said. “I think that’s what Taiwan has done.”