Let’s face it, since the first appearance of COVID-19, Canada was in a better position than our big neighbor to the south – better prepared, better endowed with resources and better organized. But our cases and the deaths that go with them continue to grow exponentially, while citizens are still crouching in bunkers underground, and the economy is falling sharply.
Seventeen years ago, the coronaviral precursor to the current pandemic, SARS-CoV-1, caused outbreaks in several countries, including Canada, particularly Toronto. Shouldn’t we have many better prepared this time? In 2003, all of the affected sites committed serious errors. For three months, China has delayed reporting internationally and has been reluctant to release information. Canada and Taiwan made mistakes in isolating the first cases before the nature of the infection was understood, which led to rapid spread among patients, staff and between facilities. The general confusion was evident at all levels.
After SARS, the affected countries decided to do better next time. Canada created the Public Health Agency of Canada (PHAC) and staffed it with people with great expertise and experience. Their objective was and remains the prevention of disease, the promotion of health and the provision of information. During the current pandemic, press conferences are given almost every day and Dr. Teresa Tam has become familiar to everyone.
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Taiwan, just 130 kilometers from the coast of China and with considerable daily movements of people to and from the mainland, has taken a different approach. They have built an early warning system in all air and sea ports for incoming threats. The National Health Command Center (NHCC) in Taipei unifies the fight against epidemics, the fight against disasters related to biological pathogens, the fight against bioterrorism and central medical emergency operations. Teams of staff remotely assess people arriving at all ports of entry and monitor broadcasts from China, the United Kingdom, the United States, Japan, Canada and Australia for notification of new pathogens or unrecognized diseases. On May 5, 2005, when I was having lunch with the director, Dr. Chou Jih-Haw, his pager went off; TWCDC staff were aware of reports of a suspicious white powder found in a Canadian post office.
With a population of 24 million, about two-thirds of that of Canada, populating an island roughly the size of Vancouver Island, Taiwan’s preparedness and preparedness worked remarkably well during the current crisis. It registered only 363 cases as of April 4, compared to 14,408 in Canada. This is only 4% of the incidence rate in Canada (1.5 versus 38 per 100,000), and only five deaths, compared to 258 in Canada.
Was this achieved through severe blocking and the suppression of contacts and social activities? Surprisingly, many businesses are open, restaurants are operating, and children are going to school. The Taiwanese approach is careful and intensive monitoring and surveillance, and it seems to be working. When you land at the airport, before disembarking, you are required to file a health report from your mobile phone using an official QR code, and your temperature is taken while you are still on the plane. Surgical masks are worn in public for two reasons: first, although masks are not very effective in protecting the wearer, they are used for the reason that some protection is better than none; and second, if everyone wears them, anyone who is HIV positive without knowing it will naturally be less likely to get rid of others. They are distributed to everyone by the government and available in all 7-Eleven stores.
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Children go to school and wear their masks all the time, only taking them off for lunch. Their temperature is taken at least twice a day and hand washing is monitored. A third of nurses have school-aged children and having them in school means that nurses are free to continue their vital work in the hospital.
Taiwan uses passport records linked to cell phone records to track personal movements and to determine if you need to be quarantined. Anyone quarantined is taken there in a government vehicle, contacted several times a day by surveillance personnel, and meals are provided. Recently, people in quarantine have started to get paid. However, anyone who leaves quarantine before the end of their time is brought back and sentenced to a heavy fine. It is a society where health surveillance and protective quarantine are taken seriously, and the violation of some social rights during an emergency is not disputed or considered unacceptable.
Portable infrared scanners are everywhere in Taiwan, and whether on the street, in a store, office or subway station, you can expect your temperature to be taken several times a day.
Temperature analyzes are not reliable and we have the results of several surveys showing that around half of HIV-positive people will not be detected with an abnormal temperature when they arrive at the airport. But if you abandon this tool, you miss the advantage of knowing at least half of the results that are abnormal. And it is possible that many “missed” HIV-positive people will be picked up later in the day at another temperature control.
This layered approach is based on the principle that nothing in science is 100%; no test is free from false negatives or false positives, and the terms “absolute” and “never” have no place in the scientific lexicon. Surveillance and monitoring methods, essential tools for the epidemiology of communicable diseases, should not be abandoned simply because each one “leaks” a little. Instead, overlapping methods, repeating measurements, and overlapping results seem to do the job, at least in Taiwan.
Could Canada have benefited from the focus on intensive and sustained monitoring and surveillance, rather than community-wide lockdown? It certainly seems to work better than our current system and could have been implemented here with great advantage, in particular by allowing certain commercial and commercial activities to operate. But the implementation of such containment should have started at the very beginning of the pandemic, long before community spread was established. Even then, the “longest undefended border” would present very great difficulties. At this point, we can only stay the course, appreciating that Canada retains the figures better than the United States, while recognizing that it should have been much better supplied with personal protective equipment and ready to manufacture and provide equipment and devices from national sources.
The acceptance of powerful government oversight powers, even at the expense of civil liberty, is for the most part undisputed in Taiwan, given the common purpose and its importance. And this is where I suspect the loudest pushback would happen in this country if Canada needed to access our cell phone location records and our international travel tracking programs. Even during the pandemic of the century and its unprecedented financial, industrial, social and employment disruption, members of the public would be horrified by the temporary loss of civil rights. This leads us to question the true meaning of “security”.