How can Taiwan learn to coexist with COVID-19?

As the Omicron variant surges in Taiwan, case numbers are expected to reach unprecedented heights. It may not be long before we see over ten thousand cases pop up on a daily basis. In this new normal, we need to focus on preventing deaths rather than lowering numbers.

As the Omicron variant of COVID-19 spreads across the country, the daily number of new confirmed cases has surpassed two thousand. Dr. Chen Shih-chung (陳時中), Taiwan’s Minister of Health and Welfare and head of the CECC, has bluntly stated that the outbreak is still in its early stages, and that the daily count of new cases may surge as high as ten thousand.

Let’s take a look at how other parts of Asia have fared under Omicron. In February, the healthcare system in Hong Kong was all but overwhelmed by the variant. In March, South Korea reported a terrifying 620,000 new confirmed cases in a single day. Shanghai is still under strict lockdown. The threat of Omicron cannot be underestimated.

Shinkong Wu Ho Su Memorial Hospital vice superintendent Hung Tzu-jen (洪子仁) underlines the task ahead for Taiwan: The elderly must be protected.

“This year, the patients who lost their lives were mostly the unvaccinated and the elderly,” he says.

“At this stage, counting the number of confirmed cases is no longer the point,” says Chen Hsiu-hsi (陳秀熙), Professor at National Taiwan University's College of Public Health. Since most Omicron cases are asymptomatic, the key is to keep track of patients who exhibit more severe symptoms and administer medical care to prevent the symptoms from worsening, or even leading to death.

To use Korea as an example, even though there were 13 million cases and more than ten thousand deaths within two short months, more than 93.9% of the dead were patients over 60 years of age.

So, the question becomes: How do we protect our senior citizens?

Chien-jen Chen (陳建仁), Academician at the Academia Sinica, says that “Vaccines, rapid tests, and antiviral treatments are all very important.”

Rapid tests and treatments can fill the gap left by vaccines

As of April 14th, 69.9% of Taiwanese residents aged 65 to 74 have taken their third dose of the COVID-19 vaccine, while only 56.1% of those above 75 have been administered their third shot.

According to numbers published by the United Nations’ International Vaccine Institute, the chance of dying from the Omicron variant is only 0.22% for those who have taken three shots of the vaccine.

Due to this, Chien-jen Chen thinks that Taiwan’s top priority at the moment is to massively expand the coverage of the booster doses.

The next task is to make rapid tests and antiviral drugs more easily available to every stratum of the healthcare system. 

(Source: Shutterstock)

Currently, Taiwan mainly purchases the orally administered antiviral pill Paxlovid, developed by Pfizer. If the drug is taken within five days of contracting the virus, the chances of hospitalization or death are lowered by 85%. Taiwan has already procured 700,000 doses of Paxlovid from Pfizer. Over 100,000 pills are expected to arrive before May. 

Experts: High-risk patients should take drugs once diagnosed

“While it is obviously necessary to stock up on medicines, the whole operation hinges on whether local doctors can conduct rapid tests on suspected cases within three to five days of the first symptoms, and then administer antiviral drugs if the cases are confirmed,” says Chien-Jen Chen.

This is the most pressing issue as the number of confirmed cases increases rapidly every day.

Huang Yu-cheng (黃玉成), northern area director of the Communicable Disease Control Medical Network (CDCMN), points out that high-risk patients include those above 65 years of age and those diagnosed with chronic illnesses. “Once such patients are diagnosed, even if they are asymptomatic, medication must begin immediately to lower the risk of the symptoms becoming more serious.” 

In Taiwan, confirmed cases aged between 65 and 70 are among those most at risk, but medical care may not be immediately accessible. If a patient wants to take oral medication, their doctor must receive authorization by placing a call to the local area director and confirming the patient’s symptoms and eligibility for taking the drug. Then, the doctor must send a request to their hospital for the drug. 

All these layers of red tape may eat up precious time and narrow the window for effective treatment. 

Korea’s approach may be worth emulating. Korea promoted online consultation and allowed patients to buy oral drugs in pharmacies. “Taiwan needs to do something like this,” says Huang. 

As an Asian country that had earlier access to Paxlovid, the problems faced by Korea at the start of the outbreak may be a good point of reference for Taiwan.

Other options are available besides Pfizer 

Because ingesting Paxlovid has been known to cause drug interaction with treatments for hepatitis or acute kidney failure, many patients diagnosed with COVID-19 were unable to use this drug in Korea, and so they had to rely on antipyretics. 

Huang explains that it is necessary to have a doctor act as the gatekeeper for patients using Paxlovid. “If Paxlovid is not an option, Merck’s Molnupiravir is also available in Taiwan.”

However, while Paxlovid can reduce the risk of hospitalization or death by nearly 90%, the track record of Molnupiravir is only about 30%.

He adds that patients with chronic diseases are already at greater risk, so the best thing to do would be to get vaccinated and reduce the chance of catching COVID-19. 

(Source: Ming-Tang Huang)

Zero cases no longer achievable; we must make every effort to mitigate risk

Many countries around the world have realized that lowering the number of cases to zero is no longer a possibility. Instead, these nations are working to reduce the number of severe cases and mortalities through high vaccination rates. Taiwan must also find its own way of coexisting with the virus. 

Chen Hsiu-hsi points out that what Taiwan has to do is to “mitigate the disaster”. In other words, Taiwan must try to flatten the curve. “This way, our hospitals and healthcare facilities will not be overwhelmed, and there will be enough time to get everyone a third dose of the vaccine.”

Chien-jen Chen says that in practice, mitigating the crisis would mean enacting a triage system for vaccination and treatments depending on the severity of the symptoms. Currently, 78.1% of the population in Taiwan has been fully vaccinated. Coverage of the third dose of the vaccine is at 53.7%. There are 250 official testing stations across the country, capable of testing 194,455 individuals every day. 

In terms of treatments, 15,200 more doses of the oral treatment Paxlovid will arrive in a couple of weeks. Before the end of the second quarter, the total inventory will stand at 350,000 doses. There are also 12,000 doses of the treatment Remdesivir. 

“Judging by the experience of other countries, Taiwan must come to accept the fact that we will only return to better times after a large-scale outbreak,” said Chen Shih-chung during a press conference.