Something to think about.  Is our security worth a loss of privacy or loss of   
   life?   
   __________________________   
      
   Taiwan's coronavirus protocol might be seen as 'extreme' to Canadians, but it   
   works   
      
   Could Canada have benefited from an emphasis on intensive and sustained   
   surveillance, rather than community-wide lockdown?   
      
      
   Let’s face it, from the first appearance of COVID-19, Canada has been in a   
   better position than our large neighbour to the south—better prepared,   
   better resourced and better organized.  But our cases and accompanying deaths   
   are still rising    
   exponentially, while citizens are still hunkered down in basement bunkers, and   
   the economy is in a steep nosedive.   
      
   Seventeen years ago, the coronaviral precursor of today’s pandemic,   
   SARS-CoV-1, caused outbreaks in several countries, including Canada,   
   especially Toronto. Shouldn’t we have been much better prepared this time?   
      
   In 2003, all the affected locations made serious errors.  For three months,   
   China delayed reporting cases internationally and was reluctant to release any   
   information.  Canada and Taiwan made blunders in the isolation of early cases   
   before the nature of    
   the infection was properly understood, leading to rapid spread among patients,   
   staff, and between institutions.  General confusion was evident at all levels.   
      
   After SARS, the affected countries resolved to do better next time.  Canada   
   established the Public Health Agency of Canada (PHAC) and populated it with   
   people of great expertise and experience.  Their focus was, and remains,   
   disease prevention, health    
   promotion and provision of information.  During the present pandemic, news   
   conferences are given almost daily, and Dr. Teresa Tam has become familiar to   
   everyone.       
      
   Taiwan, barely 130 kilometres from the coast of China and with considerable   
   daily movement of people to and from the mainland, took a different approach.    
   They built an early-warning system at all air- and sea-ports for incoming   
   threats.  The National    
   Health Command Centre (NHCC) in Taipei unifies epidemic control, biological   
   pathogen disaster control, counter-bioterrorism control and central medical   
   emergency operations.  Teams of staff remotely assess people arriving at all   
   ports of entry, and    
   monitor broadcasts from China, U.K., U.S.A., Japan, Canada and Australia for   
   notifications of new pathogens or unrecognized diseases.   
      
   On May 5, 2005, while I was having lunch with the Director, Dr. Chou Jih-Haw,   
   his pager went off; TWCDC staff had become aware of reports of a suspicious   
   white powder found in a Canadian post office.     
      
   With a population of 24 million, about two-thirds that of Canada, populating   
   an island roughly the size of Vancouver Island, Taiwan’s state of readiness   
   and preparation has worked remarkably well during the present emergency.     
      
   It has experienced just 363 cases as of Apr. 4, compared to Canada’s 14,408.   
   That’s only four per cent of the incidence rate for Canada (1.5 versus 38   
   per 100,000), and just five deaths, compared to 258 in Canada.   
      
   Was this achieved through severe lockdown and suppression of social contact   
   and activities?  Surprisingly, many businesses are open, restaurants are   
   operating, and children go to school.     
      
   The Taiwanese approach is one of careful and intensive monitoring and   
   surveillance, and it seems to be working.  When you land at the airport,   
   before deplaning, you are required to file a report about your health from   
   your cell phone using an official QR    
   code, and your temperature is taken while still on the aircraft.   
      
   Surgical masks are worn in public with a two-fold rationale: first, although   
   the masks are not very effective in protecting the wearer, they’re used on   
   the rationale that some protection is better than none; and second, if   
   everyone wears them, anyone    
   who is virus-positive without knowing it, will naturally be shedding less to   
   others.  They are distributed to everyone by the government and available in   
   all 7-Eleven stores.           
      
   Children go to school, and wear their masks all the time, removing them only   
   to eat lunch.  They have their temperature taken at least twice a day, and   
   handwashing is supervised.  A third of nurses have school-aged children and   
   having them in school    
   means nurses are free to continue their vital hospital work.     
      
   Taiwan uses passport records linked to cell phone records to track personal   
   travel and to help determine if you should be in quarantine.  Anyone ordered   
   into quarantine is taken there in a government vehicle, contacted several   
   times a day by surveillance    
   staff, and meals are provided.  Recently, people under quarantine have started   
   getting paid.  However, anyone leaving quarantine before their time is up, is   
   brought back and fined heavily.   
      
   This is a society where health surveillance and protective quarantine is taken   
   seriously, and the infringement of a few social rights during an emergency is   
   not contested or seen as unacceptable.     
      
   Handheld infra-red scanners are everywhere in Taiwan, and whether on the   
   street, in a store, office, or subway station, you can expect to have your   
   temperature taken several times a day.   
      
   Temperature scans are not reliable and we have the results of several surveys   
   showing that roughly half of virus-positive people will not be detected with   
   an abnormal temperature on arrival at the airport.  But if we abandon this   
   tool, we miss the    
   advantage of knowing at least the half of the results that are abnormal. And   
   there’s a chance many of the “missed” virus-positive people would be   
   picked up later in the day at another temperature check.       
      
   This layered approach is predicated upon the principle that nothing in science   
   is 100 per cent; no test is free from false negatives or false positives, and   
   the terms “absolute” and “never” have no place in the scientific   
   lexicon.   Methods of    
   surveillance and monitoring, essential tools for communicable disease   
   epidemiology, should not be abandoned just because each one “leaks” a bit.   
   Instead, layering the methods, repeating the measurements and overlapping the   
   results appears to get the    
   job done, at least in Taiwan.     
      
   Could Canada have benefited from an emphasis on intensive and sustained   
   monitoring and surveillance, rather than community-wide lockdown? It certainly   
   appears to work better than our present system and could have been implemented   
   here to great advantage,    
   not least allowing the operation of some business and commercial activities.   
      
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)