假的安全感與秘密小茶屋，摧毀台灣的防疫 TIME 20210521

【縛雞之見】
TIME的報導摘譯：
疫情爆發從華航貨機機師開始，透過獅子王與萬華茶屋而展開。
在成為全球頂尖的防疫典範後，台灣從去年夏天開始鬆懈。
無疫情的台灣，是否能從各國的慘痛經驗中有效學習到教訓？
為何SARS的SOP在台灣成功防疫之後沒有用了？不遵守SOP是原因。
華航旅館違反機師檢疫規定，且與一般來賓同處一棟大樓。四月中，台灣降低機師檢疫從5+9，降為3+11。
萬華紅燈區的感染，全數與華航旅館相同病毒株，來源就是華航NOVOTEL旅館。
CECC的專家未能想定萬華茶屋對病毒傳染如野火般。
陳建仁說，因為先前兩例特種營業感染（林森北路？）並未成為破口，官員不相信茶屋會成為問題。
只擁有30萬劑AZ疫苗（來自COVAX）的台灣是病毒的處女地，幾乎無人因疫苗而擁有抗體。幾乎落後大多數國家。
沒有疫情，施打意願低。在5月初，只有40％的台灣人有意願打疫苗。數字是全世界21個做調查的第二低。
陳說，台灣還等到其他監管機構批准COVID-19疫苗之後才開始進行購買協議。到那時，大多數首批產品早已被其他政府搶購一空，其中許多政府已為它們的發展提供了資金。因此，儘管台灣現在已經從各種來源獲得了約2000萬劑疫苗，但它比大多數發達經濟體慢得多。
北京曾表示提供疫苗，但台灣官員指控混淆政治而拒絕。美國已承諾會在釋放其數百萬劑阿斯利康劑量時提供幫助。週三，從國際疫苗分發計畫COVAX收到了40萬劑AZ疫苗。
Chen說，兩種國產疫苗的未發表研究表明，它們產生的抗體與已被證明可有效抵抗COVID-19的其他疫苗相似。政府計畫在完成第三階段功效試驗之前授權疫苗。
但是台灣抵抗COVID-19的最有效武器可能是台灣人民。雖然有防疫疲勞，但大多數台灣人（即使有的話）比政府更加謹慎。（中文節摘由Google翻譯，Taimocracy修正）

How a False Sense of Security, and a Little Secret Tea, Broke Down Taiwan's COVID-19 Defenses    TIME 20210521

ll it took to break down the world’s most vaunted COVID-19 defense was a little secret tea.

After almost 18 months of nearly unblemished success keeping the coronavirus pandemic at bay—including the world’s longest streak of case-free days—Taiwan is now in the grip of its first major COVID-19 surge.  Total cases, which had been below 1,300 through the entire pandemic, have surged to more than 3,100 in the span of a week.  Many offices have sent workers home, the streets of the capital Taipei have cleared out and the government has begun scrambling to secure vaccines to improve one of the worst inoculation rates in the developed world.

The outbreak likely began after spilling over from cargo plane crews.  However, the bulk of the surge has been traced back to two sources: a local Lions Club International gathering, and tea houses in the red-light district of Taipei’s Wanhua neighborhood.  The two clusters were at first thought to be unrelated—until a former president of the Lions Club revealed that he had visited one of the tea houses.

The movements of the civic leader in his 60s, nicknamed by Chinese-language media “The Lion King,” show he had at least 115 contacts while potentially infectious—and reveal just how vulnerable the island of 23 million was to a major outbreak.

After rapidly imposing world-leading infection control measures, Taiwan slowly began to let down its guard last summer.  Crowds of thousands of people were allowed to return to concerts, baseball games and religious festivals.  Large meals and family gatherings became increasingly common, and masks became rarer as months passed with no local infections.

“Last year, we started to kind of go out, but deal with it in a careful way,” says Freddy Lim, a rockstar turned lawmaker who represents Wanhua in Taiwan’s legislature.  “But this year, I think we forgot the part about being careful.”

Taiwan’s outbreak is now proving to be a test of whether a society relatively untouched by COVID-19 can effectively put to use the lessons the rest of the world learned the hard way.

How Taiwan’s COVID-19 defenses failed

Taiwan’s fight against COVID-19 began on Dec. 31, 2019—the day the first reports emerged of a mysterious viral pneumonia in Wuhan, China.  By Jan. 2, 2020, health officials began screening arrivals from mainland China.  Authorities set up temperature checks and stronger border controls in the following weeks—before the World Health Organization had even confirmed that the virus was spread by human-to-human transmission.

The self-ruled island, which is claimed by Beijing, implemented strict infection control measures at hospitals and was among the first places to close its borders to nearly all non-residents and order strict quarantines for anyone who did arrive.  Masks were distributed to the population and made mandatory in places like mass transit by March.  Meanwhile, police closely monitored travelers to ensure they adhered strictly to quarantines and contact tracers pried deeply into infected people’s movements to ensure close contacts were found and isolated.

READ MORE: Taiwan Says It Tried to Warn the World About Coronavirus. Here’s What It Really Knew and When

All of this meant that by mid-April 2020 Taiwan had only about 400 confirmed cases.  At the same time, the U.S. was reporting more than 30,000 infections per day.

The success was 17 years in the making, dating back to the 2003 SARS outbreak, which also originated in mainland China and killed dozens on the island, says Dr. Chen Chien-Jen, who served as Taiwan’s Vice President until last May.

Chen, an epidemiologist and former health minister, helped to design and lead Taiwan’s COVID-19 control measures.  So why did those protocols fail after holding out successfully through the worst of the pandemic?

“Life will find its way out, as said in Jurassic Park,” Chen tells TIME.  “The virus will always try to replicate, to mutate, and it becomes more and more infectious.”

The majority of recent COVID-19 cases reported in Taiwan are the virus variant first found in the U.K., which scientists believe is more easily transmitted.  Complicating this is the fact that many patients have only minor symptoms or none at all and don’t know they’re spreading COVID-19 until it’s too late.

This appears to be what happened in the “Lion King” case.  Dozens of people connected to the Lions Club cluster were infected by one or more carriers who believed it was safe to socialize.

But, lax adherence to the island’s safety protocols also played a role.  Taiwan’s current community outbreak began in April with cargo plane crews at the Novotel at Taipei’s Taoyuan International Airport.  The hotel violated COVID-19 rules by housing quarantined flight crews and non-quarantine guests in the same building.  In mid-April, Taiwan also lowered quarantine requirements for non-vaccinated flight crews from five days to just three.  At least 29 cases are linked to the Novotel cluster, including hotel staff.  Officials say cases in the Novotel cluster, the Lions Club cluster, and the cluster of cases in Wanhua’s red light district were all infected with the same strain of the coronavirus—suggesting they have a common source.

Taiwan’s tea shops become a COVID-19 breeding ground

Chen, now a distinguished professor at the Academia Sinica in Taipei, also concedes that he and others behind Taiwan’s COVID-19 surveillance program never envisioned how the shadowy world of Taiwan’s hostess tea shops would be uniquely vulnerable to spreading COVID-19 like wildfire.

Many of the Wanhua tea shops are relatively innocent: clients are mostly older men who have tea with middle-age hostesses who keep them company and make conversation. However, some reportedly operate as fronts for brothels and employ migrant women who are in Taiwan illegally.

READ MORE: Southeast Asia Kept COVID-19 Under Control For Most of the Pandemic. Now It’s Battling Worrying New Surges

It’s not hard to see how COVID-19 would ricochet easily through such an environment.  The shops are often poorly ventilated and dimly lit.  It’s also common for patrons to “bar-hop” from shop to shop and mingle with multiple hostesses and other patrons.  “There is no way that you can wear masks in the tea houses, no matter if it is with sex workers or a just normal tea houses because you are eating food, you are drinking tea and you are singing, and so on,” says Lim, the legislator for the area.

Combine that with customers who aren’t eager to tell contact tracers—or their own families—that they visited such an infamous area, along with marginalized workers who may be hesitant to come forward, and the red-light district in Wanhua has become the catalyst for more than 1,000 of the infections reported across Taiwan.

Chen says health officials didn’t believe the tea houses would be a problem because two previous cases where COVID-19 patients went to other so-called “adult entertainment” venues didn’t result in transmissions.

Taiwan’s vaccine shortfall

The other major reason that COVID-19 has spiked so quickly in Taiwan is that the virus found virgin immune territory.  Very few people have been exposed and thus very few have antibodies. Taiwan’s vaccination rollout has also been almost non-existent.

The island received just 300,000 doses of the AstraZeneca vaccine before the outbreak and had been hard-pressed to administer even those, with less than 2% of the population immunized. That’s a number that stands out even in Asia, which has lagged much of the rest of the world in vaccine rollouts.

The problem has been both supply and demand.  The lack of virus on the island has meant most Taiwanese people see no urgency in getting vaccinated.  Incidence of side-effects, including the very rare occurrence of blood clots for the AstraZeneca vaccine, have been heavily reported by local media . A YouGov survey in early May found that just 40% of Taiwanese people said they were willing to be vaccinated—second-lowest among 21 places polled around the world.  Since the outbreak, demand for vaccines has increased dramatically.

Taiwan also waited until after COVID-19 vaccines were authorized by other regulators to begin striking deals to buy them, says Chen.  By then, most of the first batches were long snapped up by other governments—many of which had helped fund their development.  So while Taiwan has secured some 20 million doses of vaccine from various sources, it is farther back in the line than most developed economies.

The government in Beijing, which views Taiwan as a breakaway province that must be reunited with the rest of China, has offered to provide vaccine doses, though Taiwanese officials accused the mainland of trying to sow confusion and discord with the offer. The U.S. has pledged to help once it releases its stockpile of millions of AstraZeneca doses. On Wednesday, 400,000 doses arrived from COVAX, the international vaccine distribution scheme.

Taiwan’s two domestically developed vaccines may be more likely to fill the gap.  The government has promised to begin rolling them out in July following the completion of Phase 2 safety trials, which have been carried out on 4,000 test subjects for each vaccine.  Chen says that unpublished studies of the two vaccines show they provoke similar antibody levels to other vaccines that are already proven effective in fighting COVID-19. The government plans to authorize the vaccines before completing Phase 3 efficacy trials.

Learning from the world’s mistakes

The government has responded swiftly to the surge in cases: It has opened testing centers in hotspots, restricted the size of gatherings, began enforcing mask mandates with hefty fines, shut down schools and urged residents to stay home.

But Taiwan’s most effective weapon in fighting COVID-19 may be its people.  Whereas most new surges around the world are met with increasing amounts of pandemic fatigue and lower levels of compliance with social distancing rules, most Taiwanese people have been—if anything—even more cautious than the government.

As cases began to spike, people rushed supermarkets, clearing shelves of food and, yes, toilet paper.  The usually teeming streets of Taipei are all but empty as most people choose to stay home.  Many restaurants voluntarily closed or banned indoor dining, and those who kept their dining rooms open are now largely empty.

Beating this COVID-19 wave has become a point of pride.  After the government imposed Level 3 pandemic restrictions—one degree below a full lockdown—memes began to circulate on social media that vowed to quash the surge in short order.  “Look world, Taiwan will only show you once how to remove a Level 3 alert in two weeks,” reads a popular boast.

Ya-chu Chuang, a 28-year-old freelance stenographer, has been working from home, but could not avoid going into her workplace one day this week.  When she arrived, she went through a routine that was new to her, but all-too familiar across the world for the last 18 months.  She sprayed down her desk with alcohol and did everything she could to keep herself away from others in the office.

She feels like it’s her duty to do what she can to help reduce the spread of COVID-19 as quickly as possible.  “I know that we’re experiencing what happened abroad about a year ago,” she says.  “As long as we all do what we can and follow the instructions, we will be able to overcome this crisis.”