key: cord-0988336-ihyj9fpi authors: Galvin, Cooper J.; Li, Yu-Chuan; Malwade, Shwetambara; Syed-Abdul, Shabbir title: COVID-19 preventive measures showing an unintended decline in infectious diseases in Taiwan date: 2020-06-23 journal: Int J Infect Dis DOI: 10.1016/j.ijid.2020.06.062 sha: 6898860b3f2c9d7417678bb00f77667392746384 doc_id: 988336 cord_uid: ihyj9fpi Abstract Many communicable diseases may have contact, airborne, and/or droplets transmission. Following the COVID-19 outbreak, Taiwan government implemented the use of masks and sanitizer and other prevention measures, like social distancing for prevention. This public response may have likely contributed significantly to the decline in the outbreak of other infectious diseases. Public response to the COVID19 threat may have diminished the effect of the 2020 influenza (flu) season in Japan and Singapore 1, 2 . With the outbreak of novel coronavirus (COVID-19) 3 , Taiwan's government and society also responded swiftly, implementing systemic precautions and disseminating prevention knowledge to the public 4 In Taiwan, flu infects over hundreds of thousands annually, according to Taiwan's centers for disease control (CDC) website 6 . Previous work has shown that the public is likely to utilize face masks when they perceive themselves as susceptible and the pandemic threat as severe 7 . Use of face masks, hand sanitizers, ban on social events, working from home etc, were among the measures being followed to curb the spread of the COVID-19. Taiwanesepanic-bought nearly all available mask and hand sanitizer stocks within two weeks of the first case in Taiwan The recent COVID-19 outbreak has stimulated a public-driven movement for prevention. Google searches for the terms "Face mask" and "Hand sanitizer" have spiked ~100-fold in Taiwan since the first COVID-19 case, stimulating mask shortages and government investment in production, rationing, and distribution of masks (Figure 1 ), post 5 th week since 1 st January 2020. During the following months, severe complicated influenza (SCI), and IPD cases declined as compared to the 6-year averages. What started as a higher than average, SCI season has dropped to 6-year lows, with rates during spring months ~10% of the 10-year average. These differences may be due to an earlier than average occurrence of the influenza season, but the absolute baseline is significantly lower than previously observed. Another interesting observation was that the incidence rates were not only lower, but also reached to a persistent zero for a continuous period of 3 months, which was never noticed earlier. IPD diagnoses have also reached record lows (over two standard deviations below the 10-year mean). Due to zero new COVID-19 cases for a continued duration, the government retracted mask rationing after week 21, which further led to an increase in Google search for "Face mask" for online shopping. Throughout spring 2020, in a public-lead prevention effort, in Taiwan's major cities, nearly every medical facility, museum, shopping mall, and popular restaurant required temperature checks and ethanol hand washes before entry. Since many communicable diseases have contact, airborne, and/or droplets transmission, we assume the use of masks and sanitizer and other COVID-19 prevention measures, like social distancing, may have contributed significantly to the observed decline inSCI and IPD cases. There could be multiple factors contributing to the lower incidence rates of complex influenza and pneumococcal disease. It could be because of low intensity of the disease this year, higher vaccination rates, lower utilization of hospitals and we assume proactive public response for preventive measures. As society reels with the financial, societal, and health costs of severe COVID-19 response measures globally, we invite interdisciplinary researchers and policy-makers globally to investigate and facilitate the right level of prevention of future epidemics, including seasonal flu. Would we want to, and would it be possible for the public to largely reduce infectious diseases including seasonal influenza , with the use of face masks and hand sanitizers? So far, seemingly these measures are useful. Regardless, we urge the general public to actively participate in preventative measures because they may both contain COVID-19 and reduce the overall burden of communicable diseases. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Figure 1 . Relationship between public awareness of COVID-19 prevention and communicable disease incidence tracked in real-time. Infectious disease rates were provided by the notification system of the Centers for Disease Control of Taiwan (Taiwan's CDC). For a conservative estimate of the decrease in communicable diseases seen this year, pending cases were included with confirmed cases in the incidence presented. Weekly averages are reported with standard errors from the mean. We chose Google searches for the mandarin Chinese translation of "face masks" (口罩) and "hand sanitizer" (乾洗手) as our indicators of public interest in COVID-19 prevention behaviors. Search data for individual days was provided in relative units (out of 100 maximum). J o u r n a l P r e -p r o o f Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Japan Decreased Influenza Incidence under COVID-19 Control Measures Clinical Characteristics of Coronavirus Disease 2019 in China Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing Taiwan marks 50 days without new local coronavirus case, only 9 still undergoing treatment Real-Time Surveillance of Infectious Diseases: Taiwan's Experience. Health Secur The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model We are extremely thankful to the Centers for Disease Control for providing the online statistics system downloadable for research purposes. We are thankful to Ministry of Science and Technology (MOST) and Taipei Medical University and Wanfang Hospital, Taiwan for providing the necessary funding to carry out this research work. J o u r n a l P r e -p r o o f Supplementary information: Definition of Severe Complicated Influenza 1. Clinical criteria Patient with complications (e.g. lung complications, neural system complications, myocarditis or pericarditis) within two weeks after the onset of flu-like symptoms and is required of ICU care or deceased. Patient with any of the following conditions: (1) Influenza virus detected from respiratory tract clinical specimens.(2) Molecular nucleic acid test conducted on clinical specimen and proved positive. 3. Epidemiological criteria Subject had close contact with confirmed cases (e.g. providing daily care, living together, has direct contact with patient's respiratory tracts or body fluids). Those who fits clinical criteria. (1) Possible case Those who fits clinical criteria.(2) Highly possible case Those who fits both clinical criteria and epidemiological criteria.(3) Confirmed case Those who fits both clinical criteria and screening criteria.