key: cord-1020070-b6mc1fnr
authors: Jian, Shu-Wan; Kao, Chien-Tse; Chang, Yi-Chia; Chen, Pi-Fang; Liu, Ding-Ping
title: Risk Assessment for COVID-19 Pandemic in Taiwan
date: 2021-01-21
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2021.01.042
sha: b7cc86d5da15c50ee990098ede8e7076cd6d6176
doc_id: 1020070
cord_uid: b6mc1fnr

Background and objectives Event-based surveillance and rapid risk assessment for acute public health events are essential in emerging infectious disease control. Since detecting the unusual signal in Wuhan in December 2019, Taiwan has been aligning risk management to policy planning via conducting regular risk assessments to combat the coronavirus disease 2019 (COVID-19). This article aims to provide some insights into Taiwan’s experiences and corresponding actions for the outbreak. Results The COVID-19 risk level in Taiwan was raised to “moderate-to-high” in mid-January 2020 when neighboring countries had reported cases and the human-to-human transmission became obvious. The risk level became “high” on 24 January due to China’s escalating epidemic situation and imposed a lockdown in Wuhan. We learned that the commander recognized the importance of risk assessments and considered advice from the experts was crucial in making the correct decision at the early stage of the crisis. Conclusions Given the surge of COVID-19 cases globally, understanding the evidence-driven mobilizations via detailed risk assessments in Taiwan may be an example worth considering for other countries. We believe that strengthening a global epidemic intelligence network and sharing information timely and transparently are essential for confronting new challenges of COVID-19 and other emerging infectious diseases.

The coronavirus disease 2019 (COVID-19) pandemic significantly impacted the global J o u r n a l P r e -p r o o f health and economy. By 7 December 2020, there were more than 66 million people confirmed with COVID-19 globally (World Health Organisation, 2020). Taiwan was expected to be one of the most affected countries due to its close relationship with China, both geographically and economically (Robert Koch Institute, 2020). Learning from the Severe Acute Respiratory Syndrome (SARS) outbreak, extensive public health infrastructure has been established in Taiwan. With early detection of the outbreak in Wuhan via the event-based surveillance (EBS) system, followed by the rapid risk assessment and management, Taiwan could respond to COVID-19 early and avoid national lockdown in the following months. This article aims to provide some insight into Taiwan's epidemic intelligence and risk assessment for the COVID-19 pandemic and how they resulted in proactive risk management.

Taiwan Centers for Disease Control (Taiwan CDC) adopted both manual screening and real-time public opinion monitoring system (i.e. InfoMiner.io) to monitor international and domestic epidemic news worldwide at the country level and generate alerts when acute public health events were detected. All relevant information and data detected by the EBS system were gathered from international organizations, government official websites, scientific journals, news, social media, and internet bulletin board from both domestic and international sources. Considering Taiwan's proximity to China and previous epidemics in China, the EBS for China has been implemented particularly at provincial and city levels. In addition, Taiwan CDC used the risk assessment protocol published by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) as a guide to perform daily risk assessments J o u r n a l P r e -p r o o f in response to the COVID-19 outbreak (World Health Organisation, 2012, European Centre for Disease Prevention and Control, 2019). After filtration and validation of the information, risk assessment was divided into three qualitative aspects: risk of disease importation, risk of community outbreak, and impact on the country. Each aspect was given a low, moderate, or high risk level, and an overall risk level was assigned at the end. Political, economic, social and other factors were also considered in the context analysis. Based on the risk level and context analysis, Taiwan CDC would then devise appropriate responses against the outbreak and discuss with major decision-makers.

Since 18 January 2020, Taiwan CDC conducted daily risk assessments on each province of China based on the following factors: the outbreak magnitude, number of Taiwanese residents, numbers of direct flights to Taiwan, number of confirmed cases, case fatality, number of exported cases to other province(s), status of cluster infection, generation of disease transmission, and weekly traffic volume to-and-from each major city (Bogoch et al., 2020) . A level-one epidemic area defines an area with confirmed cases of unknown source and disease exportation to other provinces, implying a sustained community transmission. A level-two epidemic area defines an area with third generation cases, over 400 confirmed cases, or rapid increase in the case volume (eg. doubled case volume from the previous day), implying community outbreak.

Based on the international situation and the understanding of disease transmission, the Central Epidemic Command Center (CECC) has applied scientific approaches to lift border controls gradually since 22 June 2020. Short-term business travellers who arrived from low-and low-intermediate risk countries with no travel history in the past 14 days prior to entering Taiwan were allowed for entry and shortened home quarantine period. Countries with less than ten daily new COVID-19 cases and less than one average daily new COVID-19 cases per 1,000,000 in the past 14 days were listed as 

The risk level from 24 January 2020 onward: High Ever since Shenzhen and Shanghai cities reported their suspected cases on 18 January, Taiwan CDC commenced daily risk assessment on each province of China. As China's epidemic situation was escalating exponentially and Wuhan city officials prohibited all transports in and out of the city on 23 January, Taiwan CDC raised the risk level to 

Since mid-June, Taiwan has re-opened its border for essential travels and conducted 

During the COVID-19 pandemic, early recognition via the EBS systems and conduction of risk assessment formed the basis of risk identification and management in Taiwan. Importantly, they were used as strong references and prompt decisions were made accordingly. The painful lessons from the past epidemics paved the way for Taiwan's containment of COVID-19. As the COVID-19 pandemic has persisted for more than half a year, a delicate balance between reviving the economy and keeping stringent border control is a crucial task for every country. We share our experience at the early stage of the pandemic and during de-escalation, with a view of hoping that information sharing and international collaboration could be reinforced in confronting new challenges of COVID-19 and other emerging infectious diseases in the future. J o u r n a l P r e -p r o o f

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Ministry of Finance stressed that there is currently no outbreak. Surveillance measures for the disease control and prevention. Found early, early treatment)

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武汉不明原因肺炎患者转传染病医院，市场 附近有居民感染 (Patients with unexplained pneumonia in Wuhan were transferred to infectious disease hospitals, and residents near the market were infected

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Wuhan Municipal Health Commission (WJW)

武汉市卫健委关于不明原因 的病毒性肺炎情况通报. (The Wuhan Municipal Health Commission reported on viral pneumonia of unknown cause