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CDC lunch on dealing with Covid-19



The ECCT, in conjunction with ICRT, hosted a lunch on the topic "Dealing with the coronavirus outbreak - Precautions and contingencies for business". The event featured guest speakers Dr Chen Yee-chun, Professor of Medicine at the National Taiwan University College of Medicine and Dr Angela Huang (Song-en), Medical Officer, at the Taiwan Centers for Disease Control (CDC).

In her presentation, Dr Chen made the point that hospitals are also businesses that need to have contingency plans and that Taiwan has been preparing for the possible outbreak of an influenza pandemic for years.

While medical professionals have known about coronaviruses for years, before Covid-19, they did not pay much attention to them because they were mostly confined to animal species.

Just yesterday, 11 March, the WHO declared Covid-19 as a pandemic, the first pandemic caused by a coronavirus. In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled. As of yesterday, there were more than 118,000 cases in 114 countries, and 4,291 people have lost their lives.

Chen pointed out that these are just reported cases and one should be aware of countries that have reported few or no cases, which may be because of a lack of testing, not good controls.

Taiwan's containment measures have been effective so far.

Critical factors that determine the effect of an epidemic are transmissibility, severity, preventability and treatability. The transmissibility of Covid-19 is higher than that of SARS, MERS and pH1N1 influenza. It is impossible to know what will happen this early on as to how severe the pandemic will be. The scope, morbidity, and mortality will depend on the combination of severity and transmissibility. Chen's advice is that is that we should pay attention but not panic.

She made the point that even if just 1% of the population of any given country becomes infected it will create a huge burden for the healthcare system, as has been seen in China and more recently in Italy and Iran. And, of course, the impact on the economy will be significant, given that supply chains have become so complex due to globalisation.

While we learn more about Covid-19 every day, we still don't know the exact cause, transmission route and what treatment to use. What we do know is that that it may be transmitted from its natural reservoir to a susceptible host in different ways including direct contact, through droplets, or by touching surfaces that have been touched by infected patients.

As to why only a few people become infected, the answer is not definitive but it is likely to depend on the balance between the pathogen, the environment and the host, that is, the amount of pathogen a person is exposed to, the health of the person and the environment. For example, places with poor air flow are high risk areas for spreading the virus.

The WHO has stressed that describing the situation as a pandemic does not change the WHO's assessment of the threat posed by this virus. It doesn't change what the WHO is doing, and it doesn't change what countries should do. The WHO maintains that all countries can still change the course of this pandemic if they act decisively to detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission. According to the WHO, even those countries with community transmission or large clusters can turn the tide on this virus and several countries have demonstrated that the virus can be suppressed and controlled.

Timing is critical in the fight to contain infectious diseases. Taiwan has made every effort to contain the virus until now. According to Chen, the most important objective during the first phase is to try to prevent incoming cases from abroad in order to give local healthcare authorities time to prepare. The second objective should be to lower the peak number of cases. Success in the first stage requires proactive action early.

According to the WHO, the challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same as those who have succeeded in controlling the spread but whether they will. Some countries are struggling with a lack of capacity. Some countries are struggling with a lack of resources while some countries are struggling with a lack of resolve. These measures are taking a heavy toll on societies and economies.

All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights.

According to Chen, a key issue for epidemiologists is helping policy makers decide the main objectives of mitigation, for example, minimising morbidity and associated mortality, avoiding an epidemic peak that overwhelms health-care services, keeping the effects on the economy within manageable levels, and flattening the epidemic curve to wait for vaccine development and manufacture on scale and antiviral drug therapies. Such mitigation objectives are difficult to achieve by the same interventions, so choices must be made about priorities.

In terms of precautions and measures companies should take to safeguard their employees, they should adopt: infection prevention and control measures, implement social distancing measures, travel-related restrictions, entry screening of travellers, environmental cleaning and ventilation decontamination, flexible working schedules/shifts for employees, distance working/teleworking, physical distancing measures, the use of email and teleconferences to reduce close contacts, flexible leave policies, promote hand hygiene, cough etiquette and the use of face masks.

On the subject of face masks, Chen noted that there is no evidence on the usefulness of face masks worn by persons who are not ill and therefore this is not advisable. It is possible that the use of facemasks may even increase the risk of infection due to a false sense of security and increased contact between hands, mouth and eyes. However, she added that we cannot guarantee any given environment is sterile even if it is cleaned regularly and that in some crowded areas the government is asking people to wear masks.

Chen concluded that countries must take a whole-of-government, whole-of-society approach, built around a comprehensive strategy to prevent infections, save lives and minimize impact by preparing and being ready to detect, protect and treat, reduce transmission, innovate and learn.

In her presentation, Dr Huang noted that the number of confirmed cases has been falling in countries like China but rising in others, especially Europe and the Middle East.

Given the fact that the incubation period is about 14 days, it is sometimes difficult to determine where patients contracted the virus. For example, there were some confirmed cases of people who take only short overseas trips of 7-10 days, meaning it is possible that they may have contracted the virus before they left Taiwan.

Investigations revealed that many cases can be traced to people on cruise ships, in Asia and in Egypt.

On the question as to whether or not Taiwan is testing enough, the CDC website now shows how much testing it is doing, which Huang said was about 500-700 cases per day. The CDC is now also looking into whether or not they are testing the right people and considering expanding testing to include not just contacts of the contacts but also other people living in the communities of infected people to make sure that the virus has not spread further.

Since 20 January the CDC stepped up its vigilance and cross-ministerial collaboration on handling the virus. The first imported case in Taiwan was confirmed on 21 January. Efforts were further increased with the setting up of the National Health Command Center on 23 January, when all flights from Wuhan were halted and quarantine measures were revised. Shortly afterwards authorities negotiated increased production, banned exportation, and implemented name-based sale of surgical masks.

In terms of disease containment and surveillance efforts, authorities then began testing and isolation of patients with symptoms compatible with disease who also had travel history, the quarantine of persons with travel history to affected areas, monitoring and expanding high risk areas, expansion of testing by changing case definitions, testing of patients reported to have influenza with severe complications but tested negative for influenza.

Following WHO guidelines, authorities are now combining containment and mitigation efforts such as suspending classes, designating hospitals for isolation, updating quarantine measures.

In the Q&A session, Huang noted that people who have been in contact with infected people should be quarantined. However, people should not worry about contacts of contacts.

For businesses, Huang advised employees to stay at stay at home if they are sick, postpone or cancel travel plans, use more video conferencing and consider postponing or cancelling large events.

As to the holding of events, Dr Huang said companies should monitor the situation which is evolving on a day to day basis by checking the CDC website. She also advised having contingency plans for all events and cancelling or delaying travel plans.

On the question of vaccines, Dr Chen said at least two research teams are working on vaccine development. However, the process is technically very complicated and will take time.

On a question about whether or not it is safe to use the MRT, Dr Huang said that she used the MRT herself and feels safe because, while she does not wear a mask on the MRT, almost everyone else does. However, she urged people, if they're sick, to stay at home and not use public transport. Dr Chen agreed that the chances of getting infected when most people are wearing masks are low. People can lower the risk even further by avoiding touching surfaces in public spaces and washing their hands as soon as possible after having done so.

On a question as to whether or not one should see a doctor, Dr Huang said that it is up to the individual with just mild symptoms. However, she stressed that if you have respiratory symptoms you should see a doctor right away, although you should not use public transport to get there. Dr Chen added that if you have travelled overseas and have a fever or a cough, you should visit one of several dedicated clinics assigned exclusively to coronavirus screening without delay. Bookings can be done online and the process takes just 30 minutes.