COVID-19 pandemic in Taiwan
The COVID-19 pandemic in Taiwan was a part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of 19 March 2023[update] in Taiwan, 10,231,343 are confirmed cases, including 18,775 deaths.[1]
| COVID-19 pandemic in Taiwan | |
|---|---|
Confirmed cases per 100,000 residents by subdivision | |
Confirmed cases per 100,000 residents by township | |
| Disease | COVID-19 |
| Virus strain | SARS-CoV-2 |
| Location | Taiwan |
| First outbreak | Wuhan, Hubei, China |
| Index case | Taoyuan International Airport |
| Arrival date | 21 January 2020 (3 years and 4 months) |
| Confirmed cases | 10,239,998 (25 April 2023)[1][2][3] |
| Recovered | 10,220,993[4] |
Deaths | 19,005 (25 April 2023)[1][2][3] |
| Fatality rate | 0.186% |
| Vaccinations | |
| Government website | |
| Taiwan Centers for Disease Control | |
The virus was confirmed to have spread to Taiwan on 21 January 2020, with the first case being a 50-year-old woman who had been teaching in Wuhan, China.[6] The Taiwanese government integrated data from the national health care system, immigration, and customs authorities to aid in the identification and response to the virus. Government efforts are coordinated through the National Health Command Center (NHCC) of the Taiwan Centers for Disease Control, established to aid in disaster management for epidemics following the 2003 SARS outbreak.[7][8] The Journal of the American Medical Association says Taiwan engaged in 124 discrete action items to prevent the spread of the disease, including early screening of flights from Mainland China and the tracking of individual cases.[9][10]
Starting 19 March 2020, foreign nationals were barred from entering Taiwan with some exceptions such as those carrying out the remainder of business contracts and those holding valid Alien Resident Certificates, diplomatic credentials, or other official documentation and special permits.[11] Restrictions have since been relaxed for foreign university students and those seeking medical treatment in Taiwan, subject to prior government approval.[12][13] All who are admitted into the country must complete a fourteen-day quarantine upon arrival, except for business travelers from countries determined to be at low or moderate risk, who are subject to five- or seven-day quarantines and must submit to a COVID-19 test.[14][15]
In response to the worldwide spike in cases in October and November 2020, Taiwan announced that all travelers to and transiting through Taiwan, regardless of nationality, origin, or purpose, must submit a negative COVID-19 test performed within three working days of arrival.[16][17][18][19] Exceptions are granted to travelers responding to family emergencies or arriving from countries where on-demand or self-paid tests are unavailable, but they are required to be seated apart from other passengers and take a self-paid test immediately on arrival in Taiwan.[20]
In 2020, the pandemic had a smaller impact in Taiwan than in most other industrialized countries, with a total of seven deaths.[21][22] The number of active cases in this first wave peaked on 6 April 2020 at 307 cases, the overwhelming majority of which were imported.[23] Taiwan's handling of the outbreak has received international praise for its effectiveness in quarantining people.[10][24][25]
However, an outbreak among Taiwanese crew members of the state-owned China Airlines in late April 2021 led to a sharp surge in cases, mainly in the Greater Taipei area, from mid May. In response, the closure of all schools in the area from kindergarten to high schools was mandated for two weeks, and national borders were closed for at least a month to those without a residence permit, among other measures.[26] In addition to a low testing rate and the recent shortening of the quarantine period for pilots to just three days,[27] Taiwanese medical experts said that they had expected the flare-up due to the emergence of more transmissible variants of the coronavirus (the Alpha variant was found in many of those linked to the China Airlines cluster[27]), combined with the slow progress of Taiwan's vaccination campaign. Critics linked the latter issue to several factors, including Taiwan's strategy of focusing on its own vaccine development and production, making it less ready to quickly buy overseas vaccines once those became available; and hesitation among residents to get vaccinated due to previously low case numbers.[28] Additionally, heavy reporting on rare side effects of the AstraZeneca vaccine was believed to have played a role. Demand for vaccines greatly increased, however, with the surge in cases from May 2021.[29]
Timeline
As of 19 March 2023[update], there are 10,231,343 confirmed cases in Taiwan, including 18,775 deaths.[33]
2020
Q1
On 21 January, the first case in Taiwan was confirmed in a 50-year-old woman who had just returned to Taoyuan International Airport from her teaching job in Wuhan.[6][34] She self-reported on her own initiative and was hospitalized without formal domestic entry.[34] The first domestic case was diagnosed in Taiwan on 28 January. A man in his 50s was believed to have acquired the disease from his wife, who had traveled to Wuhan and was confirmed before him.[35] Among the first confirmed cases was a Taiwanese man in his 50s who was fined NT$300,000 for failure to report his symptoms and attempting to conceal his subsequent activities, leading to a potential contamination incident at a ballroom in Kaohsiung.[36]
The first death in Taiwan was confirmed on 16 February, involving a man in his 60s who had both Hepatitis B and diabetes. His was the fifth death in the world outside mainland China.[37] A woman in Taiwan was reported to have tested positive for novel coronavirus on 19 February 2020, though she had not traveled outside of Taiwan for two years.[38] Five new cases of COVID-19 were reported in Taiwan on 29 February 2020, four of which marked the first transmission of the disease in a hospital setting.[39] Taiwan's fiftieth case of coronavirus was confirmed on 13 March 2020, an American expatriate who hosted four United States citizens at his home in Taiwan.[40] The next day, three new cases of coronavirus were confirmed to have been imported from Europe.[41] A Taiwanese national aboard the Diamond Princess tested positive on 6 February.[42] As of 19 February, five Taiwanese nationals aboard the ship tested positive.[43] Two Taiwanese who fell ill on the Diamond Princess were discharged from Japanese hospitals in February 2020.[44] The nineteen other Taiwanese passengers on the Diamond Princess were quarantined in Taiwan until 7 March 2020. All tested negative for coronavirus and were released.[45] The index case for coronavirus in Taiwan recovered from the disease and was discharged from the hospital on 6 February 2020.[46] Approximately a week later, a second Taiwanese national, the tenth case of coronavirus, had also recovered.[47] Though community spread within the Taiwanese society did not necessarily break out, a hospital cluster was recorded after case 34. A female patient with diabetes and numerous cardiovascular diseases transmitted the virus to eight people contacted throughout February and March.[48] She later died due to heart failure on 30 March.[49]
On 15 March, Taiwan announced six new cases, all imported. Subsequently, Taiwan's health minister advised people to remain in Taiwan and avoid travel.[50] After discovering the mass imports of foreign cases, on 17 March, the CECC announced that it would trace the contacts of travelers that had arrived from Europe between 3 and 14 March.[51] On 20 March 2020, Taiwan reported 27 new cases, the highest single-day increase.[52] The second death linked to coronavirus in Taiwan was announced on 20 March and involved a man in his 80s who had no recent travel history, but did have hypertension, diabetes and relied on kidney dialysis.[53] The death of a guide who had led tours to Austria and the Czech Republic was reported on 29 March.[54] The next day, two Taiwanese nationals who had traveled to Spain were reported to have died of coronavirus.[55]
Q2
A Taiwanese man who had toured Egypt in March died of coronavirus on 9 April.[56] On 18 April 2020, three Republic of China Navy cadets were confirmed to have contracted coronavirus following a military operation in Palau.[57] Other personnel on the ship were confirmed to have contracted the disease as part of the first cluster to affect the Republic of China Armed Forces.[58] As more cases from that cluster were identified,[59][60][61][62][63][64][65][excessive citations] President Tsai Ing-wen asked the Ministry of National Defense to investigate the situation.[66] Defense Minister Yen Teh-fa said vice admiral Kao Chia-pin and rear admiral Chen Tao-hui had been removed from their posts as commander of Republic of China Naval Fleet Command and leader of the ROCN's Friendship Fleet, respectively.[67] On 30 April 2020, an employee of the Taipei Representative Office in France was confirmed to have fallen ill with coronavirus, becoming the first Taiwanese diplomat stationed overseas to contract the disease.[68][69]
On 10 May, Taiwan recorded 28 consecutive days or two cycles of the average incubation period of the virus without newly recorded domestic cases.[70] Therefore, the CECC deems the risk of being infected within Taiwan is low.[71] The death of a man who had visited the United States and contracted coronavirus was confirmed on 11 May.[72] On 26 May, Chang Shan-chwen announced an end to the Central Epidemic Command Center's investigation on COVID-19 cases from ROCS Panshih. The ship's index case was likely to have been infected in Taiwan. Though the probe closed without finding a more specific location, it did find that sailors were infected with a Southeast Asian strain present in the Philippines and that infections occurred in four waves, around 10 March 20 March, the beginning of April, and the middle of April.[73] On 30 May, a second member of Taiwan's diplomatic corps was confirmed to have contracted COVID-19 in Honduras.[74]
By 7 June, Taiwan had not reported local cases for over four incubation periods which is 56 days. As a result, Taiwan began lifting pandemic-related restrictions.[75] Starting 10 June, press briefings held by the Central Epidemic Command Center were scheduled weekly.[76] On 12 June, the Ministry of National Defense disclosed further conclusions regarding the ROCS Panshih cluster, attributing the cluster to substandard health testing. Subsequently, Chen Tao-hui and Kao Chia-pin returned to their posts.[77] The patient involved in the longest hospitalization in Taiwan due to COVID-19 spent 75 days in the hospital and was released in mid-June.[78]
On 24 June, the CECC announced that a Japanese university student who had returned to Japan on 20 June had been diagnosed with COVID-19 by Japanese health authorities.[79][80] Analysis of the student's test results led the CECC to conclude that she was a weak positive, although the agency did not rule out the possibility of infection in Taiwan or the potential for a false positive. The case was not added to Taiwan's total, as the student was not tested in Taiwan.[81][82] The CECC confirmed that the student did not spread COVID-19 to others during her stay in Taiwan.[83][84]
Q3
On 2 July, the Chinese Taipei Basketball Association announced that the 2020 William Jones Cup would not be held due to the pandemic. This was the third cancellation since the competition's founding in 1977. The tournament had been previously canceled in 1989 because of a fire in the host venue and again in 2003, during the SARS outbreak.[85]
Taiwan's annual public air raid drill was held on 14 July, albeit with significant changes. The thirty-minute drills typically require citizens to clear the streets and remain indoors until the drill concludes. On the advice of the CECC, however, the Ministry of National Defense did not restrict the movement of citizens to prevent the formation of crowds, especially in public transit stations.[86]
A case of COVID-19 that possibly originated in Taiwan was found by Thai health authorities on 25 July. A Thai migrant worker who had entered Taiwan on 17 January 2018 and returned to Thailand on 21 July 2020 and had not left Taiwan during that time frame tested positive for the virus while in quarantine. The CECC reported it had learned of the positive result on 27 July and immediately ordered workers who shared a company dormitory with the migrant worker to go into quarantine. By 28 July, the CECC identified 189 contacts to be tested for COVID-19. 18 people were placed in quarantine, including one in full hospital isolation due to having symptoms consistent with COVID-19.[87][88][89] The CECC also tested the contacts for COVID-19 antibodies to see if any of them had contracted and recovered from COVID-19 earlier,[90] but reported on 29 July that no positive cases nor antibodies were found.[91]
On 1 August, another possible domestically transmitted case was identified in a Belgian engineer who had worked in Taiwan for two months before his diagnosis. The CECC has identified 89 contacts to quarantine and test for COVID-19.[92] The CECC has not yet classified the case as imported or domestic because it described the test as a "weak positive" and has received test results for COVID-19 antibodies, suggesting the infection may already have passed. It is now testing his contacts to "more accurately" determine if it is more likely he acquired the infection before or after entering Taiwan.[93] On 4 August, it reported it was testing 441 possible contacts for COVID-19 antibodies.[94]
On 19 August, the CECC announced it was closing the investigations of four cases where COVID-19 had possibly been acquired in Taiwan. Two cases were regarded as solved: that of the Belgian engineer and that of a Vietnamese migrant worker. The CECC said the Belgian engineer had likely contracted the virus in Belgium several weeks before he entered Taiwan and had not been contagious during his stay. The Vietnamese migrant worker had likely been infected in a quarantine facility by his roommates shortly after returning to his home country. The other two cases' origins could not be identified, but tracing and testing of all four cases' contacts in Taiwan failed to detect either active COVID-19 infections or antibodies that indicated past and resolved infections. As such, the CECC regarded the cases as closed.[95]
On 9 August, National Taiwan University announced that the preliminary results of a mass-testing study conducted by its College of Public Health in partnership with the government of Changhua County, located on the west coast of central Taiwan, had found COVID-19 antibodies in four target groups that included recovered patients, their close contacts, people who had been in home isolation or quarantine, and healthcare personnel in Changhua.[96] The CECC said the study might indicate that hidden domestic cases have occurred that may be the source of ten cases whose origins are unknown, but if so, they have not caused large community outbreaks. The study has tested 3,000 people out of a target of 10,000, and further results and analysis will be released on 25 August.[97]
However, the study came under fire from the CECC for discussing preliminary results before they had been peer-reviewed, which intensified when the results were delayed to allow them to be reviewed by six experts. Partial results were released on 27 August, which found COVID-19 antibodies in four out of 4,841 subjects. Full results will be released at a later date, but the study appears to indicate that any incidence of undiagnosed COVID-19 cases in the general Taiwanese population has been very low.[98][99]
Throughout September, the CECC announced that Taiwan had received notifications from Vietnam (2 September),[100] Japan,[101][102] the Philippines,[102] and China[103] that travelers that had recently arrived from Taiwan had tested positive for COVID-19 or its antibodies. Contact tracing and testing revealed no active cases or antibodies from past infections.
On 3 September, a pharmacist in New Taipei City found evidence that masks received from the government's face-mask rationing program, which is supposed to supply domestically made, medical-grade masks, were, in fact, non-medical-grade masks imported from China. The company, identified as Carry Masks, had apparently imported the masks from China, relabeled them as "made in Taiwan" and as medical-grade, and then distributed via the name-based rationing system.[104] The owner of Carry Masks, Lin Ming-chin, admitted the next day in comments to the press that the masks were imported from China. However, he claimed that they were not of an inferior grade and had been imported to meet the excessive demand placed on his company by the government's rationing system, which was denied by multiple government officials. It was also revealed that the government had caught Carry Masks importing masks in March 2020 and had confiscated the masks and fined the company, but did not inform the public at the time. One other company was also under investigation for importing masks.[105]
On 22 September, a Kaohsiung-based manufacturer was accused of adding new production equipment without notifying or gaining approval from the mask rationing program, raising questions on their origin and quality. On 24 September, further arrests were made in Taichung of individuals suspected of also importing non-medical grade masks from China, though these were not distributed via the mask rationing program.
In response to these criminal probes, the government mandated that all masks distributed by the National Health Insurance system would be imprinted with the letters MD for "Medical Device" and MIT for "Made in Taiwan" to help combat mask fraud and assure their quality.[106]
Q4
On 28 October, the CECC reported that one person had mistakenly been diagnosed with COVID-19 due to a mix-up of test samples taken upon arrival in Taiwan on 11 October. The patient, designated as Case 530, was initially diagnosed with COVID-19 and hospitalized, but a subsequent test showed no trace of the virus, prompting an investigation of all 30 individuals who had arrived at the same time. A DNA test of the sample proved that Case 530's sample had been misidentified for that of another patient, Case 536. Case 536 had mistakenly been allowed to return home for the mandatory 14-day quarantine period but was later correctly tested and diagnosed with COVID-19 on 16 October after developing symptoms. The error was apparently the result of incorrect manual operation of testing equipment, and the CECC implemented stronger "error-proofing mechanisms" to prevent misidentification of test samples and recommended an increase of personnel at ports of entry to prevent fatigue from causing more mistakes.[107][108]
On 29 October, Taiwan reported 200 days without local transmission of the coronavirus, becoming one of the only nations in the world to reach the milestone.[109]
On 9 November, it was announced Taiwan was not invited to an assembly of the World Health Assembly of the World Health Organization, despite the country's success in the COVID-19 pandemic and petitions in support of its inclusion by over 2,000 legislators and diplomats from over seventy countries worldwide. It was stated that mainland China had "obstructed" Taiwan from entering the meeting. However, the 14 countries that recognize Taiwan as a sovereign state may introduce Taiwan's membership for discussion at the meeting.[110][111]
On 18 November, the CECC announced three major measures in response to the arrival of winter, a worldwide rise in cases (which led to active cases, all imported from abroad, tripling from 33 on 1 November to 103 on 30 November), and an expected rise in passenger traffic for several holidays. The measures will take effect from 1 December through 28 February 2021. First, all travelers, regardless of nationality, origin, or purpose for traveling to or transiting through Taiwan, must submit proof of testing negative for COVID-19 within three working days of arrival, with exceptions made for travelers arriving from countries where on-demand or self-paid tests are not available or travelers responding to family emergencies. Such travelers must be seated in a dedicated separate section of the aircraft and take a test immediately on arrival in Taiwan.[20] Second, masks must be worn in high transmission risk areas, namely medical settings, public transportation, markets of any kind, educational institutions, entertainment venues, religious events, public events, and businesses, with the failure to do so subject to fines up to NT$15,000 (US$490). Third, it asked all medical institutions and local governments to step up screening measures for symptoms of COVID-19 in patients, noting that a major goal was to prevent the healthcare system from facing the double burden of seasonal influenza combined with an outbreak of COVID-19, as seen in other countries.[16][17][112]
A spike in imported COVID-19 cases among Indonesian migrant workers began on approximately 27 November but extended into December, prompting the CECC to suspend all migrant workers arriving from Indonesia from 4–17 December.[113] Taiwan also banned eight Indonesian manpower agencies from operating in the country due to a large number of infected personnel they had sent to Taiwan.[114] After bilateral talks between the two nations, Indonesia's Agency for the Protection of Indonesian Migrant Workers announced that it would investigate manpower agencies to help ensure none were negligent in observing health measures.[115]
On 16 December, the CECC announced it was "indefinitely" suspending the entry of Indonesian migrant workers.[116]
Two migrant workers were diagnosed after they had been released from quarantine and had shared a crowded open dormitory. There was a possibility that one had infected the other at that time, but the CECC announced it had determined that both workers were infected prior to arrival in Taiwan. However, in response to the risks posed by open dormitories, which are commonly used to house migrant workers across Taiwan while waiting to complete mandatory health checks unrelated to COVID-19, it issued new regulations requiring migrant workers to either stay in individual rooms or in dormitories with social distancing and sanitization measures for at least seven days after being released from quarantine.[117] In addition, all migrant workers, with the exception of those originating in Malaysia, will be tested for COVID-19 at the end of their 14-day quarantine, with the cost of the test itself covered by the CECC and transportation costs to be covered by employers and labor brokers.[118]
On 22 December, a contact of a New Zealand pilot working for EVA Air who flew into Taiwan on 4 December was diagnosed with COVID-19, marking the first local transmission since April 2020. Local authorities stated they would fine the man NTD$300,000 (US$10,563) for not recording all the contacts and places he had visited and not wearing a face mask.[119][120]
2021
Q1
On 1 January 2021, new, stricter quarantine rules went into effect. Foreign flight crew were required to quarantine for seven days, and all entries must quarantine alone. Transit passengers are banned, as are most foreign entries.[121]
A domestic infection cluster was identified beginning 11 January at a hospital in northern Taiwan. Taiwanese media reported on 12 January that a mass evacuation of patients had begun and that the hospital had told local first responders to take emergency patients elsewhere.[122] Later that day, the CECC confirmed that a doctor involved in treating COVID-19 patients had contracted the virus, making him the first medical professional in Taiwan to become infected in the course of their duties. At that time it was reported he had also infected his girlfriend, a nurse at the same hospital who did not treat COVID-19 patients.[123]
On 16 and 17 January, another nurse and doctor, respectively, at the same hospital were confirmed to be infected. They had come into contact with the first doctor. All the new cases' movements have been documented and publicized, with some sites around Taoyuan City undergoing disinfection after cases were confirmed to have visited them.[124]
Health and Welfare Minister and head of the CECC, Chen Shih-chung, was criticized for not naming the hospital in question, which he explained was out of concern of possible ostracization of hospital staff and patients. Depending on the level of contact with the infected doctors and nurses, their families, coworkers, and patients have been told whether to quarantine at home, monitor their own health, or continue as normal, and those with closest contact have been tested, some multiple times. As of 14 January, it was not deemed necessary to identify the hospital.[125] However, on 18 January, he accidentally revealed to a reporter that the outbreak was occurring at Taoyuan General Hospital, and it has been generally acknowledged as such in the press since.[126]
As of 23 January the cluster had expanded to thirteen people involving 2 doctors, 4 nurses (plus three of their family members), 1 caregiver, and 1 patient (plus two of his family members). 967 people had been identified by contact tracing as possibly exposed to the virus and placed in quarantine.[127]
The cluster has prompted several cities, organizations, and event planners to cancel or postpone various celebrations for the upcoming Lunar New Year and Lantern Festival, and the Taiwan Railway Administration announced several measures to help curb potential spread during the high traffic volumes typically seen during the holidays, including partitions in food court areas and more infrared temperature sensors to bolster those already in place at station entrances.[128][129][130]
On 24 January, two more cases in the hospital cluster were identified, bringing the total to fifteen. However, neither had contact with the other cases during their treatment, and the circumstances of their infection remain unknown.[131] In response, all inpatients present at Taoyuan General Hospital between 6 and 19 January, plus their close contacts, were required to go into 14-day quarantine. If fourteen days had already elapsed as of 24 January, they are required to adhere to self-health management protocols for seven days, such as recording their body temperature twice a day and avoiding all unnecessary travel.[132]
On 30 January, four more cases related to the cluster were diagnosed, bringing the total to nineteen, and among them was Taiwan's eighth death since the pandemic began, a relative of one of the infected nurses who was in her 80s and had diabetes, high blood pressure, and heart problems. As a close contact of a confirmed case, she had been in home isolation since 18 January.[133] She developed COVID-19 symptoms on 28 January and was diagnosed shortly before she died the night of 29 January. She was Taiwan's first COVID-19-related death since 11 May 2020.[134] Two of the other cases were also relatives of the nurse. The fourth domestic case was a man who visited his mother while she was being treated at another hospital in the Taoyuan area. He came into contact with an infected person who had been treated at Taoyuan General Hospital and was seeking medical attention again at another location.[135]
On 4 February, the CECC announced the death of the ninth person with COVID-19 in Taiwan the night before on 3 February. The deceased was a British national in his 70s who had come to visit family, developed symptoms in quarantine, and was admitted to a hospital on 29 December. He eventually developed several complications and died due in part to his age and cardiovascular disease. He was the first foreign national to die of COVID-19 in Taiwan.[136]
On 5 and 9 February two more domestic cases were identified, both of whom were family members of previously diagnosed nurses in the Taoyuan General Hospital cluster. The number of infected in the cluster stood at twenty-one as of 9 February. However, since the new cases had already been identified as close contacts of previous cases, they had been in quarantine for several days or weeks before they were diagnosed, and thus presented little risk of spreading the disease further.[137][138]
On 15 February, Health Minister Chen declared that the cluster had been successfully capped at twenty-one cases and one death.[139] Taoyuan General Hospital reopened at reduced capacity on 19 February, and plans were announced to upgrade its COVID-19 wards to specialize in patients in serious condition from the virus, as well as gradually increase admittance to full capacity after several reviews of its readiness.[140]
Q2
On 23 April, Taiwan confirmed its first locally transmitted case of COVID-19 since 9 February. The patient is the teenage son of an Indonesian airline pilot for China Airlines living in Taiwan. The pilot was diagnosed in Australia after flying a cargo flight from Taiwan and experiencing symptoms, prompting Taiwanese health authorities to begin contact tracing. The pilot may have been infected by a coworker, also a pilot, who was recently in the United States. The three attended a religious service at the Taipei Grand Mosque on 16 April. It is still unclear whether this indicates a cluster infection, as the investigation is on-going.[141] The cluster of infections eventually grew to over 30 cases.[142]
On 24 April, Taiwan reported its twelfth COVID-19-related death. The deceased was a Taiwanese national in his seventies returning from the Philippines. He was staying at a quarantine hospital when he reported having no appetite on 19 April and was given a medical examination which found no other symptoms of COVID-19, so he returned to the hotel. On 21 April he was found in his room by hotel staff with no heartbeat. A post-mortem test revealed he was infected with the virus at the time of his death.[143]
From mid May, Taiwan saw a surge in cases, which had been anticipated by experts due to the combined effect of the emergence of more transmissible variants of the coronavirus, and a low proportion of vaccinated residents (about 1 per cent,[28] or even lower, making it the least vaccinated population in Asia[144]). The low vaccination rate was ascribed to a combination of supply issues with vaccines purchased overseas, and a complacency in the population due to previously low case numbers.[28][144]
As confirmed by the government on 13 May through genetic analysis, the outbreak arose from a cluster of cases among China Airlines pilots that had developed since late April.[145] The pilots had been staying at a hotel at Taoyuan International Airport which, in violation of COVID-19 rules, had also housed non-quarantine guests.[29] The hotel was evacuated from 29 April and sterilized.[146] The cluster eventually grew to include at least a dozen pilots, several of their family members, at least one flight attendant, and cases at hostess bars in Wanhua District. Reluctance to disclose recent visits to the area proved to be a hindrance in contact tracing.[144][29] Many of the cases were found to belong to the more transmissible Alpha variant of the coronavirus.[27]
Health Minister Chen Shih-chung announced on 10 May that all China Airlines pilots currently in Taiwan, or returning to Taiwan, would be subject to quarantine for 14 days.[147] Seven new local cases were reported on 11 May, and 16 such cases – a record high in the pandemic – on 12 May.[142] President Tsai Ing-wen urged people not to panic.[142] On 14 May, with 29 new community transmission cases reported nationwide, business closures in Taipei and other northern counties were announced by local governments, to take effect the following day. Rapid testing stations were set up in Wanhua District, to which 16 of these cases were linked; this was a first in Taiwan during the pandemic.[148] After 180 new domestic infections were reported on 15 May,[149] the alert level was raised to three in the four-tier system in the Taipei area, which entailed shutting cinemas and entertainment spots, limiting gatherings to five indoors and 10 outdoors, making it mandatory for people to wear masks at all times when outside,[150] and an encouragement by the government to work and study from home. The new restrictions did not affect the high-tech manufacturing hub in Hsinchu County.[151]
On 17 May, 333 new cases were reported, of which 306 originated in the Greater Taipei area. All schools below university level in the area were closed from 18 May until prospectively 28 May. Non-residents and transit passengers were banned from entering Taiwan for a month, with exceptions allowed for humanitarian reasons.[152] Passenger numbers on the Taipei Metro during morning peak hours dropped by over 40 per cent.[153] Taipei Metro operator TRTC halved the disinfection times of stations and trains to two and four hours, respectively.[154]
On 18 May, Chen announced that 37 cases among students from kindergarten to university level had been reported from throughout the country the previous day; the CECC announced that all schools would suspend face-to-face classes until 28 May.[155]
On 19 May, the alert level throughout the country was raised to level three in the four-tier system.[150]
On 3 June, Chen said that while "[t]here's no cause for optimism" regarding the trend of infections, it would be premature to talk about raising the alert level and implementing a full lockdown. He urged citizens to refrain from family related travel for the upcoming Dragon Boat Festival wherever possible.[156]
On 5 and 6 June, the chip testing and packaging company King Yuan Electronics Co (KYEC) shut down its main plant in Miaoli County and resumed its operations afterwards with local staff at lower-than-normal production volumes. Over 2,000 KYEC's overseas workers were placed into 14-day quarantine by the government.[157] A large part of the at least 206 cases up to 7 June had been among foreign workers.[158] Local media raised concerns that the cluster of infections could exacerbate the chip shortage worldwide, which had led to Taiwan's semiconductor industry to operate at maximum capacity.[158]
On 7 June, the nationwide level three alert was extended until 28 June.[159] On 24 June, it was further extended to 12 July.[160]
On 21 June, as new case numbers dropped below 100 for the first time since mid-May, President Tsai said that Taiwan had been "somewhat caught off guard" at the outset of the rise in cases, and that a "thorough review" of the epidemic prevention system should be carried out after the pandemic was over. The opposition had sharply criticized Tsai's government for what it considered a lack of preparedness.[161]
On 26 June, Health Minister Chen Shih-chung said that six people in Pingtung County had been confirmed as having the Delta variant, among which one case had been classified as domestically transmitted. It was suspected that two of the cases had become infected in Peru, from where they had returned.[162] Measures taken by the Pingtung County Government included a lockdown of Fenggang and Shanyu villages in Fangshan, Pingtung, ordered by county magistrate Pan Men-an, before test results were announced.[163]
Q3
On 3 July, the CECC announced that the outbreak of the Delta variant in Pingtung County appeared to have been contained, with all contacts having been identified. No cases were reported on that day from that county.[164]
On 17 July, the number of new domestic cases dropped to single digits, with eight new domestic cases, for the first time since 11 May.[165] On 23 July, premier Su Tseng-chang said that, in view of the domestic COVID-19 situation having "gradually stabilized", the alert level would be decreased again to level 2 from 27 July. The relaxed restrictions allow gatherings of up to 50 people indoors and 100 outdoors. Su reminded the public to continue to adhere to pandemic prevention guidance in order to "guard this hard-earned achievement".[166]
Q4
In the first local case of COVID-19 in more than a month, a female laboratory worker in her 20s at the Academica Sinica research institute tested positive on 9 December. Authorities suspected the source of the infection to be a mouse bite which occurred in November, but said that the case required further investigation. The building where the woman had worked was closed for three days.[167][168] It later emerged that the worker had previously reported an additional bite in October. The investigations found the strain of the virus to be the same as that present elsewhere in the laboratory, suggesting a cross-contamination had led to the infection; a mouse bite as source of the infection was deemed "unlikely".[169]
2022
After months without domestic transmission, a cluster which started at Taoyuan Airport, the country's main international airport, in January 2022 resulted in an uptick of cases, which included community cases. In response, restrictions were re-tightened in Taoyuan and nearby areas and mandatory outdoor masking was reintroduced nationwide.[170][171]
On 8 April 2022, Taiwan officially replaced its zero COVID-19 policy with the "new Taiwanese model".[172] Health and welfare minister Chen Shih-chung (陳時中) said that an immediate suspension of contract tracing would apply to travelers who tested positive in Taiwan, either on arrival or during quarantine, in order to free up resources to monitor the growing number of domestic cases.[173] He stressed that despite the spike, the number is low compared to other countries such as South Korea, and later added that Taiwan ordered an additional 700,000 courses of Pfizer's Paxlovid beyond the 20,000 that it had placed previously. Mandatory mask wearing is still in place however.[174]
Preventive measures
Before first case reported
On 31 December 2019, Taiwan Centers for Disease Control (CDC) implemented inspection measures for inbound flights from Wuhan, China in response to reports of an unidentified outbreak.[175] The passengers of all such flights were inspected by health officials before disembarking.[175] Taiwan's Central News Agency reported that Luo Yi-jun, deputy director for Taiwan's Centers for Disease Control, had been reading on PTT in the early hours of New Year's Eve when a thread about an unknown disease causing pneumonia in Wuhan caught his attention. He saw a post including screenshots from a group chat with Li Wenliang. He immediately emailed colleagues and put the country on alert.[176][177]
A six-year-old passenger who arrived in Taiwan on 31 December after transferring in Wuhan and developed a fever was closely monitored by the CDC.[178] At this time, there were 27 reported cases of the new pneumonia in Wuhan.[178]
By 5 January 2020, the Taiwan CDC began monitoring all individuals who had traveled to Wuhan within fourteen days and exhibited a fever or symptoms of upper respiratory tract infections. Said people were screened for 26 known pathogens, including SARS and Middle East respiratory syndrome; those testing positive were quarantined.[7]
On 20 January, the government deemed the risk posed by the outbreak sufficient to activate the Central Epidemic Command Center (CECC).[179][180][181] Originally established as a level 3 government entity,[180] the CECC was promoted to level 1 on 28 February.[182] The CECC has coordinated government responses across areas including logistics for citizens on the Diamond Princess, disinfection of public spaces around schools, and providing briefings with Chen Shih-chung, the Minister of Health and Welfare.[7]