The coronavirus pandemic could have been contained if the authorities in Wuhan had notified the World Health Organization earlier and allowed an expert team to investigate in December 2019, according to Chen Chien-jen, Taiwan’s former vice-president, a renowned epidemiologist and health minister who made his name during the SARS [Severe Acute Respiratory Syndrome] outbreak nearly 20 years ago.
“Transparency and openness is very important for the containment of infectious diseases,” Chen told Al Jazeera in an interview. “If the situation in Wuhan was very well reported to the World Health Organisation and the WHO organised a team and went to Wuhan in mid-December 2019, I think the disease could have been contained and no other countries would have suffered.”
This week marks a year since the central Chinese city was sealed off and placed in a strict lockdown. A WHO team is now in Wuhan and is expected to begin on-the-ground investigations after completing a 14-day quarantine.
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More than 97 million people around the world have now been diagnosed with COVID-19 and more than two million have died, according to Johns Hopkins University.
Chen was Taiwan’s health minister during the SARS crisis and played a critical role in overhauling the island’s epidemic response system, which is credited with its relative success in keeping the coronavirus at bay.
Taiwan has so far seen just seven deaths and experienced an eight-month streak without a local infection for much of 2020, which ended in late December.
When will we see things return to normal?
Since the first round of vaccine has already been distributed in several countries – especially in North America and Europe – I think that it really depends on how fast the supply of the vaccine can be distributed around the world.
In Europe, I can see that if the vaccination programme is followed, maybe by June the situation in Europe will become so-called “normal”. But I always say we shouldn’t go back to old normal, we should establish a new normal – which means despite the fact that we have controlled the pandemic we should still keep vigilance on any emerging infectious diseases in the future.
What can you tell us about the new virus strain in the UK?
It is not unexpected.
SARS Coronavirus-2 [COVID-19] is an RNA [ribonucleic acid] virus and an RNA virus is quite likely to have a mutation. The reason COVID-19 virus has mutated so rapidly is [because] it spread very widely and passed through a lot of humans, so it was more likely to evolve into a highly infectious strain.
From a virus point of view, the best virus is highly infectious but less virulent. It won’t cause too many people to have a severe disease and then die. The SARS virus was very virulent. The case fatality was as high as 10 percent, and a lot of people infected with the SARS virus got very sick and had to go to the hospital to be isolated and treated there. Once they were isolated in the hospital, there was no way for [virus] to spread.
And that’s the reason why the SARS virus was contained.
I think for the UK strain, we have to be very careful because it’s highly contagious so we are competing for time between the vaccination and the rate of transmission. If the transmission goes much faster than the immunisation programme, then immunisation basically fails.
There are many different vaccines in the works but there has been a lot of scepticism about China’s vaccine. Can you explain why?
Usually, it would take 10 to 15 years for a company to develop a vaccine and get approval. This time you can see that in only nine to 10 months, we already have a vaccine and the reason for that is a lot of countries governments have a huge investment in vaccine development.
We can use RNA vaccines: Moderna, BioNTech, and Pfizer they are “messenger RNA vaccines.” Some companies are developing a DNA vaccine, and then there’s the protein subunit vaccine, like Medigen in Taiwan. There’s an adenovirus vaccine, that’s AstraZeneca and Oxford University and then there’s an inactivated vaccine and this is basically the Chinese vaccine. The Chinese vaccine companies manufacture a lot of inactivated vaccines.
The most important thing that no matter which platform you use, regulatory agencies are going to do a review. One important thing is transparency and openness. All companies have to publish all their clinical trial data to gain the public trust of the vaccine and that’s the reason why WHO has so far only approved Moderna and Pfizer-BioNTech. Even AstraZeneca has not yet received approval from WHO because they have to receive all of their research data and clinical trial data.
This is the reason why people might have some doubts on the Chinese vaccine, because we haven’t seen transparent information for the review. It will make people worry about efficacy and safety of the vaccine.
Taiwan has had one of the most successful strategies in dealing with COVID. Do you think some of this had to do with your speed and the fact you addressed it early?
We always keep a very vigilant surveillance of any pandemic in this region, because we had SARS, H5N1 from mainland China, and also African swine flu.
On December 31, 2019, one of our CDC officers went to the PTT [Bulletin Board System] and they saw messages about [an] atypical pneumonia in Wuhan. At that time there were only seven cases, but seven cases of atypical pneumonia is a big thing to us because atypical pneumonia equals SARS.
On the same day, we started on-board quarantine of passengers from Wuhan. By mid-February, we already had border control for passengers from China, Hong Kong and Macau.
In early January, we [also] started to name COVID-19 as a reportable disease. We mobilised more than 20,000 isolation rooms for patients and 12,000 ventilators for the possible demand of the emerging infectious disease.
After SARS, we also asked all the hospitals to have one month’s stock of PPE – personal protection equipment. When I was the health minister, I set up a national health command centre. Once there is an epidemic or pandemic, it is reactivated, so this had all been done in the first two weeks of January last year.
(It) is also very important is to gain the public trust and public support. We upgraded our command centre to cabinet level and then we held daily press conferences and we were quite open and we had transparent information about [our] operations.
So, prudent action, rapid response, early deployment, transparency and solidarity they are all very important, not only early detection.
Can you describe what SARS was like 20 years ago and what Taiwan learned from that experience?
At the very beginning, we had the first few cases of SARS, and at that time we felt quite confident because all the cases were taken care of in the medical centre and they had very good equipment and good knowledge and experience to take care of patients with emerging infectious diseases.
So, we considered, “Oh, we are quite good, we have no problem.” But when you face emerging infectious diseases, viruses respect no borders. If you are quite arrogant and you ignore them, then it is quite likely you will fail.
What we have been doing for COVID-19 is to follow our experience and the knowledge we learned from SARS.
Taiwan was not well-prepared for any pandemic challenge, so we started our transformation of the Taiwan CDC [Taiwan Centers for Disease Control], the Taiwan health Ministry, our Communicable Disease Control Act, our medical care system for infectious diseases, and set up our National Epidemic Health Command Centre.
After that we also had a challenge from mainland China from H5N1 avian flu and the H1N1 pandemic in 2009-2010. The Taiwan people and the Taiwan government learned a lot from previous challenges.
How does China’s response to COVID-19 compare with SARS?
I was surprised by Wuhan.
Originally, we thought Wuhan’s practice [must be] quite good because China was the most severely affected country by SARS. People there should have learned a lot. But when we sent two experts to Wuhan – we requested to go on January 6 and they allowed our experts to go there on January 11 – and they asked questions: “These are the patients hospitalised, and how about their close contacts? How about their family members, their colleagues at work or their students in school?” And they said, “No, they [the contacts] don’t have any pneumonia so they are not taken care of.”
After they came back, we said, “Oh my god. It’s really bad.”
The reason for that is for any kind of pandemic, treatment is good for the patient but treatment is not good enough for the containment of an outbreak. If you want to contain an outbreak, you definitely have to pay more attention to close contacts, because close contacts are the ones who are most likely to spread the virus in the community. They are in the incubation period. They don’t have any kind of symptom, however, they are capable of transmitting the virus.
This is the reason why in Taiwan we paid a lot of attention to get the names of all the close contacts of confirmed cases. Then we ask them to stay at home for 14 days and we use an electronic fencing system to monitor them.
Where do you think the virus came from? The first SARS virus was reportedly traced to a single bat cave in Yunnan province.
From an infectious disease epidemiologist point of view, the disease should come from the first outbreak area. It can never be in one area and then transmitted to another area to cause an outbreak there. This is quite, quite unlikely.
At least the person-to-person transmission should have occurred in Wuhan, no matter if the first patient zero is infected from a bat in Yunnan or somewhere. It is much easier to blame a wild animal, but how can a bat from Yunnan infect people in Wuhan? So maybe in Huanan Seafood Market, right? If they did eat a lot of bats, it is likely, but people also suspect the virus is from the P4 lab [Wuhan National Biosafety Lab.] If they used a bat to try to get the virus, that’s another possibility. It needs investigation and it needs transparency in order to discover the origin of COVID-19.
Do you believe in the theory COVID-19 was made in a lab?
Sort of. It’s one of the possibilities. If people are not doing their research carefully, they are likely to get the infection. There was a scenario in Taiwan. In December , at our Institute of Preventive Medicine that belongs to the National Defence Medical College, a P4 lab, a colonel was carrying on a study but he was rushing to Singapore to attend a meeting. So he took care of everything, but he saw in the garbage tank there was one piece of garbage, and he just used his bare hands to take it out and put in the disinfection tank. Then he went to Singapore to attend a SARS international conference but he was infected after he came back. He did not transmit it to anyone but it created [political] turbulence because 100 people were at the conference.
He was a very careful person and a very good scientist and still only a small mistake and he was infected. It’s not unusual for lab workers to get an infection. It’s one possibility, so it needs investigation.