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SARS: Taiwan's WHO bid nothing to sneeze
at
By Laurence Eyton
TAIPEI -
What a difference a week makes. On April 20-21 Taiwan
hosted an international conference on severe acute
respiratory syndrome (SARS). The conference was partly
to act as a talking shop both for health-related
professionals to discuss treatment of the new disease
and for economic punditry about the effect of the
illness on the regional economy. It was also intended as
a forum in which to showcase what Taiwan was then
calling its "SARS achievements". At the time, these
included very limited local transmission of the disease
and no deaths, despite Taiwan's huge traffic with the
heavily affected areas of Hong Kong and southern China.
But the overarching theme of the ostensibly
health-related conference was political, namely to
remind the world that Taiwan, excluded from the World
Health Organization (WHO) by Beijing's enmity, deserved
a place in the United Nations organization because it
had a serious contribution to make.
Six days
after the conference wound up, a seriously panicking
Taiwan enacted draconian measures, placing all visitors
from Hong Kong, mainland China, Singapore and the
Canadian city of Toronto in compulsory 10-day
quarantine, as well as imposing extensive quarantine
measures locally. One week later the conference looked
like the height of hubris. Its political message,
however, looked more meaningful than ever.
If
the government isn't a laughing stock, it is only
because people are far more worried about the spread of
the virus in Taipei in the past week. As the SARS
outbreak raged in China and Hong Kong from mid-March on,
Taiwan seemed to have a charmed existence. The only
sufferers of the disease appeared to have contracted it
outside Taiwan or were health workers who had contracted
it from their patients. The government instituted a
policy of quarantine for those who had been in contact
with known SARS spreaders, and for a four-week period
while Hong Kong ground to a standstill and China went
from denial to pondering the imposition of martial law,
Taiwan thought it had the disease under control.
Skeptics pointed out that since so little was
known about the disease, especially about its method of
transmission and its incubation period, any
self-congratulation in Taiwan would be premature until
the epidemic subsided regionally. And given that 10,000
people a day entered Taiwan from Hong Kong, and that
about 250,000 Taiwanese were residing in China and would
flee home if the situation there appeared to be getting
out of hand, it could only be a matter of time before
the epidemic took hold in Taiwan itself. Restrict travel
between Taiwan and Hong Kong immediately, they argued,
and only then might you have a chance of avoiding a
local outbreak of the illness.
Such advice was
ignored - at least until it was too late - for a number
of reasons. First, mainland China was doing its utmost
to keep the SARS epidemic under wraps. As a result, its
extent and the potential for it to spread to Taiwan were
little understood. But, more important, opposition
parties, which have taken it upon themselves to use any
pretext they possibly can to pry open direct aviation
links between Taiwan and the mainland, would have
reacted furiously to any attempt to limit cross-Strait
travel. Indeed, at the beginning of the SARS outbreak,
when it appeared to be more of a problem in Hong Kong
than in mainland China, they were advocating direct
cross-Strait flights so that Taiwanese on the mainland
might avoid the SARS black spot of Hong Kong, a policy
that would have, in fact, resulted in the spread of the
disease far sooner in Taiwan.
The current
situation - at the time of writing, five dead, about 100
definite cases, and nearly 5,000 people in quarantine -
is the result of a visit to Taiwan by a resident of Hong
Kong's Amoy Mansions, the now notorious apartment
complex that has produced so many of the territory's
SARS cases. The man, surnamed Tseng, flew to Taiwan on
March 26, took a train to Taichung to see his brother
the following day - to carry out the traditional spring
cleaning of the family tomb - and flew back to Hong Kong
the day after. His brother was infected with the virus,
admitted to hospital on April 3 and had the dubious
distinction of becoming Taiwan's first SARS-related
fatality last Sunday.
It was not, however,
infection spreading from the Taichung case that
destroyed Taiwan's relative complacency over SARS.
Rather it was a female fellow traveler on the train
Tseng took to Taichung who was the "index patient" for
the first outbreak of SARS through local transmission in
Taiwan. Feeling ill, she went to the Taipei Municipal
Hoping Hospital, where she is though to have passed the
virus on to several medial staff and a laundry worker.
On April 23, just two days after Taiwan's backslapping
SARS conference ended, the hospital reported seven
hospital staff and two patients with the disease.
Within 24 hours the number of reported cases was
up to 26 - although almost half the reported cases were
found not actually to have SARS. The government ordered
the entire hospital quarantined. All 930 staff and 240
inpatients were to be confined for 14 days. Any staff
not in the hospital when the quarantine order was issued
were to return to the hospital immediately to start
their isolation.
The result of the quarantine
order has been several displays of personal selfishness
and lack of concern about the public good that have kept
newspaper opinion pages and radio call-in shows busy for
a week. April 25 saw a demonstration at the hospital
that involved bottle-throwing by staff angry about being
quarantined. Meanwhile some 32 staff who were out of the
hospital when the order was imposed refused to return
and went into hiding. A nurse, hiding from the
quarantine order, wrote to a newspaper complaining that
"no punishment can exceed the terror cast by the shadow
of SARS" and claiming that quarantine was a death
sentence. While the public was still wondering about the
professional ethics of a nurse who was afraid of
catching an infectious disease, it was presented with
the less-than-edifying behavior of Dr Lee Yi-tsang, an
ear, nose and throat specialist at Hoping, who not only
dodged the quarantine but continued to work in his
private clinic treating patients. Only when threatened
with arrest by the police did he return to Hoping.
This week a second Taipei city hospital was
closed down as the result of having 17 medical staff
showing SARS symptoms, with three confirmed as having
the illness.
The effects seen in Hong Kong in
early April are now beginning to show themselves in
Taipei. People wear masks on the subway and in offices -
some of which even recommend being silent in elevators
as a way of avoiding spreading infection. Nightlife is
virtually non-existent; taxi drivers drive with all
their windows open. Nobody, unless he is very sick
indeed, will visit a hospital. The city government is
preparing to dole out bleach to every household in
Taipei to encourage what it calls a "mass sterilization
of communities".
On Monday the government
imposed a mandatory 14-day quarantine on all incoming
travelers from China, Hong Kong, Singapore, Macau and
Canada. It later relaxed this to let passengers who had
only transited in Hong Kong avoid the quarantine, pretty
much an essential measure since so many of Taiwan's
connections with the outside world are routed through
the former British colony. Currently Taiwan residents
have to go home and stay there for two weeks;
non-residents will be put up at Taipei's Chiang Kai-shek
Airport Hotel, while an army camp is also being prepared
for detainees near the airport.
Some lawmakers
have suggested that the government declare a state of
emergency over the SARS outbreak. So far it has not done
this, partly because it is afraid of being seen to
overreact, but also because the powers that are granted
by an emergency decree, mostly about moving supplies to
areas affected by a natural disaster and providing
budgets for disaster relief, are of very limited use in
this kind of situation.
The principal concern of
the government, apart from containing SARS, is the
potential economic impact of the disease. This comes in
a number of directions. First there is the immediate
pain in the airline, hotel and travel businesses. The
airlines might well need bailing out. Hotel occupancy is
running in some places at a mere ten percent, with some
establishments simply closing for the duration. This
will lead to a spike - if no worse - in unemployment,
already at near record highs, and a lack of visitors to
Taiwan's tourist attractions means no cash for the
economically depressed rural areas where these mostly
are.
Two economic issues are more worrying to
the government, however. The first is the possibility of
a mass outbreak of SARS at the Hsinchu Science-based
Industrial Park, the home of Taiwan's high-tech industry
and its export-earnings cash cow. A few cases could see
entire factories having their workforces quarantined,
for the science park, with its US$50 million a day in
production value and the tight order-to-delivery
schedules of the information-technology (IT) industry,
this could be a nightmare. And as WHO raised Taiwan's
status as a SARS-affected area to the same level as that
of mainland China and Hong Kong on Friday, it was a fear
that is not likely to go away soon.
On top of
this is worry about the situation on the mainland. Much
of Taiwan's industry is involved in three-cornered
trade, making components shipped to China for assembly
and thence to the United States for sale. Anything that
seriously interrupts China's economy is, therefore, a
problem for Taiwan as well. While Beijing might be
coming clean about its plight, many in Taiwan, in both
business and the government, find the absence of
information from the Shanghai area and southern China,
where SARS originated, anything but reassuring.
There is, however, one silver lining to Taiwan's
SARS cloud. If the Hoping Hospital outbreak has shot
full of holes Taiwan's reputation as a place that
successfully contained the disease, preventing mass
local transmission, it does not damage Taiwan's case to
join the World Health Organization. Taipei covets WHO
membership, at least as an observer, because WHO is a UN
organization, membership of which would give Taiwan some
of the diplomatic legitimacy that it wants and Beijing
does so much to deny it. It also feels that WHO is the
international UN-related organization most vulnerable to
Taiwan lobbying for membership both because of a moral
argument - why should Taiwanese have their health
endangered because of lack of access to medical know-how
as a result of China's politicking? - and a practical
one - everyone has an interest in making sure countries
with killer diseases don't export them. It has long been
hoping to get the World Health Assembly, WHO's
decision-making body that meets annually, to hear
Taiwan's case. Given China's ignominy over fudging its
SARS data - which may still be going on - Taiwan now
thinks its WHO chances have improved considerably.
(©2003 Asia Times Online Co, Ltd. All rights
reserved. Please contact content@atimes.com
for information on our sales and syndication policies.)
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