TAIPEI – Facing Taiwan’s largest outbreak of the pandemic and looking for rapid virus test kits, the mayor of the island’s capital did what anyone might do: He Googled it.
“If you don’t know, and you try to know something, please check Google,” Taipei Mayor Ko Wen-je quipped.
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Praised for its success at keeping the virus away for more than a year, Taiwan had until May recorded just 1,128 cases and 12 deaths. But the number of locally transmitted cases started growing this month and it soon became clear that the central government was ill prepared not only to contain the virus, but to even detect it on a large scale due to a lack of investment in rapid testing.
That left officials like Ko scrambling to catch up as the number of new infections climbed to some 300 a day. Ko’s search put him in contact with six local companies who make rapid tests and his government was soon able to set up four rapid testing sites in a district that had emerged as a virus hotspot.
Rapid tests, experts say, are a critical tool in catching the virus in its early days. The alternative that Taiwan has been relying on — tests that have to be sent out to a lab for processing — has led to backlogs that may be obscuring the true extent of the outbreak.
“You want to identify those infected cases as soon as possible,” to contain the spread, said Ruby Huang, a professor in the medical college at National Taiwan University. “And then you’re basically running against time.”
With so few cases, Taiwan had been a bubble of normalcy for most of the pandemic. Schools stayed open, people went to bars and restaurants, and the island’s economy was among the few globally that saw positive growth.
Its success was built largely on strict border controls that primarily allowed in only citizens and long-term residents, who then faced mandatory two-week quarantines.
From time to time it found small clusters of infections and stamped them out through contact tracing and quarantines. Last month authorities found a cluster involving pilots from the state-owned China Airlines.
Stopping the virus this time would prove difficult, in part because under government policy pilots were only required to quarantine for three-days and did not need a negative test to get out of quarantine. Soon employees at a quarantine hotel where China Airlines flight crew stayed started getting sick — and so did their family members.
The virus had escaped quarantine and was spreading locally, mostly in Taipei and surrounding areas.
The government in Taiwan — where only about 1% of the population have been vaccinated — responded by ordering a lockdown, closing schools and switching offices to remote work or rotating shifts. Contact tracers identified 600,000 people that needed to quarantine themselves.
The biggest roadblock has been testing.
Government policy throughout the pandemic has been to rely on polymerase chain reaction, or PCR, tests, which are seen as the gold standard for diagnosis but must be processed using special machines in a lab. The government has not encouraged rapid tests, which are quicker and cheaper but potentially less accurate.
In and around Taipei, labs have been working overtime in recent weeks but are still struggling to process all the samples.
Tim Tsai said on just a single day last week his lab in New Taipei city received 400 samples from hospitals to test. He said his lab was only able to process about 120 samples a day.
“Our medical technicians, they were leaving work at midnight,” he said.
The government's Central Epidemic Command Center said in a statement that all 141 government designated labs have the capacity to process 30,000 PCR tests a day. However, it declined to provide the actual number of tests being processed.
It said it was “continuing to work with relevant labs to research ways to accelerate and expand our capacity, without impacting accuracy.”
Throughout the pandemic the government has maintained there are few benefits to mass testing, with the health minister saying last year that public funds and medical resources could better be used elsewhere.
The government instead has emphasized a strategy of contact tracing and isolation and only testing those with symptoms and direct contact with someone infected.
“This is more efficient, effective and accurate,” said Chen Chien-jen, the island’s former vice president, who led the pandemic response last year before retiring.
Experts say such a strategy may have been appropriate when case numbers were low, but needed to change as infections spread.
“You should have a two-pronged approach. You do the quarantine, but you should do massive widespread testing," said K. Arnold Chan, an expert on drug and medical products regulation at National Taiwan University. "For whatever reason the government is completely unprepared.”
Taiwanese companies developed rapid tests for COVID-19 early last year, but the majority of their sales have been overseas.
“Back then the CDC didn’t support rapid tests, and there was no epidemic,” said Edward Ting, a spokesperson for Panion and BF Biotech, which has had its own test since March 2020. “We tried to sell, but it wasn’t possible.”
The central government finally appears to be coming around, with the health minister last week asking local governments to set up rapid testing sites. Ting said his company has since had calls from governments across the island asking about its tests.
The central government also is now offering subsidies for labs to buy new machines to process PCR tests.
Aaron Chen, whose company developed a machine that can process up to 2,000 PCR test samples every four hours, said he has diverted two machines bound for export to be used locally instead.
Ko, the mayor of Taipei, said his city has purchased 250,000 rapid test kits. Though the city is still relying on PCR tests to confirm actual cases, Ko said the rapid tests better allow him to monitor the situation on the ground.
Ko, a former surgeon, said it was important to be open to change.
“There’s a phrase in Chinese: One thrives in times of calamity and perishes in soft times. Because when you’re very successful you are not forced to improve. Only when you fail, then are you forced to improve,” said Ko. “We were too successful in the past year.”