Translation Section Editors
Prof. Yen-Ching Chen, ScD
Since the COVID-19 epidemic outbreak, Taiwan has reported more than 20 additional cases in a single day, a significant increase compared to prior reports of no more than10 new cases daily). During this period, Taiwan received many individuals who worked, studied, and visited relatives abroad to return to Taiwan. Furthermore, it has been reported that asymptomatic patients were moving freely in the community. As a result, whether or not mass testing is necessary has sparked public debate.
Regarding what was mentioned in media that the government should conduct community-based mass testing, Shih-Chung Chen, the head of the Central Epidemic Command Center, spent 20 minutes introducing the “Taiwan Model for Combating COVID-19 in the first 100 days” at a press conference. He clarified the controversies surrounding mass testing and rapid diagnostic test since the epidemic outbreak. Chi-Mai Chen, the vice-premier of the Executive Yuan, analyzed on his Facebook page and indicated that if there is no substantial increase of positive cases, more emphasis should be on identifying high-risk populations instead. Additionally, the Ministry of Health and Welfare also compiled comprehensible information via social media to diminish public concerns about not conducting mass testing.
According to estimates from the frontline medical workers, asymptomatic patients account for 30% of all patients infected with COVID-19, which demonstrate a high proportion of asymptomatic cases. With an prevalence of less than 1%, experts and scholars suggested that there is no need for mass testing. Plus, Medical facilities in Taiwan conduct COVID-19 screening tests diligently. For instance, patients with mild symptoms, suspected pneumonia, and abnormal sense of taste (dysgeusia) are all subject to screening tests. With such an intensive screening mechanism, there are merely approximately 400 confirmed cases among near 60,000 testees. Since the percentage of symptomatic patients is low, the proportions of asymptomatic patients in communities should be of low too, Thus, their existence should not be a concern. If the decision of mass testing is adopted hastily, false-positive results will lead to an unnecessary burden for the healthcare system, accompanies by negative social and economic impacts. Similarly, false-negative results will cause sense of insecurity, which reduces public confidence and compliance with the government’s disease control measures.
Iceland and Korea have conducted mass testing to identify asymptomatic patients infected with COVID-19 so that community spread can be interrupted.
However, the potential pitfalls of mass testing are not discussed. For instance, mass testing can result in false-positives and false-negatives. False positive results refer to mistakenly identify an individual not infected with the virus as tested positive. Given the low prevalence in Taiwan, many of those tested positive are actually healthy, yet quarantine measures would still be implemented due to the false positive test result. Thus, from the legal perspective, the mandatory quarantine measures could lead to human rights violations, even though quarantine measures aims to contain the infection and safeguard public’s health. However, such good intentions does not mean the government could arbitrarily limit patients’ freedom of movement, especially when many of those are actually erroneously labeled infected due to false-positive results. Quarantine should not be regarded as an absolute measure as it could be doubtful for the above reasons. Therefore, upon considering whether to conduct mass testing, the principle of proportionality, the rule of necessity, and the minimization requirement should be considered to protect people’s fundamental rights. Secondly, the growing number of patients resulting from mass testing will cause social panic, stigma, and discrimination. Such social instability would be detrimental to disease control if patients thereby conceal their illnesses. Besides, the act of excluding and alienating the confirmed cases violates human rights.
Generally, Testing strategies should be rooted in epidemiology. the scale of social impact and the possibility of infringing human rights should be carefully evaluated.
Translation Associate Editor
Yun-Tzu Chen, Pei-Yi Chen, Hsuan Chang
Yi-Yun Cheng, Yao-Chung Chang