https://english.cw.com.tw/article/article.action?id=2688
Considering the global explosion in the number of new coronavirus disease (COVID-19) cases, Taiwan’s first death from the virus may now seem like a distant memory. But with the benefit of hindsight, the passing of a private car driver on Feb. 15 marked a critical juncture in Taiwan’s battle against the epidemic.
The driver had no travel history and was the one who “fell through the cracks” from among many who reported severe flu symptoms but tested negative for the flu. In fact, he did not test positive for COVID-19 until the day he died.
Changhua County Police Department chief Fang Yeang-ning treated an epidemic investigation into a COVID-19 fatality like a major crime investigation.
The patient was a private car driver who had diabetes and hepatitis B but no history of travel to an area affected by the epidemic or of contact with people confirmed to have the disease. When he was examined in a hospital emergency ward on Feb. 3 and was then transferred to the ICU, he came into contact with many people, potentially setting in motion a major community infection.
The news of the new COVID-19 case and the patient’s history in the hospital gave Yeh Yen-po the chills.
When the meeting ended at 8 p.m. that night, a team of more than 30 people was given two tasks – tracking the patient’s activity in the hospital’s ICU and emergency ward.
The ICU was relatively simple, consisting only of a single negative-pressure room. The emergency ward, on the other hand, was an open space in which the driver spent about eight hours. The team had to figure out the people he may have come in contact with.
Yeh said Centers for Disease Control (CDC) epidemiologists went until late at night studying all available surveillance video to come up with a list of people who could have been infected by the deceased.
A driver with the legal taxi company Taiwan Taxi in Changhua County disinfects his car.
The driver’s customers were the focal points of the investigation.
Yeh said the driver first developed symptoms on Jan. 27, so their investigation had to span 22 days – starting from Jan. 13 because of the potential 14-day incubation period all the way to Feb. 3, when he was admitted to the hospital.
His customers were in an enclosed space in close proximity to an infected person, and if they were coming from or going to the airport, they would have been in the car for at least half an hour, putting them at a fairly high degree of risk.
At that point, the Changhua County Police Department joined the team, and this major epidemic investigation, likely to be every bit as intense as a major crime investigation, was set in motion.
The starting point for the police was the driver’s “white” license plate, which led them to believe he was an Uber driver and would have complete travel records only to find he was illegally serving passengers. (“White license plate” drivers are drivers of private cars unaffiliated with any legal taxi companies and are generally illegal.) Through the license plate, police found the for-hire car company he worked for and first tracked the movements of 53 people consisting of the company’s owner and other company drivers.
The company was not very cooperative initially, but that changed when police warned that it could be struck down by the highly contagious virus if it did not tell the truth. The police eventually learned that during the time the driver could have been infected, he was dispatched on 164 jobs, but there were no records of his customers’ names or telephone numbers.
In the end, the police tracked down 117 of the driver’s customers and after checking their travel records found that six had recently returned home from Zhejiang province, Shanghai, and Guangzhou in China and from Japan and were picked up at Taichung International Airport.
Yeh then directly contacted the Ministry of Health and Welfare to access records on doctor visits of the driver’s customers through the national health insurance system.
Among them there was only one person – a Taiwanese businessman coming back from Zhejiang – who went to a doctor seeking help for respiratory problems.
Their ability to complete this “mission impossible” was largely due to the preparations made by the police bureau in advance.
Fang said that as soon as news of the epidemic emerged in January, National Police Agency Director-General Chen Ja-chin described the battle against the epidemic as a war and declared epidemic detection to be as important as a major criminal investigation.
As a result, even before the first confirmed cases were reported, the Changhua police bureau mobilized people from different police branches and precincts and the local criminal investigation brigade to form and train an elite team. It included an administrative police expert in handling thefts, investigators specialized in analyzing call records and movement records, and police skilled in conducting inquiries by phone.
One example of this: Because the dispatch records of the deceased driver were incomplete, the team had to gather data from the national freeway’s e-Tag automatic toll collection system and video from highway surveillance cameras and feed it to seasoned experts, who used it to piece together the driver’s movements during the 22 days.
The investigation team mobilized about 60 people to do the detective work. In the end, the 117 customers and 53 people with the for-hire car company all tested negative for the new coronavirus, but four members of the driver’s family who shared a meal with him tested positive.
Yeh Yen-po, head of the Changhua County Public Health Bureau, holds up a statement issued by his agency saying that workers at a clinic that treated the deceased driver all tested negative for COVID-19, helping the clinic fight off rumors that its workers had been infected.
Yeh may deserve kudos for Changhua County’s handling of the private car driver’s death, but he owes some of that success to his mentor and teacher Ho Mei-shang, a renowned epidemiologist and virologist with Academia Sinica’s Institute of Biomedical Sciences.
Ho worked as a medical epidemiologist at the Centers for Disease Control in the United States in the late 1980s, and she was the first Taiwanese to be trained through the CDC’s Epidemic Intelligence Service.
Her relationship with Yeh goes back more than two decades. In 1998, when Taiwan faced a major outbreak of enterovirus 71 that resulted in 78 deaths, children were dying every day in Changhua at the height of the epidemic. Yeh at the time was responsible for disease control while learning about epidemic investigations at NTU’s College of Public Health, and Ho was his teacher. She even accompanied him to Changhua to guide his investigation into the enterovirus raging at the time and helped unravel the mystery of why children were dying.
More recently Yeh consulted Ho on the driver’s case, asking her about the nature of the virus. When she concluded that the coronavirus was not likely to be spread by airborne transmission, he breathed a sigh of relief.
The silent battle waged in Changhua was just a microcosm of the concerted efforts being made by medical and law enforcement personnel to contain the new coronavirus, and reflects the experience health officials in Taiwan have with several infectious diseases in the past 25 years.
As Yeh said: “This fight has been about how well we harnessed our experience from the enterovirus, SARS and H1N1 along with the power of new technologies.”
Considering the global explosion in the number of new coronavirus disease (COVID-19) cases, Taiwan’s first death from the virus may now seem like a distant memory. But with the benefit of hindsight, the passing of a private car driver on Feb. 15 marked a critical juncture in Taiwan’s battle against the epidemic.
The driver had no travel history and was the one who “fell through the cracks” from among many who reported severe flu symptoms but tested negative for the flu. In fact, he did not test positive for COVID-19 until the day he died.
His death triggered rumors of a community spread that rifled around Taiwan, and Changhua County was suddenly talked about as a potential “disaster area.” Not long after, however, life in this agricultural county of 1.3 million returned to normal, without any spread of the disease.Two officials were primarily responsible for stabilizing the threat – Yeh Yen-po, director-general of the Changhua County Public Health Bureau, who was well-known in Taiwan for his previous work in dealing with a food safety scare, and Fang Yeang-ning, director-general of the Changhua County Police Department.
Changhua County Police Department chief Fang Yeang-ning treated an epidemic investigation into a COVID-19 fatality like a major crime investigation.
Critical 8 Hours in the Emergency Room
In the afternoon of Feb. 15, a patient in Changhua who had been in an intensive care unit (ICU) with pneumonia for quite some time but tested negative for the flu was confirmed to have COVID-19 after the Central Epidemic Command Center (CECC) went back and tested him.The patient was a private car driver who had diabetes and hepatitis B but no history of travel to an area affected by the epidemic or of contact with people confirmed to have the disease. When he was examined in a hospital emergency ward on Feb. 3 and was then transferred to the ICU, he came into contact with many people, potentially setting in motion a major community infection.
The news of the new COVID-19 case and the patient’s history in the hospital gave Yeh Yen-po the chills.
“What popped into my mind was SARS. I thought of many different scenarios,” Yeh said. He knew a large-scale epidemic investigation was about to begin and gathered several section chiefs to get ready for the challenge. Soon after, he received bad news from the hospital. The patient had died three hours after being confirmed as having COVID-19.Yeh directed hospital staff to obtain and preserve pathological specimens from the patient and prepared to meet with experts sent by the CECC and central Taiwan branch of the country’s infectious disease network to discuss the investigation.
When the meeting ended at 8 p.m. that night, a team of more than 30 people was given two tasks – tracking the patient’s activity in the hospital’s ICU and emergency ward.
The ICU was relatively simple, consisting only of a single negative-pressure room. The emergency ward, on the other hand, was an open space in which the driver spent about eight hours. The team had to figure out the people he may have come in contact with.
Yeh said Centers for Disease Control (CDC) epidemiologists went until late at night studying all available surveillance video to come up with a list of people who could have been infected by the deceased.
A Real Detective Story: 164 Trips in 22 Days
But even bigger challenges loomed – finding the source of the driver’s infection and figuring out whom he might have infected while doing his job.A driver with the legal taxi company Taiwan Taxi in Changhua County disinfects his car.
The driver’s customers were the focal points of the investigation.
Yeh said the driver first developed symptoms on Jan. 27, so their investigation had to span 22 days – starting from Jan. 13 because of the potential 14-day incubation period all the way to Feb. 3, when he was admitted to the hospital.
His customers were in an enclosed space in close proximity to an infected person, and if they were coming from or going to the airport, they would have been in the car for at least half an hour, putting them at a fairly high degree of risk.
At that point, the Changhua County Police Department joined the team, and this major epidemic investigation, likely to be every bit as intense as a major crime investigation, was set in motion.
The starting point for the police was the driver’s “white” license plate, which led them to believe he was an Uber driver and would have complete travel records only to find he was illegally serving passengers. (“White license plate” drivers are drivers of private cars unaffiliated with any legal taxi companies and are generally illegal.) Through the license plate, police found the for-hire car company he worked for and first tracked the movements of 53 people consisting of the company’s owner and other company drivers.
The company was not very cooperative initially, but that changed when police warned that it could be struck down by the highly contagious virus if it did not tell the truth. The police eventually learned that during the time the driver could have been infected, he was dispatched on 164 jobs, but there were no records of his customers’ names or telephone numbers.
The next move, according to Fang Yeang-ning, was to obtain the records of 317 telephone communications made during this time period and cross-check them against his vehicle’s movements. If for example his car was dispatched at 9 a.m., the police inferred that any communication at around the car’s estimated time of arrival was with a customer.The police then sought out these potential customers and asked them where they got on and got off, who was in the car, how much they paid for the ride and whether they had any symptoms.
In the end, the police tracked down 117 of the driver’s customers and after checking their travel records found that six had recently returned home from Zhejiang province, Shanghai, and Guangzhou in China and from Japan and were picked up at Taichung International Airport.
Yeh then directly contacted the Ministry of Health and Welfare to access records on doctor visits of the driver’s customers through the national health insurance system.
Among them there was only one person – a Taiwanese businessman coming back from Zhejiang – who went to a doctor seeking help for respiratory problems.
Health authorities immediately got the clinic to send his medical records, only to find that the first of five times the businessman sought treatment, he had already been coughing for seven days. Though he later tested negative for COVID-19, an antibody test was done confirming that he in fact was previously infected with the virus.It was therefore extremely likely that the driver was infected by this businessman, allowing Taiwan to breathe a sigh of relief that the source had been identified.
Tracing the Problem to its Roots
Looking back at the investigation, the Changhua team of health and police officials operated with tremendous efficiency despite the driver already being dead, finding the source of the driver’s infection within just 36 hours after obtaining his telephone records.Their ability to complete this “mission impossible” was largely due to the preparations made by the police bureau in advance.
Fang said that as soon as news of the epidemic emerged in January, National Police Agency Director-General Chen Ja-chin described the battle against the epidemic as a war and declared epidemic detection to be as important as a major criminal investigation.
As a result, even before the first confirmed cases were reported, the Changhua police bureau mobilized people from different police branches and precincts and the local criminal investigation brigade to form and train an elite team. It included an administrative police expert in handling thefts, investigators specialized in analyzing call records and movement records, and police skilled in conducting inquiries by phone.
One example of this: Because the dispatch records of the deceased driver were incomplete, the team had to gather data from the national freeway’s e-Tag automatic toll collection system and video from highway surveillance cameras and feed it to seasoned experts, who used it to piece together the driver’s movements during the 22 days.
The investigation team mobilized about 60 people to do the detective work. In the end, the 117 customers and 53 people with the for-hire car company all tested negative for the new coronavirus, but four members of the driver’s family who shared a meal with him tested positive.
Epidemic Prevention: Experience + Technology
The team’s outstanding performance should in large part be credited to Yeh, who gained fame for his work on a food safety case involving the Ting Hsin International Group in the mid-2010s. He is the most senior of all local health department chiefs in Taiwan, having served 16 years in his post under county commissioners of both of Taiwan’s main political parties. It was not until the epidemic broke out that the outside world noticed he had solid experience in investigating diseases.Yeh Yen-po, head of the Changhua County Public Health Bureau, holds up a statement issued by his agency saying that workers at a clinic that treated the deceased driver all tested negative for COVID-19, helping the clinic fight off rumors that its workers had been infected.
Yeh may deserve kudos for Changhua County’s handling of the private car driver’s death, but he owes some of that success to his mentor and teacher Ho Mei-shang, a renowned epidemiologist and virologist with Academia Sinica’s Institute of Biomedical Sciences.
Ho worked as a medical epidemiologist at the Centers for Disease Control in the United States in the late 1980s, and she was the first Taiwanese to be trained through the CDC’s Epidemic Intelligence Service.
Her relationship with Yeh goes back more than two decades. In 1998, when Taiwan faced a major outbreak of enterovirus 71 that resulted in 78 deaths, children were dying every day in Changhua at the height of the epidemic. Yeh at the time was responsible for disease control while learning about epidemic investigations at NTU’s College of Public Health, and Ho was his teacher. She even accompanied him to Changhua to guide his investigation into the enterovirus raging at the time and helped unravel the mystery of why children were dying.
More recently Yeh consulted Ho on the driver’s case, asking her about the nature of the virus. When she concluded that the coronavirus was not likely to be spread by airborne transmission, he breathed a sigh of relief.
The silent battle waged in Changhua was just a microcosm of the concerted efforts being made by medical and law enforcement personnel to contain the new coronavirus, and reflects the experience health officials in Taiwan have with several infectious diseases in the past 25 years.
As Yeh said: “This fight has been about how well we harnessed our experience from the enterovirus, SARS and H1N1 along with the power of new technologies.”
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