Mystery Illness Highlights Taiwan’s Health Isolation

The appearance of three cases in Taiwan of an acute form of pneumonia has implicitly exposed the country's isolation from the WHO.

When the three cases of what the WHO is calling "severe acute respiratory syndrome (SARS)" were reported last week, Twu Shiing-jer (涂醒哲), director-general of the Department of Health, was on a semi-diplomatic trip to the US to appeal for support for Taiwan's bid to become a WHO observer.

In the WHO's updated report about the SARS outbreak on Sunday, the organization called the disease "an atypical pneumonia of unknown etiology."

Taiwan's first two cases were reported to the Center for Disease Control (CDC) last Friday. The center reported the two cases to the WHO that day, it said.

The center also immediately reported the third case to the WHO after it was discovered on Saturday, it said.

The WHO issued an emergency travel warning regarding the disease on Sunday and an updated report on the outbreak yesterday.

However, when the WHO listed the countries from where it had received reports of SARS cases in its statements, Taiwan was conspicuously absent from the list.

Nevertheless, the center said it had done its best to keep the WHO up to date on the conditions of Taiwan's SARS cases.

Twu said that during his US visit he appealed for the WHO's help in investigating Taiwan's cases.

"The WHO is coordinating the international investigation of this outbreak and is working closely with health authorities in the affected countries to provide epidemiological, clinical and logistical support as required," the WHO's statement on Sunday said.

Although so far the organization has offered Taiwan no direct assistance, two officials from the US Centers for Disease Control and Prevention (USCDC) arrived at Taiwan on Sunday to join the investigation of the cause of the three cases.

On Sunday, Twu expressed disappointment that the WHO did not want to work with Taiwan.

But Chen Tsai-ching (陳再晉), director-general of Taiwan's CDC, said yesterday that the country needed to consider the WHO's dilemma in dealing with such diseases in a non-member state such as Taiwan.

"As long as the WHO has suggested the USCDC send officials to help us, we are very grateful," Chen said.

Hsieh Szu-min (謝思民), an infectious disease specialist from National Taiwan University Hospital, where the first two cases are in quarantine, said the WHO's help would be useful in determining how the two caught the disease.

"As SARS cases have been reported in many countries, transnational cooperation coordinated by the WHO would be more efficient to investigate the cause," Hsieh said.

But Hsieh said he expected a lot from the USCDC officials in examining the cases because "the center is very experienced in investigating unknown agents and viruses."

Hsieh said that over the past few decades, the center had accumulated considerable experience in studying outbreaks and their causes.

DPP lawmaker Lai Ching-te (賴清德), himself from a medical background, said yesterday he regretted the WHO's inability to offer Taiwan direct help in handling the cases.

"As Taiwan is not a WHO member, it can't join other countries' investigation of SARS cases. It can't obtain first-hand information about the disease from the WHO, either," Lai said.

Taiwan cannot know how many SARS cases there are in other countries immediately, nor can it find out in which areas in the countries these cases were found, Lai said.

"We can't quickly know how these countries treat these cases. We don't know what health policies these countries adopt to contain the spread of the disease," Lai added.