Taiwan's COVID-19 response: Timely case detection and quarantine, January to June 2020.

The coronavirus disease 2019 (COVID-19) pandemic has become severe threats to economic, societal, and healthcare systems. To analyze the epidemiological characteristics of the COVID-19 outbreak in Taiwan and evaluate the key interventions, we conducted a retrospective cohort study during January 17-June 30, 2020. As of June 30, the COVID-19 outbreak, including 447 laboratory-confirmed cases, was eliminated by mixed approaches: border control, enhanced surveillance, case detection with contact tracing, quarantine, and population-based interventions like face mask use. The improvement of median time from disease onset to notification (5 days [range -3 to 27] before March 1 to 1 day [range -8 to 22] after March 1) suggested the timeliness and comprehensiveness of surveillance and contact tracing. Travel restrictions with quarantine, resulting in fewer clusters, were also complementary to minimize disease spread. Under combined interventions, Taiwan successfully contained the COVID-19 spread within the country and minimized its impact on the society.

Hematological and biochemical factors predicting SARS fatality in Taiwan.

BACKGROUND/PURPOSE: Severe acute respiratory syndrome (SARS) has a high fatality rate worldwide. We examined the epidemiologic and clinical factors associated with death for all laboratory-confirmed SARS patients in Taiwan. METHODS: Using initial data in medical records reported by hospitals to the Center for Disease Control in Taiwan, we analyzed whether hematological, biochemical and arterial blood gas measures could predict fatality in 346 SARS patients. RESULTS: Both fatalities (n = 73; 21.1%) and survivors had elevated plasma concentration of initial C-reactive protein (CRP), but the mean CRP concentration was higher in fatalities (47.7 +/- 43.3 mg/L) than in survivors (24.6 +/- 28.2 mg/L). Initial lymphocyte counts were low in both fatalities (814 +/- 378/microL) and survivors (1019 +/- 480/microL). After controlling for age and sex, multiple logistic regression analysis showed that hematological factors significantly associated with fatality included initial neutrophil count > 7000/microL (odds ratio [OR] = 6.4), initial CRP concentration > 47.5 mg/L (OR = 5.8) and lactic acid dehydrogenase (LDH) > 593.5 IU/L (OR = 4.2). Factors significantly associated with initial CRP concentration > 47.5 mg/L included dyspnea (OR = 4.3), red blood cell count < 4.1 x 106/microL (OR = 4.3) and serum aspartate aminotransferase > 57 IU/L (OR = 3.1). CONCLUSION: Initial neutrophil count, CRP and LDH levels are important predictors of mortality from SARS.

An interferon-gamma-related cytokine storm in SARS patients.

Fourteen cytokines or chemokines were analyzed on 88 RT-PCR-confirmed severe acute respiratory syndrome (SARS) patients. IFN-gamma, IL-18, TGF-beta, IL-6, IP-10, MCP-1, MIG, and IL-8, but not of TNF-alpha, IL-2, IL-4, IL-10, IL-13, or TNFRI, were highly elevated in the acute phase sera of Taiwan SARS patients. IFN-gamma was significantly higher in the Ab(+) group than in the Ab(-) group. IFN-gamma, IL-18, MCP-1, MIG, and IP-10 were already elevated at early days post fever onset. Furthermore, levels of IL-18, IP-10, MIG, and MCP-1 were significantly higher in the death group than in the survival group. For the survival group, IFN-gamma and MCP-1 were inversely associated with circulating lymphocytes count and monocytes count, but positively associated with circulating neutrophils count. It is concluded that an interferon-gamma-related cytokine storm was induced post SARS coronavirus infection, and this cytokine storm might be involved in the immunopathological damage in SARS patients.