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How to live with COVID‐19 pandemic: Taiwan experience

Submitted by:
Kuei‐Yu Liang, MD, MS
Director, Division of Geriatric Psychiatry, Mental Health Center, Wei‐Gong Memorial Hospital, Miaoli,
Taiwan
Secretary‐General, Taiwanese Society of Geriatric Psychiatry


Ms. T, a graduate student in Los Angeles, received a notice that her university dormitory would be closing soon due to the COVID‐19 pandemic. She decided to return to Taiwan and continue learning through their online curriculum. During air travel she wore a face mask and goggles for droplet precaution, and upon arrival in Taiwan, she received a form to record her temperature for the next 14 days. Because she had a cough which started a week prior to departure, she was escorted by security for secondary screening. Ms. T had her temperature taken and completed a health declaration form. She then underwent COVID‐19 testing at the airport and her bags were disinfected. Ms. T was not allowed to take public transportation, so she was provided a ride home via a government disease prevention taxi. She was quarantined for 14 days and tracked through her mobile phone to ensure she remained at home during the incubation period. The Taiwan Centers for Disease Control and local government office provided assistance during the two‐week quarantine by keeping in touch with Ms. T via phone or text messages; delivering a packet of masks and a thermometer; as well as providing supplies like groceries and other necessities.

The Taiwan government established the National Health Command Center (NHCC) one year after the SARS outbreak. The NHCC acts as the operational command point for direct communications among central, regional, and local authorities. The Central Epidemic Command Center (CECC), a part of NHCC, was officially activated by the Taiwan Centers for Disease Control (CDC) on 20 January 2020, while sporadic cases were reported from China. In the following five weeks, the CECC has rapidly generated and applied at least 124 action items including border control from the air and sea, case identification, quarantine of suspicious cases, proactive case finding, resource allocation, public education and reassurance, formulation of policies toward schools and childcare, and relief to businesses.1

The outbreak of COVID‐19 has increased stress levels and caused fear and anxiety throughout the population. The Ministry of Health and Welfare (MOHW) in Taiwan provides support for mental and psychosocial well‐being in different target groups during the outbreak. “We think only when information is transparent, and people have sufficient medical knowledge, will their fear be reduced,” the government spokeswoman said. People can get information updates online or via media, and medical officials hold daily briefings. The MOHW website also provides a counseling hotline and health education manuals, as well as guidance for the general population, more vulnerable populations (e.g., children and elderly), individuals under mandatory quarantine, individuals with confirmed or suspected COVID‐19, and medical workers.

The global death toll due to coronavirus has increased over 245,000 with the elderly and patients with pre‐existing conditions like cardiovascular disease and diabetes being disproportionately affected. Weaker immune systems and cognitive decline can render older adults more susceptible to the pandemic. In these unusual times, we should be mindful of our own health while paying more attention to the seniors in our community. The Taiwanese Society of Geriatric Psychiatry recommends the use of “P.E.A.C.E” to better aid the elderly in fighting this pandemic. (see below) The Taiwan Alzheimer’s Disease Association proposes the Reference Handbook of Dementia Care in Responding to COVID‐19. Hopefully, we can provide support for mental health needs of elderly and their caregivers during this time.

1. Wang CJ, Ng CY & Brook RH. Response to COVID‐19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA. 2020; 323(14): 1341‐1342. doi:10.1001/jama.2020.3151

Helping the Elderly through the Pandemic ‐‐‐ P. E. A. C. E.
Taiwanese Society of Geriatric Psychiatry Press Release April 1, 2020

In the last three months COVID‐19 has spread globally from China across the world. The death toll has increased well over 30,000 affecting elderly patients and those with pre‐existing chronic conditions such as cardiovascular disease and diabetes. Weaker immune systems and cognitive decline can render older adults more susceptible to the pandemic. In these unusual times, we should be mindful of our own health while paying more attention to the seniors in our community. The Taiwanese Society of Geriatric Psychiatry recommends the use of “P.E.A.C.E” to better aid the elderly in fighting this pandemic.

P (Peace, Plain language) Describe coronavirus disease (COVID‐19) and preventive measures to the elderly using plain language and with a calm voice. Gentle and repeated explanation can reduce anxiety and distress.

E (Everyday routine, Emotional balance) In face of the uncertainty surrounding COVID‐19 emotions such as anxiety and dysphonia can affect older adults and those with cognitive issues. Maintaining an everyday routine and emotional balance can help while coping with this pandemic.

A (Alter, Alternative) Instead of focusing solely on the pandemic, altering attention to other aspects of life can help relieve anxiety. During an infectious disease outbreak with some restrictions in life, alternative activities (such as board games, music, or socialization) should be provided.

C (Care, Concern, Consideration) Provide care, concern, and consideration to the elderly, especially those with anxiety, depression, and dementia. Older adults may have a more difficult time during the pandemic, and those with dementia may have great difficulty remembering proper precautions and instructions. A little kindness, such as delivering a meal or essential medicine, can go a long way and be truly helpful for those quarantined or living alone.

E (Exercise, Expand connections) Social distancing at home may reduce the odds of transmission, but long periods indoors may exacerbate mental disorders and disuse syndrome. A better option would be to avoid population‐dense areas and areas with poor ventilation while maintaining an exercise routine and outdoor activity when possible. Expanding connections and interacting with friends/relatives via phone, video chat or social media can improve mental health.

Acknowledgements

Acadia Pharmaceuticals Otsuka Pharmaceuticals Cambridge University Press Avanir Pharmaceuticals
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