To the Editor — Your June editorial1 highlights the importance of testing and decisive early control measures for controlling COVID-19. Taiwan has achieved extraordinary success in limiting the impact of SARS-CoV-2 as a result of its early-stage containment policy2. Since 9 May, zero confirmed cases have been detected in the country. By 7 June — five months after the World Health Organization declared a global health emergency3 — a total of 443 confirmed Taiwanese cases had been recorded and 73,471 people tested (3,089 tests per million people), making Taiwan one of the most unaffected countries worldwide, despite its proximity to the virus’s source (https://www.cdc.gov.tw/En). However, as SARS-CoV-2 continues to spread worldwide and an outbreak is expected to recur in coming seasons4, advanced preparatory measures continue to be deployed rigorously in Taiwan and the country is actively developing vaccines and medications to combat coronavirus outbreaks.
As a result of the country’s pandemic preparedness and early containment policies, the COVID-19 case load in hospitals was brought quickly under control, supplies of protective equipment for healthcare workers were sufficient, and economic disruption was minimized. This meant that production of medical supplies and protective equipment could be scaled up quickly. In the early months of the pandemic, the government rapidly coordinated enterprises to set up 60 face mask production lines, with production reaching 13 million masks daily by the end of March — a production level sufficient not only for Taiwan but also to aid other countries heavily hit worldwide (https://taiwancanhelp.us).
In addition, a tremendous effort has been made to expand existing SARS-CoV-2 testing capacity in Taiwan to prepare for the next wave of the COVID-19 pandemic, which will surely come. Although some SARS-CoV-2 antigen rapid assay and rapid serological tests for antigen-specific immunoglobulin M and immunoglobulin G have been authorized by US Food and Drug Administration Emergency Use Authorization, their effectiveness in confirming disease resistance and curbing the pandemic remain under investigation. The reverse transcription (RT)-PCR test is the only option for early viral infection detection, is more sensitive, and remains the gold standard for COVID-19 diagnosis, which is indispensable for disease control and identifying infected and infectious individuals. However, RT-PCR is a time-consuming and labor-intensive procedure and may expose technicians to unnecessary risk during the sample processing.
Your editorial mentions the problem of existing clinical laboratories being overwhelmed by COVID-19. To solve the increasing loads of COVID-19 testing, companies in Taiwan have taken advantage of automated manufacturing to develop robotic systems aimed at expanding the testing capacity of SARS-CoV-2 PCR assays5. A fully automated system was produced by integrating nucleic acid extraction, liquid handling and RT-PCR machines with a pair of six-axis, vertically articulated robot arms (Fig. 1). The throughput is up to 2,016 samples daily, with the added benefits of minimizing contamination risks and reducing burden for laboratory technicians. This robot is expandable and flexible to fit various PCR kits. The test accuracy has been preliminarily validated and now under a final check by Taiwan Centers for Disease Control6. The system is also being submitted for the Emergency Use Authorization recently issued by the Food and Drug Administration7.
We consider this machine an efficient tool that may assist countries in need of rapidly expanding testing capacity during this difficult time8. The manufacturer is in contact with international humanitarian groups to donate these machines to aid countries in Southeast Asia, Africa, and Central and South America, which remain heavily hit by COVID-19 and still lack sufficient testing capacity.
Despite not being a member of the World Health Organization, Taiwan is still doing its best to fight COVID-19 with the world together. We wish our experiences and efforts to be seen and shared to save more lives in the world.
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World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) (2020).
Kissler, S. M. et al. Science. 368, 860–868 (2020).
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TCI Co., Ltd. How has TCI managed “accurate” coronavirus scanning? https://www.tci-bio.com/en-us/official/20200413-qvs96 (2020).
Sheridan, C. Nat Biotechnol. 38, 515–518 (2020).
Anonymous. Nat. Biomed. Eng. 4, 355–356 (2020).
Y.-H.L. is chairman and president of TCI Co., Ltd.
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Wu, WK., Liou, JM., Hsu, CC. et al. Pandemic preparedness in Taiwan. Nat Biotechnol 38, 932–933 (2020). https://doi.org/10.1038/s41587-020-0630-0