Different Ship, Same Virus : Taiwan Navy Battles COVID-19



Preparing to disiect the ROCS Pan Shi fast combat support ship
Photo : ROCN

The COVID-19 pandemic which began in Wuhan City, China late last year has now spread to almost the entire world ( 185 countries ) with a total of more than 2.92 million infected and 200000 deaths. Due to its mode of transmission through respiratory droplets and direct contact between individuals, anywhere with a high population density and a high rate of social interaction will be at risk of an outbreak. We have seen how cruise ships can become epicenters of the COVID-19 disease, with the virus infecting passengers and crew alike as they are all trapped onboard with nowhere to go or hide, and how it can spread beyond the ship after docking. Military vessels are not much different from their civilian counterparts with large numbers of sailors living and working together in confined spaces and can therefore be assumed to have a similar risk profile. Recent COVID-19 outbreaks on the USS Theodore Roosevelt ( CVN-71 ) and the French Navy's FS Charles de Gaulle ( R91 ), both nuclear powered aircraft carriers, have proven that even the most advanced navies are incapable of completely shielding themselves from the virus.

Last week, another ship had the unenviable honour of joining the list - the ROCS Pan Shih ( AOE-532 ) fast combat support ship of the Taiwan Navy. The outbreak occurred during a midshipman training cum friendship deployment to the western Pacific nation of Palau ( 帛琉 Bo Liu in Chinese ), ironically one of the last few places on Earth with still no reported COVID cases. At the time of writing, there are 31 confirmed cases of COVID-19 infection all of whom have embarked on the Pan Shih supply ship. Procedural lapses during and after the deployment meant that 744 naval personnel were granted home leave and had dispersed to 90 different sites in 10 counties before they were recalled for testing. The Taiwanese government is now in a race against time in contact tracing and is even contemplating the unthinkable - a lockdown. We review how the recent events unfolded and try to understand that apart from the immediate risk of triggering a nationwide epidemic, what else could be at stake for the Navy and Taiwan from the fallout of this shipboard health crisis.

Taiwan's Dunmu Friendship Deployments

Taiwan is officially known as the Republic of China ( 中華民國 Zhonghua Minguo ). It is an island separated from mainland China by the Taiwan Strait ( Formosa Strait ). It considers itself a country and is ruled by a democratically elected government. The Chinese however considers Taiwan a renegade province and has always claimed the island as its own sovereign territory. China has actively opposed the declaration of independence by Taiwan and had prevented Taiwanese membership from many international organisations such as the United Nations and the World Health Organisation. Taiwan on the other hand tries to forge as many alliances as possible, usually through direct financial and humanitarian aid incentives, but has so far found success with only an ever dwindling handful of small and poor nations in Africa, the Caribbean and the southern Pacific. The Republic of Palau is one such example.

In support of its international outreach program, the Republic of China Navy ( ROCN ) has been conducting friendship missions to its allies to strengthen military and diplomatic ties since 1953. Known as the Dunmu Long Distance Sea Training Detachment ( 敦睦遠航訓練支隊 ), it is mainly a naval officer cadet or midshipmen sea training deployment with a secondary objective of diplomacy and cultural exchange. It became a regular annual affair since 1965, with the fleet initially visiting places like Singapore, Indonesia, Philippines, but increasingly the south Pacific localities including the Solomon Islands, Marshall Islands, Tuvalu, Nauru, Kiribati, Fiji and the central American region - Honduras, Dominica, Belize, Panama, St Vincent, Guatemala, Grenada, Haiti and Salvador.

Apparently, there is a great amount of significance attached to these Dunmu missions and only the best of the best among the naval fleet commanders are selected to lead the flotilla every year. This is according to Taiwan's retired Chief-of-Navy Admiral Ye Chang-Tong ( 葉昌桐 ). Upon the successful conclusion of the mission, the award of medals and commendations are the norm.

The Friendship Flotilla

The Dunmu 2020 fleet consisted of three ships, the fast combat support ship ROCS Pan Shih ( 磐石艦 AOE-532 ), the stealth frigate ROCS Kang Ding ( 康定艦 FFG-1202 ) and the guided missile patrol frigate ROCS Yueh Fei ( 岳飛艦 PFG-1106 ). A total of 744 naval personnel embarked for the deployment out of which perhaps slightly more than 200 must have been comprised of the midshipmen and their instructors from the R.O.C. Naval Academy, undergraduates from the Political Warfare Cadres Academy Fu Hsing Kang College, a detachment of the honor guards, the ROCN military band and the marine corps. The task group commander is Rear Admiral Chen Tao-Hui ( 陈道輝 ), a naval veteran of 30 years.

The Pan Shih is the ROCN's largest ship by tonnage with a full load displacement of 21194 tons. It is very new, having been in commission only since 2015. It is a logistic ship designed to conduct replenishment at sea with 2 vessels at the same time. It carries fuel, ammunition, dry stores and refrigerated stores. Built with Humanitarian Assistance and Disaster Relief ( HADR ) missions in mind, it has hangars that can accommodate up to 3 medium helicopters and even has a medical and dental center complete with an operating theatre and 3 wards with a total capacity of 15 beds. It has blood storage facilities, X-ray and ultrasound, a laboratory and even negative pressure isolation rooms for infectious diseases. It has a complement of 165 but for the Dunmu mission a total of 377 personnel embarked. Since 2016, the Pan Shih has been the designated flagship for all the Dunmu missions.






Pan Shih at Zuoying Naval Base in 2016. Photo : Wikimedia Commons

The Kang Ding is a modified La Fayette-class stealth frigate built by the French contractor Thales / DCNS in 1992. The procurement of the Kang Ding frigates was marred by a huge corruption scandal involving commissions and kickbacks of some 500 million dollars and even the murder of a naval captain Yin Qing-Feng in 1993. 13 other Taiwanese and French nationals involved in the scandal subsequently died under mysterious circumstances ... the list can be found at the bottom of the article here. Despite its inauspicious beginnings, the somewhat ageing stealth frigate is still a potent surface combatant though, and the ROCN plans to upgrade its Sea Chaparral missiles with the naval version of the Tien Chien II AAM ( TC-2N ). It displaces 3200 tons and has a complement of 176.

The Kang Ding stealth frigate FFG-1202. Photo : ROCN

The Yueh Fei is a Cheng Kung-class patrol frigate whose design was based on the FFG-7 Oliver Hazard Perry-class frigates of the US Navy. It bears the characteristic profile of the FFG-7 frigate complete with the forward Mk 13 missile launcher which when viewed at certain angles would seem like the ship is giving the middle finger sign. Like the Kang Ding frigates, the Yueh Fei is armed with both the indigenously developed Hsiung Feng II and III anti-ship missiles. With a full load displacement of 4169 tons, it can accommodate up to 2 anti-submarine helicopters and has a complement of 235.

Patrol Frigate Yue Fei ( PFG-1106 ) and sister ship Tien Dan. Photo : Wikimedia Commons

Dunmu 2020

The Dunmu deployment typically starts in late February or early March with an island wide stopover at several large cities or ports in Taiwan over the span of two to three weeks. This is the local training phase (  国内航训 ). Kaohsiung, Makung, Su'ao, Hualien, Taichung, Keelung and Tainan are usually included. At each port, the ROCN will have an open house event lasting for two days where the public will be welcomed to visit the ships. Part of the aim is to attract young people to join the navy as career soldiers.

This year, the detachment officially formed on 20th Feb 2020 but most likely due to the movement restrictions from the authorities there has been no mention about ship open house events. The flotilla departed Kaohsiung City's Zuoying Naval Base on 5th Mar bound for the Republic of Palau in the southern Pacific. It would have been the 15th visit to Palau by the Dunmu deployment since 2001.

Crowds at Keelung waiting to board AOE-532 Pan Shi at last year's Dunmu mission.
ROCN Photo

Dunmu 2020 Fleet : PFG-1106 (L), AOE-532 ( center ) and FFG-1202 (R)
Photo : ROCN

The Dunmu Detachment arrived at Palau on 12th Mar but due to Palau's port regulations only the stealth frigate Kang Ding docked while the other two ships remained at anchor off-shore. The usual welcoming ceremony and diplomatic exchanges took place and there were several performances that took place including the martial arts demonstration by the marine corps and the marching band performance by the Naval Academy. A friendly game of softball took place at the Asahi Field after which the detachment commander Adm. Chen donated a set of softball equipment to the Palau Softball Team. While at the pier and just before the departure on 15th Mar, the Kang Ding conducted a joint flag hoisting ceremony where both the Taiwan * and the Palau flag were raised simultaneously. Staff from the R.O.C. Embassy in Palau which included the Ambassador Wallace Chow and some local dignitaries from Palau were invited onboard to witness and participate in the ceremony.

* The flag of Taiwan is also known as the Blue Sky, White Sun, and Wholly Red Earth flag ( 青天白日满地红 Qing Tian Bai Ri Man Di Hong ). The significance of each component here.

Ambassador Chow, Vice President of Palau and ship officers
take group photo with no mask or physical distancing.
Photo : ROC Embassy in Palau

Naval Academy Marching Band performance. Again no mask or physical distancing.
 Photo : ROC Embassy in Palau

 

Joint flag hoisting ceremony on Kang Ding.
Most personnel unmasked.
Photo : ROC Embassy in Palau

Due to the COVID-19 pandemic, the detachment did not have any other port visits apart from Palau which is most unusual. It would have otherwise visited several countries in a normal year. Palau could have been chosen as the sole Dunmu destination because it was free from COVID-19 when the fleet departed Taiwan, just as it is still officially free from the virus today. The flotilla then spent the next 25 days at sea until its arrival back at Zuoying Naval Base on 9th Apr, without any interaction with foreign navies or any port visits, as claimed officially. Not including the local training phase before 5th Mar and the 6 days of quarantine after arrival on 9th Apr, Dunmu 2020 spent 36 days at sea, the shortest on record. In contrast the Dunmu 1981 mission to South Africa had spanned a total of 82 days at sea.

Dunmu 2020 intended (dotted) and actual ( solid ) route.
Image : Liberty Times Net

Since the trip to Palau only took 7 days but the return journey had taken 25 days, there was a lot of speculation as to where the flotilla went and what it did during the 18 "unaccountable days". Conspiracy theories abound as to whether the fleet had visited Guam where the USS Theodore Roosevelt lay stricken by the coronavirus or whether the fleet had participated in training exercises with the USN* which was conducting live firing operations in the Philippine Sea around that time and then somehow got infected. On 24th Apr under public scrutiny, the Ministry of Defense through spokes person Brigadier Shi Shun-Wen finally revealed the route map of the Dunmu 2020 which showed that after departing Palau the fleet sailed south west passing south of Mindanao through the Celebes Sea, passing through the Makassar Strait between Kalimantan and Sulawesi, through the Java Sea towards Singapore ( closest approach on 27th Mar ) and then turned northeast through the South China Sea past the Taiwan administered Taiping Island which is the largest of the naturally occurring Spratly Islands, and then the Taiwan controlled Pratas Islands ( Dongsha Islands ) before arriving home in Zuoying Naval Base.

The original plan was for the fleet to sail north through the Strait of Malacca ( dotted red lines ) to demonstrate the long distance and endurance capabilities of the fleet with a stop over in Singapore for replenishment. However the deteriorating COVID-19 situation in Singapore during the second half of March with double digit growth in daily new infections made the naval command change its mind.

The revelation of the flotilla's navigation route still did not shed any light on whether the navy had undertaken any special missions on the return leg. The Defense Minister denied any tasking of covert missions but President Tsai seemed to suggest that there were some special missions involved but she was not at liberty of disclosure, adding that the fleet did not go anywhere else other than Palau. My suspicion is the resupply of Taiping Island and Pratas Island by the Pan Shih logistic ship and perhaps some electronic or signal intelligence gathering in the troubled South China Sea.

* the LHA-6 America Expeditionary Strike Group





Endless watch duties at sea during Dunmu 2020. Photo ROCN.

 

 

Welcome ceremony with colors party of the ROC Naval Academy. Photo ROCN

End of mission ceremony. Banner indicates year 109 of the Minguo calendar
which is 2020. Photo ROCN



President Tsai welcoming the home bound sailors.
Photo ROCN

The returning sailors were greeted by the President of Taiwan Tsai Ing Wen herself at the pier though due to the fear of COVID-19 the president merely waved from ashore and did not board any of the ships for an inspection.

The sailors were then quarantined for 6 days onboard their respective vessels before being granted home leave and dispersed from the naval base on 15th Apr. This was in accordance with Taiwan Centers for Disease Control ( CDC ) guidelines which required 30 days of quarantine from that date of departure from the last port of call. The Dunmu sailors would have fulfilled this requirement on 15th Apr if they had left Palau on 15th Mar and did not make any landfall after that.

The 6 days of quarantine were uneventful except that the two frigates Kang Ding and Yueh Fei were scrambled on 12 Apr to intercept the Chinese Liao Ning aircraft carrier group which was spotted by the Japanese crossing the Miyako Strait and held drills near Taiwan. They returned on 13 April. And so the Dunmu 2020 was supposed to have concluded and nobody knew at that time what was about to happen.

Taiwan-Palau Pandemic Prevention Cooperation Project

It is worth mentioning that on 2nd Apr just two weeks after the Dunmu visit, a special chartered flight from Taiwan arrived at Palau under the auspice of the Taiwan-Palau Pandemic Prevention Cooperation Project delivering a RT PCR machine, a centrifuge machine, an automated extraction machine, 1000 test kits and 2 infrared thermometers. Two Taiwanese medical experts from Shin-Kong Hospital also arrived to help with the installation of the equipment and to provide the necessary training to the Palauans. The reverse transcription - polymerase chain reaction ( RT-PCR ) method through a deep nasal or throat swab is currently the gold standard in diagnosing an acute COVID-19 infection. Those rapid serology test kits that involve blood testing for coronavirus antibodies ( IgM, IgG or both ) can only indicate past infection and are only useful for epidemiological studies and not for diagnosis. Many rapid test kit manufacturers vastly exaggerate the accuracy of their products. It is not uncommon to have claims of 90% sensitivity on Day 14 of infection but in practice only found to achieved 30% sensitivity.

Vice President of Palau Raynold Oilouch, Ambassador Wallace M.G. Chow,
and Health Minister Emais Roberts with the donated COVID testing equipment.
Photo : Embassy of ROC in Palau

 

The First Signs of Trouble

A trainee embarked on the Pan Shih was unwell since 12th Apr with headache and anosmia ( loss of sense of smell ) as the main symptoms. He sought treatment immediately after disembarking the ship and reaching home on 15th Apr. He had a repeat consultation on 17th Apr and subsequently tested positive for COVID-19 on 18th Apr and became Taiwan's Case 396. His bunkmate was similarly unwell since early April with sore throat, running nose, cough, headache and anosmia. He sought treatment on 17th April and was confirmed to be infected the next day, becoming Case 397. Another room mate had anosmia since 13th April and sought treatment on 17th April. He was tested positive becoming case 398.

It is notable that all 3 cases were trainees embarked on the Pan Shih sharing the same room. They had symptoms that can be suggestive of COVID-19 infection for several days prior to disembarkation but the commanders were not vigilant enough to take any preventive measures.

More Trouble

On 18th Apr with 3 confirmed cases from the ship, the navy hastily conducted an emergency recall for its more than 700 personnel from the Dunmu mission with the objective of testing all of them. By the next day, 21 cases were detected bringing the total number of infected sailors to 24. All were from the Pan Shih, the majority being trainees. 3 more new cases emerged the next day and the subsequent 4 days brought 4 more cases each, which made the latest tally 31 infected.

At the time of the recall, the Dunmu sailors had dispersed to more than 90 different cities and towns spreading over 10 counties and had come into contact with an unimaginable number of people. At the time of writing Taiwan CDC determined through contact tracing that there were 1843 at risk individuals of which 530 were advised home quarantine and 1313 were on self-monitoring.

To complicate matters, of the 19 assembly points for the emergency recall selected by the navy, 10 were various elementary and high schools all over Taiwan. The navy did so without first informing or consulting the schools, the Ministry of Education or the Mayors, thereby potentially placing the health of the students and teaching staff and the public at risk. The most contentious incident occurred at the Taichung Municipal First Senior High School where the military quarantine vehicle actually entered the school compound and cause alarm among the students, teachers and the large number of the members of the public in the vicinity of the school. It necessitated deep cleaning at the affected schools afterwards and generated a lot of unhappiness from the education community and the municipal officials.

Green dots show areas where infected sailors had visited. Mainly cities and town
on the highly industrialised and populated west coast of Taiwan. Taiwan CDC.

Palau : Still No COVID-19?

 

The news of a COVID-19 outbreak on the ROCS Pan Shih understandably caused panic in Palau. In response to speculation that the Dunmu personnel could have contracted the coronavirus from Palau, the Taiwanese embassy staff in Palau as well as the locals who had visited the Taiwanese ship or had contact with the ship crew were subjected to COVID tests from 18 April onwards but none had turned out positive. So the origin of Pan Shih's outbreak seems less likely to have come from Palau especially when the first 3 cases all became symptomatic only after early April, more than 2 weeks after the flotilla departed Palau. We know that the incubation period of COVID-19 can be anywhere between 2 to 14 days with an average of about 4 or 5 days. However, subsequent serology tests on ship crew would have added doubt to this trend of thought.

It is important to understand that a negative COVID-19 swab test does not exclude an infection as all medical tests including the RT-PCR test have a small inherent false negative ( as well as false positive ) rate. Therefore no single test method can claim to be foolproof or have 100% sensitivity. Further more, the swabbing procedure itself is operator dependent and if the sampling is not done properly, for example the nasal swab not inserted deep enough or at the right spot means that the accuracy of the test can be affected. Here's a good video on how a proper nasal swabbing is done courtesy of the New England Journal of Medicine.

Another factor to consider is the proficiency level of the lab technicians doing the PCR and the bio-protective capabilities of the laboratory. PCR tests are complicated to perform and requires technicians with high level of expertise. Palau needed Taiwan's assistance for COVID-19 diagnosis as recent as Mar 2020 when it had to test a suspect case which fortunately turned out to be negative. The RT-PCR machine was donated only on 2nd Apr and we do not know how well trained the Palauan technicians are in just a matter of days. Once taken by the medical team of doctors or nurses, the swabs need to be processed by the lab which, according to US CDC recommendation, should be a BSL-2 ( Bio-Safety Level 2 ) lab with unidirectional airflow and adopting BSL-3 precaution. How much of these highly technical specifications can be met in a far flung locality like Palau is way beyond my imagination.

So is Palau really the last place on Earth that is COVID-19 free? A tropical paradise it definitely is but I would not be so certain about its COVID free status. After all, with a testing capacity that is said to be between 30 to 60 a day, only a small fraction of its citizens had been tested. Palau has plans to test 500 people within the next 3 weeks.

Tropical Paradise Palau :  Jellyfish Lake Ongeim'l Tketau  Wikipedia

Hunt For The Source

With the aim of uncovering the origins of the COVID-19 infection onboard the Pan Shih, the Taiwanese authorities began conducting serology test on the Dunmu participants. Unlike the diagnostic RT-PCR test, serology testing for antibodies against the SARS-CoV-2 virus which causes COVID-19 will reveal prior infection. Depending on type, these antibodies begin to appear in the body and reach detectable quantities from about day 5 of infection onwards and will remain in circulation for at least months to years after the infection. To their surprise, at least 30 sailors from Pan Shi actually had circulating antibodies against the COVID-19 virus which indicated that Case 396, 397 and 398 were NOT the first three cases from the ship. It tells us that the infection had probably been brewing onboard the Pan Shih for sometime and it had spread among the ship crew without the knowledge of the medical team. The index case ( the first infected person ) can only be discovered through a thorough contact tracing effort with the help of the case notes of the ship's medical officer. Hopefully the doctor would have kept good and detail notes on the daily sick parade that was conducted onboard the ship.

So far the Defense Ministry had determined that 148 persons had reported sick a total of 226 times fleet-wide during the entire deployment. Of these, 10 had symptoms suggestive of upper respiratory tract infection ( cough, running nose and sore throat ) and 5 had fever. The medical officer did not believe these were anything more than a common cold or an influenza infection. Of these 5 febrile cases, only one was deemed serious enough by the detachment commander to be reported to the Naval Command. Serology tests would reveal that 3 of these 5 febrile cases tested positive for the antibodies but had negative PCR test, confirming that they had prior COVID-19 infection and had since recovered. They had fever on 21st, 23rd and 26th Mar respectively, well within 14 days of departing Palau.

It would seem to me that the medical team should have had demonstrated heighten vigilance against the possibility of COVID-19 infection given the rapidly deteriorating global situation in March and April.

The result of the serology surveillance, in combination with the knowledge gained from the USS Theodore Roosevelt COVID-19 epidemic that about half of those infected remained asymptomatic, can only mean that Palau can still be the source of infection. The only way Palau could have absolved itself was for the ROCN to prove that disease transmission occurred onboard ship BEFORE the fleet's arrival at Palau. The crucial evidence therefore lies in the ship's medical log.

Of course there is still a possibility that the naval personnel did not get infected in Palau but after Palau. A possible clue would be that all the infected were exclusively from the logistic ship but not the frigates. Depending on the type of special missions that the Dunmu ships carried out, it might have been possible for the Pan Shih crew to get infected should they have unloaded supplies at the two Taiwan administered islands in the South China Sea, Taiping and Pratas. No doubt both are very tiny atolls equipped with airstrips but we know that there are many things that cannot be brought in by air, like heavy equipment and building and construction materials. How about anti-ship missiles for coastal defense, anti-access / area denial??

Did the flotilla visit the islands? Did they dock? Did anyone come aboard or did the ship complement go ashore? COVID-19 infection would have been much more likely if they did any of the above.

Dongsha ( Pratas ) Islands with a 1800m airstrip

 

Casualties

On 21 Apr the Minister for Defense Yen De-Fa, his Deputy Zhang Ze-Ping, the Inspector General and the Chief of the Political Warfare Bureau made a public apology for the Pan Shi coronavirus cluster during a press conference. Yen held himself accountable and said that together with Chief of Navy Liu Zhi-Ping, they were both willing to accept any punishment meted out by the president, including that of resignation. He also announced the removal of the two highest ranking officers directly involved with the Dunmu 2020 mission, detechment commander Rear Admiral Chen Tao-Hui and his direct superior, commander of the R.O.C. Naval Fleet Command Vice Admiral Kao Chia-Pin (高嘉濱) from their current commands while awaiting the conclusion of the ongoing investigations.

File photo Rear Admiral Chen Dao-Hui ( center ) and Chief of Navy Liu Zhi-Ping ( L )
with President Tsai in 2018. Adm Chen was relieved of his command
 for mishandling the Pan Shi outbreak. 

Drama at the Legislative Yuan

On 22 Apr with the Pan Shi COVID-19 cluster developing into the largest in Taiwan, the defense committee of Taiwan's Legislative Yuan invited the Defense Ministry to an inquiry to clarify matters. Opposition KMT lawmaker Lyu Yu-ling, member of the defense committee had originally wanted 3 people to testify through video-link since they were all still under quarantine - Detachment commander Chen, CO ROCS Pan Shih and the medical officer who had the rank of lieutenant. It appeared that Dunmu commander Rear Admiral Chen Tao-Hui was under direct orders to keep mum and was forbidden to testified through video link. The Defense Ministry then told the Legislative Yuan the three officers had already stated the day before that they did not wish to appear on video-link while they were serving quarantine. All three were also apparently not contactable through their phones. The committee deliberated for an hour and was about to give up when Adm Chen somehow managed to call-in at the inquiry and his testimony was broadcasted to the entire assembly through legislator Lyu Yu-ling. In it, he swore that he would never hide the truth and spoke emotionally about how he would rather die at sea or die onboard his ship rather than knowingly bring harm to the Taiwanese people whom he had pledged to protect in the first place. He said that he would have immediately terminated the mission had there been a known case of COVID-19 in his task group. He was asked about the number of febrile cases in the detachment and whether he reported them to the naval command. The reply was there were 5 cases but only one was serious enough that he reported to the naval command. He was also asked about who had given the order to disperse the ship company on 15th Apr after 6 days of quarantine to which he said he did not have the authority and was merely following orders. It was then that the phone was snatched from the legislator by the Chief of Naval Staff Ao Yi-Chi and immediately silenced causing many members of the public to wonder if the naval command or the ministry of defense had something to hide. It took another day before the Deputy Defense Minister Zhang Ze-Ping came up with the explanation that the phone was taken away because the ministry was concerned about the state of mind of Adm Chen after his emotional speech which was interspersed with choking episodes and that to allow him to continue would be inappropriate. The phone was removed after the consent of legislator Lyu Yu-ling was sort.

To make things even more muddled, Adm Chen subsequently publically retracted some of the statements he made over the telephone link saying that he did not have a clear state of mind after 3 sleepless nights and 5 days of quarantine and could have remembered some of the facts wrongly.

All these drama only make the Taiwanese politicians and the military look like fools and only serve to provide entertainment for their communist counterparts on the mainland.

Taiwan's COVID-19 Response : Poster Boy No More?

Like Singapore, Hong Kong, Vietnam and China, Taiwan experienced a severe SARS epidemic in 2003 and had learnt many valuable lessons in disease prevention and control. As a result, Taiwan activated its epidemic prevention measures very early during the COVID-19 outbreak on 31 Dec 2019 when it received news about 7 cases of atypical pneumonia * being isolated for treatment in China. This was even way before human-to-human transmission was confirmed possible by WHO, before the illness was identified as a coronavirus disease. Taiwan just assumed it can spread among humans since isolation was required, and acted on that assumption immediately, implementing inspection measures for inbound flights from Wuhan. By 26th Jan short term visits from Hubei Province were banned from entry and by 5th Feb all tourist from mainland China were banned.

It even regulated the prices of surgical masks and had a nationwide system of rationing such that all citizens have access to masks and could buy at least 2 masks per week at 50 cents each. The price of surgical mask in Taiwan has now dropped to 20 cents with the easing of initial shortages. It helps that Taiwan is one of the major mask producing countries outside of China. It also went on to ban all export ** of masks keeping everything produced for its own people. Taiwan never had to lockdown its cities unlike what many other countries are doing but yet managed to keep its COVID-19 count before the Pan Shih incident to "only" 395 cases and 6 deaths despite being located practically at China's doorstep. It is the poster boy for the global COVID-19 response and the envy of many countries.

After 3 days without new cases known locally as Jia Ling ( 加零 zero added ）on 14, 16 and 17 Apr, the sudden appearance of 31 new confirmed cases from the navy to form Taiwan's biggest COVID-19 cluster within a short span of a few days had really shaken the Taiwanese society. It created fears that the epidemic might spin out of control necessitating lockdowns. Taiwan's Centers for Disease Control website now lists 429 confirmed cases and 6 deaths.

Contact tracing had revealed that upon disembarkation, some infected sailors had, unknowingly, visited motels, hotels, karaoke lounges and other commercial malls and entertainment sites as well as restaurants before they headed home. 13 out of the first 27 positive cases admitted to having intimate contact with their partners before they were diagnosed, and these figures maybe under represented as not every servicemen might be completely forthcoming with their movement history and contacts.

There is a probable chance that Taiwan's Covid-19 numbers might spike in the next few weeks due to the navy's lapse in shipboard infection control and it might then have to relinquish its " gold standard " status becoming a cautionary tale like Singapore.


* The Chinese frequently use the term " atypical pneumonia "  to mean SARS and the Taiwanese took no chances when that term appeared in the Chinese media. That the causative agent was subsequently identified as a coronavirus ( which the SARS and MERS viruses belonged to as well ) only affirmed their conviction.

** In Jan 2020 a Singapore State-owned defence company ST Engineering with mask making facility ( Air+ N95 series ) in Taiwan found itself unable to export masks to Singapore because of the ban. To get around the ban, the production lines were shut and the automated mask making equipment were shipped back to Singapore. The incident is causing ripples even till this month.




Taiwan Daily New Cases : Grey - Local, Red - Imported,
Yellow - Others ( ROCN ). Image : UDN 



Possible Casualty : Indigenous Defense Submarine

One might wonder how the coronavirus outbreak on a navy ship could have affected an ongoing high priority national defense program. Taiwan has 4 diesel-electric attack submarines, two of which are more than 70 years old ( ex-USN Guppy II ), used for training only and may not even be sea-worthy. The other two Chien Lung-class ( improved Zwaardvis ) SSK were all commissioned more than 30 years ago and are in urgent need for replacement. Since no submarine exporting country is willing to endure the wrath of China by selling submarines to Taiwan and the US no longer build conventional submarines, the Taiwanese have no option but to consider the indigenous route.

IDS model. Wikipedia

Launched in 2016, the Indigenous Defense Submarine ( IDS 自製防禦潛艦 ) project to build 8 diesel-electric attack submarines for the ROCN is a high risk project and success is not guaranteed. It is the pet project of President Tsai Ing Wen. Even with the availability of funds, blue prints, engineering expertise and yard facilities, submarine construction is highly complicated. Nonetheless the IDS program seemed to have progressed well so far and the construction of the first prototype was supposed to start at the end of this year and was projected to be completed by 2025. It would then undergo 1 to 2 years of sea trails before entering service.

However, not everyone has faith in the IDS project and there are always political entities especially those from the opposition KMT party calling for the project to be terminated. Currently one of the main proponent and main driving force for the project from the navy's perspective would be Admiral Huang Shu-Kuang ( 黃曙光 ), the ex-Navy Chief who was promoted to position of Chief of the General Staff on 16 Jan 2020 after the unexpected passing of his predecessor Gen Shen Yi-Ming in a UH-60M crash.

Adm Huang of course would have realized that the IDS program is a long term project and will never see fruition within the tenure of his own military career. Born in 1957, Huang would have reached mandatory retirement age by next year. He would have to have a clear succession plan to ensure the IDS project has the best chance of success. With his background from the submarine forces, it is of no surprise that he favours Vice Admiral Kao Chia-Pin, another ex-sub skipper and his subordinate, to be his successor. The two had a long history of friendship and cooperation - in 2007 Huang was squadron commander and Kao the skipper of the submarine Hai Hu SS-794 that successfully sunk a target ship, the oiler AOG-515, with a heavy torpedo during the annual Han Kwang exercise.

 

Ex-Commander of Republic of China Naval Fleet Command
Vice Admiral Kao Chia-Pin ( 高嘉濱 ). Photo : ROCN

Kao himself is a high flyer and was the detachment commander of the Dunmu 2018 mission. As a rear admiral he created a new record by being appointed the Inspector General of the Defense Ministry, a position normally reserved for two-star generals and above. All this with the recommendation of his mentor Adm Huang of course. Kao's next appointment would be the commander of Naval Fleet Command ( 海軍艦隊指揮部 ) and was in-line and groomed to eventually be the commanding general of the navy.

Unfortunately, barely 6 months into his job as commander of Naval Fleet Command, he was relieved of his duties because of the COVID-19 outbreak in the navy. This really disrupts Adm Huang's succession plans as there aren't many high ranking naval officers within the ROCN that are submarine qualified. Unless he is reinstated pending investigations, lack of a suitable naval chief who thoroughly understands submarine warfare to continue to push the Navy's agenda for new submarines may eventually doom the project.

To make matters worse, it was also Huang who appointed Chen Tao-Hui as this year's Dunmu commander. Although Chen was previously a frigate captain and not submarine qualified, he was nonetheless one of the up and coming young flag officers that Huang admired. So in one fell swoop, two of Adm Huang's and the ROCN's promising generals had been removed from duty.

As it takes more than 20 years to groom a naval officer to senior ranks of rear admiral and above, many, including the 90 year old ex-navy chief Ye Chang-Tong, are questioning the rationale of removing the 2 officers for some things that are beyond their control.

From Routine Mission To Public Relations Fiasco

The annual Dunmu Friendship Mission by the ROCN is of great significance to the Navy as well as the nation of Taiwan. First it provides sea training for the graduating class of midshipmen who are expected to put all they had learnt into practice. It's their rite of passage. For Taiwan, it is a chance to show its handful of allies its appreciation of their friendship and recognition of Taiwan. It had never been interrupted for more than 50 years but in hind sight perhaps this year's friendship mission should never have taken place because of the COVID-19 pandemic.

By early March, there was already mounting evidence of rampant COVID-19 infection onboard multiple cruise ships and the situation on land was no better. Although China had successful controlled the spread of the virus through a nationwide lockdown, other countries in Europe and American were seeing exponential increases in their infected citizens.

ROCN made the decision to carry on with the friendship mission after consulting the Taiwan CDC and then had the President approved the mission. The worldwide COVID-19 situation is changing so fast that even 3 days would seem like a lifetime. CDC would likely not be able to accurately predict what would have happened 2 months down the road and played only an advisory role in any case. Adm Kao should not have given the green light for the mission and place the health of more than 700 sailors at risk. ROCN should never have assumed any place was COVID-19 free, including far flung Palau, especially when no tests were conducted in those localities.

At Palau, photos on social media have shown that the officers and men interacted with the local people mostly without wearing masks and also failed to maintain any meaningful form of physical distancing. This lack of caution could have stemmed from the false assumption that Palau is COVID-19 free. Now I am not saying that Palau has COVID-19 but rather nobody can be sure Palau does not have COVID-19. It pays to be careful.

The management of the sick crew members during the sea deployment was also wanting. It is probably of no secret that in a conscription based military system like those of Singapore, Israel and Taiwan, the most junior medical officer would be tasked to follow a long sea voyage. These young doctors may be qualified but are likely to lack experience having just graduated from medical school for not more than a couple of years. Still, to have febrile cases onboard the ship dismissed as just another case of common cold or influenza infection during a COVID-19 pandemic is beyond my comprehension. Granted it is not possible to differentiate between common cold and COVID-19 infection base on symptoms and clinical examination and that it is not possible to perform the diagnostic PCR swab test onboard the naval vessel. But at least the medical officer could have a heightened sense of vigilance and these sailors with flu-like symptoms should have been isolated straight away in one of the Pan Shi's negative pressure isolation rooms!


Failure of reporting most of these fever cases to command HQ also defies logic but perhaps the detachment commander had other considerations and chose not to report. He might be concerned that the Friendship Mission could be prematurely terminated should there be too many sailors coming down with fever and that could ultimately affect his performance appraisals and future promotion. In other less trying times, this would never be a problem as ships are rarely ever recalled for minor illnesses occurring onboard.

From past experience, during a deployment, the ship crew will hardly report sick once the ship is underway. They are young and generally healthy to start off with. Even when down with a minor illness, most would just self medicate rather than report sick. They will just continue with their usual watch duties as long as they are not too ill. On arrival at a port of call, nobody would report sick because everyone wants shore leave. The busiest time for the ship medic would be after the port visit when crew members would stumble in for treatment of traveler's diarrhea, minor wounds from falls and fights and sometimes sexually transmitted diseases. The last day of the deployment will also miraculously have nobody reporting sick as everyone wants home leave!

Now I believe it should be in every ship's Routine Orders that everyone should be checking their temperatures at least twice a day and anyone who is unwell or having a fever should report sick without delay. The medic should assume that fever + acute respiratory infection = COVID-19 and isolate until proven otherwise. Even more worrisome are those infected that showed no symptoms as the USS Theodore Roosevelt experience have taught us - half of those infected did not display any signs or symptoms! So the best course of action now for the navy is not to deploy the ships at sea unless it involves a mission that is critical to the survival of the nation. Training missions and diplomatic missions like the Dunmu deployment can be postponed until the pandemic is under control. The graduating midshipmen may miss their sea training but let them graduate anyway. They can join their juniors in the following year's Friendship Mission as ensigns.

The handling of the recall also showed that the navy was completely unprepared for such an event. Some kind of recall plans should have been made even before the ship crew dispersed. Randomly choosing schools as assembly points puts the students and public at risk of infection. Many would have taken public transport to the assembly points and whoever had contact with them could be endangered as well. It does not make sense for a mass recall to have happened this way. Remember that by 18 Apr which is 3 days after dispersal, the ship crew are now scattered all over Taiwan with one even reaching Jinmen Island. Instead, the ship crew should have been told to report to the nearest government test centre for COVID-19 tests immediately. Better still, all returning sailors should have been tested for COVID-19 before being granted home leave just like what Singapore and China have been doing for some weeks - testing ALL arriving passengers at the airport. The Dunmu mission had 6 days of quarantine at Zuoying Naval Base, that's more than enough time to test all 744 members.

The ROCN should continue its efforts to uncover the source of the ROCS Pan Shih outbreak. Only when this is achieved can better preventive measures be implemented. This COVID-19 outbreak has already caused the navy to lose two of its brightest and most promising admirals and potentially affect its succession plans for up to two decades. It can disrupt the Indigenous Defense Submarine program and it has yet again tarnished the reputation of the Navy. Let's hope it does not claim any lives.