全球大流行期間總體醫療防疫安全體系之建立

Establishing the Total Epidemic Prevention Healthcare System During Pandemic Responsiveness

COVID-19新冠肺炎百年大疫，我國公衛防疫運用大數據科技成功將疫病阻絕境外，同時台灣醫界擔綱最重要的護國長城，醫療體系超前部署進階版動線管制（enhanced traffic control bundling，eTCB），以六標準差高規格保護醫療工作者，並從醫療端截斷社區傳播鏈。境內防疫雖有低度社區隱性感染之虞，經由民眾配戴口罩與酒精洗手之全民運動，阻滯病毒在社區增幅傳播之風險，一起寫下「台灣有個金鐘罩，醫療酒精與口罩」的故事。現階段正值疫苗開打，與經濟解封防疫鬆綁的關鍵時刻，吾人宜加強醫療總體分流整備，以社區大流行為想定情境，針對篩檢以及病人收治進行分流，佈建從重症醫療到地區醫院到基層社區居家醫療之網絡。社區基層醫療位居總體網絡之樞紐，大流行期間，可依地區造冊之基層醫療同仁輪駐「社區篩檢站」，以達有效保護基層醫護，並發揮人力資源以及防疫物資之最佳配置與運用。社區篩檢站之規劃想定可採長照2.0，以國中學區或台北市68次分區佈點設計，於大流行期間，發揮篩檢收治轉診之樞紐作用。上述台灣模式可與疫苗施打同步進行，於達成群體免疫前，阻斷病毒基本再生數（R0）增幅導致之病毒變異，如此台灣模式將可成為全球防疫最佳典範。

Taiwan’s successful pandemic response adapts to the unique challenges arising from COVID-19. Interventions include enhancing its 2003 SARS Traffic Control Bundling model to manage asymptomatic/ presymptomatic patients. Taiwan emphasized containing hospital and community-hospital-community transmission by implementing enhanced Traffic Control Bundling (eTCB) while working closely with the public to encourage community hand hygiene and facemasks. Avoiding lockdowns, Taiwan’s approach is a low intervention and effective model for countries as vaccination campaign and variants compete with each other in controlling COFVID-19 pandemic. In terms of mitigating community epidemic, Taiwan’s major government goal is to minimize pandemic impacts in the interim period between the outbreak and vaccine availability while enhancing surge capacity. We propose a layered containment strategy as an initial response based on TCB and six-sigma principles to divide administrative districts into smaller sub-districts. Each sub-district deploys one “community screening station” as the hub of the total network of the healthcare system to link between primary healthcare at the community level and isolation hospital groups. Taiwan’s example demonstrates that effective pandemic response requires a government willing and able to adapt policies and engage the population in response to changing conditions. Given the likelihood of additional COVID-pandemic waves following vaccination campaign and reopening, and the high economic costs of drastic lockdowns, the Taiwan experience can be the ideal model for pandemic responsiveness before global herd immunity is achieved.