In general, Taiwan's medical establishment and public health system should be sufficient to serve as a firm line of defense against epidemics, but the organization of hospitals, particularly the administration at the grassroots level, can leave gaps in this defense.

Therefore, the government should take the lead at once to fill the gaps in the various levels of organization and consolidate the overall system of epidemic prevention and elimination.

At this critical point when all walks of life are worrying about community infection, loopholes have been found in grassroots-level administrative systems. These loopholes can lead to community infection and greatly increase the possibility of the epidemic spreading.

Effective quarantine is the most important means of checking the spread of the disease. Most of the suspect or probable cases are still in hospital quarantine. But, if home quarantine cannot be enforced effectively, the epidemic can break out at any time.

According to many reports, home quarantine is clearly not yet enforced effectively. Nor are the administrative departments at the grassroots level able to control the situation regarding home quarantine.

There was a case of a SARS patient who still had not received his quarantine notice when he died. Some students in home quarantine who have been attending cram schools have not received quarantine notices either.

There are also people who comply with home quarantine and report themselves voluntarily, but the health authorities at the grassroots level have no proper guidelines and even require people in quarantine to report in person. It seems that it must be the result of an overbearing bureaucracy, if not ignorance or incompetence.

In fact, what is so worrisome is the administrative organization's low efficiency and the lack of discipline, which could possibly be the primary reason behind the severity of the SARS outbreak in Taiwan.

The Department of Health (DOH) should immediately order all grassroots medical authorities to strictly supervise the enforcement of home quarantine.

As for the lack of manpower at the lowest levels of the health-care system, the Executive Yuan and the counties and cities should transfer personnel from other departments as soon as possible. When necessary, they should mobilize military personnel and ask for support from non-governmental agencies. The supervision of home quarantine must be clear-cut and conclusive.

Hospitals are the front line in the battle against the epidemic. One after another, Hoping Hospital and Jen Chi Hospital fell into the enemy's hands. More hospitals have been mobilized to support these two hospitals. Large, teaching hospitals that are strongholds of epidemic prevention are also facing critical situations.

However, the defense line of hospitals cannot be allowed to fail. For a long time, hospitals have become increasing lax and inefficient as a result of the erosion of the nation's social culture, particularly the bureaucratic culture.

Suddenly, the cruel attack of SARS has thrown the hospital system into crisis.

At the same time, the public hospitals, except those in the cities of Taipei and Kaohsiung, are under the jurisdiction of the DOH.

These hospitals can be mobilized by the DOH directly, but special attention must be paid to whether the DOH can control them properly.

As the hospital system is facing such a serious epidemic, it is of utmost importance to strictly monitor and prevent the epidemic from spreading in the hospitals. Just as Chang Shan-chwen (張上淳), director of the Department of Infectious Diseases at National Taiwan University Hospital, emphasized, hospitals and medical teams must strictly prevent any possibility of infection. And even if there is infection, those infected must be monitored and isolated for special treatment as quickly as possible.

Although we do not want to blame the front-line medical workers, the epidemic certainly broke out from Hoping Hospital. The loophole in epidemic prevention was clearly the result of negligence on the part of medical workers.

We expect medical workers to also bring us salvation from such a dangerous situation.

Finally, the government must integrate vertically and horizontally to fight the epidemic. The top government leadership should not just shout propaganda to boost morale, without the various organizations joining together to create an effective safety net.

As for the recently passed SARS prevention bill and relief regulations, the DOH, Ministry of Transportation and Communications, Ministry of the Interior and National Science Council have all compiled huge budgets and should be able to adopt more effective measures for SARS prevention.

What is more important is the mobilization of the overall government system and resources as soon as possible to effectively deal with the rapidly changing epidemic situation.

Chiu Hei-yuan is a research fellow at Academia Sinica's Institute of Sociology and a member of the Taipei Society.

Translated by Grace Shaw