How Taiwan minimized the spread of corona

On any normal day one could expect 2000 Chinese tourists visiting the island. Instead it appears that this tiny democracy has emerged as one of the best in the classroom. On Monday there were a mere 59 reported cases of corona virus and only one reported death, in a population of almost 24 million. Of 100 listed territories, Taiwan seems to have the fewest cases per capita. At the same time (as of Tuesday) and on the other side of the planet, Sweden reports seven dead and over 1300 confirmed cases and its health system lacks both hospital beds and basic supplies to care for its citizens. Country after country, with few exceptions, seem to be taken completely by surprise. What then is Taiwan’s secret?

Strict border control was decisive

According to Anders Tegnell, Sweden’s national advisor on epidemic disease, closed borders have never contained an epidemic. In an interview with news program Ekot he cites abundant literature proving this. Even the World Health Organization, WHO, supported by China’s communist party, insisted that travel restrictions were not necessary nor were they supported by evidence. WHO’s Director-General, Tedros Adhanom, on the 3rd of February, said that the spread of the virus outside China was minimal and slow. The Chinese delegate to WHO criticized countries that denied visas or air travel to persons travelling from the afflicted Hubei province. There is a growing international concern over the influence the Chinese Communist Party holds over WHO and their activities, though this concern has not been widely reported in the Swedish media.¹

Taiwan on the other hand, alongside Hong Kong and Singapore, had already on February 1^st for all practical purposes established a ban on travel from mainland China for all but their own citizens and a few select groups. They did this despite the heavy economic cost this drastic measure would mean for them. The Communist Party’s aversion to travel restrictions seems odd when one considers their own strategy of isolation, targeting Hubei province and other afflicted areas. The party’s mistake seems rather to be their initial tardiness in closing their own internal borders. When the party did react, it reacted with verve. The equivalent in the EU would have been a total quarantine of Italy, stopping all travel. This obviously did not happen.

In Taiwan the authorities acted proactively. They didn’t wait for reports from sources that were unsure or open to political influence. Answering a question posed by the BBC concerning Taiwan’s success, the minister of Health, Shih-chung (陳時中) said there were three key factors to Taiwan’s success thus far, including a high level of vigilance, past experience battling SARS, and professional advice provided by experts.

Taiwan had already begun rigorously screening travellers from Wuhan by the 31st of December 2019. At that time there were only 29 confirmed cases in Wuhan. Taiwan screened all travellers from Wuhan even before it was confirmed that the virus could spread between people. Individuals with symptoms were being quarantined days before the Communist Party closed Wuhan down in January. On February 29th Anders Tegnell rejected the idea of airport controls, claiming that they “lent a false sense of security”. Taiwan’s minister of Health, Chen Shih-chung, on the other hand, claims that early screening of travellers from China was a key to Taiwan’s success.

Fastest out of the blocks is the winner

Wisdom in retrospect is always easy, but the Public Health Agency of Sweden on the 17th of January judged the risk that cases of corona virus could appear in Sweden as “extremely low”. The Swedish authority referred to the fact that WHO hadn’t made any recommendations with regard to travel and the lack of “conclusive evidence that the virus could spread from person to person”. The authority still instructed persons who had been in Wuhan and had developed a cough or fever, to seek medical attention. There was no mention of quarantine.

Anders Tegnell said at the time, “Any major outbreak is contingent upon the virus being easily transmitted from person to person. This doesn’t seem to be the case here.”

By investing in what, from a European point of view, appeared to be disproportionately much at a lower risk level, they have been able to cope with the spread of infection, while Sweden now seems to always be “one step behind”.

Taiwan has of course also been affected by this global pandemic. On Tuesday, headlines reported ten new cases – the largest daily figure since the epidemic broke out. All of them were Taiwanese that had been traveling outside the country.

Anyone entering Taiwan from areas where the contagion is present will be immediately placed in quarantine at home for fourteen days, a quarantine monitored through their cell phones, through home inspections and enforced with the imposition of heavy fines and threat of public disclosure of names. A man who had returned from Wuhan, who did not report symptoms and who visited a dance club when he should have been in quarantine was fined the equivalent of 10,000 dollars. In the case of those who were confirmed to have the disease, officials followed up on the health status of all of those they had come into contact with. The Taiwanese minister of health says that  this system of quarantining and monitoring all contacts has helped prevent the outbreak from spiraling out of control.

Centrally co-ordinated crisis intervention

In Sweden, efforts to control the virus are, to a great degree, undertaken regionally and by a variety of authorities and institutions. Authorities and schools have been asked to come to their own conclusions, something that has led to confusion. In Taiwan efforts are led by the Central Epidemic Command Centre (CECC) under the personal command of the Minister of Health.

The CECC co-ordinates the government’s response. In five weeks they were able to present 124 different policies for dealing with everything from schools to places of work and communication. For example, every morning, before the school day begins, parents measure their children’s temperature and reports it to the school.

CECC came into being after the mishandled effort to contain the Sars virus in 2002. They ensured that a crisis plan, alongside relevant regulations would be in place as soon as any virus started to spread.

Taiwan activated its Central Epidemic Command Centre (CECC) already in January to meet the threat of the virus. Minister of Health Chen Shih-chung is at the microphone Photo: Walid Berrazeg/SOPA Images/Shutterstock

Sars also taught the value of transparency in winning the trust of the population. CECC releases new statistics on a daily basis reporting the number of those tested, how many were infected and how many were tested negative. This transparency ensures that citizens will be attentive without inducing panic and strengthens a necessary bond of trust between the population and the authorities.

Wide testing in order to discover cases

The Public Health Agency in Sweden does not report the number of people tested on their website. The agency’s press secretary, Pernilla Engström, on Tuesday told Kvartal that she didn’t have the actual number, but that 4600 persons had been tested during the first week of March.

Sweden’s methods in testing differ greatly from those of countries that have fought the virus more effectively. This became clearer when new guidelines for testing emerged on March 11^th. Testing would be reserved for persons who were seriously ill or were in hospitals in the Stockholm region. This applied even to those who had been traveling to affected areas abroador had been in contact with persons confirmed to be infected with covid-19.

In Singapore an early decision was made to test everyone with flu-like symptoms or  pneumonia. Authorities or police traced every possible contact between an infected person and others, making sure that those put into quarantine were compensated and were supplied with everything they needed. Also, testing in Taiwan was widespread and possible contagion was traced to discover hidden cases in the general population, even among persons who hadn’t been out of the country. Patients who had been tested negative for the flu were tested once more for covid 19. In this way they were able to find one hidden case of covid 19 among the 113 persons tested.

An abundance of masks and ample hand disinfectant

Another way to keep people calm and ensure support for the authorities is to have plenty of protective supplies on hand, supplies like face-masks and hand disinfectant. Citizens in Taiwan can still wander through night-markets and temples, can go to work and to school. There are heat cameras at all entrances, controlling body temperatures. There are dispensers with hand disinfectant by doors and elevators. Busses and taxis have signs describing how often they’ve been disinfected. Buttons on lifts are covered in plastic film which is changed several times a day.

On the 26th of February, the Swedish television news aired a report on the inventory of protective clothing, for example face-masks, in Sweden. It seems that, as in other countries, this inventory was done more than a little too late. By then there had been more than a month of reports from China about that lack of face-masks and other protective gear. Still, it wasn’t until the 15th of March that the EU forbade the export of protective materials.

On March 11th, when it became evident that Sweden didn’t have sufficient supplies in stock, the small paper Markbladet reported that a textile manufacturer, the Ludvig Svensson company, had been sending face masks to China, where they have a factory.

In times of crisis, elements command economy and protectionism can be successful methods.

Taiwan introduced an export stop already January 24th. State authorities took over some production. On Tuesday the 9^th of March president Tsai Ing-wen announced a production increase from 2.4 million face-masks each day, to over 10 million. In times of crisis, elements of command economy and protectionism can be successful methods, even in a market-economy like that of Taiwan. The country now is the world’s second largest manufacturer of face-masks. The Taiwanese military was called in to help with the packaging of face-masks. Taiwan’s government-owned alcohol manufacturer also scaled up their production of sanitary and disinfectant products.

The People’s Republic of China has also demonstrated how quickly production can be increased on a mega-scale. China has increased mask production ten times, to a total, reported in the New York Times of March 13^th, of 115 million masks a day. The scarcity of supplies in the EU can be traced to the lack of medicine-technical production in these countries. Before the crisis, China produced half the masks in the world. When the corona outbreak was a fact, China stopped exporting masks and bought a large portion of what was available elsewhere. Now China is able to send masks and badly needed equipment to hard-hit regions. Last week the first load of protective clothing from China landed in Italy.

Face masks help – if you believe what they say in East Asia

In Europe and in the United States, people are told that there is no reason for them to wear face-masks. The reason given is that the common man or woman doesn’t know how to use them correctly or that the infection will find other ways to get in, for example through the eyes. In East Asia, experts say the opposite and it might be interesting to hear some of their arguments. Yuen Kwok-yung, adviser to Hongkong’s working group battling covid-19 is reported in the web magazine Inkstone as stating that the masks stop the virus spreading from people before they exhibit symptoms. Others also claim that face-masks do indeed provide protection.  In an article in the respected medical journal, The Lancet, researchers Chi Chiu Leung, Tai Hing Lam and Kar Keung Cheng report that the virus can elude normal procedures for prevention because of the long period in which a person is able spread the virus before becoming aware of symptoms themselves. People who wear masks for their own protection unwittingly help others. At the moment it seems that social distancing and the obligatory use of masks is the only thing, in the opinion of these three researchers, that protects against the virus, at least in the short run. They conclude that, given the uncertainties around the corona virus, it is unwise to reject mask use an ineffective. A major study of school-aged children in Japan has shown masks as effective in protection against flu viruses.

Since the end of January the Communist Party in China has decreed that all persons present in public places in large cities shall wear masks. Anyone using public transportation without wearing a mask may be arrested. For most people, wearing a mask is an obvious step in prevention. In Taiwan it is recommended that one wears a mask any time one has a cough or visits a hospital. So many wear masks as part of their daily attire, there is no stigma attached to it.

In Taiwan’s tightly built cities, masks are an important psychological tool for making citizens feels safe and guarding them from panic.

It is possible to combat the epidemic while respecting human rights

For China’s Communist Party, the battle against corona is one more proof that their methods surpass those of any democracy. While fighting the virus, Chinese transgressions against human rights have increased.

Taiwan on the other hand demonstrates that a democracy, without selling its soul, is able to act with strict resolve. Maya Wang, senior researcher for Human Rights Watch, writes on Twitter “We can beat the epidemic while respecting rights. Some Asian countries, esp. Taiwan, are shinning examples in this difficult time which tests our values:

Preparations to meet the threat of epidemics are made years before the outbreak, says Emanuele Capobianco, health director for the International Red Cross to The Times. If the number of hospital beds in a country diminishes year by year, it will be difficult to compensate in a short time. Taiwan, already before the crisis, had one of the world’s best public health systems and health insurance for all.

Minister of Health Chen says that the situation in Europe shows how a little carelessness can cause the situation in a developed region to worsen rapidly

Taiwan’s president Tsai Ing-wen has seen her popularity grow. She has until now managed to protect both her borders and the health of her citizens. Provisions that three months ago seemed extreme have softened in comparison to those a number of countries in Europe have been forced to adopt. On Tuesday the 17th of March the EU commission announced that it would stop all non-necessary travel within Schengen countries. Whether or not Europe’s politicians will enjoy a similar rise in popularity will depend on whether or not these respective methods succeed.

 

Translation Edward Bromberg.

Ola Wong is Kvartal’s cultural editor and has lived and worked in Shanghai and Beijing for more than ten years as the China correspondent for Swedish newspapers.