One year into the pandemic, countries around the world have struggled to control cases of COVID-19. Yet, one country, Taiwan, with a population of over 23 million, which is comparable to Australia, Netherlands, and Florida, has managed to only have 808 cases and 7 deaths with most of the cases being imported cases rather than local cases.
According to Johns Hopkins University, Taiwan is the country with the lowest COVID-19 related deaths per 100,000 people, with only 0.03 deaths per 100,000 people. Comparably, the United States has 107.46 deaths per 100,000, while Romania, with a population of 19 million, has 82.05 deaths per 100,000.
Australian National University Medical School professor Peter Coolignan states, “Taiwan is the only major country that has so far been able to keep community transmission of Covid eliminated… [Taiwan] probably had the best result around the world.” With its impressive COVID-19 response that allows citizens to continue their daily life as usual in the midst of a pandemic, how did Taiwan do it?
“Taiwan is the only major country that has so far been able to keep community transmission of Covid eliminated… [Taiwan] probably had the best result around the world.”
Peter Cooligan, Australian National University Medical School
A brief introduction to Taiwan, an island nation 586 miles off the coast of China
To start off, there are many misconceptions about Taiwan. Taiwan is an island country located off the coast of China, just 586 miles (943 km) from where the COVID-19 virus was first reported in Wuhan, China on December 31, 2019.
While many people may consider Taiwan a part of China because of the complicated history between the two countries, it’s important to distinguish between Taiwan and China. China does not have any control over Taiwan, despite claiming that Taiwan is a province of China, and the COVID-19 response in Taiwan was carried out completely by the Taiwanese government, which is separate from the Chinese government. In fact, in nearly all definitions, Taiwan is considered a country – it has its own government, president, population, passport, currency, and a defined territory, but Taiwan is not officially recognized by the United Nations or the World Health Organization (WHO).
This is unfortunate, as Taiwan has one of the best pandemic control systems in the world, which has been proven during the COVID-19 pandemic, even though they were unable to efficiently receive information about the pandemic from the WHO. In addition, while some may suspect that Taiwan has been covering up its COVID-19 cases, Taiwan is a democratic nation with freedom of speech and freedom of the press, so it is unlikely that Taiwan would be able to cover up a pandemic.
How Taiwan started preparing for COVID-19 17 years ago
Now onto the actual events of the pandemic. In 2003, the severe acute respiratory syndrome (SARS) outbreak, another virus in the coronavirus family, was discovered in Asia. This disease caused severe symptoms, including chills, difficulty breathing, and sometimes eventually pneumonia or long-term damage to organs in the body. Taiwan was one of the countries most heavily impacted by the pandemic, with 346 confirmed cases and 73 deaths, making it the third highest infection rate in the world.
However, instead of forgetting about the outbreak, Taiwan’s government set up a system to control future pandemics, including an emergency-response network for containing infectious diseases called the National Health Command Center (NHCC) led by the Minister of Health and Welfare, Chen Shih-Chung, and the experiences of SARS helped the government and the people prepare for controlling the spread of infectious diseases, with safety measures such as wearing masks and hand washing already in place.
These systems helped Taiwan prepare for future emergencies, so when the COVID-19 pandemic began, Taiwan began to implement the plans for controlling the pandemic.
Taiwan implemented travel restrictions and quickly responded to COVID-19, aided by technology
A major safety measure were the travel restrictions implemented in the beginning of the pandemic, as Taiwan began imposing travel bans or health screenings on travellers from certain countries.
Health screenings of passengers arriving from Wuhan, China began on December 31st, the date when the COVID-19 virus was first reported, and by January 5th, all travelers who had visited Wuhan in the past 14 days showing symptoms of the disease were to be screened and quarantined. Screening travellers from China is no easy feat either, as it is estimated that 2.71 million people travel from China to Taiwan yearly, but government officials stayed vigilant about screening all the passengers.
However, this couldn’t have been done without the collective effort of many different departments, including Ministries of Health and Welfare, Transportation, Economics, Labor, Education, and Environmental Protection Administration, and the technologies used to track and monitor those showing signs of the disease.
This is because Taiwan is one of the only truly single-payer insurance systems in the world, with its National Health Insurance (NHI) program covering around 99% of the population, and this program allows for an efficient and quick identification of travelers, since the NHI database could be integrated with the customs and immigration database to alert the authorities when a clinical visit had symptoms of a respiratory disease related to recent travel. The NHI database aided in helping Taiwanese officials track down those with signs of COVID-19, which was done frequently to prevent the virus from spreading. By mid-January, Taiwanese officials were sent to Wuhan to investigate the virus, where they discovered the virus could indeed spread from human-to-human contact. Eventually, with the integration of people’s travel history and the NHI database, this information was made available to all hospitals, pharmacies, and clinics so medical professionals could be on the lookout for symptoms of COVID-19 in patients that had recently traveled to high-risk areas.
While Taiwan reported signs of human-to-human infection to the WHO and asked for additional information, they received no response and the WHO continued to state China’s claim that there is no evidence of human-to-human spread. As we now know, COVID-19 can spread through human-to-human contact, but this information was only acknowledged by the WHO much after Taiwan had noticed and reported it.
Nevertheless, Taiwan was able to use this information from the beginning of the pandemic to implement measures to stop it, so by late February, the NHCC had drafted a list of implementations to prevent the impacts of COVID-19, which included: “border control from the air and sea, case identification (using new data and technology), quarantine of suspicious cases, proactive case finding, resource allocation (assessing and managing capacity), reassurance and education of the public while fighting misinformation, negotiation with other countries and regions, formulation of policies toward schools and childcare, and relief to businesses.” Creating a strong plan for was a crucial step in managing the pandemic.
How Taiwan prevented a mask and supplies shortage
In addition to using technology to manage the pandemic, citizens were also given resources to combat the pandemic. All travelers must quarantine at a hotel for two weeks, with food being delivered daily and monitoring from the government through electronic devices to ensure that all travellers were abiding with quarantine regulations.
In the beginning of the pandemic in the United States, mask shortages were a huge issue as citizens were advised to leave masks for essential workers. However, Taiwan avoided the face mask shortage by funding the production of masks through government funds, putting prison inmates to work by making face masks, and distributing the masks through the NHI card, which prevented mass purchasing of masks like the toilet paper frenzy in the beginning of the pandemic. In fact, Taiwan began donating masks to other countries because it had amassed a supply of masks that surpassed its citizens’ needs. The government created a software that kept track of mask inventories, so citizens could use the app to find face masks nearby. Free and fast COVID-19 testing was available nearly everywhere, and all buildings have temperature checks for everyone entering the building.
In addition, Taiwanese public officials improved open communication by conducting daily to weekly briefings in order to educate the public about new findings and regulations regarding the pandemic. These measures allowed citizens to receive support from the government. It’s also noted that the community mindset in Taiwan is much more developed compared to in the US, since many people are willing to give up their “individual desires and benefits,” in order to protect the community, while in the US, the culture is more individualistic. The community mindset in Taiwan has been shown in the stigma against people who violate COVID-19 orders, as the community creates social pressures for those who don’t wear a mask or avoid quarantine. Citizens are also vigilant about helping the government identify COVID-19 cases, as there is a hotline for citizens to report suspected cases to the government.
What has life for Taiwanese citizens been like?
With the addition of wearing face masks in buildings and metros and occasional temperature checks when entering buildings, daily life for Taiwanese people has barely changed. Students can still go to school, and people can still go to work. In fact, Taiwan has been holding concerts, marathons, New Year’s parties, parades, and more, which is nearly unimaginable in many parts of the world. Public places such as swimming pools, bars, and restaurants are open as well, and most people have described life during a pandemic in Taiwan as oddly normal, considering the chaos everywhere else in the world.
For travellers, only Taiwanese citizens are allowed to visit Taiwan, and all travellers arriving in Taiwan must quarantine for 14 days. Government officials are responsible for ensuring that everyone complies with quarantine orders and COVID-19 restrictions, and heavy fines are imposed on those who violate quarantine orders.
“To put it bluntly, life in Taiwan this year has been ridiculously normal. “
Tim Culpan, journalist for Bloomberg Opinion
Can other countries replicate Taiwan’s success?
Even though Taiwan’s strategy for combating the pandemic has worked brilliantly, is it possible for other countries to replicate its success? One major contributor to Taiwan’s success is the integration of the National Health Insurance (NHI) database with the customs and immigration database of information, and this could only be done so quickly because the NHI had been long established.
Taiwan is one of the only few single-payer systems, with the others being Canada, Denmark, Norway, Australia, and Sweden, which may mean that these countries could utilize the information on their databases similar to Taiwan’s strategy, since having this national database with the health information of nearly all citizens on hand is an important step in having a quick COVID-19 response.
The National Health Command Center established after the SARS epidemic was also crucial for Taiwan’s fast and efficient response, especially as Taiwan responded as soon as news about the virus had reached the government while other countries waited around to establish preventative measures.
In addition, many government officials in Taiwan have a medical background, such as former vice president Chen Chien-Jen, who is an epidemiologist and an alumnus of Johns Hopkins Bloomberg School of Public Health and Chen Shih-Chung, the Minister of Health and Welfare.
However, while these pre-established measures allowed for Taiwan’s quick response, that doesn’t mean other countries can’t copy Taiwan’s open communication with citizens, strict quarantine mandates for travellers, and compliance from the public. For the United States, there’s no excuse for the delayed response and dangerous mix of politics and public health that led to the skyrocketing COVID-19 cases a year into the pandemic. Nevertheless, there are many valuable lessons to learn from Taiwan’s COVID-19 response that could be applied to different countries.
While some may consider Taiwan’s COVID-19 relief success just a stroke of luck, a mortality rate of 0.3 deaths per 100,000 people is much more than just a lucky streak. With its close proximity to China and high population density, Taiwan managed to control its COVID-19 cases because while other countries delayed their COVID-19 response, Taiwan had already started preparing for a pandemic 17 years ago since the SARS epidemic, and the collective efforts of multiple government departments and the public have all worked to flatten the curve of the pandemic.
With compliance from the public in following COVID-19 guidelines, people in Taiwan are now able to enjoy their daily lives – going to bars, restaurants, gyms – and celebrations – weddings, graduations, and parties. More than that, while the economy of countries around the world have suffered tremendously, Taiwan is one of the only countries with a GDP that is estimated to grow in 2020, at 2.71%.
As illustrated by Tim Culpan, a Bloomberg News journalist currently living in Taiwan, Taiwanese people have gained true freedom by following simple COVID-19 orders, and if there’s one thing everyone can learn from the Taiwanese people, it’s that a bit of self-sacrifice can last a long way, so wear your mask and help prevent the spread!
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