Taiwan Keeps Mercurial Coronavirus at Bay

CDC officers explain quarantine rules to a Japanese arrival at Taoyuan International Airport. Photo: CNA

The next step is to fully reopen safely and share disease-control expertise with the world.

The scene at Taipei’s Songshan Airport on a Saturday in July was surreal, at first blush utterly removed from the coronavirus pandemic that has shut down vast swaths of the world over the past six months. Passengers packed the domestic terminal. Flights to the offshore islands of Penghu, Matsu, and Kinmen were full. All of them. People patiently waited in long lines to clear the security check.

Only the ubiquitous face masks worn by passengers and airport staff signaled that Taiwan remained at war with an invisible adversary, one that worldwide had sickened 15.5 million people and resulted in 632,000 deaths as of late July. Masks and temperature checks will be necessary precautions for the foreseeable future, but the virus in Taiwan has receded to the point that domestic travel is considered safe again. Taiwan last recorded a case of local COVID-19 transmission on April 12.

Taiwan stands out as one of the few countries in the world able to corral the coronavirus. By preventing community transmission from taking hold, Taiwan has avoided a public health and economic disaster. Most of its 455 cases have been imported, and there have been only seven deaths. The government has used contact tracing to identify and isolate local cases, stymieing the type of stealth transmission that has occurred in Singapore and Hong Kong, which were both once hailed as epidemic-control leaders.

Geography has worked in Taiwan’s favor, too. “In a pandemic, being an island country is a definite advantage if you do everything right,” says Heather Lin, chief operating officer of the Taipei-based International Research Based Pharmaceutical Manufacturers Association (IRPMA). “It’s easier to close borders.”

By now, Taiwan’s adroit response to the pandemic is well known. The health authorities got out in front of the virus when the disease was still a blip on the radar of other countries. Technology has improved epidemic control but has not been the decisive factor in Taiwan’s success.

Even more important was the experience gained when Taiwan had previously faced a mysterious respiratory illness from China before. During the 2002-03 SARS outbreak that originated in Guangdong Province, 346 Taiwanese were infected and 37 succumbed to the disease. SARS infected about 8,000 people globally before burning out in 2004. 

“SARS was traumatic for Taiwan,” Lin says. “We spent the next 17 years preparing for another SARS, and when it came, it was time to show our capabilities.” After SARS, Taiwan had the administrative structure in place to deal with a public-health crisis.  The Central Epidemic Command Center (CECC) was activated to deal with the coronavirus as early as January 20, and all air travel to and from China was suspended six days later.

Not only has Taiwan’s disease-control borne fruit for public health, it also may help the economy stave off recession. “Taiwan will likely be the only Asian tiger to pull off positive GDP growth this year,” says Darson Chiu, vice president of the Taiwan Institute of Economic Research (TIER), which is projecting growth in the 1-1.5% range. He sees the main growth drivers as fixed-asset investments from the reshoring of supply chains, rising Chinese imports of Taiwan’s ICT components, and “excellent pandemic control supporting domestic demand.”

In contrast, South Korea’s economy is forecast to contract by 1.2%, Hong Kong by 2%, and Singapore 5.8%. Hong Kong’s GDP growth has been in negative territory since November 2019, while South Korea and Singapore entered a technical recession in the second quarter.

Economists say that Taiwan likely even managed positive growth in the second quarter, when much of the world was in lockdown. The Chung-Hua Institution for Economic Research (CIER) reckons that Taiwan’s economy grew 0.64% in the April-June period.

By avoiding a lockdown, Taiwan has been spared widespread job cuts that would sap domestic demand. The unemployment rate rose from 3.64% in January to 4.07% in May, according to data compiled by the Directorate General of Budget Accounting and Statistics (DGBAS), before easing to 3.96% in June.

Travelers getting ready to board a train at Taipei Main Station. Photo: CNA

Reopening and risk management

While “reopening” for many countries refers to the economy, schools, and borders, Taiwan has been able to keep the former two almost fully operational throughout the pandemic. It is only the borders that have been closed.

A consensus on when and how to open to foreign visitors has yet to emerge, although some limited business travel has been permitted since late June. At the same time, a mandatory 14-day quarantine requirement remains in place for any Taiwanese citizens or foreign residents returning to the country from overseas. As long as that rule exists, outbound travel from Taiwan will be limited.

The government implemented the mandatory quarantine requirement in March as imported infections surged, mostly among people returning from Europe and the U.S. Strict adherence to it has helped Taiwan prevent community transmission.

But travel restrictions are not a permanent solution. With the virus still raging on every continent but Antarctica, the challenge for Taiwan will be figuring out how to ease those restrictions safely. “Even though there are still sporadic cases of imported COVID-19, we will continue to employ strict border controls,” Health Minister Chen Shih-chung said in a recent weekly press conference.

Dr. Chan Chang-chuan, dean of National Taiwan University’s School of Public Health, stresses the need to carefully manage the flow of migrant workers, who play essential roles as construction workers and caregivers in Taiwan. Many of the male workers come from Vietnam, Thailand, and Myanmar, where the pandemic appears under control. Female caregivers, however, are often from Indonesia, where conditions are worsening.

“We have to learn from Singapore, where migrant workers were the weak link in the epidemic prevention chain,” Chan says, referring to the crowded dormitories in the city-state that house about 1 million workers from South Asia and China. The cramped, unhygienic conditions have fomented rapid spread of the virus, often outstripping the Singaporean government’s ability to trace the source of infection. Migrant workers account for most of Singapore’s 48,000 cases.

In June, Taiwan’s Ministry of Labor (MOL) said that employers of migrant workers with contracts due to expire between June 17 and September 17 could apply for a three-month extension to reduce overseas travel during the pandemic. The MOL previously offered a three-month extension to workers whose contracts expired between March 17 and June 17. More than 82,000 migrant workers had their contracts extended or were reassigned to other jobs as of the end of June, according to data compiled by the MOL.

To reopen the borders safely, Chan says Taiwan should test visitors on arrival, using Iceland’s approach. Since June 15, the European island nation has been offering visitors from the EU and another dozen countries the option of either doing a 14-day quarantine or being tested for COVID-19 on arrival. The cost of the test is US$65 if paid in advance or US$80 on arrival, and test results are provided within 24 hours. While awaiting the results, visitors are not required to quarantine, but are advised to head directly to their accommodations and practice social distancing.

The Iceland system gives anyone who tests positive the option of further testing to determine if the infection is active. If it is, the person must self-isolate and stay in touch with a dedicated contact tracing team. The Iceland government provides rooms in specialized isolation centers free of charge to those without an appropriate location to self-isolate.

Through July 2, just 28 of the 15,197 tests administered to visitors were positive for COVID-19, according to the Iceland government’s data. Twenty-two had developed antibodies, while the remaining six were active infections and were quarantined. The number of visitors permitted to enter the country daily depends on testing capacity. “It is scientific and logical,” Chan says.

He urges the Taiwan government to conduct more testing on the local population to better understand the nature of the coronavirus. Taiwan has so far done about 80,000 COVID-19 tests, according to the Centers for Disease Control. “If you do more testing, you will have more confidence,” Chan says.

The CECC counters that with such a low infection rate in Taiwan, mass testing would not be an optimal use of resources. The government estimates that it would cost NT$54 billion (about US$1.8 billion) to test 18 million people.

Exporting expertise

Over the past six months, Taiwan has shown the world its epidemic-control prowess, well encapsulated in the government’s “Taiwan can help” tagline. Yet China’s opposition to Taiwan’s participation in the World Health Organization (WHO), even as an observer, remains a huge obstacle.

In contrast, working outside of the constraints of such organizations has huge potential. The U.S. and Taiwan already collaborate on a number of public health and biomedical research initiatives. Taiwan may find a growing number of other eager partners as major democracies like the United Kingdom, Australia, Japan, and India encounter difficulty getting along with an increasingly pugnacious PRC.

In June, the U.S., Japan, Australia, and Taiwan co-organized the virtual Global Cooperation and Training Framework (vGCTF) workshop in Taipei to share best epidemic-control practices. Seventy experts from 16 countries participated.

The pandemic may even help spur Taiwan’s long-anticipated software revolution. To that end, Taiwan’s AI Labs has developed a social-distancing app that the UK is considering adopting. The Bluetooth app issues an alert on users’ phones when they get too close to other people and provides information about crowded locations so they can be avoided. The app complies with the data-privacy laws of both Taiwan and Europe, according to the CECC. The Taiwan government says it is willing to provide the source code to other countries.

“If the UK adopts this app successfully, other European countries can easily use the same app to prevent the spread of infectious diseases,” says Patrick Wu, an analyst at the semi-governmental Market Intelligence & Consulting Institute (MIC).

The global medical supply chain is another area where Taiwan has the opportunity to tap rising demand, especially as the risks of concentrating production in China have become evident. Taiwan’s capabilities in testing methods, viral genetic sequencing, and drug development may help strengthen its position in the global medical supply chain, Wu says.

While Taiwan labs could possibly develop a coronavirus vaccine, data to support clinical trials is limited, says IRPMA’s Lin. Ironically, in this instance Taiwan is a victim of its own success, with just 455 cases. China, with more than 83,000, or the U.S., which has 4 million cases, have much more data to use as they race to develop a vaccine.

Ensuring access to a vaccine developed elsewhere could be a challenge for Taiwan, Lin says. “If the WHO or other NGOs end up distributing the vaccine, they may look at Taiwan, with its low incidence of the virus, and think it is not a priority.”

Lin urges the government to allocate the necessary budget to ensure that Taiwan can inoculate its citizens once a coronavirus vaccine becomes available. “We won’t be able to get the best vaccine quickly if we offer a low reimbursement price,” she says.

William Reinfeld, an economist and adjunct professor at New York University Shanghai, sees the pandemic as a chance for Taiwan to transform its economy, achieve leadership distinction, and support long-term diplomatic goals.

“Eventually, all countries will be turning their attention to preparing themselves for future pandemics and allocating billions of dollars for everything from face masks, ventilators, vaccines, drugs, testing, and tracking to research and training of specialists, administrators, and technicians,” he says. “Taiwan already has a solid base” from which it could expand capacity as needed to meet demands,” he notes.  

Reinfeld, previously a long-term resident of Taiwan, says the country should borrow a page out of its own book, referring to the transformation in the 1970s and 1980s from a “low value-added semi-industrial economy to a showcase high-tech and developed economy.” Among his recommendations: prepare a master plan, empower a national champion to lead the initiative, carry out the project as a joint public-private effort, and build global partnerships.

The difficulties and risks in pursuing this objective are “small in comparison to the far-reaching rewards for Taiwan’s economy, global recognition, and quality of life,” he says.

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