Confronting COVID-19: Contrasts between Taiwan and the U.S.

Photo: Princeton University

Few people are more qualified to comment on the respective responses to COVID-19 by the U.S. and Taiwan than Tsung-mei Cheng. A native of Taiwan, she has lived in the U.S. for many years and is currently a health policy research analyst at Princeton University’s Woodrow Wilson School of Public and International Affairs. Her late husband, Uwe Reinhardt, was among the healthcare specialists who advised Taiwan when it established its National Health Insurance system in the 1990s.

Cheng noted the huge disparity in the number of coronavirus-related cases and deaths in the two countries, even after adjusting for population size. “The contrast is vast,” she said in a telephone interview from her home in Princeton, New Jersey.

For Taiwan, a big advantage was having undergone the SARS crisis in 2003. “Both the government and the public learned some very painful lessons from that experience,” said Cheng. “So this time around, people listened to what government instructed them to do, which they understood to be science-based and evidence-based, not just something being pulled out of the air.” 

In addition, the existence of Taiwan’s universal health insurance coverage has been a big benefit, she said. “People don’t have to worry about who will pay for their care if they are stricken with COVID or even suspect that they have it, whereas one in 10 Americans would have real problems meeting the financial burden if they have COVID because treatment can get very expensive.”

Is it too late for America to get control of the pandemic? “I would say no,” Cheng replied, saying “there are still things that we could and should be doing to affect the course of the COVID pandemic in this country.” She stressed the need to increase testing in order to stem community spread of the virus. “It’s already in the community, nationwide. We need to find who is infected, and the only way we will know is through testing.” 

Unfortunately, for most tests so far it has taken at least three and up to 12 days to get the results. “Anything longer than one day means that people are walking around spreading the virus,” Cheng said. “That’s not acceptable. We need the kind of testing that will give the results in minutes. There are saliva tests and other tests that give you a much faster result.” 

She laments the lack of a national COVID-combatting plan in the U.S. that would include mandatory mask wearing, with stiff penalties for those who don’t comply.  The plan should also include rules on social distancing and avoiding crowding, as well as educating people to promote hand hygiene and regular temperature-taking. “If we would rally the public, emphasizing that we’re a nation and all in this together, it would make a huge difference,” she said.

Cheng attributed Taiwan’s success in large measure to the faith that the public had in the government, ensuring that most people would abide by the “dos and don’ts” outlined by the health authorities. In the U.S., in contrast, people are “basically doing whatever they want.”  Although there are mandates in certain jurisdictions about such matters as mask-wearing and social distancing, “many people don’t obey and enforcement is very lax.” She cited one study of three communities with mandatory mask wearing, which found that less than half the people were wearing a mask. And of those who wore a mask, less than 50% wore it correctly. Instead, “they attached it ear to ear but then pulled it down from their nose, which stops the mouth from spewing things, but not the nose.”

In its handling of the coronavirus, “Taiwan stands heads and shoulders above others in the international community” and has received a lot of positive attention in the media, Cheng said. “Taiwan comes out of this with flying colors. As long as it keeps doing what it’s been doing, maintaining its excellent health system, it’ll continue to shine.”