As the novel coronavirus sweeps across much of the world, with confirmed global case count now reaching 700,000, countries and citizens worldwide are critically evaluating the responses of various governments to learn lessons from the successes and failures of their disease control and prevention measures. As part of this assessment, some countries, like South Korea and Taiwan, have been praised for their well-organized and aggressive mitigation efforts.
However, in order to draw meaningful inspiration from such countries and export their models worldwide, it is necessary to contextualize not only their divergent policies and the subsequent results of those policies, but also the unique challenges facing those countries in order to determine how much of their success can truly be attributed to their widely-acclaimed decision-making.
While South Korea‘s aggressive testing program has become the gold standard, enabling it to become one of the few countries to “flatten the curve” of new cases, it is pertinent to analyse why Taiwan, which is only two hours away from Wuhan, has less than 300 confirmed cases, while South Korea is nearing 10,000.
So how did the self-governed island, which receives more than a million people from the mainland each year, manage to have so few cases, with only two deaths, despite its proximity–both geographical and otherwise–to China?
For one, Taiwan initiated response mechanisms very early, in large part due to its experience with SARS in 2003, after which it put systems in place for such a situation. Taiwanese authorities were also the most proactive in investigating the then-unidentified respiratory disease in Wuhan and became aware of the disease on December 17. In fact, Taiwan’s Centres for Disease Control contacted mainland authorities and the World Health Organisation about the possibility of human-to-human transmission on December 31, the day China merely acknowledged the presence of a new mysterious respiratory disease.
The island started to inspect inbound passengers and crew members from Wuhan starting December 31 and has made them undergo health checks since January 5. Anyone who had travelled to Wuhan within the past two weeks and reported respiratory complaints or a fever was tested for different viruses, while the ones demonstrating symptoms of the coronavirus were quarantined. Taiwan also slowly imposed stricter border controls, which eventually led to the banning of Wuhan residents on January 23, the suspension of tours to China on January 25, and the eventual ban on all Chinese visitors on February 6.
Subsequently, similar restrictions were imposed on more countries and areas as the coronavirus spread across borders, and by March 19, the travel ban had been extended to nearly all foreigners without Taiwanese residence certification.
South Korea, on the other hand, is only now ordering everyone to go into self-quarantine for two weeks, a rule that will be applied from April 1. This measure, too, was only taken after the figures on Sunday revealed that out of the 105 new coronavirus cases, 41 were travellers arriving from overseas.
Clearly, a travel ban is most useful and effective when it is enacted early on, not after the outbreak has already occurred. This explains the highly divergent numbers in Taiwan, which imposed a travel ban in early February, and South Korea, which only barred visitors from Hubei.
Additionally, although both Taiwan and South Korea are jointly praised for rationing face masks from very early on, there lies a big difference in how each government handled this key aspect. The Taiwanese government took control of face mask distribution from the private sector on January 31 and launched the face mask rationing system purchasing policy on February 6, wherein each person can buy only two masks at once and only once per week. In the end, the country had added assembled 32 additional supply lines boosting production capacity to 13 million in a day from 4 million. Conversely, Seoul introduced strict rationing only after demand in the country outstripped production. In fact, the South Korean government was heavily criticized by the public for the miscalculation. The Moon administration also faced severe denunciation for providing masks in support of China’s crisis response, which left South Korea short when COVID-19 cases spiked in Daegu.
One area where both countries have done equally well is in their use of technology and data, with regards to high-tech monitoring and pubic notifications to identify and contain new cases. Taiwan’s cloud-based health care information system played a crucial part as the integration of the national health insurance database with the immigration and customs database helped trace and keep tabs on the movements of confirmed and suspected cases. Officials in both countries are working with local phone companies to track their cell phones and alert others who may have come into contact with them and have been calling to check up on those who have been quarantined, getting updates from them on their symptoms. Quarantined people are also required to download monitoring applications that allow authorities to alert others if patients break protocols. And although there is a strict restriction on quarantined people, Taiwan even has a special fleet of quarantine taxis, specially designed to help facilitate the movement of the passengers who arrive at airports but have to undergo coronavirus quarantine.
While people in the US have been vociferously advocating the adoption of South Korea's strategy, this big data-enabled epidemic response with such a high and detailed level of surveillance would be anathema to American or European standards of personal privacy.
Nonetheless, South Korea’s strategy should be seen as a model for countries that failed to contain the spread initially and where there is overwhelming evidence of community transmission of the virus. A country that once had the highest number of cases outside of China, leading to 170 countries imposing travel bans on South Koreans, now sees more recoveries than deaths from the virus.
Unlike other countries, the South Korean government streamlined the government’s response by bringing together government agencies and reaching out to private companies and cutting red tape. In fact, just a week after its first phase authorities met with medical companies to request the immediate development and mass production of test kits. Quick government approval and the high standards of innovation ensured that, within a matter of weeks, South Korea was producing 100,00 kits per day, which take only 10 minutes to detect the virus. This enabled the country to test 287,000 people in the first eight weeks; the US, on the other hand, tested only 55,000 people within the same time frame. And although Trump is right to say that the US has tested more people than South Korea, the US' positive testing rate is 15.9%, while South Korea's is 2.9%. This is indicative of the fact that the US was and is well "behind the curve", with a severe delay in response, despite both countries reporting their first case on the same day.
In comparison with Taiwan, South Korea, a country of 51.8 million, conducts around 15,000 tests a day and has drive-through test centres. Taiwan, with a population of almost 24 million, currently conducts only around 800 screenings a day and not everyone under quarantine is tested. Hence, while testing is crucial, it need not be the main driver of a country's coronavirus response. That being said, the low level of testing in Taiwan can partly be attributed to the fact that it never reached those exorbitant numbers to begin with.
Both countries have accomplished their goals with different strategies, without imposing nationwide lockdowns or declaring widespread quarantines and closure of businesses, malls, and other public places, like in other countries. While Taiwan's response can be seen as a model to prevent the crisis before it spreads, South Korea's model provides a model strategy for containing the virus and flattening the curve once the level of infections has reached higher levels.
Image Source: The Daily Beast
Assessing the COVID-19 Responses of Taiwan and South Korea
March 31, 2020
