Taiwan managed to contain the coronavirus outbreak: they did so

Against all odds, and despite their proximity to China, the islands of Taiwan have maintained an astonishingly low level of infection. As of today, the country has 77 cases and a single death, data that will surely be somewhat increased. Figures that are widely exceeded in places so remote from the initial focus of the pandemic, such as Spain (more than 11,000 infections) and that will continue to increase also in Chile (201), Peru (117), Ecuador (111), Mexico (82 ) and the vast majority of countries.

Knowing the enemy

At this point we are all clear that, in this crisis, the main danger for society is the saturation of health resources, and that is why it is a priority gain time and slow down the rate of contagion. In such a situation it is essential react soon, given that the growth in the number of infections is exponential. Sadly, it is a type of growth that is difficult for most people to understand, since we are used to working with sums, multiplications and powers. This calculation goes further: numbers that multiply by themselves, and with increasing frequency.

Growth examples: Red: linear, Blue: cubic, Green. exponential.

This is so because each person infected with the virus can, in turn, infect other people. And those people to other people. In the case of COVID-19, we observe that the number of detected cases doubles approximately every three days. A first contagion in your country, then 2, then 4, then 8, 16, 32, 64 … The main strategy to tackle the high incidence of cases is to make it difficult for the virus. Restricting interactions between people has proven to be an effective way to reduce the spread of the virus to levels that are acceptable to health. After two long months, China managed to control the penetration of the virus.

Another serious danger is the invisibility of the epidemic, since it can take many days for an infected person to show symptoms, and yet infect during all that time incubation to people around you. According to an urgent publication yesterday in the journal Science, it is estimated that up to two thirds of the infections would be caused by undetected cases.

And another terrible fact: infected people are more likely to die the older they are. Those with respiratory problems are also especially affected. Many of these patients are in critical condition and need to be admitted to the Intensive Care Unit (ICU) of the hospital. These are highly qualified areas that provide continuous care for the sick, and are subject to high stress. The problem that ICUs must endure in this pandemic crisis is that they have a limited number of beds and health personnel. Because we must not forget that the rest of diseases, accidents, heart attacks and serious problems do not go on vacation, but continue to affect people's health.

In addition to all this, some voices affirm that up to 60% of the world population could be infected by COVID-19. This is very bad news for people of a certain age, with the corresponding anxiety and uncertainty it will cause in them. Another reason to save time and delay infections as much as possible, given that there is still no medicine or cure.

For all these reasons, the isolation of people who do not have symptoms is a solidarity and necessary gesture. The Washington Post newspaper published an article on its website (in English) with a visual simulation of the behavior of a virus and the effects of confinement measures.

They know they are together in this, which predisposes them to comply with the measures implemented by the government.

What action did Taiwan take?
  1. Preventive action
    In Taiwan they were able to recognize the scale the virus could reach at an early stage of the outbreak. This allowed them to carry out preventive actions. The SARS crisis in 2002 prepared them and they learned to integrate data from various sources available to the National Center for Health Action.
  2. Border control
    At an early stage, the government introduced public health laws, closing borders with China, Hong Kong and Macao, and, among other measures, banned the export of face masks. This made it easier for the government to allocate resources.
  3. Technology
    Integration of immigration and customs data with national health insurance. A combination that allowed doctors to identify suspected contagion patients based on their travel history. It was also made easier for travelers to inform the authorities of any symptoms, just by scanning a QR code upon arrival in the country. Then they would receive a message with the diagnosis. This was decisive in classifying those infected early and appropriately, facilitating follow-up.
  4. Citizen participation
    Dr. Chunhuei Chi

    Taiwanese still have fresh memories of the difficulties they experienced with SARS. The Taiwanese people's sense of community predisposed them to comply with regulations and respond to the outbreak. In the words of Dr. Chunhuei Chi (Oregon State University): "They know that they are in this together, which predisposes them to comply with the measures implemented by the government."

  5. Medical Investigation
    Dr. Chi also highlights that the investment in Taiwanese research of the last decades has allowed us to count on teams focused on producing rapid diagnostic tests for COVID-19. A recent development could allow them to produce a new rapid test that would allow the diagnosis of the coronavirus in 20 minutes.
  6. International exchange
    Taiwan shares the progress of research and epidemic prevention strategies with other countries, helping them fight the pandemic. Despite the blockade imposed by Beijing to prevent Taiwan from joining the WHO, the small country bet heavily on transparency and committed itself to other countries on public health issues.
Other decisive measures by Taiwan
  • Before the human-to-human transmission was confirmed (January 20), passengers from Wuhan were already undergoing health screenings.
  • Also on January 20 a centralized command center for the epidemic. A list of 124 points was compiled, including border control, regulations for workers and schools, and communication and resource management plans for hospitals.
  • On February 1, Taiwan, along with Hong Kong and Singapore, proactively implemented travel restrictions on passengers from the Asian continent, despite the insistence of the WHO, which stated that there was no need to restrict travel. These precautions implied a significant economic cost, since their tourism and their airports depend mainly on mainland China.
  • On February 2, it was announced that elementary and secondary schools would be closed until February 25.
  • In early February, the epidemic command center requested the mobilization of military resources.
  • The Taiwanese Tobacco and Liquor Corporation and the Sugar Corporation increased their alcohol production by 75% to ensure the supply of sanitary alcohol.
  • The export of digital thermometers was banned between March 4 and March 31.
  • Last Monday (March 16), the presidential administration decided that several industries in the country would be in charge of mass producing sanitary attire (bathrobes), eliminating its dependence on the US DuPont.
Dr. C. Jason Wang, Director of the CPOP at Stanford

"If we think that containing an epidemic is like running the 100-meter dash, we can say that Taiwan came out ahead by being prepared," says Dr. C. Jason Wang, director of CPOP at Stanford University.

The rapid mobilization of Taiwan contrasts with South Korea and Japan, countries also close to China and with advanced health systems. The slow reaction has cost them criticism and has led to separate outbreaks of contagion.

We are witnessing many measures, more or less restrictive, that are sure to alter our lives over a long period. A whole series of lessons that many countries are still in time to apply.

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