Lessons from Taiwan

As we struggle to strike a balance between public health and economic health, it looks like the government will go along with at least some of the proposals from businessmen to restart economic activity by extending the community quarantine at the end of the one-month period on April 14, but with certain restrictions eased.

By that time, “mass testing” for coronavirus disease 2019 is supposed to be underway. The phrase is in quotes, because it’s far from the mass testing being undertaken in wealthier countries such as South Korea and Germany, where the capability is about 10 times greater than ours. The United Kingdom, for example, is promising to conduct 100,000 tests for coronavirus disease 2019 or COVID-19 every day.

Going by the examples of other countries, it looks like if we want to restart the economy without putting public health at risk, we have to ramp up our country’s capabilities in several aspects: detecting COVID symptoms, testing, isolating the infected and ensuring that they remain under quarantine. To prevent contagion from the asymptomatic, we have to maintain preventive measures such as social distancing and wearing of masks in public places.

Over the weekend I chatted on FaceTime with a resident of Taiwan, which has been ignored by the World Health Organization in the COVID crisis while it heaps fulsome praise on China and its response to the pandemic. The same thing had happened during the SARS epidemic in 2003, when China blocked Taiwanese access to critical information on the disease from the WHO. It had grievous consequences; 73 people died in Taiwan – about a tenth of global SARS deaths.

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Non-communist Taiwan, like democratic South Korea, has not resorted to a lockdown despite having 363 confirmed COVID cases and five deaths (with 54 recoveries) as of yesterday. Like South Korea, Taiwan has learned its pandemic lessons well.

Because of Taiwan’s experience with Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome, as soon as China disclosed the emergence of a novel coronavirus similar to SARS and MERS in December, Taipei began mobilizing its infectious disease protocols.

Unlike the Philippine government at the start of the pandemic, Taipei did not worry about offending Chinese feelings to protect the health of its citizens, and doesn’t need Chinese offshore gaming operations for revenue. As early as Jan. 26, Taiwan banned the entry of travelers from China’s Hubei province (where Wuhan City is located). On Feb. 5, Taiwan closed its borders with China.

By January, the resident told me, their government began distributing three disposable masks per week to each person with a Taiwanese health card. Failure to wear a mask in public means a fine of 10,000 to 15,000 New Taiwan (NT) dollars (about P17,000 to P25,200).

Taipei also suspended the export of masks starting Jan. 24, and imposed restrictions against hoarding and price manipulation of essential commodities. A digital app was created to inform residents about the places where they could procure masks.

The government collaborated with 30 private manufacturers to ramp up mask production. As of mid-March, the factories could churn out 10 million face masks daily.

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The resident told me that Taiwanese typically feel confident about their country’s supplies, and there was hardly any panic buying or hoarding when COVID-19 cases began rising. As in South Korea, mass testing also started early in Taiwan.

Passengers on all incoming flights are subjected to thermal scans and checks for other symptoms. If even a single passenger becomes a person under investigation (PUI), contact tracing is done and all the other passengers must be placed under home quarantine.

Each one is issued a digital chip that allows not only the monitoring of body temperature by health personnel but also the detection by police of movement outside the quarantine area. The national health ID card of every Taiwanese also includes the person’s travel history.

Local village chiefs, akin to our barangay personnel, deliver necessities to persons under quarantine. A person who leaves the quarantine area without permission is fined from NT$200,000 to a whopping NT$1 million, or between US$6,600 to $33,000.

The resident told me that there was in fact a COVID case on the upper floor of her condominium building. But because of the strict quarantine measures – actually a total lockdown for a specific household – the other building residents aren’t too worried about being infected.

All mass transportation facilities continue to operate, but social distancing is observed, and anyone with a temperature of 37.5 degrees Celsius is barred. Taiwan has an extensive public health care system with 99.9 percent coverage. So far, the hospitals have not been overwhelmed, and there is no shortage of ventilators, the resident told me.

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We don’t have Taiwan’s resources, high-tech capability or level of preparedness against emerging infectious diseases. But we can improve our monitoring capability, to have something similar to that chip that can be worn on the wrist or perhaps ankle. Such devices will allow targeted isolation of individuals or groups (in the case of flights or ships). This is better than isolating entire communities, with the majority of healthy people restricted together with the PUIs and persons under monitoring.

As for the disposable masks, practical Pinoys prefer reusable, washable masks. It’s amazing how quickly such masks, which come in various designs, have proliferated everywhere, and just as well: mask making has become one of the new sources of income for marginalized sectors. Each mask is padded and contoured to fit comfortably on the face. Obviously, it’s no N95 or 3M medical mask that can keep out pathogens, but it’s good enough for everyday use, to prevent the wearer from spreading cough or sneeze droplets.

The Taiwanese resident, incidentally, still managed to buy an N95 mask recently from a Carrefour outlet for NT$139 (about US$4.50) – an indication of their supply situation.

Taiwan’s response, according to reports, is being emulated by Israel’s Benjamin Netanyahu and New Zealand Prime Minister Jacinda Ardern.

We’re no high-tech Israel or New Zealand, but there are some doables from the Taiwanese example that we can implement, if we want to gradually relax quarantine protocols.