Taiwan dodged big coronavirus outbreak thanks to the SARS effect

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This story is one in a three-part series on how Greater China regions—Taiwan, Hong Kong, and Macau—have responded to the coronavirus outbreak.

In late December, news reports began trickling out of China about an unknown pneumonia-like virus infecting a few dozen people in the city of Wuhan.

At the time, officials in mainland China had not yet confirmed that the disease was transmissible between humans, and most countries did not yet recognize the threat the novel virus would pose. Taiwan, however, was an exception.

By Dec. 31, Taiwanese officials had already begun screening passengers on flights from Wuhan for flu-like symptoms, according an article published in the Journal of American Medical Association (JAMA). By Jan. 12, Taiwan had sent a team of medical professionals to Wuhan to inspect the situation.

The government of Taiwan was among the quickest to recognize and counteract the potential dangers of the coronavirus, which causes the Covid-19 disease, while being one of the regions in closest proximity to it.

Taiwan’s capital of Taipei is a three hour flight from Beijing, yet the two sides remain at odds over unresolved tension from a civil war in the 20th Century. Taiwan considers itself a self-governing country, while China sees Taiwan as a Chinese province that’s gone rogue.

The coronavirus so far has infected over 156,000 people around the world and killed over 5,800, according to Johns Hopkins University. Taiwan, which received over 2.7 million Chinese visitors in 2019 and has up to 850,000 of its citizens living in China, has confirmed only 53 cases of coronavirus and one death as of Sunday, according to Taiwan’s Centers for Disease Control.

Experts assessing Taiwan’s response to the coronavirus so far give it a glowing critique. “No country (was) better prepared than Taiwan in facing this epidemic,” said Chunhuei Chi, the Director for the Center of Global Health at Oregon State University, who’s studied the Taiwanese health care system. With forward-thinking governmental policies, widespread public adoption of prevention and control measures, and a sophisticated epidemic-response infrastructure, Taiwan is less at risk to the dangers of the coronavirus pandemic than perhaps any other place on Earth, Chi said.

Taiwan’s SARS legacy

It’s important to note that Taiwan had a recent run-in with a different outbreak. In 2003, the epidemic of severe acute respiratory syndrome or SARS, a viral disease with a similar genetic make-up to the coronavirus that also originated in China, infected 346 people and killed 73 in Taiwan, making it the third hardest-hit after mainland China and Hong Kong.

TAIWAN-CHINA-HEALTH-VIRUS — A man wearing a face mask walks past wigs on display in Ximen district in Taipei on March 4, 2020. Taiwan has so far fended off a major Covid-19 crisis because it’s been preparing for a large-scale outbreak since the last one in 2003.

Taiwan “learned [its] lesson” from the SARS experience and “became more self reliant” in making its own assessments of the potential dangers of new diseases, rather than simply trusting reported data from other places like China, says Jason Wang, director of the Center for Policy, Outcomes, and Prevention at Stanford University, who authored the JAMA report on Taiwan’s response to the epidemic.

The Taiwanese government established the National Health Command Center (NHCC) in 2004, an entire agency tasked with preparing for and responding to potential outbreaks. In response to the coronavirus outbreak, the NHCC mobilized a unit called the Central Epidemic Command Center, which “rapidly produced and implemented a list of at least 124 action items,” according to Wang, which included border control, case identification, and quarantine of suspicious cases.

“The memory (of SARS) is still fresh…,” Chi said. “[T]hey know too well what is at stake.”

Taiwan’s wider response

Another action Taiwan took early was border monitoring. It banned visitors from Wuhan on Jan. 26, and soon after began requiring that all travelers scan their travel information via QR codes at border checkpoints. The Taiwanese government then linked the travel histories to its national health care system’s online platform so authorities could search for potential cases of the virus, monitor those under quarantine, and collect information about potential outbreaks.

Despite the close ties between Beijing and Taipei, the actual number of Chinese travelers in Taiwan in January was likely low compared to past years. In mid-2019, China restricted some travel to Taiwan, amid the ongoing Beijing-Taipei tension.

Taiwan also took proactive measures in allocating resources and addressing potential shortages. In late January, Taiwan banned the export of surgical masks and ramped up its own production. It is now producing (with the help of prison labor) more than 8.2 million surgical masks per day, and has instituted strict rations on supplies to citizens of two per person every week.

Scientists and researchers in Taiwan started working on developing new tests and vaccines for the virus in February. A group of them claims they have a developed a new test that can screen for the virus in just 15 minutes. The test is still three months away from being deployed; once that happens, it would provide a quicker turnaround than the fastest test currently in use in the world, which shows results in three hours.

Public opinion

Equally striking has been the public response to Taiwan’s measures. Citizens have largely complied as Taiwan has instituted regular fever checks, carried out sanitation sweeps of public buildings and infrastructure, and established some extreme quarantine measures. Though there is a risk in not complying, with violators facing fines up to $5,000.

What’s more, Taiwan has kept citizens abreast of its response with daily press briefings by the command center and through updates to a government-run public information app.

“Ordinary people are taking these precautions very, very seriously as their responsibility,” said Harry Harding, a professor of public policy at the University of Virginia and a China expert, who spoke to Fortune from Taiwan. “You have so many masks on the street, and going into any building everyone is now scanned for fevers.”

Taiwan’s response has not been perfect. Wang notes that authorities allowed the Diamond Princess cruise ship, which later became a coronavirus hotspot, to dock in Taiwan. Passengers from the ship disembarked and visited tourist locations on Jan. 31. Government communication has also largely been available only to Chinese-speaking audiences, leaving foreign travelers and residents who speak other languages with less information.

Going without WHO

An interesting wrinkle in Taiwan’s response is that it’s carried out its measures without aid or input from the World Health Organization.

The WHO has excluded Taiwan since 1972, when the U.S. switched diplomatic recognition from Taiwan to mainland China. Taiwan was granted WHO “observer” status in 2009 during a period of friendlier Sino-Taiwanese relations, but in 2017, Taiwan was not invited to WHO meetings. Taiwan blamed the rejection on China, an influential WHO member, with Taipei accusing Beijing of seeking retribution for Taiwan’s election of President Tsai Ing-wen and a more anti-China government.

Taiwan’s exclusion from the WHO means that it does not have a formal voice in how the world should respond to the pandemic, and it can’t access the channels through which countries share information and strategies for combatting the disease.

Taiwan’s exclusion from the WHO might have actually benefited the self-governing territory in this instance, Chi said. Because Taiwan was forced to draft a unilateral response to the outbreak, it may have put less stock in the early assessment from China that the virus couldn’t transmit human-to-human. China didn’t confirm human-to-human spread until Jan. 20, the same day WHO acknowledged limited transmission of the disease that way. At that point, Taiwan had already been screening passengers from Wuhan for three weeks.

Taiwan didn’t “trust information provided by China,” Chi said, and that early skepticism might have positioned it better than neighbors like South Korea and Japan, which currently have 8,086 and 773 cases, respectively.

The WHO says it has been communicating with Taiwan during the outbreak, and China says information about the outbreak can “flow readily” without Taiwan’s inclusion in the organization. But, to some experts, this might not be enough.

“Not being at the table delays information sharing,” said Wang. “The WHO, more than any other organization, should know the importance of being inclusive.”