- Taiwan has been praised for its highly effective Covid-19 response.
- Taiwan, which has nearly 24 million citizens, has had only 451 cases and seven deaths.
- Taiwan had a plan in place for years, which involved quarantines, contact tracing and wide availability of masks, among other things.
CNBC is looking at how places around the world have tackled Covid-19. By talking to a wide range of experts, as well as everyday citizens, we're taking stock of what's gone well — and what hasn't.
Taiwan, the third subject of our series, has confirmed 451 Covid-19 cases and seven deaths in a population of 23.7 million. Everything is mostly reopened, and the only signs of Covid-19 are the frequent temperature checks and the expectation to wear masks on the subway. People are traveling internally for vacations, including visiting restaurants, bars and beaches, and most are back to the office.
By way of comparison, the U.S., with about 330 million people, has seen more than 3.4 million cases and more than 136,000 deaths.
Travel and quarantine
When Catherine Chou arrived in Taipei after flying from Los Angeles, authorities told her she would need to quarantine for two weeks. For Chou, a citizen, that meant booking herself into a hotel at her own expense, although subsidies are available and the government has paid stipends for some stays.
When she first arrived, she got a welcome package including dish soap, nail clippers and laundry detergent. Food was delivered to her doorstep. Several times a day, a representative of the local district's office phoned her to check in and thank her for doing her part.
She's now almost wrapped up her hotel room stay. Once she's officially cleared of Covid-19, she'll be free to go. After living in the U.S., which is still partially closed in various states, she's looking forward to simple pleasures like visiting her family at home or sitting in a coffee shop with a good book. Taiwan allowed many of its restaurants and bars to reopen in May.
"We have this phrase in Taiwan that roughly translates to, 'This is your country, and it's up to you to save it,'" she said. "I'm really glad that they're taking this quarantine seriously."
As of June 22, some business travelers from countries deemed low-risk (the U.S. is not among them) have been exempt from the stringent quarantine. That marks a change in policy from late January, when Taiwan ramped up travel restrictions and set up a home quarantine system using geofencing technology. That helped limit the spread of Covid-19, and Taiwan now has one of the lowest coronavirus death counts in the world. Moreover, visitors who wish to remain on tourist visas have been allowed to without needing to do a visa run every 90 days, said Erin Hale, a journalist based in Taipei.
"Taiwan is close to China and could have been a total disaster," said Dr. Ezekiel Emanuel, author of a new book about the best health care systems around the world. "So I see their lack of cases as a truly amazing result."
A clear plan and no exceptions
"Taiwan's population is more than 23 million people — and they have 451 cases with only seven deaths," said Tsung-Mei Cheng, a health policy research analyst at Princeton University. "That shows how successful they have been at both prevention and control."
Cheng said the key lesson for the rest of the world is that leadership matters. She noted that Taiwan's government had a strong plan — one that had been in place since the SARS scare of 2003 — for managing a pandemic. And there were no exceptions to the rules. "They have professionals running the show," she said. "These are people who have trained for years for this."
Taiwan has been excluded from the World Health Organization because China claims Taiwan as its province with no right to its own diplomatic representation on the global stage and in international organizations. As a result, health officials say they were left out of receiving firsthand information on the coronavirus outbreak.
William Hsiao, emeritus professor of economics in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health, praised Taiwan for its effective early action, noting that health officials had developed a careful advance warning system for diseases around the world. If Taiwan had been a member of the WHO, he said, it might have been able to share its precautions with the organization and help other countries more easily.
But it was still able to move forward with a concrete and effective plan of its own.
"There was easy access to almost free and rapid testing centers," said Han Jin, founder of a start-up in Taiwan called LucidPix. "At every building, including restaurants, gyms and offices, they check your temperature — and you cannot enter without face masks."
There's also enforcement for those who don't follow the rules. There are huge fines if people are caught not wearing masks in designated areas, such as the subway, and for breaking quarantine.
Social pressure also plays a part. Jin said that it's become part of the culture in Taiwan to name and shame those who are not wearing masks in the subway or are breaking quarantine early. Those who do so might see their face pop up on a social media app.
Getting ahead of mask shortages
As countries around the world feared they would run out of essential supplies, including masks, Taiwanese citizens used their national health insurance cards to purchase their allotment of masks.
"At the end of January, my husband and I were memorizing delivery schedules at convenience stores near us, and going to them at 2 a.m. to try to find masks for our toddler," said Catherine Shu, a local journalist. Shu noted that in addition to ramping up production, the government also introduced software tools, including maps with real-time updates about mask inventory nearby.
Regular communication with the public
Taiwan's health officials are in regular contact with the public. For months, there were briefings daily. As of this month, the Central Epidemic Command Center, a division of the Taiwan CDC activated in response to severe infectious outbreaks, announced it would instead conduct weekly interviews. "I think for me, this was an emotional milestone, because I trust the CECC — their work and transparency has been exemplary — and I took that as a signal that I could finally let myself relax a bit," said Shu.
Shu said she's primarily concerned these days for family and friends in America.
The digital health care system
Emanuel explained that everyone in Taiwan has a health-care record tied to their name, which allows their doctors and nurses to access their medical information online. That gives health officials near real-time data on hospital visits. From there, health officials were able to send alerts to doctors about their patients at higher risk for having the virus based on their travel history.
"They could closely monitor who had been to China and Wuhan," he said. "And then test people who had been to China, as well as those with respiratory symptoms, which meant they could get ahead of a potential hotspot."
Hsiao notes that in Taiwan, there's a strong feeling that sometimes people have to give up their "individual desires and benefits" for the sake of their community — a mindset that Hsiao contrasts to Americans' tendency to be more individualistic, based on his experience living in this country. That community-oriented mentality helped Taiwan come together to tackle the threat in a more unified way, and it meant that very few people declined to follow the public health recommendations.
More education around prevention
Hsiao struggled to think of examples of where Taiwan could have done better but said there could have been more emphasis — at least initially — on teaching the public how to stay safe. He said that before reliable tests are developed people have to take precautions and warned of the risk of people letting their guard down after a seeming success. Once the crisis has passed, he recommends, all countries should consider appointing a scientific nonpolitical committee to help monitor infectious disease and prepare for future emergencies.
"I'm confident that no country's response has been 100%," he said.
Masks for foreigners
"Foreigners struggled to get masks at first, which could only be purchased with a certain kind of residency visa once the government started stockpiling and rationing them," said Hale. "At my school, where many students are on a tourist visa, the school ended up handing them out to everyone without an alien resident certificate."
Hale noted that migrant workers and domestic workers might have also struggled to access masks.
Some citizens said the government's response felt a little intrusive.
"The use of smartphone location tracking to monitor folks in quarantine and alert people who had possible exposure to someone had been diagnosed with COVID-19 did underscore how much power the government potentially has to monitor individuals' movements," said Shu, the journalist. "I trust the government's public health measures, but I would like more clarity into how that data will be protected after the pandemic."
More flexibility around remote work
Many people were nervous about getting Covid-19, particularly in the early months. Shu said she wished that more Taiwanese companies had implemented remote work policies or provided more flexibility in late January and February.
"I work from home anyway, but I know that a lot of my friends who don't were frustrated that they had to take public transportation to workplaces that required all employees to wear masks, even though they didn't have time, because of their work hours, to line up to get mask rations," she said. "Schools were also closed in February, and it was a juggle for parents of school-age kids."
We asked every expert we spoke to for their score out of 10 (1 is extremely poor and 10 is ideal). It's an extremely subjective measurement, but the average across all of them for Taiwan is 9.25.
"I definitely feel like I've been living in a parallel timeline compared to my friends in other parts of Asia and back home in the West," said Hale, who gave Taiwan a score of 10. "It's remarkable how normal my life has been since coronavirus broke out."