A tale of two countries and how they controlled the Coronavirus

Read an article in IEEE Spectrum last week about Taiwan’s response to COVID-19 (see: Big data helps Taiwan fight Coronavirus) which was reporting on an article in JAMA (see Response to COVID-19 in Taiwan) about Taiwan’s success in controlling the COVID-19 outbreak in their country.

I originally intended this post to be solely about Taiwan’s response to the virus but then thought that it more instructive to compare and contrast Taiwan and South Korea responses to the virus, who both seem to have it under control now (18 Mar 2020).

But first a little about the two countries (source wikipedia: South Korea and Taiwan articles):

Taiwan (TWN) and South Korea (ROK) both enjoy close proximity, trade and travel between their two countries and China

  • South Korea (ROK) has a population of ~50.8M, an area of 38.6K SqMi (100.0K SqKm) and extends about 680 Mi (1100 Km) away from the Asian mainland (China).
  • Taiwan (TWN ) has a population of ~23.4M, an area of 13.8K SqMi (35.8K Sq Km) and is about 110 Mi (180 Km) away from the Asian mainland (China).

COVID-19 disease progression & response in TWN and ROK

There’s lots of information about TWN’s response (see articles mentioned above) to the virus but less so on ROK’s response.

Nonetheless, here’s some highlights of the progression of the pandemic and how they each reacted (source for disease/case progression from : wikipedia Coronavirus timeline Nov’19 to Jan’20, and Coronavirus timeline Feb’20; source for TWN response to virus JAMA article supplement and ROK response to virus Timeline: What the world can learn from South Korea’s COVID-19 response ).

  • Dec. 31, 2019: China Wuhan municipal health announced “urgent notice on the treatment of pneumonia of unknown cause”. Taiwan immediately tightened inbound screening processes. ==> TWN: officials board and inspect passengers for fever or pneumonia symptoms on direct flights from Wuhan
  • Jan. 8, 2020: ROK identifies 1st possible case of the disease in a women who recently returned from China Wuhan province
  • Jan 20: ROK reports 1st laboratory confirmed case ==> TWN: Central Epidemic Command Center activated, activates Level 2 travel alert for Wuhan; ROK CDC starts daily press briefings on disease progress in the nation
  • Jan. 21: TWN identifies 1st laboratory confirmed case ==> TWN: activates Level 3 travel alert for Wuhan
  • Jan 22: ==> TWN: cancels entry permits for 459 tourists from Wuhan set to arrive later in Jan
  • Jan 23: ==> TWN: bans residents from Wuhan, travelers from China required to make online health declaration before entering
  • Jan. 24 ROK reports 2nd laboratory confirmed case ==> TWN bans export of facemasks; ROK, sometime around now the gov’t started tracking confirmed cases using credit card and CCTV data to understand where patients contacted the disease
  • Jan. 25: ==> TWN: tours to china are suspended until Jan 31, activates level 3 travel alert for Hubei Province and Level 2 for rest of China, enacts export ban on surgical masks until Feb 23
  • Jan 26: ==> TWN: all tour groups from Wuhan have to leave,
  • Jan. 27: TWN reports 1st domestic transmission of the disease ==>TWN NHIA and NIA (National health and immigration authorities) integrate (adds all hospital) patients past 14-day travel history to NHIA database, all tour groups from Hubei Province have to leave
  • Jan 28: ==> TWN: activates Level 3 travel alert for all of China except Hong Kong and Macau; ROK requests inspection of all people who have traveled from Wuhan in the past 14 days
  • Jan 29: ==> TWN: institutes electronic monitoring of all quarantined patients via gov’t issued cell phones; ROK about now requests production of massive numbers of WHO approved test kits for the Coronavirus
  • Jan. 30: ROK reports 2 more (4 total) confirmed cases of the disease ==> TWN: tours to or transiting China suspended until Feb 29;
  • Jan 31: ==> TWN: all remaining tour groups from China asked to leave
  • Feb 2 ==> TWN extended school break from Feb 15 to Feb 25,gov’t facilities available for quarantine, soldiers mobilized to man facemask production lines, 60 additional machines installed daily facemask output to reach 10M facemasks a day.
  • Feb 3: ==> TWN: enacts name based rationing system for facemasks, develops mobile phone app to allow public to see pharmacy mask stocks, Wenzhou city Level 2 travel alert; ROK CDC releases enhanced quarantine guidelines to manage the disease outbreak, as of today ROK CDC starts making 2-3 press releases a day on the progress of the disease
  • Feb 5: ==> TWN: Zheijanp province Level 2 travel alert, all cruise ships with suspected cases in past 28 days banned, any cruise ship with previous dockings in China, Hong Kong, or Macau in past 14 days are banned
  • Feb 6:==> TWN: Tours to Hong Kong & Macau suspended until Feb 29, all Chinese nationals banned, all international cruise ship are banned, all contacts from Diamond Princess cruise ship passengers who disembarked on Jan 31 are traced
  • Feb 7: ==> TWN: All foriegn nationals with travel to China, Hong Kong or Macau in the past 14 days are banned, all Foreigners must see an immigration officer,
  • Feb 14:==> TWN: Entry quarantine system launched fill out electronic health declaration for faster entry
  • Feb 16: ==> TWN: NHIA database expanded to cover 30 day travel history for travelers form or transited through China, Hong Kong, Macau, Singapore and Thailand.
  • Feb 18 ==> TWN: all hospitals, clinics and pharmacies have access to patients travel history; ROK most institutions postpone the re-start of school after spring break
  • Feb 19 ==> TWN establishes gov’t policies to disinfect schools and school areas, school buses, high speed rail, railways, tour busses and taxis
  • Feb 20 ==> ROK Daegu requests all individuals to stay home
  • Feb 21 ==> TWN establishes school suspension guidelines based on cases diagnosed in school; ROK Seoul closes all public gatherings and protests
  • Feb 24 ==> TWN, travelers with history of travel to china, from countries with level 1 or 2 travel alerts, and all foreign nationals subject to 14 day quarantine (By this time many countries are in level 1-2-3 travel alert status in TWN)
  • Feb 26 ==> ROK opens drive-thru testing clinics, patients are informed via text messages (3 days later) the results of their tests
  • Mar 3? ==> ROK starts selling facemasks at post offices
  • Mar 5 ==> ROK bans the export of face masks

As of Mar 16, (as reported in Wikipedia), TWN had 67 cases and 1 death; and ROK had 8,326 cases and 75 deaths. As of Mar 13 (as reported is Our world in data article), TWN had tested 16,089 and ROK had tested 248,647 people.

Summary of TWN and ROK responses to the virus

For starters, both TWN and ROK learned valuable lessons from the last infections from China SARS-H1N1 and used those lessons to deal better with COVID-19. Also neither country had any problem accessing credit information, mobile phone location data, CCTV camera or any other electronic information to trace infected people in their respective countries.

If I had to characterize the responses to the virus from the two countries:

  1. TWN was seemingly focused early on reducing infections from outside, controlling & providing face masks to all, and identifying gov’t policies (ceasing public gathering, quarantine and disinfectant procedure) to reduce transmission of the disease. They augmented and promoted the use of public NHIA databases to track recent travel activity and used any information available to monitor the infected and track down anyone they may have contacted. Although TWN has increased testing over time, they did not seem to have much of an emphasis on broad testing. At this point, TWN seems to have the virus under control.
  2. ROK was all about public communications, policies (quarantine and openness), aggressively testing their population and quarantining those that were infected. ROK also tracked the goings on and contacts of anyone that was infected. ROK started early on broadly testing anyone that wanted to be tested. Using test results, infected individuals were asked to quarantine. A reporter I saw talking about ROK mentions 3 T’s: Target, Test, & Trace At this point, ROK seems to have the virus under control.

In addition, Asian countries in general are more prone to use face masks when traveling, which may be somewhat restrict Coronavirus transmission. Although it seems to primarily reduce transmission, most of the public in these countries (now) routinely wear face masks when out and about. And previously they routinely wore face masks when traveling to reduce disease transmission.

Also both countries took the news out of Wuhan China about the extent of the infections, deaths and ease of disease transmission as truthful and acted on this before any significant infections were detected in their respective countries

What the rest of the world can learn from these two countries

What we need to take from TWN a& ROK is that

  1. Face masks and surgical masks are a critical resource during any pandemic. National production needs to be boosted immediately with pricing and distribution controls so that they are not hoarded, nor subject to price gouging. In the USA we have had nothing on this front other than requests to the public to stop hoarding them and the lack of availability to support healthcare workers).
  2. Test kits are also a critical resource during any pandemic. Selection of the test kit, validation and boosting production of test kits needs to be an early and high priority. The USA seems to have fallen down on this job.
  3. Travel restrictions, control and quarantines need to be instituted early on from infected countries. USA did take action to restrict travel and have instituted quarantines on cruise ship passengers and any repatriated nationals from China.
  4. Limited testing can help control the virus as long as it’s properly targeted. Mass, or rather less, targeted testing can also help control the virus as well. In the USA given the lack of test kits, we are limited to targeted testing.
  5. Open, rapid and constant communications can be an important adjunct to help control virus spread. The USA seems to be still working on this. Many states seem to have set up special communications channels to discuss the latest information. But there doesn’t seem to be any ongoing, every day communications effort on behalf of the USA CDC to communicate pandemic status.
  6. When one country reports infections, death and ease of transmission of a disease start to take serious precautions immediately. Disease transmission in our travel intensive world is much too easy and rapid to stop once it takes hold in a nation. Any nation today that starts to encounter and infectious agent with high death rates and seemingly easy transmission must be taken seriously as the start of something much bigger.

Stay safe, be well.

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