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Saving Taiwan’s COVID-19 Success Story

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Saving Taiwan’s COVID-19 Success Story

With significant community spread, it’s time to rethink Taiwan’s pandemic strategies.

Saving Taiwan’s COVID-19 Success Story
Credit: Office of the President, ROC (Taiwan)

Taiwan was highly successful in fighting COVID-19 in the early days of the pandemic. Taiwan screened visitors rigorously early on, ramped up mask production, and established a sophisticated contact tracing and quarantine system to keep the virus at bay. Taiwan emerged as a country with one of the lowest COVID-19 case counts in the world. By distributing its masks around the world in the early days of the pandemic, its slogan of “Taiwan can help” reflected a proud technocratic vision that succeeded in stopping the virus on its tracks.

Yet, the unprecedented arrival of significant community spread of COVID-19 cases in Taiwan has proven to be an abrupt change in mindset for the authorities and people on the island used to COVID-free living. This community spread coupled with high positivity rates has challenged the viability of Taiwan’s zero-COVID policy, which it had pursued from the beginning, together with other polities such as Singapore, Australia, and New Zealand.

Confident that Taiwan would be able to contain the virus as it had done with tiny clusters over the past year, the authorities chose not to enact a lockdown. Rather the government relied on its tried and tested strategy of universal masking, widespread fumigation, targeted testing, quarantine, and closures. Yet, the exponential growth suggests that existing policies may be inadequate in fighting widespread community transmission. For example, averting a full lockdown in the face of high positivity rates in parts of Taipei City meant that the national government allowed many schools to continue operating on the island. Many white-collar workers remain in indoor offices at close proximity, even as international experts have warned that COVID-19 transmission can occur indoors even with universal masking after a short period of time.

Taiwan probably did not see the need to learn from other countries’ tumultuous experience in fighting COVID-19 until the most recent outbreak. Even though Taiwan lacked access to vaccines partly due to geopolitical reasons, the country’s low COVID-19 cases meant that it did not have to go beyond targeted testing, tracing, and isolation. In the face of significant community spread, Taiwan has drawn primarily on its early days of success by encouraging – rather than compelling – people to stay at home.

Since Taiwan’s initial success in March 2020, a broad scientific consensus has emerged on the idea that COVID-19 is spread primarily through close contact indoors and can be transmitted through aerosol particles. Despite exhorting flexible working hours and encouraging working from home policies, Taiwan’s willingness to allow many white-collar workers to continue working in indoor offices with close proximity is inconsistent with its policy of suppressing COVID-19 transmission. The widespread use of plexiglass and other barriers in indoor settings, which Taiwan had adopted, appears to be only mildly effective based on current scientific research. More important steps would be improving indoor air circulation, installing air filters, and taking work events and press conferences outdoors and online as an alternative to the many indoor meetings still taking place across the country.

Because COVID-19 transmission is relatively limited outdoors, activities such as exercising alone or with immediate family members in parks, gardens, and stadiums are comparatively much safer. Yet, Taiwan’s media reportage has criticized people exercising outdoors, even though such activities can significantly alleviate the mental and physical stress of staying long hours at home.

Moreover, Taiwan’s reluctance to completely shut down indoor dining goes against ongoing research that indoor dining remains a crucial vector in transmitting the virus in the absence of widespread vaccination. The Singapore government, which is also struggling with a similar COVID-19 outbreak and pursues a similar zero-to-low COVID policy, has recently forbidden indoor dining in the face of such new research. Australia has also banned indoor dining in short snap lockdowns to eradicate community transmission. Taiwan should strictly limit indoor dining across the country if it wants to maintain a policy of zero-to-low COVID-19.

South Korea’s extensive efforts at expanding and refining COVID-19 testing and contact tracing could be helpful to Taiwan’s efforts at mitigating community spread. Like Taiwan, South Korea, as a democracy, has eschewed lockdowns. Moreover, South Korea has not closed its borders the same way Taiwan has, and opted for a mitigation policy rather than explicit eradication of COVID-19 within its borders. So far, South Korea’s efforts have proven relatively successful in mitigating spikes in COVID-19 cases. Drawing on its experiences in fighting MERS in 2015, South Korea has established and refined comprehensive testing and tracing mechanisms in combatting COVID-19. South Korea has developed a variety of COVID-19 testing sites across the country and encourages widespread testing for suspected patients, their contacts, and patients with respiratory ailments. Testing possible asymptomatic patients as part of South Korea’s robust contact-tracing program is also key to keeping COVID-19 rates low in the country.

In contrast, Taiwan has adopted a more targeted approach, mainly testing only in specific sites that had demonstrated community spread. Part of this approach is connected to local authorities’ recent remarks that the large number of cases has made contact much more difficult, putting into doubt the future of Taiwan’s existing excellent contact-tracing system. Moreover, high positivity rates of 10 percent at Wanhua district, one of the key epicenters of the spread, suggests Taiwan could do much more testing quickly to curb the spread of COVID-19. Without adequate testing, contact tracing becomes much more difficult as missing links between possible contacts remained undiscovered. More testing and tracing at this stage is likely more helpful than the current widespread fumigation of districts with bleach (which Taiwan did in February 2020) since the disease is unlikely to be transmitted primarily through fomites outdoors.

The biggest challenge Taiwan faces is unlearning some of its successful strategies at the beginning of the pandemic – including widespread fumigation and reluctance to evacuate indoor spaces of people – and keeping those that have worked, including a strong quarantine system as well as universal masking. Moreover, Taiwan has many strong historical fundamentals in fighting pandemics, including an enviable national health insurance system, which meant that any symptomatic patients can access care without significant cost; a strong democracy with a highly educated population who demanded political accountability for pandemic management; and a highly popular government who could enact difficult measures to contain the virus.

Taiwan’s COVID-19 management is not yet doomed to go from success to failure, but it needs to test and trace more residents and take more steps to mitigate the indoor aerosol transmission of the virus. Revisiting the myriad history of COVID-19 policy measures by democratic countries will be critical in maintaining Taiwan’s democracy as well as its admirable zero-COVID policy.

Special thanks to Javier Cha and John DiMoia of Seoul National University for their insights on the South Korean experience in fighting COVID-19.