By Patricia Fitzpatrick, Full Professor of Epidemiology & Biomedical Statistics, University College Dublin, Originally published at The Conversation.
Taiwan has been widely applauded for its management of the pandemic, with one of the lowest per capita COVID-19 rates in the world and life on the island largely returning to normal.
Just 11 people have died from COVID-19 in Taiwan since the pandemic began, an impressive feat for a country that never went into lockdown.
At the start of the pandemic, Taiwan was considered a high-risk country for COVID-19 due to its proximity to China and the frequent travel that takes place between the two countries.
With a history of SARS in 2003, which was not considered to be handled particularly well, the Taiwanese government acted quickly to close its borders this time around. It set up a Central Epidemic Command Centre on January 20 2020 to coordinate cooperation across different government ministries and agencies, and between government and businesses.
A new study in the Journal of the American Medical Association has examined further just why Taiwan did so well at conquering COVID-19. The study’s authors, from a range of health institutes and hospitals in Taiwan and the US, compared the estimated effectiveness of two types of COVID-19 policy in the early months of the pandemic: case-based and population-based measures.
Case-based measures include the detection of infected people through testing, isolation of positive cases, contact tracing and 14-day quarantining of close contacts. The population-based measures included face mask policies, personal hygiene and social distancing.
The effects of these policies were quantified by estimating the effective reproduction number (R number).
The R number is a way of rating an infectious disease’s ability to spread – it represents the average number of people that one infected person will pass a virus onto. An R number of greater than 1 means the virus will continue to spread and outbreaks will continue. An R number below 1 means that case numbers will start to reduce.
While previous studies in other countries have simulated hypothetical scenarios, this paper combined transmission modelling with detailed real data to estimate effectiveness.
The authors collected data on 158 cases between January 10 and June 1 2020 from the Taiwan Centers for Disease Control, and all cases were confirmed by PCR testing. The data related to locally acquired cases, confirmed clusters, and imported cases in people who entered Taiwan before March 21 2020.
They then compared the outcomes they found in Taiwan with an estimated R number of 2.5, based on the estimated equivalent number in nearby China at the beginning of its COVID-19 outbreak.
The Winning Combination
The study found that the case-based policies alone, like contact tracing and quarantining, could lower the R number from 2.5 to 1.53. Quarantine contributed the most to lowering the R number.
Case-based interventions could not substantially prevent transmission from one person to another, but could reduce transmission onwards from those secondary cases to a third or fourth person, as long as close contacts quarantined.
Population-based policies like social distancing and face masks, meanwhile, reduced the R number from 2.5 to 1.3.
The authors concluded that it was the combination of case-based and population-based policies, along with widespread adherence, that led to Taiwan’s success in containing COVID. Combining both approaches led to an R number estimated using two different methods to be 0.82 and as low as 0.62. They also found that considerable population-based policies were needed to achieve containment even though the number of circulating infections was small.
Neither approach would have been sufficient alone, even in a country with an effective public health system and sophisticated contact tracing.
What Does This Mean for Other Countries?
Acknowledging that all models make assumptions, and this analysis is no different, this paper does confirm that the full suite of public health measures we have been using fairly consistently across the world – to varying degrees of length and stringency – have been necessary. Though it’s worth noting that the results in the study reflects a time when new variants with greater transmissibility were not a problem.
The authors assumed that testing and isolation occurred simultaneously. This was the case in Taiwan, but not in other countries, for example England, where delays between testing, results and isolation diminish the effectiveness of case-based measures.
Taiwan is an island nation with the ability to control the introduction of new cases through border control, and the authors acknowledge the findings of this study may not be fully applicable to other countries. This is the reason the authors focused on the effectiveness of case-based and population-based interventions on local transmission, rather than on border controls on the number of introductions of COVID-19.
The authors conclude that intensive contact tracing is not possible when public health systems are overwhelmed. This never happened in Taiwan due to the success of its strategies, but it did, for example, take place in Ireland in January 2021, which experienced a damaging third wave of COVID-19.
This paper also found similar results for seven-day and 14-day quarantine and suggest that the quarantine period could be shortened. This is being considered by some countries, including the USA, but it has not been introduced on a widespread basis to date.
We already knew there was much to be learned from Taiwan’s success in preventing COVID-19 from taking hold. Now, as vaccines roll out and new variants emerge, we have more information about the comparative and combined contributions of public health measures.
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what about cambodia? similar sized population, similar death total. is anyone supposed to believe their health system stopped the virus? it’s take some real effort to ignore the the obvious fact that the asian countries have extraordinary low infection rates which might suggest some level of existing immunity.
Yes… except that China, an Asian country, originated and rapidly spread the disease in the first place…
Huh? What about the massive effort China had to undertake to stop the virus? They locked down 70% of the economy, far more strictly than any US lockdown (in Beijing and other cities, you had to pass a temperature test to leave your building, for instance). They had overwhelmed hospitals to the degree they had to build emergency ones for Covid, or did you miss that too?
Did you also manage not to read any of Jerri-Lynn’s numerous pieces on the relentless contact and trace efforts in Hong Kong? And that they are bloody-minded about quarantines for those cases?
Asia had experience with SARS. And they have a mask-wearing culture. It’s considered rude not to wear a mask when you have a respiratory infection.
yeah and NZ too? Australia too? Come on, it isnt that hard. Seal the damn borders
Not taking anything away from Taiwan as they did a brilliant job here in suppressing the virus but other countries succeeded that not only had a border with China but fewer resources to do so whereas Taiwan is relatively wealthy and is an actual island. JohnMc above points out Cambodia as one and in a comment by Kfish yesterday said ‘I think the real COVID champions are Vietnam. Long border with China, dense population and yet they stopped it completely.’ But I would judge that in all cases, what really succeeds is going in early and going in hard.
And a different view of ‘freedom! and responsibiity’ cultural self-restraint, societal conformity than OOSA OOSA OOSA! ?
Bad stereotyping, I know…
“Stereotyping” that the Vietnamese proudly embrace, in the national spirit of dau tranh (‘struggle’, not always of the armed variety).
The Vietnamese PM declared last year: “Each citizen is a soldier, each house, hamlet, residential area is a fortress in the fight against the pandemic.” Sounds totally over the top, sure, but such rhetoric is normal and expected. You merely comply, your opinion in the matter is not asked. So little actual compulsion is needed.
In dysfunctional societies, in contrast (do I really need to name them?), individuals feel entitled to exempt themselves from inconvenient rules, whether it’s a hostile “Mind yer own dam’ business!”, or the shrug/handwave “Rules for Thee, but not for Me” evasions more common in Europe. These behaviors also afflict elites in highly stratified societies (basically, people with servants).
Another thing Taiwan and Vietnam have in common is a healthy distrust of anything China and/or WHO says, they preferred to trust their own experience and (no doubt) what their intelligence services are telling them. Taiwan certainly seems to have been a step ahead of everyone in realising something bad was brewing in Wuhan.
I don’t really know about Cambodia, but its a deeply corrupt country so I doubt any figures from it can be trusted. They may well also have some climate/cultural advantages as Thailand has done very well too. The majority of people in Cambodia live in very open, airy buildings which may help.
On the subject of Cambodia, there is an article in todays Guardian saying that there is a new and very powerful surge there.
It seems that we will have to wait a long time before deciding which countries have done best with Covid.
“a country with an effective public health system”
Imagine America with Medicare For All, and no for profit medicine.
I believe it is down to individuals, individual families and individual businesses to be responsible citizens and be more alert and aware of the situations. Masks are not donned or are improperly donned. Hoax theories get promoted. People selfishly ignore basic anti-pandemic practices and still travel about. Workplace safety is a joke for medium to large size businesses for their non-office workers. Governments turn a blind eye to travel and workplace transmission issues. Our bombastic governments and their officials arrogantly claimed that they knew what they were doing (easy to say) but did very little in being vigilant (work to do). Every little action contributes to reduce the R-factor but we just fail to do it as a population. Taiwan and Vietnam never had to lock down. So doing the right things protect much of their economy and daily life. While we focus on protecting the economy and end up having to shut it down. I live in Ontario Canada and is being locked down due to a devastating third wave. In the meantime, workplace issues are still not addressed. We get what we deserve. Our individualistic and selfish culture does not work well fighting pandemics. We now have to rely on vaccination and infections to get to herd immunity. I am not Taiwanese but I go there often and admire their people for their honesty, modesty, and hospitality. They do well for what and who they are.
Do make your mind up.
“the Taiwanese government acted quickly to close its borders this time around. ”
as did every other country that did well in this pandemic. Not one exception is there? And many are NOT Islands
it’s really hard for me to take these articles seriously when they do not mention that the country (Taiwan, NZ, Aussie) is an island.
The United States could not close down its borders without threatening its status as global superpower, so it didn’t. Instead, it chose to vaccinate its population instead of controlling the virus.
As opposed to Australia, which has had awful vaccine rollout, but doesn’t have the virus around.
Islands are awesome if you don’t mind being a hermit every once in awhile.
Sorry, but Thailand, Vietnam, and Cambodia have also gotten Covid well under control. Thailand with a population of 70 million has had 99 deaths. Not 99 thousand. 99.
And that with Bangkok being the most visited city in the world.
Seems to me that they closed off their entire peninsula, more or less. No incoming flights. No ships allowed at dock.
It’s a great feat. The only way contact tracing can really work is if you’re truly willing to close your borders. Can’t have a porous border and successful tracing of cases. Like I said, American empire cannot afford to close down.
Taiwan and NZ are the countries I keep hearing about all the time, with no mention of geography. But closing your border is a hell of a lot easier with an ocean helping out.
The “UK”is an island too – with a somewhat less successful record of restraining the spread of Covid19. The word shambolic comes to mind. They do however seem to be getting their collective act together with their vaccine rollout, resulting in a fairly rapid reduction in Covid 19 cases and associated mortalities. This is in sharp contrast to their immediate neighbours in France, where Covid19 case rates remain high and have not diminished recently.
Everyone here seems to be forgetting Israel, which has also had great success in coping with the virus. (https://www.timesofisrael.com/israel-to-reopen-schools-lift-outdoor-mask-requirement-on-sunday-as-covid-ebbs/) I guess the lesson would be you don’t have to be an actual island to have extremely stringent border control.
You can say that Israel has had great success in coping with the pandemic, but I’d say it’s a long, ongoing lesson. I don’t know to what extent the Shin Bet mass surveilance/contact tracing of infected individuals was effective, but as controversial as it was it most certainly surpassed any contact tracing efforts made in the U.S. Otherwise I see many similarities in the responses between both countries, (allowing for considerable variation among states here in the U.S). Netanyahu began easing restrictions around May 9th of 2020 at which time there had been about 230 covid 19 deaths. He partially reopened schools, initially with restrictions, but he eased them considerably as the month progressed and he opened up even more. When the spike in cases and first wave occurred many schools had to shut down again, and there was a halting and reversal of the forward course elsewhere, which eventually resulted in the first lockdown by the end of the first week in June. Two more waves resulted in 2 more lockdowns that varied in stringency depending on circumstances, with some selective implementation of restrictions. The last lockdown was eased relatively recently, and at this point in time there have been 6,335 deaths. I’m hoping for the best and keeping a close eye on Israel.
Mate, New Zealand has an enormous diaspora relative to its small population. The virus was brought into the country by family returning from the USA for a wedding in the rural south of the country. It became the biggest cluster, a “super spreader” event. NZ is globally connected. And there are also biz jets flying around every day. And in and out.
Errr…
“the Taiwanese government acted quickly to close its borders this time around. It set up a Central Epidemic Command Centre on January 20 2020 to coordinate cooperation across different government ministries and agencies, and between government and businesses.”
What I found significant is that to control coronavirus you have to do everything; test, trace, quarantine (7 days), mask, social distance, and personal hygiene. But if the borders aren’t closed, as in the Americas and Europe, and only partial measures taken, it is all for naught. The ideology of the “free movement of people, capital, goods and services” (the foundation belief of the globalist Western Empire) killed 581,061 Americans, 373,442 Brazilians and 212,228 Mexicans.
The fifty state Departments of Health meant that the case-based policies were never universally and effective applied in America. This is the reason the USA is #1 in deaths. Command and control, testing, and messaging are a debacle. The federal government intentionally prioritized funding the warp speed for-profit mRNA vaccine campaign. With about a third of Americans vaccinated and the number of cases rising for a fourth time, it is becoming clear that mRNA jabs are bound to fail to control coronavirus due to variants, short period of immunity, and jab hesitancy. This and the pandemic’s economic depression must be the impetus for the recent hysteria, riots, gunmen running amok, and impending doom that are seeping out despite the private/public PR campaign that vaccines are great and the economy is about to boom.
The only thing that will control coronavirus is making the community (school and work bubbles), the city and then the state virus free. The corporate bought federal government will do nothing. More Americans will die and survivors maimed by long COVID. Years from now the pandemic will fade away after waves of plague run through the population like the suspected coronavirus Russian flu did from 1889 to 1895. When done, the Western Empire will be gone. An ill, poor, famished Americas will remain.
Perhaps an ill poor famished Americas will be able to evolve some kind of Renaissance the way an ill poor famished Europe did after the Great Plague had finally run all its courses.
“the Taiwanese government acted quickly to close its borders this time around. It set up a Central Epidemic Command Centre on January 20 2020 to coordinate cooperation across different government ministries and agencies, and between government and businesses.”
Key date: January 20th. Europe and the US had a window of opportunity in which to do something. It took another two months until they did anything. Meanwhile, Europe and the US became the centre of the outbreak.
A trans-Tasman Sea travel bubble has opened. COVID free. The Cook Islands joins next month. And there is talk of the rest of the Pacific joining, though probably not the French overseas territories which are rife with COVID. Probably Taiwan, Singapore, Vietnam …. you name it … soon.
https://www.rnz.co.nz/news/national/440808/trans-tasman-travel-bubble-opens-in-photos