One Year After Pandemic Was Declared – Taiwan’s Fast, Flexible Policies Preserve Normal Life In Focus 12/03/2021 • Val Crawford Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Wulai, a scenic town near Taipei, was still packed with crowds of local tourists on weekends – as the lunar New Year holiday ended in mid-February. Not many places resemble the pre-pandemic world more than Taiwan. Residents do wear masks, and the ways in which people use public spaces have changed. But in a locked-down world of damaged economies, Taiwan’s institutions are functioning; its classrooms, tourist sites and restaurants carry on. TAIPEI – One year after COVID-19 was declared to be a global pandemic, Taiwan’s policies have kept COVID cases under 1000 reported infections and just 10 deaths in a population of 23 million. In comparison, Florida has had 1.9 million cases and 30,700 deaths in 21 million residents. Taiwan’s success is due largely to the high-tech policies of President Tsai Ing-wen’s government. Imported cases have been efficiently isolated and contacts traced to halt community transmission. This is a pandemic success story, yet the world knows little about Taiwan. Blast into the Past Returning to Taipei in November 2020 from northern Minnesota felt like a trip back in time – not only to a place where I had lived and worked for many years – but back to normal life as well. Rural America was broken just after the election, with most services and organisations closed and no end in sight. I nearly hitchhiked 200 frigid miles to the Minneapolis airport because COVID had closed the jitney services. Every day my county’s rate of new cases was higher; I left as these jumped into the newly-created black zone – more than 100 cases per 100,000. Most businesses didn’t challenge maskless Trump supporters; everyone desperately needed customers as the pandemic had kept most summer visitors away from our lake resort town. The COVID numbers were worse in counties north, west and east of Hubbard County, where the White Earth, Red Lake and Leech Lake reservations of Anishinaabe (also known as Chippewa or Ojibwe) tribal groups remain vastly underserved by medical resources. We ordered our groceries and stayed home, but the nearby town of Nevis actually voted against the governor’s mask mandate. Because its Muskie Days music festival was officially maskless, we stayed in the car to listen safely. Strict Quarantine with a Heart After that dystopia, landing in Taiwan felt like relaxing into a Club Med holiday: every quarantine-related detail was well-managed and convenient. At the airport we were whisked to get quarantine SIM cards. Taiwan Centers for Disease Control workers checked our pre-filed quarantine papers and gave us phone numbers where police would call us daily. (We paid for these, but they were a bargain for the local phone service with unlimited data we would need anyway.) Monitor at the Taipei immigration office displays information about COVID while people wait for their number to be called. I was guided to a quarantine taxi – which was an ordinary taxi charging the usual metered fare, around US $5 in town – except that drivers were well-masked, gloved and trained to disinfect surfaces. I shudder to think how much this would cost in the USA, where every possible markup is applied to services that are even remotely health-related. Then I settled into my apartment for the 2 weeks of isolation. I was fortunate to have tree-shaded windows overlooking a busy street and a laundry balcony to step into sunlight and fresh air. Quarantine hotels were almost entirely full when I arrived, but they do make sourcing meals less demanding; friends brought food to my apartment when Uber Eats and Food Panda couldn’t use my foreign credit cards. That SIM card delivers daily texts from police involved in the quarantine effort; they come to the door if they don’t get a return text indicating I’m fine / not fine / need help. Most days an officer also called to politely inquire whether I needed anything. When I complained I’d used up the calling credit, a free loaner phone was delivered for the remaining days of quarantine. The officer who delivered it even made an extra trip to the convenience store downstairs; I knew I was home when she brought a fish-liver rice ball and salty tea eggs. I looked out the windows a lot, and noted how the city had painted waiting lines at popular bus stops so people line up in a more orderly fashion – which also helps encourage distancing. My friend who let me “video shop” for quarantine groceries showed me markers keeping customers spaced in checkout lines too. The New Normal at Work Given the traumatic experience of the 2003-04 SARS outbreak that shut down public life for much of that year, Taiwanese readily accepted that in the case of SARS-CoV2, masking allows meeting, and that these policies are for the common good. Perhaps the only pushback is slightly spottier mask wearing in areas that have not seen cases. An English teacher in Hsinchu noted that her elementary-age students resist the mask rule. Yet after a year with no cases in the area, the private school’s leaders still discipline maskless students. Even with a negligible case rate (only about 3 new COVID cases in the past week), many events are distanced or outdoors. Jitters about recent cases cancelled many popular Lunar New Year’s fireworks/concert celebrations in February, including the Lantern Festival. In public areas, such as medical waiting rooms, every other seat is frequently marked off, although this is not the case in buses or trains. An art museum had a sign-in with ID numbers and body temperatures noted; if cases are traced to a museum-goer, we can all be notified. Visitors are strongly encouraged to rub their hands with alcohol from dispensers provided at entrances and restrooms. Many stores and apartment buildings as well as transit stations use equipment to detect body temperatures. At the university where I used to work, meetings continue with an online option. As a result, conferences may drop hefty registration fees – expanding access to elite scholarly events for students and others who lack institutional support. But the experts do confer in person here as well as onscreen; papers are delivered and scholarly life goes on in shared laboratories and libraries. My teacher friends still lecture, but they are getting used to screens. This is easier because many institutions had already embraced open courseware, so students can access and review any class at any time. Institutions also limit potential exposures by keeping groups physically separated. In the case of my former employer, Taipei Medical University, there was a severing of campus and hospital to minimise potential virus spread. Entering either compound requires a separate temperature check and ID scan. Once inside the university-affiliated hospital, I was overjoyed to find my old friends who staff three massage chairs in the hospital hallway. As massage has always been integral to Asian traditional medicine, the hospital provides this service so patients can buy 10-minute increments for about US$ 3.50. Outside the hospital premises, however, storefront massage studios get less traffic, and are notable losers from pandemic fears; my favourite place is having trouble paying its staff even by extending hours. In stores, plastic wrap now adorns many fruits and vegetables we pinched and sniffed in times past; bakeries and buffets often pre-wrap as well. Vigilant Monitoring, Flexible Response Bopiliao historic district in downtown Taipei is a restored area of Qing dynasty-era buildings, is known for its artistic events and cultural displays. It has remained open for business – although more local patrons and fewer foreign tourists come to enjoy the quaint alleyways. Policies keep changing; this month Taiwan has reopened to nonresident travellers with visas and will allow transit passengers after two months of suspending these arrivals. Since my flight in November, COVID testing has become mandatory for everyone boarding a flight to Taipei. There has also been a tightening of quarantine rules; returnees with apartments may quarantine in their homes, but only if they have monthly rentals. A German expat told me she won’t be allowed to quarantine with her own domestic partner this summer when they return from a European trip together – she said adults must each have their own bathroom, although families with children are allowed to share. Unlike other hard-hit institutions of higher education around the globe, Taiwan has managed to keep its substantial foreign student population mostly intact, with foreign students now allowed to enter with quarantine too. The accredited quarantine hotels and hostels are often full and are not cheap (averaging over US$100 a night). Until recently, however, a government programme covered part of the cost. The government also offered domestic tourism incentives and sold restaurant vouchers for a third of their face value to strengthen demand in those areas. Taiwan’s health system was recently ranked #1 worldwide for a third consecutive year in the online database Numbeo. This reflects the system’s effectiveness, cost-efficiency and universal coverage; South Korea, France and Japan were the runners-up. Since Taiwan’s national health insurance was launched in 1995, administrative costs have been limited to less than 1% of health spending. I remain amazed by and grateful to this system; last month a university dental clinic took two x-rays and repaired my broken tooth for US$ 23. A government list of drugs approved for reimbursement saves Taiwanese from pharma price-gouging – in contrast to the wildly varying markups and zero transparency seen in the United States. The system’s successes are not only due to health policies, per se. Digital minister Audrey Tang is widely credited for adopting a series of a strategies that had been crowdsourced by Taiwan’s g0v.tw “shadow government” before Tsai was elected in 2016. And this digitalization contributed to more effective COVID response. For instance, one of the earliest pandemic responses was quick rationing and distribution of disposable masks that included live digital tracking of supplies at every local pharmacy. Stigma Against Foreigners Taiwan has shown that fast and smart pandemic response can deliver both optimal health and economic results. It has therefore been a delight to return to normal life here, where good sense and kindness can be felt at every level. Masked visitor to the iconic Dihua street – Taipei’s best preserved historic shopping district. Well, almost every level. Recent video ads show health authorities speaking out against stigmatizing foreigners and others due to public perceptions that we are COVID risks. There is a need for this campaign, because almost every visibly foreign resident with whom I have spoken has noted the fishy looks that they may receive in elevators, and the empty seats next to them in crowded trains and buses. I’ve also been chased from a restaurant twice by a manager who wouldn’t let a foreigner sit in her place (I was allowed to order take-away if I stayed outdoors). Usually this would be cause for much drama on my part, but compared with daily standoffs with COVID deniers and mask avoiders in my US hometown it seems rather mild. After all, the restaurant owner didn’t threaten to kill me with a macho enactment of disbelief in science and contempt for public health; she just wanted her restaurant kept safe. Time for Taiwan Even though my riverfront home in my native Minnesota is dirt-cheap and parklike by Taiwan standards, rural Minnesota’s social divisions and dysfunctional health system have made Taiwan a better home for me. I’m happier in a safe, functioning metropolis with optimal public transit, famously great food and reliable, affordable health care. I first saw Taiwan when it was a dictatorship in 1978 and 1980. Its social and political development have impressed me ever since martial law ended in 1986. Since 2011, I also edited English documents for the health ministry’s international cooperation section, which gave me a catbird seat to observe Taiwan’s health diplomacy. Under the comparatively pro-China Kuomintang government, Taiwan was allowed to join the World Health Assembly as “Chinese Taipei.” Since Tsai took office, Chinese pressure at the World Health Organization has blocked the current government from attending, even as an observer. Yet Taiwan has had valuable knowledge and policies to share with world health leaders all along, and now it is finally recognised worldwide for its unmatched success against the pandemic. Will the world stand by as China strangles it like Hong Kong? ___________________________________________ Freelance editor Val Crawford has worked in international news and scholarly publishing, and edited for United Nations University in Tokyo and the World Health Organization. She taught scientific writing, journalism and popular culture courses at Taipei Medical University from 2010 to 2019, and served as visiting professor at the University of the Philippines and Sri Ramachandra University in Chennai, India. Image Credits: Val Crawford. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. 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