Containing COVID-19 – Lessons from South Korea and Taiwan

新冠病毒防護措施 - 韓國和台灣案例分析

Author:
Arthur Liao, SFU Centre for Comparative Muslim Studies Research Assistant

*Mandarin Chinese version follows.

The impact of the highly infectious Novel Coronavirus, resulting in the disease of COVID-19, has been global. State authorities have responded in different ways, some more effectively and successfully than others. Results have depended on several factors, including efficiency, availability of resources, transparency, and the level of trust between state and society.  Nevertheless, as WHO (World Health Organization) official and Canadian Physician, Dr. Bruce Aylward, told CTV News, because “the virus spreads so rapidly, the steps countries take to flatten the curve need to be equally as aggressive.” But what are those needed steps? The remarkable success of South Korea and Taiwan in flattening the curve provides valuable answers. This article looks at the measures adopted by these two countries and how they helped contain the spread of the virus.

1)   South Korea

Both South Korea and the United States confirmed their first cases of COVID-19 around the same two-day period - Jan 20, 2020, for South Korea, Jan 21, 2020, for the United States. Yet, the approaches taken by both countries to prevent the spread of COVID-19 are drastically different. The significant drop in the infection cases for COVID-19 in South Korea is due to the fast intervention of the government and civilians.

I. Early Vigilance

Even before the first confirmed case in South Korea on Jan 20, 2020, South Korean Biotech company Seegene had begun the development of testing kits on January 16  in anticipation of an outbreak. And within days, detection kits were developed. One week after the first case of confirmed COVID-19 in South Korea, government officials met with several medical companies to immediately develop test kits for mass production. Before February 18, South Korea had recorded a total of 30 cases and no deaths. That slow increase in infections soon changed.

II. Mass Testing

With South Korea’s confirmation of its 31st COVID-19 case on Feb 18 in the city of Daegu, the nation’s infection rate suddenly multiplied within a two-week span., The individual known as Case 31 had taken part in a mass religious congregation and other events, and passed the virus onto unsuspecting residents of Daegu. As the virus spread wider, medical experts were diagnosing more than 900 new cases a day, making South Korea the second-largest outbreak in the world at the time. Authorities quickly established 600 testing centres, with testing taking 10 minutes at most and the results usually on the next day through mobile text. These  frequently administered tests have also helped to catch asymptomatic COVID-19 patients, enabling tracing and quarantining of infected citizens. South China Morning Post explains this mass testing in its brief 2 minute video.

III. Isolation and Contact Tracing

In the case that the test comes back positive, the individual is then required to go into isolation in government shelters, with their phones and credit card data traced for previous movements, As this New York Times article explains:“When someone tests positive, health workers retrace the patient’s recent movements to find, test — and, if necessary, isolate — anyone the person may have had contact with, a process known as contact tracing.”

IV. Technology and Surveillance

In combination with mass testing and quarantine, the South Korean government has also created a GPS-enabled app to monitor those under quarantine and to set off an alarm to the police if they venture outdoors. Violators are given fines by the government. Furthermore, travelers entering the country are asked to record their health status on a state-sponsored app. In addition, people who are self-isolating, including those who have yet to test positive, each receive 454,900 won a month to cover basic living expenses. Many private businesses have also been taking their own precautionary procedures. For example, restaurants check the temperatures of their customers before accepting them, and offices, hotels, and other large privately owned buildings use thermal image cameras to identify people with fevers.

2)   Taiwan

The first case of COVID-19 was confirmed in Taiwan on Jan 21, 2020, also the same day as the United States. Yet, the trajectory of the two areas has been extremely different. With a significant number of Taiwanese working in China and the high frequency of flights and travelers between the two areas (2.7 million tourists visited from China last year),  COVID-19 outbreaks in Taiwan were a matter of time. Yet Taiwan acted swiftly and effectively, containing early on COVID-19 outbreaks on the Island.

I. Getting Ready: the CDC of Taiwan

 Following the 2004 SARS outbreak, additional resources were already set aside for the establishment of the National Health Command Center (NHCC) by Taiwan’s Centers for Disease Control (CDC) to aid specifically in disaster management for epidemics. As soon as news from Wuhan began to emerge in December 2019, authorities in Taiwan began to prepare for a potential outbreak. On December 31, 2019, Centers for Disease Control in Taiwan implemented inspections measures on all inbound flights from Wuhan in response to a report for an unidentified infected passenger; once the plane had arrived in Taiwan, all passengers were inspected by health officials. And by January 5 2020, the Taiwan CDC began monitoring all individuals who had travelled to Wuhan within 14 days and exhibited a fever or symptoms.  Those testing positive were quarantined. By January 20, 2020, the Central Epidemic Command Center (CECC) under NHCC was activated, mobilizing government funds and the military to facilitate surgical mask production.

II. Aggressive Border Measures and Rationing of PPE

Following the first confirmed case on the island on Jan 21, 2020, the Taiwanese authorities announced a temporary ban on the export of surgical masks to secure a supply of masks for its own residents. Surgical face masks were then released by a mask rationing system instituted by the government to prevent individuals from overstocking face masks. This DW’s video discusses Taiwan's PPE rationing measures. From February 6 to 11, successive measures were placed to temporarily halt all direct and transfer flights traveling through or from mainland China, Hong Kong and Macau. In addition, all visitors to Taiwan since March 19, 2020 have had to be in mandatory home quarantine for 14 days, and required to download a GPS enabled application  tracked by authorities.This PBS News Hour’s 7 minute video explains the quarantine measure in brief details.

III. Quarantine and Big Data

Authorities in Taiwan implemented smart phone technology in conjunction with rationing of surgical masks, and strict border policies to contain the spread of COVID-19. So-called ‘electronic fence,’ monitors phone signals, and gives alerts to the police and local officials if individuals in home quarantines moved away from their address or turned off their phones, with authorities responding by contacting, or visiting those who trigger an alert within 15 minutes. Officials also call twice a day to ensure people do not avoid tracking by leaving their phones at home. In addition,  immigration data has been integrated with the local health care system to track individuals' travel history. This Global News Video explains the additional big data integration measures taken by Taiwan.

SARS, MERS and Lessons from History

The success of South Korea’s containment of Covid-19 is tied to lessons learned from the SARS and MERS outbreaks in 2002 and 2012 respectively, during which South Korea developed tools and practices for aggressive contact tracing. Health officials were retracing patients’ movements using security camera footage, credit card records, even GPS data from their cars and cellphones. As South Korea's foreign minister, Kang Kyung-wha, told BBC news, lessons learned from previous outbreaks allowed the development of testing for COVID-19 even before the country had a significant number of cases, thus leading to a dramatic drop in new cases.

In Taiwan’s case, its handling of the outbreak has received international praise for its effectiveness in quarantining citizens , in using the "electronic fence", as well as in the early procurement and rationing of PPE to prevent shortage. The memories of SARS which ultimately took the lives of 181 out of 668 (27% fatality) infected patients, has kept both the Taiwanese authorities and its peoples vigilant about the COVID-19 outbreak.

KEY STEPS behind Successful Containment

1. Mass testing, and as early as possible
2. Strict border measures and restrictions on local mobility
3. Transparency of information
4. Procurement and rationing of medical supplies (PPE and COVID-19 testing kits)