With some 850,000 Taiwanese living and working in China, Taiwan could have been one of the hardest hit when the coronavirus outbreak emerged in late December in Wuhan, a central Chinese city of 11m people and the epicentre of the outbreak. According to an Al Jazeera report, the timing would prove devastating for China and the rest of the world, as the outbreak began to accelerate around Lunar New Year, a time when hundreds of millions of Chinese travel abroad or return home to see their families. But Taiwan, an island democracy with a population roughly the size of Australia, has so far managed to keep cases to 45 and one death, even as infection rates in China have topped 80,000 and the virus has mushroomed in places like South Korea, Japan, Iran and Italy.
The report says Taiwan's success so far in handling the infection has largely been due to its early response at a time when the virus was still poorly understood and its transmission rate still unclear. It also relied on historic experience rather than waiting for cues from the World Health Organisation (WHO), which continues to deny Taiwan observer status for political reasons.
"Taiwan was hard hit by SARS and with that hard and bitter lesson Taiwan came very prepared," said Chunhuei Chi, a professor in the College of Public Health and Human Sciences at Oregon State University.
After the SARS epidemic, Taiwan established a central command centre for epidemics the following year, keeping it a few steps ahead of other places in Asia before the coronavirus hit, Chi is quoted in the report as saying. The command centre made it easier for medical authorities to gather data, redistribute resources, investigate potential cases and follow up on their contact history, while they also were able to quickly isolate patients found to be carrying the virus.
Learning from SARS, Taiwan also quickly conducted health checks on passengers from Wuhan in early January, well before it was understood that the virus could pass between humans. By the first week of February, Taiwan began rationing surgical masks and restricting the entry of passengers with a travel history in China, while requiring a 14-day quarantine for those who had been to Macau and Hong Kong.
Hand sanitiser and fever checks became customary in many public buildings, while the Centres for Disease Control and other agencies issued daily mobile phone alerts about the latest cases and information on the places they had visited.
Jason Wang, the director of the Centre for Policy, Outcomes and Prevention at Stanford University, said the Taiwanese government "was really super alert" in its response. "When it became clear it was going to become a big issue they started to do more. They were prepared."
Experts said in the report that Taiwan's success is comparable to Singapore's, where while there are now more than 100 coronavirus cases, early action has kept the illness from spreading further despite its high-risk status as a major Asian transit hub, and strong trade ties with China and Hong Kong. Learning from SARS, Singapore also moved quickly to impose health checks before closing its borders in late January to most travellers from China, as well as imposing heavy fines on anyone found violating self-quarantine orders. It also closed schools and universities.
The report says both Taiwan and Singapore also offered large stimulus packages as the economy felt the impact of the coronavirus and a loss of tourism from China. While Taiwan and Singapore's leadership acted swiftly, other countries hit by the virus were either slower to act, or to be open to the public about possible risks. "My impression is – (although) I'm at some distance – that the political leadership (in Singapore and Taiwan) took this cue and advice from the ministry of health from the scientists and the clinicians. I think that's a very good formula," said William Schaffner, an infectious diseases specialist at Vanderbilt University.
The report says Taiwan's actions contrast sharply with China's, where decisive action came only after the outbreak had already spread widely. Japan and South Korea have also been criticised for their response. The report says as the coronavirus continues to spread east and west, many other countries are finding themselves unprepared to deal with the kind of large-scale epidemic that has not been seen for decades. In Iran, political infighting and restricted access to information have been cited by experts as reasons why cases have now reached 4,744, with at least 124 deaths, after the virus reportedly first broke out in the holy city of Qom. In Italy, authorities were forced to scramble as the coronavirus spread rapidly across its northern towns. There were at least 4,646 cases and 197 deaths in Italy as of Saturday. Europe's Schengen Treaty, however, presents several challenges to EU health authorities, as it guarantees the free movement of people, according to Claire Standley, an assistant research professor at Georgetown University's Centre for Global Health Science and Security.
Matthew Kavanagh, also a global health expert at Georgetown University, added that many world leaders, including US President Donald Trump, have repeated the mistakes of their Asian counterparts. "We had an opportunity to really robustly get out there instead of focusing on the likelihood there was an outbreak in the US. Instead, Trump focused on a policy that was purely containment – keeping it out of the US through travel bans and quarantine," Kavanagh said.
The report says delayed action from the US and much of Europe means that effective but laborious options that were available to Taiwan and Singapore, such as isolating anyone in contact with the virus, are no longer available because it is already spreading within the community.Full Al Jazeera report