How the US should have responded to covid-19… For next time?

If you are scared of the coronavirus and you want to travel somewhere in the world to escape it, ironically, you might want to book a ticket to the Republic of China, more commonly known as Taiwan because Taiwan has demonstrated a way to effectively prevent the pandemic.

Taiwan is a capitalist democratic island nation (colored orange on the map) just off the coast of China (colored purple). Taiwan is completely independent of the communist Chinese dictatorship based in Beijing. Oddly both Taiwan and China insist in claiming that they are one unified country due to their shared history and cultural ties, and they are very economically integrated these days, but they have completely different political and economic systems.

Both nations are Chinese linguistically, culturally, and historically, and given their closeness and asymmetrical sizes, Taiwan has a lot of interchange with China (as predicted by the gravity model of globalization). Taiwan had more than one visitor from China for every ten Taiwanese residents just last year alone! Taiwan is simply flooded with Chinese people and probably the number of trips that Taiwanese people make to China every year is over 10% of the Taiwanese population too.  Heck, 3.7% of Taiwan’s population even has residency in China.

Taiwan is very densely populated with more people than the continent of Australia all crammed into an island that is about the size (and climate) of Florida, but unlike Florida, most of Taiwan is uninhabitable because Taiwan is full of steep, cold mountain ranges.

So if there is one nation in the world outside of China that should have the worst odds for getting the corona virus, it is Taiwan. It’s people live in one the highest population densities in the world and per capita it probably has more visitors to and from China of any independent nation in the world.

But Taiwan has only 45 corona virus cases total so far.  That is only about half the number in Australia and about a fifth the number in the Netherlands. All three nations are of comparable size and levels of economic development, so given Taiwan’s much higher risk of exposure, they must be doing something right.

Stanford Health Policy researcher Jason Wang wrote a new article in the Journal of the American Medical Association about Taiwan’s success and Kelsey Piper intervened him:

The most important thing about crisis management is to prepare for the next crisis. [Taiwan] started to do that. [in 2004, after the last SARS epidemic] They set up a command center, the National Health Command Center, and integrated different agencies.

It was a 24/7 command center. There’s the media room, there’s the data room where the data from different local governments could come in, there’s a place for people to rest, so you could actually sleep there. And so you get data analysts there, you have different experts there, you have people talking to the media, the information center, people managing logistics.

The lesson for the US is… We need to test people for Covid-19, and refer that data back to [a] command center so we have real-time reporting for action…

when there were only a very few cases reported in China, [Taiwanese health authorities] already went onto every airplane that came from Wuhan. Health officials came on the airplane and checked people for symptoms.

Here in the US and elsewhere, we’re now seeing community spread [people getting the virus with no international travel and no links to known cases, implying they were exposed locally by an unknown source]… And so now we’re trying to see, “Oh how many people should we test?” [Now] you really need to have a very large capacity [whereas] in the beginning [it would have been easier].

… They were testing on December 31. As soon as they heard there were suspicious cases of a new type of virus, they were nervous. They were like, “Oh, we wonder if this is SARS again.” And so they were proactive. I think that’s the way we ought to treat these kinds of epidemics. It’s okay to be overly cautious… You can relax afterward, if it turns out to be nothing. But when you don’t know what something is and how serious it is, you want to be very cautious…

The [public didn’t panic because the] government very quickly began hosting a press conference every day, sometimes more than once a day. They would tell people we’ve identified one case and then we’ve identified two cases, and they were all travelers from Wuhan.

…So we knew which ones were imported cases and which ones were domestic cases that were contracted from the traveler. You could track everybody. So then you’re not that nervous because you can say, “Oh yeah, she got it because it’s her husband. He’s case number 10, and she’s case number 11.” So you will know [for each case in Taiwan, how they contracted the virus]…

I think the US has enormous capacity that’s currently not being used. We have big tech companies that really could do a lot, right? We ought to get the big companies together. get the governors together, get the federal government agencies to work with each other, and try to find innovative ways to think about how to best do this. We’ve got the smartest people here in the US because they come from everywhere. But right now those are untapped resources. They’re not working together. And the federal government, the agencies, they need to collaborate a little more closely.

If you are able to pull the data together from all the states, and the federal government agencies are working together, then the big tech companies can help predict the next hot spot. So that’s what you want to do — you want to predict the next hot spot. And then just work on it…

We need to educate the public, communicate with the public a lot more… Because… If you ask [people where] there have been cases [near] their community, they say, “Oh, maybe, I don’t really know.” So you really need to have people be more knowledgeable — and look, it’s quite possible. For example, text people, and say, “There have been three cases where you live.” It’s quite possible, right? We all have phones, right? If there is some burglary, a fire, or something like that, I get a message, I get Amber alerts and all that.

Well, why can’t we create some alert system like that where you say, “Look, there’s been a hot spot in this mall. Try not to go there”?…

I wrote the article, so that other people could look at the list of 124 [action items that were elements of Taiwan’s response] and say maybe we could do these three or four.

And maybe, they should share with other people what other strategies work. This is a global epidemic. We all live in a global village. And we need to be more proactive because you can’t just be like, “Ah, we’re safe, we’re in the United States.”

Extensive testing has been essential to Taiwan’s success in limiting the spread according to Stanford Professor Jason Wang who said, “The authorities in Taiwan …also proactively find new cases by retesting those who tested negative,” and Kolas Yataka explained that the financing of testing, healthcare, and quarantine are provided for free to encourage testing by preventing financial burdens due to the illness:

“Taiwan’s health insurance lets everyone not be afraid to go to the hospital. If you suspect you have coronavirus, you won’t have to worry that you can’t afford the hospital visit to get tested… You can get a free test, and if you’re forced to be isolated, during the 14 days, we pay for your food, lodging and medical care,” Kolas said. “So no one would avoid seeing the doctor because they can’t pay for health care.”

In contrast, the news media in America is full of stories about the high cost of getting a coronavirus test.  A man in my home town of Newton, Kansas was reported today to have been charged nearly $1,000 for the test and others have been billed over $3,000.  Given that half of American adults said that they postponed or skipped medical care last year due to cost, many Americans might hide from testing because they are afraid that a doctor visit will cause financial ruin.

As Yascha Mounk observed, the only measure that has been effective against the coronavirus has been social distancing and there are two ways that can work.  Taiwan put extreme effort into screening and testing so that they haven’t needed extreme social distancing so far.  They had just isolated 2,291 people (as of March 1) while the individuals were tested until they could be cleared.  The contacts of the few people who tested positive were aggressively investigated. Because America has failed at testing efficiently we don’t know who has the virus.  So whereas Taiwan has limited the spread to very few cases and thereby limited social distancing, America will probably need extreme social distancing.

As a Homeland Security expert advises in The Atlantic, extreme social distancing will disrupt nearly everything:

China’s government has been ruthless in stopping the virus.  In contrast, Taiwan is a free democracy, not an autocratic dictatorship like China, so its success in limiting the spread of the pandemic is a model that other free democracies like the US could emulate.  It helps that they have a expert team of public health professionals running their pandemic response rather than a Vice President Pence (who is patently unqualified in health).  In contrast, Trump disbanded America’s pandemic response team.  And even if Taiwan did appoint their Vice President to manage the crisis, he’d probably do well because he has a doctorate in epidemiology from Johns Hopkins University!

The Trump administration took the unusual step of declaring the public health meetings about the coronavirus classified which meant that many scientists were barred because they lacked security clearance and the public cannot legally learn anything about what they decided in the meetings.  That is the opposite of Taiwan’s communication approach.

I’ll give you one more hint about Taiwan’s success. Taiwan didn’t achieve it’s pandemic success by keeping Mexicans out.  Today Trump tweeted that the wall is an integral part of his coronavirus crisis strategy. Trump’s ongoing obsession with travel restrictions has been a distraction from the hard work of pandemic preparation that he should have been doing all along.  Rather than investing in early preparation like Taiwan did, he tried to slash the CDC budget by 16% in the middle of the epidemic.

Taiwan has succeeded without closing schools and other extreme social distancing measures.  Here is a video of schools reopening after their long winter holiday.  Note that Taiwanese people have been wearing facemasks routinely in public for decades, mainly due to a myth that they filter out pollution, and the covid-19 risk undoubted increases that tendency, but it is pretty normal behavior for Taiwan.

Italy has had the worst response to the epidemic so far.  Italy went from only having three cases three weeks ago to the second most outside of China today and the virus continues to grow exponentially there and has paralyzed the country.

The US is probably going to look a lot more like Italy than like Taiwan partly because the US is:

severely lagging in its testing capacity. As of March 8, only 1,700 Americans had been checked for the virus — a number that pales in comparison to the 50,000 who have been tested in Italy or the 23,000 tested in the UK, according to an analysis by Business Insider…

“Looking at all the signs, and there are many, it would be shocking to me if [the USA] didn’t have large numbers of cases undetected, silently transmitting in the community, in multiple countries and regions,” said Lawrence Gostin, a Georgetown University global expert.

If cases more than double every week — like they appear to being doing now in Italy — the US may soon be facing its own crisis.

“…if the virus had a chance to spread undetected, it’s hard to make up that time,” said Hodcroft. “The Italian situation should be a big wakeup call to the rest of Europe and the US.”