While the US, UK, and several developed economies fumbled their initial response to COVID-19, a group of Asian countries showed remarkable decisiveness and foresight. Their response has important lessons for the entire planet.

Despite being a prime target for a severe epidemic, Taiwan managed to keep COVID-19 in check. Image credits: Tom Ritson.

As the novel coronavirus started to spread out of China, it first hit the nearby states. Taiwan, South Korea, and Vietnam were three of likeliest places where the virus would spread — and so it did, in the initial phases. Yet after more than a month, all three countries have managed to suppress the outbreak, and while fears of a second wave are as valid as ever, their initial success holds valuable lessons..

The common traits of COVID-19 success

Early recognition

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There was little hesitation in how the trio of countries reacted in dealing with the outbreak. Even at the risk of overreacting, officials took containment measures early on — exactly what epidemiologists recommend — and these measures paid off in reducing the initial number of cases.

“Finding cases and isolating them so they’re not transmitting forward—that’s the tried and true way of controlling an infectious disease outbreak, and when you analyze what was done in many Asian countries, you will find that at its core,” Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security in Baltimore. told Dennis Thompson, a HealthyDay reporter.

While most of the world looked at China’s situation in expectation and disbelief (in part because the information coming from China was not always reliable), Vietnam took early action.

“They actually started preparing for this on Dec. 31. They were testing on Dec. 31,” said Ravina Kullar, an infectious diseases researcher and epidemiologist with Expert Stewardship Inc. in Newport Beach, California. “They were proactive, and that I think is a key to preventing epidemics. They were overly cautious, and that really benefited the country.”

In all countries, high-ranking officials started having daily briefs on recent developments, right from in the earliest days of the outbreak. This helped send a clear and transparent message, leaving no room for confusion: this is a serious situation, here’s what authorities are doing, here’s what individuals need to do to help.

This is in stark contrast to, for instance, the US and UK. In the former, Trump’s attempts to downplay the outbreak have turned against the country, and in the UK, the initial “herd immunity” misstep lost valuable time and sowed confusion among the population regarding the severity of the threat.

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Test, test, test

Virtually all health officials are now recommending mass testing, not only as a way to diagnose the disease, but also to have an accurate image of how the infection is spreading.

In South Korea, COVID-19 initially spread through a Christian sect and the initial extent of the outbreak was unknown. The disease spread to hundreds of people before the government caught wind of what was happening.

In order to compensate for this, South Korea wasted no time and set up several testing mechanisms, including a network of testing “phone booths” where people could easily and quickly get tested for COVID-19.

“One person at a time can enter one side of this glass-walled booth, they grab a handset, and they are connected with a hospital worker standing on the other side of the glass,” Kullar said.

The healthcare worker uses a pair of rubber gloves set into the wall to swab the patient, without any risk of exposing themselves to the virus. This approach accelerated national testing, and the government also ensured quick test availability. Everyone can get tested in this manner.

“The hospital is able to tell the patient their results within seven minutes. We don’t have anything like that at all,” Kullar said. “They had this quickly put in place in most hospitals to get patients swabbed in a way where you don’t have direct contact with a health care worker.”

Tight quarantine

Another aspect in which these countries did not waiver was installing an early (and tight) quarantine.

Taiwan instituted border controls, quarantine orders, and school closures. In Vietnam, a country that lacks the economic resources of South Korea and Taiwan, the single-party state leveraged its large and well-organized military to enact a rigid quarantine. Severe measures were taken and anyone found sharing fake news and misinformation was fined — over 800 people have been fined so far.

Vietnam, a country of almost 100 million people, had a very limited testing capability and focused on tight containment to compensate.

“If you don’t have the diagnostic testing capacity, there may be a tendency to use very blunt tools like shelter-in-place orders, because you don’t know where the cases are and where they aren’t,” Adalja told HealthDay.

Meanwhile, South Korea was testing over 10,000 people per day during a time when the US did not have 10,000 tests in total. They have over 600 testing sites, for a country that’s seven times smaller than Texas. Within two weeks of the country’s development of its own official diagnostic tests, South Korea was producing 100,000 kits per day. It’s a striking comparison to the US, where weeks were wasted and the country is only now catching up.

South Korea’s lesson shows that balancing privacy and pandemic suppression is not always possible. Image credits: Steven Roe.

These countries are now forced to re-evaluate their strategy as there is a very pressing risk of a second wave sweeping them again — after all, quarantine can’t be imposed forever, and there is a high likelihood of “importing” cases from other countries. But for now, at least, the first wave has been stopped, gaining valuable preparation time and a better chance of handing the outbreak in the future. The curve is flattened.

The darker side of suppression

South Korea, in particular, has become the “gold standard” in COVID-19 suppression. Without imposing the draconic measures of China, South Korea has managed to have even better results — even early media reports classed its response as exaggerate.

South Korea has flattened the curve and kept the epidemic under control, even without declaring a widespread quarantine or travel bans. They used a combination of transparent leadership, rapid response, public notifications, and hi-tech monitoring. All that deserves high praise.

But there is, nonetheless, one big caveat: this comes at a potential cost in civil liberties that other nations might not want to emulate.

South Korea’s “TRUST” strategy (“Transparency, Robust screening and quarantine, Unique but universally applicable testing, Strict control, and Treatment”) is intrusive.

South Korea imposed isolation and treatment for patients with mild or even no symptoms — which, on one hand, helped contain the outbreak and minimized hospital strain, but on the other hand, was imposed on the population forcefully.

South Korea has also revised laws to enable more aggressive contact-tracing, sparking concerns that the laws might still remain in act after the pandemic. The government was given the ability to access people’s credit card records, cellphone GPS data — an Orwellian scenario.

Meanwhile, in Vietnam, the ruling Communist Party encouraged people to spy on each other, using public distrust as a weapon to prevent people from breaking the quarantine.

Vietnam has shown how to fight a pandemic on a low budget. Depicted here: the iconic golden bridge in Vietnam. Image via Wikipedia.

South Korea is undoubtedly a strong democracy, ranking 23rd out of 167 countries, above the US. Taiwan is in the same category, ranking 33rd, while Vietnam is essentially not a democracy, ranking 136th.

In Vietnam, which is a single-party state, the lack of resources was compensated by decisive action and little concern for a public uproar. In South Korea and Taiwan, high-end technology was used to deploy much smoother surveillance — but surveillance it was, nonetheless. Authorities stress that the measures are only set to last for the duration of the pandemic, but can this statement really be trusted?

It’s hard to imagine South Korea and Taiwan descending into totalitarianism, but not entirely beyond the realm of possibility. What’s more, in some other countries, we are already seeing this effect.

In Hungary, parliament has voted to give PM Viktor Orban indefinite powers for an indefinite period, essentially making him the sole ruler of the country. It’s a chilling reminder that even in a developed country in an international alliance such as the European Union, democracy should not be taken for granted, and surveillance is often only a first step to dismantling democracy.

Which brings us to another important lesson.

The trilemma trade-off

Countries are faced with what is sometimes called a ‘trilemma’: a dilemma where you have 3 options, but you can only pick 2. In this case, the 3 options are:

focus on saving lives;

focus on supporting the economy;

ensure people’s freedoms and privacy.

You can only pick two of these three options. Which ones would you pick?

South Korea, Vietnam, and Taiwan have focused on the first two. It’s easy to make a very compelling argument in this regard, at the temporary expense of the third. What is more important than saving lives and ensuring that we still have a functioning society?

But as Hungary’s case has shown us there is little guarantee that it is indeed a temporary concession.

South Korea and Taiwan deserve all the praise for implementing a quick and effective response system, with accessible alerts based on big data, and with technologically-savvy solutions.

Would Americans be happy or confident to offer similar powers to a President who has proudly called himself as nationalistic and has bragged about putting his political rivals in jail? Would most Germans, who squirm even at the thought of the country’s Nazi past, even consider such a thing? It’s hard to imagine.

There are solutions for rich and poorer countries alike. Of course, rich countries are in a better position to deal with the pandemic, but there are few guarantees — just look at the US.

The problem is balancing the solution in a way that is effective and fair.

Competent, well-intended leaders will look for ways to balance the situation, prioritizing saving lives, and using surveillance only as a tool to map the disease. Authoritarian leaders will place little value on saving lives, focusing as much as possible on promoting the economy, either by eroding democracy to expand their powers or by denying or minimizing the problem. It will be a test for our democracy as well as our healthcare systems and our economy.

This is a challenge unlike any other faced by mankind in peacetime. There are no clear-cut solutions and no benefits without tradeoffs. But this does not mean that solutions don’t exist.

The experience in Taiwan and South Korea show that democracies can respond effectively to an epidemic. There are positive examples and cautionary tales to be followed closely. It remains to be seen what other parts of the world will learn from these lessons.