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All signs pointed to the novel coronavirus being bad news for Taiwan. The island of 23 million is just 81 miles from mainland China, with frequent flights back and forth and hundreds of thousands of Taiwanese citizens who live and work in China. Taiwan had 2.7 million visitors from China last year.

But as of March 10, Taiwan has just 45 coronavirus disease (Covid-19) cases, and only one death. Health experts do not expect that Taiwan is overlooking many cases, either. That’s many fewer than its neighbors like Japan and South Korea and one of the best containment track records in the world so far. The Netherlands, with a comparable population, has five times as many cases despite having much less frequent direct travel with China.

What is Taiwan doing right, and can we copy them?

That’s what Stanford Health Policy researcher Jason Wang explores in a new article in the Journal of the American Medical Association with coauthors Chun Y. Ng in Taipei and Robert H. Brook of UCLA. He argues that Taiwan’s plan — which included 124 discrete action items and impressive coordination in implementation at the first signs of trouble — saved the island from a serious coronavirus outbreak. The 124 action items include travel bans, quarantines, surveillance steps, social distancing, and more. It’s too late for the US to put all of their lessons to use, but it’s not too late to benefit from a few.

Here’s my conversation with Wang, lightly edited and condensed, about what Taiwan is doing and what we can learn from it.

Kelsey Piper

Do you want to walk me through the earliest stages of Taiwan’s response? How did Taiwan respond when they first started seeing cases from China?

Jason Wang

I think the response started in 2004, after the last SARS epidemic.

The most important thing about crisis management is to prepare for the next crisis. And so they started to do that. 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 — I know we have a task force now, but I don’t know if there’s a physical command center that’s in operation. If not, it should happen quickly. We have 50 states here in the United States, and the local governments, and so we need to be able to get the data very quickly. We need to test people for Covid-19, and refer that data back to the command center so we have real-time reporting for action.

Kelsey Piper

So I was wondering about once cases started coming in. The US has struggled with testing capacity. How did Taiwan scale up their capacity, so that they could identify all of the cases that they needed to?

Jason Wang

Well, what’s interesting is that 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]. It’s probably been here for a while. And so now we’re trying to see, “Oh how many people should we test?” Then you really need to have a very large capacity in the beginning.

Kelsey Piper

Whereas Taiwanese medical authorities were on the first plane from Wuhan at the start of the outbreak, already looking for cases, so they didn’t end up in a place where the disease wasn’t even discovered until there was lots of community spread and lots of tests needed.

Jason Wang

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.

Kelsey Piper

Better to overreact than underreact?

Jason Wang

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. There’s a right balance between not underreacting and not causing a public panic. We don’t want to be alarmists because we don’t know what this is.

Kelsey Piper

Was there a public panic in Taiwan?

Jason Wang

No.

Kelsey Piper

How did they avoid that?

Jason Wang

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.

They had like maybe 10 cases before there was spread between the travelers to the relatives that were taking care of the traveler. 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].

The way community spread here in [the United States] right now is going, there are definitely cases where we don’t know where a person got the virus from.

Kelsey Piper

So some people might say, “Oh, sure, they contained it in Taiwan and Singapore. Those are small countries. It’s a much easier test than in the US.” Do you think that’s right?

Jason Wang

Oh, the US is more complex, for sure. For one, we have 50 states. In other ways, it’s easier because people don’t live as closely to each other as people in Asia — at least, not everywhere. You go to the Midwest and people live pretty far away. New York City, people live close together. So there are advantages and disadvantages.

Kelsey Piper

So a lot of the things you’ve talked about are things that we could have done better before we reached this point with community spread like we have now. What would you say we can do better now?

Jason Wang

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. Because the resources are still limited, even in a big country.

Kelsey Piper

Is there anything that particularly stood out to you when you were studying Taiwan’s response as something that we should really be talking more about in our own response?

Jason Wang

We need to educate the public, communicate with the public a lot more, at the moment. Because most people have no idea. If you ask a typical person how many cases there have been, they have no idea. If you ask them if there have been cases in 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”? And then everybody who was close to the mall would get this message.

Kelsey Piper

And then people who were at the mall who maybe start showing symptoms later, they’ll know.

Jason Wang

They’ll know to self-quarantine. And if they have symptoms, they should inform a public official. They shouldn’t just go into the hospital because they could spread to other people. So anyway, these are all possible. I think there needs to be a more proactive approach.

Kelsey Piper

So I’m wondering, SARS taught Taiwan the importance of that proactive approach. And SARS didn’t affect the United States very badly. So maybe this is the one where we’ll learn that lesson?

Jason Wang

Well, we don’t necessarily have to be affected to learn the lesson.

That’s why 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.”

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