Takeaways From How Taiwan and South Korea Curbed COVID-19

With the number of COVID-19 cases in the United States approaching a third of the global total and more than three times that of Brazil—the country with the next largest number of cases—it’s easy to get caught up in the statistics surrounding the spread of the coronavirus in these areas and forget about the success of other countries. Digging deeper into some of their seemingly fortuitous triumphs reveals that that is, in fact, not the case at all. Instead, there is much to learn from their success.

Take Taiwan, a country that has not been in the limelight for long, especially in regards to COVID-19. Taiwan’s vice president, Chen Chien-jen, a certified epidemiologist, is working at the forefront of Taiwan’s efforts against the pandemic. He is pushing to test more people and is overseeing efforts to develop a vaccine and produce tools like testing kits. During the SARS crisis of 2003, he was a top health official. Afterward, he worked tirelessly to prepare the island for the next outbreak by building wards and research laboratories. In addition, since SARS, when Taiwan was short on personal protective equipment, the government steadily increased the production of protective gear to 13 million N95 masks per day and hopes to continue increasing this number to 15 million masks a day.

With his scientific background and current political authority, Chen straddles a crucial role, one that is arguably Taiwan’s key to handling the pandemic. It is evident that the country is doing something right; as of June 2, 2020, Taiwan has reported only 19 cases per one million people, shockingly low numbers when compared to those of other countries like the U.S. Perhaps part of their success stems from the fact that Taiwan is also home to a society that Chen says has “strong trust in science and respect for medical professionals.” Policies that are issued and new rules that are established in response to the pandemic are generally well-received. A commendable effort is made to ensure that the general public is well-informed about the magnitude of the situation.

The results and enforcement of policies in Taiwan strongly parallel the response in South Korea. Unlike many of the states, South Korea did not enforce a large scale shutdown, and people roamed the streets as early as mid-April. Similar to Taiwan, South Korea also had its own encounter with a different coronavirus strain in May 2015 named the Middle East Respiratory Syndrome (MERS), which lasted for two months. One hundred eighty-six people were infected and 38 were killed, the highest outside of the Middle East. The index case, or the first documented patient in an epidemic, was a businessman who traveled to the Middle East for a business trip. Because officials were unaware of his disease in the days prior to his hospital visit, it was difficult to trace the places he visited, the people he met, and thus the chain of transmission.

This flaw in their public health strategy caused panic within South Korean society, pushing South Korea to learn from its mistakes in preparation for the next outbreak. Evidently, their preparation paid off in curbing the spread of COVID-19, as the sharp increase in cases they saw in late February quickly leveled off. The country learned the importance of early readiness for the worst case scenario, creating a streamlined development of diagnostic tests and endlessly raising awareness of basic methods to limit transmission of the virus. Even when the country had a mere 30 COVID-19 cases, the government quickly cooperated with biotech companies to develop, mass-produce, and widely distribute tests.

Nevertheless, the main contributor to these countries’ successes is contact tracing, a technique developed largely in response to the MERS index case and SARS outbreak. Though these countries have been making use of contact tracing since the start of the pandemic, the U.S. only began widespread use of it in the past month. A cycle of contact tracing begins by testing suspected individuals in a hospital. If they test positive, everyone who came into contact with them is identified and tested. Those who tested positive in the second round of testing are quickly isolated and treated at home. Then, everyone who came into contact with these people are traced and tested as well, and so on. This strategy allows for non-random large scale testing, enabling the effective use of a limited testing kit supply.

Tracing all these people may seem like an arduous task for other countries, but Taiwan revised their infectious disease law, and South Korea passed the Infectious Disease Control and Prevention Act after their respective outbreaks. This act allowed for the collection of patients’ data and security footage during times of pandemic. This data, compiled by websites and apps, is used to alert people via smartphone notifications to stay away from nearby places that a confirmed patient has visited. If someone finds out that they've been to one of these places, they have good reason to get tested. If they test positive, then the cycle of contact tracing is once again restarted. In times like these, the country emphasizes public interests over human rights, justifying it with the non-discriminatory nature of the disease. However, this is difficult to enforce in countries like the U.S., where there is a much larger population and citizens are very outspoken about their rights.

As such, a sense of urgency was not perceived by the U.S. Though both South Korea and the U.S. saw their index cases of COVID-19 in the middle of February, South Korea's tests per 1000 people immediately shot up while the U.S.'s tests per 1000 people lagged behind, only catching up to South Korea in mid-April. Since then, the gap between the two countries' testing steadily has increased, with the United States consistently testing more people than South Korea. But the number of cases in the U.S. per million people continued to soar, while South Korea’s number stabilized. This phenomenon is because the U.S. test-positivity rate of 13 percent is far higher than that of countries like South Korea and Taiwan, whose test-positivity rates are 1.5 percent and 0.06 percent, respectively. At first glance, this may seem like the U.S. is making more effective use of their testing kits, because a bigger percentage of its tests are coming back positive. But in practice, the lower the test-positivity rate, the better. A low rate indicates that a country is proactively testing and, through contact tracing, is seeking out those who were exposed to a confirmed case and weeding out asymptomatic stragglers. A high test-positivity rate owes itself to the fact that tests are being reserved for people who show up to healthcare facilities with symptoms.

People who suspected that they were exposed to the virus but did not show symptoms were denied tests because the U.S. faced a testing kit shortage. This means that the U.S. caught and isolated few to none of the asymptomatic patients who continued to go about their normal lives and as a result, failed to contain the virus through aggressive contact tracing. In contrast, countries like South Korea and Taiwan have made effective use of contact tracing among other cautionary measures from the onset of the pandemic—reflected in how quickly they flattened their respective curves.

Now, as the curve begins to flatten in the U.S., we must keep in mind how other countries took up arms against COVID-19, learning from our grave mistake that cost the country more than 100,000 lives. We need to start preparing for the next war today.