Before the coronavirus even registered on the radars of other governments, Taiwan was testing and quarantining travelers from Wuhan, China.
The island’s fraught -- but still close -- networks with China gave it a ringside view to the original epicenter of the now-global pandemic, enabling it to act early in deploying a containment strategy that has proven one of the most successful in the world. Taiwan, which started containment measures on Dec. 31, has seen just six deaths despite its proximity to China.
That quick reaction was prompted by an internet bulletin-board post read earlier that morning by Philip Lo, a senior government health official. Because of frequent cross-strait exchanges in areas such as trade, investment and employment, Taiwan excels at monitoring Chinese government and society through news organizations, blogs and social media. The WeChat and Weibo platforms proved useful in tracking an outbreak of pneumonic plague last year, said Lo, deputy director-general at the Centers for Disease Control.
“Taiwan is a sentinel for China’s epidemic,” he said. “We can send an alarm to the world.”
The rapid response is credited with minimizing Taiwan’s infections, even with China sitting less than 100 miles away. As of Thursday, the island of about 24 million people had 440 confirmed Covid-19 cases, with six deaths, among the lowest totals in the world.
By comparison, Australia, with a similar-sized population, reported 6,895 confirmed cases and 97 deaths. Singapore, with only about 6 million people, has 20,000-plus cases and 20 deaths.
“We treated the virus as a serious epidemic from day one,” Lo said. “We didn’t wait till it broke out to take action.”
According to Lo, he rang the alarm bell after waking up at 5:30 a.m. on New Year’s Eve and going online to check social media. His Line Corp. contacts passed around an entry from PTT, Taiwan’s version of Reddit Inc., that summarized text messages and social-media posts from medical professionals in China warning about a new and unknown strain of pneumonia.
One of the summaries was written by Li Wenliang, a Chinese doctor later sanctioned by the government for being a whistle-blower about the outbreak. He eventually died from Covid-19 and became somewhat of a folk hero on Chinese social media.
About three hours after Lo read that post, his agency sent an email to its counterpart in Beijing asking for details, and that afternoon Wuhan’s health committee issued a press release saying about 27 people were infected with an unknown virus.
Taiwanese health officials also emailed the World Health Organization, telling it that some Chinese patients had been isolated for treatment -- a clear signal, in Taipei’s view, that this new infection was transmittable from person to person.
History motivates Taiwan’s vigilance. The 2003 outbreak of SARS, or severe acute respiratory syndrome, severely hit the island and gave it the third-most infections in the world.
That made Taiwan strengthen its preparation for the next epidemic, including setting up an infectious-disease prevention network and holding annual drills with hospitals.
“Taiwan has prepared for the epidemic battle for 17 years,” Lo said.
Because people infected by Covid-19 can be asymptomatic, the virus poses a greater challenge than SARS, said Chuang Yin-ching, a regional commander in the Infectious Diseases Prevention and Treatment Network. The island uses technology to trace suspected cases and deploys measures such as quarantine hotels and cabs. It also maintains a stockpile of face masks, medical officers and lab capacity to handle any outbreaks.
Taiwan has a “well-trained army against the virus,” Chuang said.
After Lo’s agency emailed Beijing and the WHO, he checked the island’s air traffic with Wuhan and discovered there were 12 direct flights a week. Officials started testing arrivals from the city that evening, and passengers with fever symptoms immediately were hospitalized.
Taiwan health officials then flew to Wuhan on Jan. 12 -- more than a week before the first WHO delegation arrived -- for a briefing from colleagues at China’s disease control agency. The Chinese officials reported 41 confirmed cases, of which 28 were related to an outdoor market selling live animals. The other 13 were not -- a marker of human-to-human transmission.
“These signs alerted us that we should be cautious about the situation in China,” Chuang said. “Someone asked me if we can downgrade the prevention measures such as temperature checks at the airport gate, and I said, ‘No, we should upgrade it.’”
At that time, Wuhan still was an open city full of energy, and just a few people wore face masks at the airport, he said.
By Jan. 20, Taiwan’s CDC set up an emergency command center to monitor regional outbreaks, and the island confirmed its first imported infection the next day. With the Lunar New Year about to start, Taiwan suspended all direct flights with Wuhan.
It then banned entry for all Chinese residents starting in early February, making it among the first places globally to do so.
The WHO didn’t declare the outbreak a global emergency until Jan. 31 after maintaining it was a local crisis. Even with that declaration, it didn’t recommend limits on travel and trade. Taiwanese Foreign Minister Joseph Wu has criticized the WHO’s handling of the coronavirus pandemic.
“If we had followed guidance from the WHO, we would have fallen behind,” Lo said. “We wanted to be on top of the virus’s development right from the beginning.”