Doctor and activist

COVID-19 Taiwan’s Successful Response 1/4/20

Taiwan’s Response to COVID-19- not perfect, but better than anyone else’s.

An article in JAMA (Journal of the American Medical Association) of 3/3/20 outlines the effective approach that Taiwan took to the COVID-19 crisis, which is why they have so few cases despite their close proximity to China.

It is instructive to look at what they did, so as to contrast the actions of other countries and look at what can be learned. It is also a measure of government competence, in that facts were known and could have been acted upon. It is not often that government competence can be directly compared across nations. It will be an interesting exercise. Some contrasts with Australia are below. The effectiveness of the US health system looks like a tragedy about to unfold.

Taiwan had a number of things in place, and then took sensible actions:
1. They had learned the lessons of the SARS epidemic of 2003 and retained an awareness of the possibility of a recurrence. They had a National Health Command Centre, which was activated on 20/1/20, and they had a National Security Council which had coordinated all government departments since 2003.

2. They had respect for scientific expertise and the Vice President was an epidemiologist.

3. All citizens were covered by Universal Health Insurance

4. There was very pro-active monitoring of the situation as it developed including:
a. Sending an observation team to Wuhan
b. A travel alert from Wuhan from 20/1/20
c. Banning entry from Wuhan from 22/1/20
d. Increasing bans on travel to and from China
e. Close monitoring and progressive bans on travellers from infected areas.
f. Systematic screening of high and low-risk individuals as soon as China notified the WHO of a problem on 31/12/19, and then questionnaire screening from 5/1/20 to and SMS messages to allow low-risk travellers to go through Immigration more quickly.
g. 124 different action items – (see appendix to article below for details)

5. Linking of the Immigration and National Health Insurance Databases to allow
a. Communication with individuals
b. Pro-actively seeking ‘at risk’ groups such as those who had fevers but tested negative for ‘flu, and testing them for COVID-19.

6. Intelligent use of technology with:
a. A Toll-free number to report illness and get tested
b. Outreach SMS communication for possible contact of infected people to get them tested ASAP.
c. Monitoring of home quarantine with mobile phones.

7. Communication with the public in a very transparent way with early and constant advertising of the facts and the behaviours required to lessen the spread of the virus.

8. Advertising the importance of hand-washing, and wearing masks, and also not hoarding masks so that the health system is not impaired by a lack of them.

9. Support for patients with provision of food and frequent health checks and campaigns to prevent stigmatisation.

10. Bans on the export of masks from an early stage, control of their prices to US17 cents and a quick ramping up of domestic mask production.

11. Generous aid for business and workers affected.
There was some criticism of the Taiwanese approach. There was not enough communication on languages other than Mandarin or to non-Taiwanese citizens. A ship, the ‘Diamond Princess’ was allowed to dock on 31/120 and later was found to have COVID-19 cases on board. The response was to ask the public to identify people from the ship and places that they had been, and to chase the cases.

To look at Australia’s response in comparison we could say that:
1. Australia was not alert to a SARS-type epidemic unfolding and did not have in place an effective committee watching the issue unfold, despite the fact that such structures exist for fires and weather events. When there was a response, it seemed that there were huge differences in what was said by whom with huge differences between Federal and States.

2. Respect for scientific knowledge seems to be falling and the downgrading of our intellectual resources seems continuous with defunding of the ABS, CSIRO and the ABC. The Chief Medical Officer was a cancer researcher and its seems public health personnel had little influence for some time.

3. Medicare is being continuously undermined and many people coming to Australia either on student visas or temporary work visas are not covered, which affects their ability to access and pay for health services.

4. There was no pro-active monitoring of China, and bans on travellers from Italy, Spain and the US were slow to come, with poor airport screening and cruise ship protocols.

5. There was not intelligent use of data. The government has insisted that data be available to it for ‘national security’, but the use of this data seems limited to terrorist threats cause by the blowback from our belligerent Middle East foreign policy rather than any wider use. The studied disinterest of Border Force in the landing of the cruise ships passengers is a clear indication of the government’s priorities. The lack of any suggestion of the use of electronic medical records in the crisis also shows how little thought had been put into this major attack on privacy.

6. As there had not been intelligent use of data, there was no intelligent use of technology for warnings, information or data collection, unless of course something happened ‘under the radar’ which it seems is how technology is used in Australia.

7. Communication with the public was very late, with no public information campaigns. People came to rely on the ABC’s Norman Swan in the absence of anything else. The plans and modelling are kept secret, which is hard to justify on any grounds, but reflects either a lack of confidence of the government in its citizens or a lack of confidence that its actions would stand scrutiny.

8. Education of the public tended to come with Prime Ministerial edicts. There was no need that these public information sessions be delivered by the Prime Minister and it reflects an unfortunate new tendency to have all issues politicised.

9. Home support seems to rely on food delivery services of stores and restaurants, which may be OK but are no thanks to the government. There does not seem an outreach otherwise.

10. There was a shortage of masks as the Chinese had bought a lot of our supplies, but no one seems to mention that they can be washed. The fact that they are disposable is merely a convenience for the manufacturers, and it is extraordinary that this has not been challenged even at this time of crisis.

11. There have been huge support packages and the unnecessary fiction of the surplus was dumped as soon as it was convenient. The Newstart allowance was effectively doubled. It will be hard to assess the effects or effectiveness of the government response in the short-term.

Australia was slow to start, and has benefited from being an island and having a few weeks of the experience of Europe to goad our government into action, and make it acceptable to open the government overdraft account. We only have to hope that it will be successful.

The USA, with its privatised health system and diffuse power structures is likely to have more problems than we, but that remains to be seen.

The crazy statements of Jair Bolsonaro in Brazil may be like the absurd statements on AIDS in Africa by Thabo Mbeki which caused a third of a million deaths. Again, that remains to be seen.

I have wrestled for a long time with the dilemma of whether it is better to have a democratic government or a competent government. Democracies are assumed to be more important because they can remove incompetent governments, but it seems that this is happening less than ever.

Certainly it would be interesting to do a comparison of how governments have performed in managing this epidemic. It remains an aspiration that governments could be democratic and competent. One plausible theory on how to achieve this is to raise the standard of education of everyone, so that dodgy stupid people have less chance of getting control. I guess we could start by going back to Gonski 1.

Arthur Chesterfield-Evans

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