Taiwan\u2019s Response to COVID-19- not perfect, but better than anyone else\u2019s.<\/p>\n\n\n\n
\n An article in JAMA (Journal of the American Medical Association) of \n3\/3\/20 outlines the effective approach that Taiwan took to the COVID-19 \ncrisis, which is why they have so few cases despite their close \nproximity to China. <\/p>\n\n\n\n
It is instructive to look at what they did,\n so as to contrast the actions of other countries and look at what can \nbe learned. It is also a measure of government competence, in that \nfacts were known and could have been acted upon. It is not often that \ngovernment competence can be directly compared across nations. It will \nbe an interesting exercise. Some contrasts with Australia are below. \nThe effectiveness of the US health system looks like a tragedy about to \nunfold.<\/p>\n\n\n\n
Taiwan had a number of things in place, and then took sensible actions:
\n 1. They had learned the lessons of the SARS epidemic of 2003 and \nretained an awareness of the possibility of a recurrence. They had a \nNational Health Command Centre, which was activated on 20\/1\/20, and they\n had a National Security Council which had coordinated all government \ndepartments since 2003.<\/p>\n\n\n\n
2. They had respect for scientific expertise and the Vice President was an epidemiologist.<\/p>\n\n\n\n
3. All citizens were covered by Universal Health Insurance<\/p>\n\n\n\n
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.
\n f. Systematic screening of high and low-risk individuals as soon as \nChina notified the WHO of a problem on 31\/12\/19, and then questionnaire \nscreening from 5\/1\/20 to and SMS messages to allow low-risk travellers \nto go through Immigration more quickly.
g. 124 different action items \u2013 (see appendix to article below for details)<\/p>\n\n\n\n
5. Linking of the Immigration and National Health Insurance Databases to allow
a. Communication with individuals
\n b. Pro-actively seeking \u2018at risk\u2019 groups such as those who had fevers \nbut tested negative for \u2018flu, and testing them for COVID-19.<\/p>\n\n\n\n
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. <\/p>\n\n\n\n
\n 7. Communication with the public in a very transparent way with early \nand constant advertising of the facts and the behaviours required to \nlessen the spread of the virus.<\/p>\n\n\n\n
8. Advertising the importance of \nhand-washing, and wearing masks, and also not hoarding masks so that the\n health system is not impaired by a lack of them.<\/p>\n\n\n\n
9. Support for patients with provision of food and frequent health checks and campaigns to prevent stigmatisation. <\/p>\n\n\n\n
\n 10. Bans on the export of masks from an early stage, control of their \nprices to US17 cents and a quick ramping up of domestic mask production.<\/p>\n\n\n\n
11. Generous aid for business and workers affected.
\n There was some criticism of the Taiwanese approach. There was not \nenough communication on languages other than Mandarin or to \nnon-Taiwanese citizens. A ship, the \u2018Diamond Princess\u2019 was allowed to \ndock on 31\/120 and later was found to have COVID-19 cases on board. The\n response was to ask the public to identify people from the ship and \nplaces that they had been, and to chase the cases. <\/p>\n\n\n\n
To look at Australia\u2019s response in comparison we could say that:
\n 1. Australia was not alert to a SARS-type epidemic unfolding and did \nnot have in place an effective committee watching the issue unfold, \ndespite the fact that such structures exist for fires and weather \nevents. When there was a response, it seemed that there were huge \ndifferences in what was said by whom with huge differences between \nFederal and States.<\/p>\n\n\n\n
2. Respect for scientific knowledge seems to \nbe falling and the downgrading of our intellectual resources seems \ncontinuous with defunding of the ABS, CSIRO and the ABC. The Chief \nMedical Officer was a cancer researcher and its seems public health \npersonnel had little influence for some time.<\/p>\n\n\n\n
3. Medicare is \nbeing continuously undermined and many people coming to Australia either\n on student visas or temporary work visas are not covered, which affects\n their ability to access and pay for health services.<\/p>\n\n\n\n
4. There \nwas no pro-active monitoring of China, and bans on travellers from \nItaly, Spain and the US were slow to come, with poor airport screening \nand cruise ship protocols. <\/p>\n\n\n\n
5. There was not intelligent use of \ndata. The government has insisted that data be available to it for \n\u2018national security\u2019, but the use of this data seems limited to terrorist\n threats cause by the blowback from our belligerent Middle East foreign \npolicy rather than any wider use. The studied disinterest of Border \nForce in the landing of the cruise ships passengers is a clear \nindication of the government\u2019s priorities. The lack of any suggestion \nof the use of electronic medical records in the crisis also shows how \nlittle thought had been put into this major attack on privacy.<\/p>\n\n\n\n
6.\n As there had not been intelligent use of data, there was no intelligent\n use of technology for warnings, information or data collection, unless \nof course something happened \u2018under the radar\u2019 which it seems is how \ntechnology is used in Australia. <\/p>\n\n\n\n
7. Communication with the \npublic was very late, with no public information campaigns. People came\n to rely on the ABC\u2019s Norman Swan in the absence of anything else. The \nplans and modelling are kept secret, which is hard to justify on any \ngrounds, but reflects either a lack of confidence of the government in \nits citizens or a lack of confidence that its actions would stand \nscrutiny. <\/p>\n\n\n\n
8. Education of the public tended to come with Prime \nMinisterial edicts. There was no need that these public information \nsessions be delivered by the Prime Minister and it reflects an \nunfortunate new tendency to have all issues politicised. <\/p>\n\n\n\n
9. \nHome support seems to rely on food delivery services of stores and \nrestaurants, which may be OK but are no thanks to the government. There\n does not seem an outreach otherwise. <\/p>\n\n\n\n
10. There was a shortage \nof masks as the Chinese had bought a lot of our supplies, but no one \nseems to mention that they can be washed. The fact that they are \ndisposable is merely a convenience for the manufacturers, and it is \nextraordinary that this has not been challenged even at this time of \ncrisis. <\/p>\n\n\n\n
11. There have been huge support packages and the \nunnecessary fiction of the surplus was dumped as soon as it was \nconvenient. The Newstart allowance was effectively doubled. It will be \nhard to assess the effects or effectiveness of the government response \nin the short-term. <\/p>\n\n\n\n
Australia was slow to start, and has \nbenefited from being an island and having a few weeks of the experience \nof Europe to goad our government into action, and make it acceptable to \nopen the government overdraft account. We only have to hope that it \nwill be successful. <\/p>\n\n\n\n
The USA, with its privatised health system \nand diffuse power structures is likely to have more problems than we, \nbut that remains to be seen. <\/p>\n\n\n\n
The crazy statements of Jair \nBolsonaro in Brazil may be like the absurd statements on AIDS in Africa \nby Thabo Mbeki which caused a third of a million deaths. Again, that \nremains to be seen.<\/p>\n\n\n\n
I have wrestled for a long time with the \ndilemma of whether it is better to have a democratic government or a \ncompetent government. Democracies are assumed to be more important \nbecause they can remove incompetent governments, but it seems that this \nis happening less than ever.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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