Life across SARS and COVID-19 in Taiwan

It was with more than a little trepidation that I first learned of a new virus in Wuhan.

Like others who lived through Taiwan’s experience of SARS in 2003, I read the news as a dark shadow of the past loo­­­­­med large. I instantly assumed that if the virus were unable to be contained, we would quickly be in a hotspot once again, along with Hong Kong.

Sure enough, John Hopkins University soon predicted Taiwan to have the world’s second largest number of cases.

Yet as I sit here writing today, the total number is less than 500 with six deaths. And this was done without a lockdown. For a writer, the subject of COVID-19 is a fast-moving target, but in the current moment Taiwan appears to have the world’s most effective coronavirus response.

Ron Hanson lived in Taiwan through the SARS pandemic, and now through COVID-19. Photo credit: Frankie Chang

It is a response built upon the legacy of a national tragedy and collective trauma.

In 2003, I was living In Taichung City, along with my brother Mark, teaching English and developing our nascent arts project. I spent most of my time with Mark, two New Zealand friends and my girlfriend who was a nurse working nights at a local hospital.  

We were reading the alarming reports in the Taipei Times about SARS in China and Hong Kong, which had certainly caught our attention. And yet in Taiwan we were meandering along comfortably enough with 1 or 2 new cases a day. Perhaps a bit of smugness had even set in.

N­­­­­­one of us were prepared for what was about to unfold.

In late April there was a sudden outbreak at Taipei’s Hoping Hospital. On April 24 the city’s newly established SARS Emergency Task Force ordered the hospital to lock down and all staff to return to the facility for a 10-day quarantine.

In total there were 930 staff and 240 patients. Nurses were understaffed and had insufficient PPE for dealing with a virus that had a death rate of around 10 percent.

There was no system for effectively isolating SARS patients. Successive outbreaks of the virus took place throughout the hospital and the chain of transmission could not be clearly established.

Protective shielding at the National Library of Public Information in Taichung City during the COVID-19 pandemic. Photo: Mark Hanson

A hospital pediatrician Lin Ping-hung kept a diary during the lockdown which was serialized in the Liberty Times newspaper. He described anarchy and few instructions on how to carry out the quarantine.

According to the Taipei Times, there would be a total of 137 probable cases at the hospital and 26 deaths, including seven hospital staff.

One patient committed suicide by hanging. A nurse attempted to jump out an 8th-floor window and had to be restrained by colleagues.

Nurses and doctors hung protest signs out windows of the hospital saying that they were healthy, wanted to be separated from infected patients and didn’t want to be left there to die. At the hospital it was unclear who was and wasn’t infected

Suddenly Taiwan became the epicenter of SARS.

Several other hospitals suffered smaller outbreaks and needed to lock down.

Doctors and nurses began to resign en masse. Taipei mayor Ma Ying-Jeou called them traitors in a time of war. Taiwan’s Health Minister, Dr. Twu Shiing-jer, would resign and be replaced by Chen Chien-jen, a John Hopkins-trained epidemiologist who is Taiwan’s current Vice President. The epidemic would eventually be brought under control.

Street scenes outside National Taichung Theatre during COVID-19. Photo: Mark Hanson

To say those were tense times would more than an understatement. It was full-blown anxiety caused in particular by the lack of information and the inability to have confidence in either the government or public response.

I remember eating lunch in a noodle shop watching looped television coverage of what appeared to be large groups of people breaking into stores and grabbing supplies.

I remember the media targeting individuals as “super spreaders” and these people being stigmatized by the public.

I would drive my girlfriend to the hospital for her night shift and observe that the proper triage system of classifying and separating patients was not yet being followed; this system was in the process of being implemented in hospitals throughout Taiwan.

I recall pained conversations with her about ­­­­­­­­­whether we should spend time apart or whether I should stop seeing my brother and friends.

We were aware that we were potentially the weak link in our social circle. In the end we stuck together and we were fortunate her hospital was not one of the dominoes to fall.

Temperature check at Top City department store in Taichung during COVID-19. Photo: Ema Chang

Fast forward to today and we’re seeing a vastly different response from both the government and the public.

Ever since SARS, Taiwan has been preparing for a future pandemic knowing it was only a question of when.

As soon as it became clear that this pandemic was going global in a big way, I immediately became concerned about New Zealand and how the response was going to go there.

Fortunately, it now appears that the government has adapted well and prevented something horrific from happening despite being ill-prepared going in.

There could still be challenges ahead, however, and, as with any response, there is the need for constant refinement. Much can be drawn from Taiwan’s experience. 

Social distancing sign on the floor in a 7-11 store in Sun Moon Lake. Photo: Ema Chang

I was thrilled when Jacinda Ardern stated publicly that New Zealand would be following closely the Taiwan model.

There are some interesting comparisons to be made. New Zealand’s and Taiwan’s governments have enjoyed similar success in communicating with the public and leaders enjoy a high level of public approval.

The daily briefings of both New Zealand and Taiwan have been informative, built trust and even became a bit of a cultural event.

New Zealand has implemented many of the same measures as Taiwan but the biggest difference has been in the speed at which it has been done.

This is particularly true in the case of the quarantine system for incoming international arrivals which New Zealand was much slower to implement.

This is arguably the key reason why New Zealand has experienced so many more infections and clusters stemming from arrivals back. Only 55 people have contracted the virus within Taiwan and of these only 10 cases could not be traced.

The early implementation of a strict quarantine system has been key to this and preventing the need for a lockdown. It should be noted that while it appears Taiwan will likely avoid a lockdown, lockdowns have been simulated and the island is prepared for that scenario. 

PPE is a common sight for public facing staff, such as those at the National Library of Public Information. Photo: Mark Hanson

New Zealand has tested at a much higher rate per capita, but Taiwan’s rate is higher per confirmed case.

Taiwan’s VP Chen is an advocate of targeted testing. He maintains that mass testing is not needed as long as you are able to trace most of the cases.

He also said that if you are testing at risk people such as nurses, taxi drivers and cashiers and no positive results are coming through then you can be confident of the infection rate of the general population.

When Bill Gates recently singled out Taiwan’s coronavirus response for praise, one of the areas he mentioned what Taiwan’s ability to prioritize who gets tested.

The most observable difference between Taiwan and New Zealand’s responses can be seen in the use of masks.  Taiwan has a mask-wearing culture that has been developed over 17 years following SARS.

 There is no debate here about their efficacy and their use is constantly advocated for and facilitated by the government. To the naked eye it would appear around 90 percent of people are wearing masks and almost 100 percent of people in service or public interface positions.

Scenes from the National Library of Public Information. Photo: Mark Hanson

Taiwanese look to the West with a sense of incredulity when they see the continued resistance to embracing masks.

In non-pandemic times, Taiwanese tend to only use masks when they are personally sick to prevent passing on the illness. In the current pandemic it is reasoned that everyone should we wearing a mask in public and their use is now mandated for those using public transportation.

Masks catch droplets. As asymptomatic and pre-symptomatic people are carrying the virus, the endeavor is to catch as many of those droplets as possible to prevent them from landing on surfaces where they will later be touched.

Masks are a mark of solidarity between Taiwanese. Wearing a mask indicates to other citizens that you are taking the threat seriously and is a reminder to maintain social distancing.    

In assessing the strength and quality of leadership in Taiwan and New Zealand it is perhaps unfair to draw too direct a comparison. Taiwan has been through this before. I’ve already written here about the chaos that unfolded during Taiwan’s first SARS experience.

New Zealand has done well for a first time round but can still learn much from Taiwan and other Asian models such as Hong Kong, South Korea and Vietnam.

Banner image credit: Frankie Chang

- Asia Media Centre