Taiwan’s government cannot take sole credit for flattening that country’s curve during the early days of the coronavirus pandemic. The work was supported by an extraordinary collaboration of tech-savvy citizens who used their expertise to help spread valuable information to the public, according to a case study by Steven O. Kimbrough, Wharton professor of operations, information and decisions, and Christine Chou, business professor at National Dong Hwa University in Taiwan. In this opinion piece, Kimbrough and Chou explain how this grassroots effort coalesced and what it signals for Taiwan’s future.
When the novel coronavirus and its disease, COVID-19, first spread in China, Taiwan was regarded as the next country most likely to be affected, due to its close geographic and economic ties with China. However, by mid-July 2020, after more than six months of rapidly growing COVID-19 cases around the world, Taiwan still counted substantially fewer cases than most countries. The worldwide news media have noted Taiwan’s initial success story, attributing it to Taiwan’s resilience, pervasive national health system, central command structure, rapid medical equipment build up, early prevention and transparent information sharing, as well as other factors. While these factors surely have played important roles in contributing to this initial success, it is too soon to tell whether that success will continue.
The purpose of our case study is to describe the work by a special group of people to assist in the pandemic response in Taiwan. That work has culminated, so its story can now be told. Our case study is based on 3,060 online community messages, 32 online shared interviews and information from several personal contacts. See “Not All Heroes Wear Capes: The Contributors Behind the Battle Against the Coronavirus Outbreak in Taiwan” for a fuller version of the study, including a detailed timeline.
The basic facts of the case are the following: Rationing of face masks began in Taiwan on January 28, shortly after the coronavirus appeared. This was partly in response to panic buying, but problems persisted, with long lines at all convenience stores that were originally designated to sell masks. There was also much agitation and anxiety among the public. At this point the idea of a name-based rationing system — tied to the national health system records — for buying face masks in the pharmacies was proposed. Under the system, each citizen or foreigner with a valid alien resident certificate could purchase two masks within a 7-day period using their identification cards as of February 6.
Once news of the forthcoming arrangement was released on February 4, a novel collaboration among the public, private and civic sectors began to emerge spontaneously. More than 1,000 software developers joined in the task of providing apps and other tools to identify in real time where face masks were available, sparing the public wasted time and anxiety. By the beginning of March, 59 map systems, 21 line applications, three chat bots, 23 mask sales location search systems, 22 apps, five audio systems, two information sharing systems, and one online mask reservation system were launched. Several applications have attracted more than 2 million users. The tools have been very effective, easing public anxiety and preventing a black market from emerging. As Microsoft executives Jaron Lanier and E. Glen Weyl wrote, “These tools showed where masks were available, but they did more than that. Citizens were able to reallocate rations through intertemporal trades and donations to those who most needed them, which helped prevent the rise of a black market.” In the end, democracy and social capital in Taiwan were strengthened.
“In the end, democracy and social capital in Taiwan were strengthened.”
The rationing system and the searching tools fully met their expectations until late April when the government was able to produce ample numbers of masks domestically. The government began to donate masks to various countries in need beginning in early April and was able to accumulate uncollected masks to donate more to other countries in late April. There are several important lessons to be learned from this case:
- An Existing Platform
The software community coalesced on the g0v.tw platform, which is “an online community that pushes for greater information transparency [and] that focuses on developing an information platform and effective related tools for citizens to participate in society.” This platform was first set up in 2012 when a group of engineers was not satisfied with the government’s stance towards data availability.
- Persistent Key Members
The channels used by the g0v community (#general and then #covid19) had persistent, attentive members. In the development of the mask-searching system, several leaders responded to the community multiple times every day. The top three members’ IDs were kiang, minexo79 and tnstiger, all of whom steadfastly replied to channel members’ messages, and continue to do so.
- Openness of Government Data
Thanks to the universal national health system, the Ministry of Health and Welfare had complete data available on pharmacies around the country. That data included pharmacists’ store codes, locations, business hours, mask inventory, and ways of issuing numbers to distribute the masks. This data was made available to the g0v developers after they requested it.
- Emotion Sharing
The g0v community shared frustrations among its members as the project got underway and elation as successes were achieved. Emotion sharing was a key element in binding the community together and serving its higher purposes.
Stepping back, we should see the generous behavior of the g0v community in a larger context. It is an example of people spontaneously coming together in the spirit of community service during a public disaster. Rebecca Solnit documented multiple such examples in her 2009 book, A Paradise Built in Hell. Her chronicle begins with the San Francisco earthquake of 1906 and the acute firsthand observations of the philosopher William James, who noted the initial effective and peaceable self-organization of response by the diverse citizenry. Sadly, that period of comity and effectiveness soon ended because authorities imposed force where it was hardly needed and, in fact, detrimental. Solnit found this to be a recurring pattern up to the present day.
“In a time of immense challenge, each contributor became a hero in his or her own way.”
Happily, Taiwan so far has been an exception. In this case, the government responded with welcome and alacrity to the pro-social impulses of the g0v community. Audrey Tang, the government’s digital minister, has been a linchpin. With expert skills and knowledge in information technology, and the political skills that come with holding an important position in the government — a rare combination — she actively supported the projects and served as a crucial go-between for the multiple stakeholders present. An exceptional talent, she is also openly a transgender woman who, remarkably for Taiwan’s historical culture, has achieved the highest levels of access and influence in government and society. Her voice is eagerly sought and listened to. See “How digital innovation can fight pandemics and strengthen democracy” for Tang’s broader take on the situation.
The success of the name-based mask projects was enabled by an unusual combination of elements including: outstanding leadership and commitment (the digital minister, the leaders of the g0v collective); trust and residual goodwill (among the g0v community, and between the citizens generally and the government, which had recently obtained a very strong electoral mandate); deep preparation and steady, highly competent, informed leadership by the government that welcomed the g0v contributions; a well-educated, highly skilled group of techies with the freedom and capacity to contribute without being paid for their services; and a general, creative openness to diverse people and ways of thinking (including enlisting volunteers to visit pharmacies in person and collect additional data).
Above all, the success of this case relied on many volunteers willing to contribute large amounts of their time and effort. As writer Andrea Randall put it so well, “Heroes don’t always wear capes, badges or uniforms. Sometimes, they support those who do.” In a time of immense challenge, each contributor became a hero in his or her own way. Not only did they help solve the problem, but they also warmed everyone’s hearts with their effort and generosity. The gratitude they merit is perhaps even more for the lasting value and example they created for the future, and what this means for Taiwan’s social capital, than for their fine achievement of the day.
*The authors acknowledge the help and authorization from CC BY 4.0 by g0v Contributors and helpful comments from Finjon Kiang.
Join The Discussion
5 Comments So Far
Jim Roberts
According to worldmeters.info, Taiwan ranks #173 in “tests per 1 Million population” – meaning, they haven’t conducted many tests. Shouldn’t that be a caveat to the story when mentioning they have “substantially fewer cases” than other countries? After all, a surefire way to have fewer reported cases is to do less testing.
Anumakonda Jagadeesh
Yes. Taiwan deid well to contain COVID – 19.
The COVID-19 pandemic in Taiwan is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pandemic has had a much smaller impact in Taiwan than in most other industrialised countries, with a total of seven deaths as of 11 May 2020. The number of active cases peaked on 6 April at 307 cases, the majority of which were imported.
The virus was confirmed to have spread to Taiwan on 21 January 2020, from a 50-year-old woman who had been teaching in Wuhan, China. The Taiwanese government integrated data from the national health care system, immigration, and customs authorities to aid in the identification and response to the virus. Government efforts are coordinated through the National Health Command Center (NHCC) of the Taiwan Centers for Disease Control, established to aid in disaster management for epidemics following the 2004 SARS outbreak.
The Journal of the American Medical Association says Taiwan engaged in 124 discrete action items to prevent the spread of the disease, including early screening of flights from Mainland China and the tracking of individual cases.
Taiwan’s handling of the outbreak has received international praise for its effectiveness in quarantining people. As of 18 June, 74,842 tests had been conducted in Taiwan with the vast majority not confirming a COVID-19 diagnosis.
Starting 19 March, foreign nationals were barred from entering Taiwan, with some exceptions, such as those carrying out the term of a business contract, holding valid Alien Resident Certificates, diplomatic credentials, or other official documentation and special permits. All who are admitted into the country must complete a fourteen-day quarantine upon arrival.
Timeline
As of 28 July, there are 467 confirmed cases in Taiwan, including seven deaths. Among the confirmed cases is a Taiwanese man in his 50s who was fined NT$300,000 for failure to report his symptoms and attempting to conceal his subsequent activities, leading to a potential contamination incident at a ballroom in Kaohsiung. As of 29 July 2020, 441 people have recovered from COVID-19.
January
On 21 January, the first case in Taiwan was confirmed in a 50-year-old woman who had just returned to Taoyuan International Airport from her teaching job in Wuhan. She reported on her own initiative and was hospitalised without formal domestic entry. The first domestic case was diagnosed in Taiwan on 28 January. A man in his 50s was believed to have acquired the disease from his wife, who had travelled to Wuhan and was confirmed before him.
February
The first death in Taiwan was confirmed on 16 February involving a man in his 60s who had Hepatitis B and diabetes. A woman in Taiwan was reported to have tested positive for novel coronavirus on 19 February 2020, though she had not travelled outside of Taiwan for two years. Five new cases of COVID-19 were reported in Taiwan on 29 February 2020, four of which marked the first transmission of the disease in a hospital setting. Taiwan’s fiftieth case of coronavirus was confirmed on 13 March 2020, an American expatriate who hosted four United States citizens at his home in Taiwan. The next day, three new cases of coronavirus were confirmed to have been imported from Europe. A Taiwanese national aboard the Diamond Princess tested positive on 6 February. As of 19 February, five Taiwanese nationals aboard the ship tested positive. Two Taiwanese who fell ill on the Diamond Princess were discharged from Japanese hospitals in February 2020. The nineteen other Taiwanese passengers on the Diamond Princess were quarantined in Taiwan until 7 March 2020. All tested negative for coronavirus, and were released. The index case for coronavirus in Taiwan recovered from the disease and was discharged from hospital on 6 February 2020. Approximately a week later, a second Taiwanese national, the tenth case of coronavirus, had also recovered. Though community spread within the Taiwanese society did not necessarily break out, a hospital cluster was recorded after case 34. A female patient with diabetes and numerous cardiovascular diseases transmitted the virus to eight people contacted throughout February and March. She later died due to heart failure on 30 March.
March
On 15 March, Taiwan announced six new cases, all imported. Subsequently, Taiwan’s health minister advised people to remain in Taiwan and avoid travel. After discovering the mass imports of foreign cases, the CECC on 17 March that it would trace the contacts of travellers that arrived from Europe between 3 March and 14 March. On 20 March 2020, Taiwan reported 27 new cases, the highest single-day increase. The second death linked to coronavirus in Taiwan was announced on 20 March, and involved a man in his 80s, who had no recent travel history, but did have hypertension, diabetes and relied on kidney dialysis. The death of a guide who had led tours to Austria and the Czech Republic was reported on 29 March. The next day, two Taiwanese nationals who had travelled to Spain were reported to have died of coronavirus.
April
A Taiwanese man who had toured Egypt in March died of coronavirus on 9 April. On 18 April 2020, three Republic of China Navy cadets were confirmed to have contracted coronavirus following a military operation in Palau. Other personnel on the ship were confirmed to have contracted the disease as part of the first cluster to affect the Republic of China Armed Forces.[42] As more cases from that cluster were identified, President Tsai Ing-wen asked the Ministry of National Defense to investigate the situation. Defence minister Yen Teh-fa said vice admiral Kao Chia-pin and rear admiral Chen Tao-hui had been removed from their posts as commander of Republic of China Naval Fleet Command and leader of the ROCN’s Friendship Fleet, respectively. On 30 April 2020, an employee of the Taipei Representative Office in France was confirmed to have fallen ill with coronavirus, becoming the first Taiwanese diplomat stationed overseas to contract the disease.
May
On 10 May, Taiwan recorded 28 consecutive days or two cycles of the average incubation period of the virus without newly recorded domestic cases. Therefore, the CECC deems the risk of being infected within Taiwan is low. The death of a man who had visited the United States and contracted coronavirus was confirmed on 11 May. On 26 May, Chang Shan-chwen announced an end to the Central Epidemic Command Center’s investigation on COVID-19 cases from ROCS Panshih. The ship’s index case was likely to have been infected in Taiwan. Though the probe closed without finding a more specific location, it did find that sailors were infected with a Southeast Asian strain present in the Philippines, and that infectious occurred in four waves, around 10 March, 20 March, the beginning of April, and the middle of April. On 30 May, a second member of Taiwan’s diplomatic corps was confirmed to have contracted COVID-19 in Honduras.
June
By 7 June, Taiwan had not reported local cases for over four incubation periods which is 56 days. As a result, Taiwan began lifting pandemic-related restrictions. Starting 10 June, press briefings held by the Central Epidemic Command Center were scheduled weekly. On 12 June, the Ministry of National Defense disclosed further conclusions regarding the ROCS Panshih cluster, attributing the cluster to substandard health testing. Subsequently, Chen Tao-hui and Kao Chia-pin returned to their posts. The patient involved in the longest hospitalization in Taiwan due to COVID-19 spent 75 days in hospital, and was released in mid-June.
On 24 June, the CECC announced that a Japanese university student who had returned to Japan on 20 June had been diagnosed with COVID-19 by Japanese health authorities. Analysis of the student’s test results led the CECC to conclude that she was a weak positive, although the agency did not rule out the possibility of infection in Taiwan, or potential for a false positive. The case was not added to Taiwan’s total, as the student was not tested in Taiwan. The CECC confirmed that the student did not spread COVID-19 to others during her stay in Taiwan.
July
The Chinese Taipei Basketball Association announced on 2 July that the 2020 William Jones Cup would not be held due to the pandemic. This was the third time since the competition began in 1977 that it was cancelled. The tournament had been previously cancelled in 1989 because of a fire in the host venue, and in 2003, during the SARS outbreak.
Taiwan’s annual public air raid drill was held on 14 July, but with significant changes. The thirty-minute drills normally require citizens to clear the streets and remain indoors until the drill concludes. On the advice of the CECC, however, the Ministry of National Defense did not restrict the movement of citizens to prevent the formation of crowds, especially in public transit stations.
A case of COVID-19 that possibly originated in Taiwan was found by Thai health authorities on 25 July. A Thai migrant worker who had entered Taiwan on 17 January 2018 and returned to Thailand on 21 July 2020 and had not left Taiwan during that time frame tested positive for the virus while in quarantine. The CECC reported it had learned of the positive result on 27 July and immediately ordered workers who shared a company dormitory with the migrant worker to go into quarantine. By 28 July, the CECC identified 189 contacts to be tested for COVID-19. 18 people were placed in quarantine, including one in full hospital isolation due to having symptoms consistent with COVID-19. The CECC also tested the contacts for COVID-19 antibodies to see if any of them had contracted and recovered from COVID-19 earlier, but reported on 29 July that no positive cases nor antibodies were found. The CECC is continuing its investigation.
Preventive Measures
On 31 December 2019, Taiwan Centers for Disease Control (CDC) implemented inspection measures for inbound flights from Wuhan, China in response to reports of an unidentified outbreak. The passengers of all such flights were inspected by health officials before disembarking. Taiwan’s Central News Agency reported that Luo Yi-jun, deputy director for Taiwan’s Centers for Disease Control, had been reading on PTT in the early hours of New Year’s Eve when a thread about an unknown disease causing pneumonia in Wuhan caught his attention. He saw a post including screenshots from a group chat with Li Wenliang. He immediately emailed colleagues and put the country on alert.
A six-year-old passenger who transferred in Wuhan and developed a fever was closely monitored by the CDC. At this time, there were alleged to be 27 cases of the new pneumonia in Wuhan.
By 5 January 2020, the Taiwan CDC began monitoring all individuals who had travelled to Wuhan within fourteen days and exhibited a fever or symptoms of upper respiratory tract infections. These people were screened for 26 known pathogens, including SARS and Middle East respiratory syndrome, and those testing positive were quarantined.
On 20 January, the government deemed the risk posed by the outbreak sufficient to activate the Central Epidemic Command Center (CECC). Originally established as a level 3 government entity, the CECC was promoted to level 1 on 28 February. The CECC has coordinated government responses across areas including logistics for citizens on the Diamond Princess, disinfection of public spaces around schools, and providing briefings with Chen Shih-chung, the Minister of Health and Welfare.
On 21 January, the same day that Taiwan’s CDC reported the first confirmed case of the novel coronavirus in Taiwan, a level 3 travel alert to Wuhan was issued, recommending avoidance of all non-essential travels to the city.
On 26 January, Taiwan suspended all air travel to and from China, and put in place quarantine measures for passengers who flew from China.
On 24 January, the Taiwanese government announced a temporary ban on the export of face masks for one month to secure a supply of masks for its own citizens. The ban was extended twice; on 13 February until the end of April, and on 13 April until the end of June. On 6 February, the government instituted a mask rationing system, requiring citizens to present their National Health Insurance card. Prior to its implementation, the system was extended to holders of the Alien Resident Certificate, and people with valid entry permits. People with odd-numbered identity documents were permitted to buy masks on Mondays, Wednesdays, and Fridays; those with even-numbered identity documents were to buy masks on Tuesdays, Thursdays, and Saturdays; anyone is allowed to buy masks on Sundays. Adults were allowed to buy two masks each visit and children four, with the restriction that a minimum of seven days must elapse since the last purchase. The date restriction for children under thirteen years of age was revoked on 27 February. Starting 5 March, adults were permitted to buy three masks weekly, and the children’s quota was raised to five. Masks were available for pre-order online from 12 March. In April, the mask rationing system was revised, so that adults could buy nine masks every two weeks. From 9 April, the specific date restrictions are to be removed. In addition, Taiwanese nationals can send 30 masks every two months overseas to first or second-degree relatives. Taiwan’s Ministry of Foreign Affairs assumed responsibility for distribution of masks to families of diplomats.
With population of 24 million, Taiwan has been producing more than 13 million masks per day since March, later increasing the output to 20 million.
On 2 February 2020, Taiwan’s Central Epidemic Command Center postponed the opening of primary and secondary schools until 25 February (originally 11 February). In early February 2020 Taiwan’s Central Epidemic Command Center requested the mobilisation of the Taiwanese Armed Forces to contain the spread of the virus and to build up the defences against it. Soldiers were dispatched to the factory floors of major mask manufacturers to help staff the 62 additional mask production lines being set up at the time. In early March, Taiwan’s average production of surgical face masks reached 9.2 million per day. By the end of March, the daily production of surgical face masks reached 13 million.
Disinfection against coronavirus
The Taiwan Tobacco and Liquor Corporation and the Taiwan Sugar Corporation increased production of 75 per cent alcohol for use in sanitation. On 25 February 2020, the Heping Women and Children’s Hospital, a branch of the Taipei City Hospital [zh], was specially designated to care for patients with coronavirus. From 4–31 March, the export of digital thermometers was banned. On 16 March, the Tsai Ing-wen presidential administration announced that Makalot Industrial and other Taiwanese companies would begin domestic mass production of protective gowns, ending a reliance on American imports from DuPont during the pandemic. A ban on the export of hand sanitisers and disinfectants was announced on 1 May 2020.
The Special Act for Prevention, Relief and Revitalization Measures for COVID-19 was passed by the Legislative Yuan on 25 February 2020, followed by a special budget for coronavirus expenses on 13 March 2020. The special budget was raised by an amendment passed on 21 April.
As of 14 March, persons returning to Taiwan from most of Europe, plus persons who have transferred through China, Hong Kong, Macau, and Dubai, must quarantine in-home for 14 days. As of 17 March, foreign nationals permitted in the country, namely, those who hold Alien Resident Certificates or who are on urgent diplomatic, business or other special missions, can rent a room in a public quarantine centre. On 20 March, the CECC has raised global travel notice to level 3; Taiwanese citizens are advised to avoid all nonessential travel. On 31 March, transportation and communications minister Lin Chia-lung announced that all passengers on trains and intercity buses were required to wear masks, as were people at highway rest stops. The Taiwan High Speed Rail Corporation installed thermal cameras at entrances to all twelve high speed rail stations. The Taiwan Railways Administration did the same for every one of its 239 stations. The CECC said on 3 April that passengers who refuse to wear masks after being asked to do so would be assessed a fine of NT$3,000 to NT$15,000, as stipulated by the Communicable Disease Control Act .
Face Masks Policy
The Taiwanese government announced on 24 January a ban on the export of face masks before the epidemic had spread to many countries, which caused controversy; however, after the outbreak of the epidemic, people rushed to buy masks in many countries around the world. (Incidents of face-mask confiscation by a government occurred in mainland China, the world’s top face-mask manufacturer.)
In early February 2020 the Executive Yuan adopted the recommendations of professors Huang Li-min and Chang Shang-chwen of the National Taiwan University Medical School, advocating that healthy people do not need to wear masks in open spaces. On 8 February, Chen Shih-chung, commander of the Central Epidemic Prevention Center, further said there was no need to wear a mask on public transportation. This caused a storm of protest, concentrating on the point that public transportation such as buses and MRT carriages are confined spaces, and viruses are transmitted more easily there than in open spaces. (Mask-wearing has a tradition of social acceptance in East Asia – regardless of scientific debates over the effectiveness of masks in impeding the transmission of viruses.)
In early April, Taiwan President Tsai Ing-wen announced the donation of 10 million masks to countries which suffered severely from the coronavirus pandemic. In response to the donation, European Commission President Ursula von der Leyen wrote in a tweet that the European Union “really appreciate[d] this gesture of solidarity”. The U.S. National Security Council also wrote a tweet thanking Taiwan’s willingness to “support and collaborate” with the U.S. In a press conference on 1 April, Chinese Ministry of Foreign Affairs spokesperson Hua Chunying responded to questions about the mask donations, advising anyone in Taiwan who would seek to politicise the pandemic to “think twice and act prudently”.
(Wikipedia)
Dr.A.Jagadeesh Nellore(AP),India
Cindy L
Jim Roberts, several reasons Taiwan hasn’t conducted many tests but mainly because they’re able to contain the outbreak by closing the border to China early to avoid community spread. Unlike many other countries, Taiwan is able to track every case and mandatory quarantine is required if you’ve been exposed to the COVID patients. Most cases in Taiwan are foreign-born therefore travelers who showing the symptoms are subject to take COVID test when entering the county. However, they take body temperature and precautions when people entering the country PLUS, mandatory quarantine if you’re a Taiwanese citizen (border is closed for most foreign travelers) coming back from high-risk countries such as US and Brazil.
Jim Roberts
I don’t doubt that they have good reasons for not testing more. My point is that if 40%+ of cases are asymptomatic, then more testing will likely pick up more cases. So the extremely low rate of testing should be noted when comparing the numbers.
For example, Grand Cayman has an extremely low number of cases, but they still were finding asymptomatic cases through random testing, even months after “locking down” the island. They rank 8th in tests / million for comparison.
Since the research here assumes that Taiwan did a superior job at containing Covid, I think it should be pointed out that the testing rate is really low.
Cindy L
Again, if a country is able to prevent the community spread, mass testing is unnecessary. Regarding some scholars’ opinion that mass testing should be required for travelers bound for Taiwan, the CECC stated that though mass testing can identify asymptomatic carriers, their measures of a 14-day period of home quarantine imposed on arrivals and a 7-day period of self-health management following the end of the quarantine period for asymptomatic individuals have continued to effectively contain the spread of coronavirus disease 2019 (COVID-19) in Taiwan. There are cases of asymptomatic individuals infecting others, which resulted in outbreaks in communities, in other countries or regions. One of the reasons for the community outbreaks in some countries or regions might be that they didn’t implement a 14-day period of quarantine or require contacts of confirmed cases to self-isolate at home for 14 days, which is different from Taiwan’s quarantine measures.
In Taiwan, after infection with COVID-19 has been laboratory-confirmed in a reported case, health authorities will identify contacts of the confirmed case who meet epidemiological criteria, including asymptomatic carriers or infected individuals with early symptoms, whether clustering is observed or not. Furthermore, molecular diagnostic testing for the diagnosis of COVID-19 is adopted. Taiwan’s epidemic prevention and control efforts are in line with the testing strategies of many medically advanced countries worldwide, and are composed of various measures, not just testing.