How Taiwan plans to stay (mostly) coronavirus-free

TAIPEI – Consider for a moment, in this time of anguish and loss and death, of mass unemployment and flattened national economies, the Twilight Zone alternate reality that is Taiwan.

For months and months, life on the island has been, in a word, normal — spookily so. Weddings have been held worry-free. People have packed pro ballgames, attended concerts and thronged night markets. Taiwan’s population is larger than Florida’s, but its COVID-19 death toll can be counted on two hands.

It is the kind of off-the-charts success against the virus that has created a sinking feeling in the stomachs of many residents: How much longer can the island’s good fortune last?

For Chen Shih-chung, Taiwan’s health minister and head of its epidemic command center, success is all the more reason not to waver on the bedrock of the government’s coronavirus strategy. The island has been sealed off to most visitors since March. People who are allowed to enter still have to quarantine under tight watch for two weeks, including Taiwanese citizens.

The high walls have kept the island from being deluged with infections, but they risk isolating Taiwan economically and politically if the rest of the world relaxes its defenses as vaccinations get under way.

The government is not likely to budge on those policies until there are vaccines that are a proven, lasting weapon against the virus, Chen said in an interview. Taiwan will not be like one of those places, he suggested, that eased lockdowns under public pressure only to have to tighten them again later.

“I believe there will be another wave,” he said. “Because everybody thinks, ‘I’ve gotten the vaccine,’ or, ‘I’m getting the vaccine next week. I’ve waited so long, I can be free now, right?’”

Once there is more evidence about whether the current vaccines offer enduring immunity, “only then can we really start to relax a bit,” he said.

As vaccinations begin around the globe, the question of how and when to ease COVID-19 border controls will also confront other places, such as Australia and New Zealand, that have used their geographic insularity as a primary defense against the pandemic.

Taiwan has already held fast to its entry restrictions and quarantines for much longer than many governments could without facing public backlash. The island’s economy has slowed along with the world’s during the pandemic, but it continues to grow at a decent clip.

Japan and South Korea, two other Asian democracies praised for their virus responses, are now grappling with large flare-ups of new infections.

But as successful and tireless as Taiwan’s health officials have been, the island has also benefited from sheer good luck, said C. Jason Wang, an associate professor at Stanford University School of Medicine.

With the case count surging globally and a more contagious variant of the virus circulating in many places, greater numbers of infected people are bound to arrive at Taiwan’s borders, Wang said, which means it is only a matter of time before more positive cases slip past the government’s defenses.

Taiwan on Wednesday confirmed its first case involving the new variant, in a person who had entered from Britain, tested positive and been hospitalized. In response, the government further tightened its entry bans and quarantine rules.

“It’s remarkable that Taiwan has held the line for so long,” Wang said. But even if the island vaccinates its population by the middle of 2021, “then you’ve still got six months to go,” he said. “It’s really difficult to keep this up for another six months.”

For Chen, 67, 2020 was a year of tough calls, even as he has pulled off a virus response that would be the envy of any public health official on the planet.

In a recent opinion poll, Chen, a dentist by training, received a higher approval rating than any other top official, including his boss, President Tsai Ing-wen. He is being talked about as a potential candidate for mayor of Taipei, the island’s capital. His cool, unflappable mien at the government’s epidemic news briefings has won him an odd kind of celebrity. It is not every middle-aged health minister who is photographed clad in Gucci for the local edition of GQ.

Yet in Chen’s telling, his decisions since the outbreak have upset people at almost every turn. Like when he barred medical workers from leaving the island in February. Or when he announced in March that the island was forbidding entry by nearly all nonresidents.

Many of the Taiwanese government’s ideas about dealing with the virus came from “feeling around in the dark,” Chen said.

For instance, when a cluster of infections appeared on the Diamond Princess cruise liner in February, officials in Japan, where the boat had docked, allowed many passengers who tested negative to walk free. Some of them later tested positive. Taiwan took note.

“By then it became very clear to us,” Chen said. “After you test, you have to quarantine both the positives and the negatives.”

Taiwan’s emphasis on strict quarantines has helped contain infections without overwhelming its hospital system or incurring huge costs for testing. But some experts are now urging the government to test more widely, particularly at the border, to catch more cases that do not show symptoms.

“We came up with many of our policies when there were a few million infections around the world,” said Chan Chang-chuan, a professor at the College of Public Health at National Taiwan University. “But now there are tens of millions, and we’re heading toward a hundred million. It’s a whole different stage.”

Chan said he believed Taiwan should begin testing everyone at the border, not just quarantining them. It has already started doing this for people arriving from Britain, where the more transmissible variant of the coronavirus has been found to be circulating.

Taiwan’s position has been that carriers of the virus who are asymptomatic after 14 days of isolation are not likely to be very infectious. Chen said he had no doubt that there had been some asymptomatic cases that never made it onto the government’s radar.

“But if those infections are not causing problems, then should I spend a lot of energy trying to find those people?” he said. “Or should I focus my efforts on infections that are already causing problems?”

It is unclear how much of a gamble this approach has involved. A study in The Lancet in October found that out of 14,765 people whose blood was sampled at a Taipei hospital, a lower share tested positive for coronavirus antibodies than in other countries. Yet the share could still imply a much higher number of asymptomatic or mildly symptomatic infections than is reflected in Taiwan’s official case numbers, the study’s authors wrote.

“Basically, it’s a trade-off between how much money you want to spend and how much risk you want to take,” said Wang, the Stanford professor. As the global case count swells and more infections are likely to leak into Taiwan, “then it’s a matter of how much leakage you want in your house.”

Dale Fisher, a professor in infectious diseases at the National University of Singapore, contrasted Taiwan’s tight border policies with Singapore’s more “nimble” approach. The city-state lifted restrictions on travelers from Taiwan, but Taiwan did not reciprocate.

“We think that even if a traveler brought it in, we think there’s a good chance it wouldn’t spread anyway,” Fisher said. “If you’ve got no faith in your system, then that would make you keep the borders harder.”

The real test for Taiwan, he said, is if the vaccines do not end up offering long-lasting immunity and the world needs to live with COVID-19 longer. How well would Taiwan’s people bear being sealed off from the wider world for another year? Another five years?

“This is why we’d say close your borders if you just want to buy time to get yourself organized,” Fisher said. “But don’t think of it as a strategy.”

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