For the first time since the outbreak began, the World Health Organization has declared the novel coronavirus a pandemic due to its alarming rate of global spread. But as the U.S. fights to contain the disease, Taiwan is setting an example of how to effectively curtail its spread.
Taiwan, an island of 23 million people just off the coast of China, was predicted to have the second-highest "importation risk" of any country. With over 850,000 of its citizens residing and working in mainland China, experts expected Taiwan to be heavily impacted by COVID-19, especially given the timing of the outbreak coinciding with Chinese New Year, one of the busiest travel times of the year.
However, Taiwan has only had 49 confirmed cases and one death, an astonishingly low number considering its proximity to China and frequency of flights between the two countries. It ranks below far-flung countries, like Finland, Iceland and Brazil in terms of cases.
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China's death toll was over 3,100 as of Thursday, with nearby countries, like South Korea, at over 7,800 confirmed cases and at least 66 deaths, and Japan, with 639 cases and at least 16 deaths, according to Johns Hopkins, which is tracking the disease's spread.
Taiwan's success has been largely credited to its early mobilization of specific strategies and plans implemented during the severe acute respiratory syndrome, or SARS, outbreak in 2003, according to an analysis by Stanford Health Policy.
Jason Wang, a pediatrician and director of the Center for Policy, Outcomes and Prevention at Stanford University, started collecting his own data back in January, when he first heard of the coronavirus outbreak. Initially, Wang started the list simply to determine whether it was safe to travel to Taiwan in February to teach his course at the New School for Leadership in Healthcare in Taipei.
"I tried to understand the government responses if they are effective and at one point my colleague, Bob Brook, was listening to this story and said, 'This is kind of interesting, you can kind of make sense of what they're doing; let's put together a list to help other people and other countries,'" Wang told ABC News.
After the SARS outbreak, Taiwan established the National Health Command Center with a branch that specifically focuses on large outbreak responses and acts as a central command post for direct, transparent communications.
As soon as news about an unknown virus came out of Wuhan, China, on Dec. 31, officials in Taiwan began restricting flights to and from the region and began to screen passengers.
It expanded its assessment criteria a week after and began quarantining anyone showing symptoms.
Centralized command center
Taiwan officially activated its Central Epidemic Command Center, a branch within the NHCC, by Jan. 20, which allowed coordination with various ministries to enact policies and strategies already in place.
For the past two months, the CECC, led by the minister of health, has swiftly implemented 124 actions, said Wang. They did so "in a span of five weeks."
"That's three or four actions every week; some of this requires cross-agencies cooperation," Wang said.
Actions included border control from the air and sea, identifying cases, quarantine of suspicious cases, managing resource allocation, daily press briefings, identifying false information and formulating economic policies to relieve families and businesses.
Big data and technology
A lot of the government's actions were made possible by Taiwan's integration of big data and technology.
In a single day, Taiwan's government was able to combine data from the National Health Insurance Administration and Immigration Agency to identify patients' 14-day travel history. In addition, with data from citizens' household registration systems and foreigners' entry cards, individuals at high risk were identified, self-quarantined and monitored through their cellphones.
Low-risk passengers could scan a QR code prior to departure or arrival to complete a health declaration form allowing expedited immigration clearance.
On Feb. 18, the government granted all hospitals, clinics and pharmacies access to patients' travel histories.
Audrey Tang, Taiwan's digital minister and the youngest minister without portfolio to hold office, utilized artificial intelligence to harness data and created real-time digital updates to alert citizens of risky areas to avoid and a live map of local supplies of face masks.
Taiwanese Vice President Chen Chien-Jen praised Tang in a Facebook post, calling her "not only a key figure in our national disease prevention efforts but also set an example of application of artificial intelligence in disease prevention."
Frequent, transparent communication
Beyond daily press briefings, top government health officials, including the minister of Health, the vice president and a prominent epidemiologist, regularly gave public service announcements about travel, personal hygiene recommendations and dangers of stockpiling masks -- all accessible online.
Both public and private sectors are cooperating with government recommendations, which has proved crucial in the nation's containment efforts. Virtually every mall, store, restaurant and offices offered hand sanitizers and screen people's temperature before entering the building.
In addition, the Ministry of Foreign Affairs has actively sought out and fought misinformation from both the news media and Chinese cyber attacks.
"The government stopped exporting and started producing," Wang said. The government began allocating funds and military personnel to expand its capacity of production.
By late January, Taiwan had a stockpile of 44 million surgical masks, 1.9 million N95 masks and 1,100 negative pressure isolation rooms.
Masks have always been considered courteous and are used regularly as a protective measure in Asian countries, like Taiwan. But during this public health emergency, demand for face masks has soared. In order to meet the growing demand, the government has taken over production. On Tuesday, President Tsai Ing Wen announced that they are now able to produce up to 10 million masks a day.
As Italy, Iran, France, Spain and the U.S. grapple with thousands of confirmed COVID-19 cases and rising death tolls, governments around the globe have been criticized for their delayed response.
With the stock market plunging, closures of schools, cancellation of all major events and health experts admitting the failing of our testing system, the U.S. is scrambling to get a handle on the worsening outbreak.
When asked if countries like the U.S., which has a population 13 times larger than Taiwan, can realistically implement similar protocols, Wang answered, "Of course."
"The U.S. has a lot of capacity, more power, it's whether we pull ourselves together with big tech companies, governors, federal agencies, to work together in the right direction," Wang told ABC News.
Taiwan learned from their mistakes during the 2003 SARS experience, Wang said, and put in place a public health emergency response mechanism that enabled experienced officials to quickly recognize the crisis at hand and respond with efficient, culturally sensitive policies that helped contain the spread and significantly minimize deaths.
"Taiwan's ability to contain the #COVID19 outbreak is a tribute to our unity & resilience. It also speaks to the collaboration between our government, people, & the many private businesses that have ramped up production to protect public health & make the impossible possible," Tsai said in a statement on Twitter.
Brook points out Taiwan's two-party system is just as divided as Democrats and Republicans.
"But they knew they had a crisis on their hands and they were able to act together, break down bureaucracy and work rapidly to get things done and that's the lesson," he said.