How Taiwan and Singapore managed to contain COVID-19, while letting normal life go on

By | March 21, 2020

Sandra Johnson’s husband had already left for work by the time she talked to the National Post Thursday — early Friday morning where she lives in Singapore.

His office was open, and the expat from Mississauga, Ont., was herself planning to visit a nearby mall later. She had gone to the chiropractor the day before.

The city-state of six million is an eastern Asian transportation hub and for a few days had the world’s second-highest number of COVID-19 cases. But its total stood at a modest 345 Friday, with no deaths.

And as Canadians hunker down in their homes or go on panic-buying sprees at the local grocery, life in Singapore motors on more or less as usual.

“I haven’t felt that I’ve been inconvenienced,” said Johnson, 51, who’s lived in Singapore since 1997. “Shops and restaurants are open … I’m able to go outside, I’m able to live my live pretty much normally right now.”

Sandra Johnson, a Canadian expat from Mississauga, Ont., says her life in Singapore has gone on more or less normally because of tough measures taken there to control the COVID-19 epidemic. Singapore and Taiwan are seen as models of how to address the coronavirus crisis without massive economic disruption. Handout

It’s not that residents there are acting recklessly in the face of the pandemic. On the contrary.

Like Taiwan, another Asian country closely linked to the coronavirus’ Chinese epicenter, Singapore has taken aggressive and innovative measures to keep the disease under control. Taiwan, which had 2.7 million visitors from China in 2019, had just 135 cases and two deaths as of Friday, versus Canada’s 846 cases and 10 deaths.

Perhaps as importantly, they have avoided the kind of mass social disruption that has wreaked havoc on the economy here. Schools, workplaces, stores and restaurants all remain open, though restrictions have slowly tightened in recent days.

In other words, they seem to have found the sweet spot between a laissez-fair “it’s just like the flu” reaction, and imposition of economically devastating lockdowns.

Commuters pack a metro train in downtownTaipei, Taiwan on March 18, 2020 in Taipei, Taiwan. Paula Bronstein/Getty Images

Both nations have concentrated on strictly isolating people who have or might have COVID-19, tightly controlling international travel and zealously pursuing those who had contact with the infected.

Singapore has deployed police officers as sleuths to track down contacts and used government-issued cellphones to keep tabs on those in quarantine.

Taiwan merged citizens’ recent international travel history with their digital health-insurance files and let doctors and pharmacists access it all, while levying stiff fines for quarantine violators.

And yet, “relative normalcy of day-to-day life has been maintained,” said a recent journal paper by three Singapore doctors.

The temperature screening station at a mall near Canadian Sandra Johnson’s home, part of Singapore’s extensive efforts to contain the COVID-19 virus. Supplied

Regina native Ben Beingessner said the 4,000-student Singapore American School, where he’s a vice principal, has taken steps to avoid crowding, but otherwise little has changed.

“It’s just hard for people watching Canadians not take things seriously, knowing that in Singapore they took it very seriously from the start and therefore have the outbreak under control,” he said by email.

Interestingly, both Singapore and Taiwan share a grim past with Canada that has coloured their response. Like Toronto, they suffered major SARS outbreaks in 2003, then worked to ensure they would not be hit as seriously by an infectious marauder again.

Although this country also tried to learn from SARS — creating the Public Health Agency of Canada in part to oversee such crises — its COVID-19 response has seemed more tentative — and less effective.

I’m able to go outside, I’m able to live my live pretty much normally

Canada should look to Taiwan and Singapore for guidance, says Dr. Jeff Kwong, a Toronto family physician and public-health professor at the University of Toronto.

“It’s not too late to implement some of these things,” he said. “This is going to be going on for months … There’s always value from learning from others who’ve had success.”

Kwong does see possible barriers to Canada adopting a similar approach, like chronic under-funding of public health here and a populace less at ease with government control than some east-Asian societies.

“I can say this because I’m (ethnic) Asian but they’re generally pretty obedient people,” he said. “I find that in a lot of Western countries there’s this philosophy of individualism.”

Government Technology Agency (GovTech) staff demonstrate Singapore’s new contact-tracing smarthphone app, as a preventive measure against the COVID-19 coronavirus in Singapore on March 20, 2020. Catherine Lai/AFP via Getty Images

Another key difference is more evident. Taiwan and Singapore have unitary governments that manage health care for everyone. Canada, with its federal system, essentially has 13 separate health jurisdictions, each delivering slightly different responses to the pandemic.

But Dr. Jason Wang, a Stanford University professor who published a recent paper on Taiwan’s COVID-19 successes, believes there is no real reason Western nations can’t take similar action.

“Just be alert and take early action to stop the spread of the virus,” he said via email.

Taiwan’s response in a sense began shortly after SARS, when it set up a national health command centre, which includes a central epidemic command centre.

A sign at a restaurant in Singapore explaining COVID-19 measures. Restaurants and stores have remained open in Singapore, which has been praised for its tough measures to contain the coronavirus. Supplied

As news of the new coronavirus emerged from Wuhan, it took extensive measures to identify cases imported into the country. Officials actually boarded planes from the Chinese city to assess passengers, ordering those with fever into isolation.

It merged health and travel databases — a seemingly complex task achieved within a day — then made that information widely available to help identify cases.

The government moved quickly to stockpile supplies, recruiting hundreds of reserve soldiers to work on production lines for surgical and N95 masks, so by late January there were 44 million and two million of each, respectively. Meanwhile, it restricted the retail price of masks to avoid profiteering, and eventually implemented a rationing system that allocated citizens two masks a week.

It also aggressively pursued quarantine violators, tracking down three Hong Kong visitors who had disappeared for a week when they should have been in isolation, fining them $ 3,000 each. And it published the names of three others who had not gone into quarantine as instructed.

A notice sent by text to Singapore residents details fines for violating at-home quarantines and how authorities will check up on those in quarantine. Supplied

Authorities also took a tough stance on misinformation, threatening $ 130,000 fines for spreading fake news, and interrogating suspects who allegedly started a rumour that increased mask production was creating a toilet-paper shortage.

Singapore followed up SARS by building a national centre for infectious disease, a dedicated 330-bed facility.

It started health and temperature screening of passengers from Wuhan on January 3, and of all incoming travellers by the end of that month. COVID-19 tests were rapidly increased to 2,200 a day.

As many as 50 police officers a day are assigned to track down contacts of infected people or find the source of a cluster of infections. “It’s like crime-solving,” Assistant police superintendent Johnny Lim told Singapore’s CNA broadcaster. “More or less, it’s similar kinds of skills required — piecing information from different people and different places together.”

A paper by Harvard public health experts recently estimated that Singapore finds three times as many infected people as the rest of the world.

Those in isolation at home can receive random phone calls that require them to take photographs of their surroundings to prove they’re at home, and texts they must respond to with GPS location information.

Fever screening is in place at malls, office buildings, community centres and places of worship. Johnson said she was given a yellow sticker to wear to show she’d passed the temperature assessment at her chiropractor’s office Thursday.

“I’m not kidding when I say that everywhere you go, your temperature is taken,” she said.

Kwong said Canada should especially look at making at-home quarantine clearly mandatory. “Canadians are very nice and we assume that everybody will follow the rules … (But) we might have been too lax.”

In Singapore they took it very seriously from the start and therefore have the outbreak under control

Meanwhile, even those applauding the two Asian countries’ response have worries.

Both places have seen continued new cases in recent days, chiefly imported from outside. And, Wang notes in his paper about Taiwan, “whether the intensive nature of these polices can be maintained until the end of the epidemic and continue to be well received by the public is unclear.”

For Johnson, though, the Singapore government’s actions have only instilled confidence that authorities are on top of the situation.

“I’m normally a very pessimistic person by nature. But, strangely at this time, I’m very positive,” she says. “I feel safe here.”

Health – National Post