Taiwan Vows to Stick to Covid-19 Limits

TAIPEI, Taiwan — 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 ball games, attended cello 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 underway.

The government is not likely to budge on those policies until there are vaccines that are a proven, lasting weapon against the virus, Mr. 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.

“It’s remarkable that Taiwan has held the line for so long,” Dr. 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 Mr. 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, Mr. 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 Mr. Chen’s telling, his decisions since the outbreak started have upset certain 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,” Mr. 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,” Mr. 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.

It is unclear how much of a gamble this approach has involved. A study published 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 Dr. 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 recently 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,” Dr. 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 for 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,” Dr. Fisher said. “But don’t think of it as a strategy.”

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