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March 19, 2020

Why COVID-19 case counts are so low in Singapore, Hong Kong, and Taiwan

Daily Briefing

    As the new coronavirus spreads through the United States and other Western counties, Singapore, Hong Kong, and Taiwan have been able to slow the virus thanks to their fast action, use of data, and widespread testing, Hannah Beech reports for the New York Times.

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    About the pandemic

    Reports of COVID-19, the disease caused by the new coronavirus, first surfaced in early December 2019 in Wuhan, China. While the number of new cases of COVID-19 reported in China has been dropping, newly reported cases of the disease have spiked in other countries, with COVID-19 reaching global pandemic status.

    As of Thursday, there have been 227,743 confirmed cases of COVID-19 worldwide and 9,318 deaths.

    How Singapore responded to the virus

    At the beginning of the outbreak in China, Singapore was at high risk for having an influx of travelers from mainland China because of the Lunar New Year. But Singapore's response appears to have largely stemmed off the viruses spread—at least on the scale seen in other countries. As of Thursday, Singapore had just 313 cases and hasn't had a single death, according to Beech.

    A major reason why the country has been able to handle the virus has been early intervention and transparency on the part of the Singapore government, Beech reports.

    Once rumors started of an unknown respiratory virus circulating through China, Singapore acted immediately, becoming one of the first countries to ban any travelers from mainland China in late January, even though the World Health Organization advised against doing so.

    Soon after, Singapore developed the ability to test over 2,000 people a day for the new coronavirus.

    The country has also implemented mandatory quarantines to stop further spread of the virus. Those who break mandatory quarantine could see criminal charges, Beech reports.

    A number of COVID-19 cases that occurred early in Singapore were mild cases and otherwise would not have been diagnosed, but regardless, officials in Singapore searched to find them to stop the possibility that the disease could spread unchecked.

    Vernon Lee, director of the communicable diseases division at Singapore's Ministry of Health, said, "We want to stay one or two steps ahead of the virus. If you chase the virus, you will always be behind the curve."

    How Hong Kong responded to the virus

    Meanwhile, the population of Hong Kong seemed immediately ready to implement disease prevention measures, having learned its lessons from the large death toll it suffered after the 2003 SARS outbreak in which almost 300 people died, Beech reports. Soon after people caught news of the new coronavirus, they were using hand sanitizer and malls and offices had set up thermal scanners, Beech reports.

    As of Thursday, Hong Kong had 208 confirmed cases and four deaths.

    Kwok Ka-ki, a lawmaker and doctor in Hong Kong, said, "The most important thing is that Hong Kong people have deep memories of the SARS outbreak. Every citizen did their part, including wearing masks and washing their hands and taking necessary precautions, such as avoiding crowded places and gatherings."

    Eventually the government of Hong Kong implemented tighter border controls and ordered civil servants to telework, which led other companies to do the same, Beech reports. Hong Kong also closed schools in January through at least the end of April.

    How Taiwan responded to the virus

    Taiwan also acted quickly, utilizing its national health command center that was set up after the SARS outbreak to begin screening passengers flying in from Wuhan, before the Chinese government had admitted the virus spread between humans. As of Thursday, Taiwan had 108 confirmed cases and one death.

    Joseph Wu, Taiwan's foreign minister said, "Having learned our lesson before from SARS, as soon as the outbreak began, we adopted a whole-of-government approach."

    By January's end, the country suspended all flights from China and began integrating its health insurance database with information from immigration and customs to begin tracking potential cases of COVID-19, according to Jason Wang, director of the Center for Policy, Outcomes, and Prevention at Stanford University.

    Why it might be too late for the West to implement these lessons

    It may be difficult for the United States and Europe to implement these exact lessons learned from Singapore, Hong Kong, and Taiwan, Beech reports.

    The monitoring systems developed by these countries had been in place for years, ever since the SARS outbreak.

    There's also the question of scale—how to implement a model used by smaller Asian centers into larger Western countries. Citizen of Western countries may also balk at the idea of the government using closed-circuit television cameras or immigration records to monitor coronavirus cases, Beech reports.

    Lalitha Kurupatham, deputy director of the communicable diseases division in Singapore, said, "Maybe it's because of our Asian context, but our community is sort of primed for this. We will keep fighting, because isolation and quarantine work" (Beech, New York Times, 3/17; Johns Hopkins tracker, accessed 3/19).

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