The pandemic deciphered
Before looking at the differences in corona infections and deaths, it is important to make sense of the characteristics of the different countries. The Netherlands and Singapore are both relatively small in size and have a higher standard of living compared to South Korea and Taiwan. The island of Taiwan is the least prosperous country and has close economic ties with China.
Table 1: Characteristics of the Netherlands, South Korea, Taiwan and Singapore
If we look at the development of the coronavirus in South Korea, Taiwan, Singapore and the Netherlands, a number of things stand out. Looking at the number of confirmed coronas infections, an exponential increase can be seen in the Netherlands, while Singapore and Taiwan hardly show any increase, see figure. 1. South Korea has seen a rapid increase, but this seems to be stabilising. Furthermore, we see that the daily death rate in the Netherlands is many times higher than in South Korea, Taiwan and Singapore, see figure 2. Differences may of course partly be caused by the quality and reliability of the data used. Consider, for example, the difference in testing capacity per country. Nevertheless, these figures raise questions about the approach in these Asian countries. Why is the infection rate in Singapore and Taiwan so low? And how come South Korea seems to be able to control the number of infections? And how come the number of deaths in South Korea, Taiwan and Singapore is so low? To answer these questions, we conducted a detailed analysis of the measures taken in South Korea, Taiwan and Singapore to combat the corona crisis.
How come the number of deaths in South Korea, Taiwan and Singapore is so low?
Figure 1: Number of confirmed corona infections per day
Figure 2: Number of confirmed corona deaths per day
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How South Korea keeps a grip on the corona pandemic
South Korea’s current approach has relied primarily on lessons learned from the 2015 MERS outbreak. At the time, the country had insufficient testing capacity, which meant that the necessary measures could not be deployed with sufficient specificity. The problem we are currently facing in the Netherlands and other European countries. South Korea has learned its lessons from the 2015 MERS outbreak and implemented new legislation allowing for accelerated entry of virus testing kits into the market. As a result, South Korea currently has a large testing capacity and is even the world champion in coronal testing. In total, over 286,716 coronagraphs have been taken since March 17. The testing capacity was also deployed at an early stage: namely, as soon as the first COVID-19 infections became known in China. As a result, South Korea has been one of the few countries able to take early action.
In addition, the new legislation also gave the government the opportunity to combine data data, making it possible to track contacts and patients’ whereabouts. As a result, South Korea is now one of the few countries able to map infected individuals and their contacts in great detail. Non-infected people are alerted via text message alerts if they are within 100 metres of an infected person. This data-driven approach seems to be particularly effective in South Korea. For example, it has helped track down about 60% of the members of the Shincheonji religious sect who refused to be tested. Figure 3 shows the main measures for combating the corona crisis in South Korea.
Figure 3: Overview of corona measures in South Korea
How Taiwan keeps a grip on the corona pandemic
Taiwan is one of the few countries that seems to be able to largely control the COVID-19 pandemic. This is even more special because Taiwan is geographically and economically very closely linked to China where the corona pandemic started. Like South Korea, Taiwan has learned its lessons from a previous virus outbreak; the SARS outbreak in 2003. A major explanation for the success in Taiwan is the work of the National Health Command Center, which was established as a result of the SARS outbreak in 2003. The command center was activated immediately at the first sign of the coronavirus. This allowed Taiwan to quickly start testing people. What is further noteworthy about Taiwan’s corona measures, as far as we know, is that they immediately introduced the necessary border restrictions. For example, travellers from high-risk areas are checked at the airport and put into self-isolation for 14 days. It should, however, be noted that Taiwan is an island and is therefore better able than other countries to control its borders. Where South Korea is world champion in coronation testing, Taiwan seems to be world champion in the production and use of mouth masks. As in other Asian countries, cultural acceptance for the use of mouth masks is high in Taiwan. In addition, Taiwan, like South Korea, combines health data and geographic data to track suspicious cases. Partly as a result of the SARS outbreak in 2003, privacy is less important among citizens and they are happy with the measures taken by the government. Based on the emergency authority, the government could quickly roll out the tracking policy broadly and identify high-risk individuals based on medical and travel data.
Figure 4: Overview of corona measures in Taiwan
How Singapore keeps a grip on the corona pandemic
The SARS outbreak in 2003 also allowed Singapore to prepare for the current corona pandemic. Like South Korea and Taiwan, Singapore has learned its lessons from the SARS outbreak and introduced new legislation to be prepared for a pandemic. Following the first reports of the coronavirus in December 2019 in China, Singapore has begun preparations. Features of the corona measures in Singapore include contact detection, screening and temperatures of incoming travellers and temperatures of staff and medical personnel. Another striking aspect of Singapore’s strategy is that people who test positive for corona are quarantined in separate hospitals. In addition, as in South Korea and Taiwan, a tracking system is used to map all contact moments of an infected person with others. These people are being tracked down and tested for the coronavirus as well. When someone tests positive for the coronavirus, they are required to be placed in home quarantine. In addition, people are monitored via their smartphones whether they are actually at home. There are substantial fines for any violations.
Figure 5: Overview of corona measures Singapore
What Asian countries don’t do
In comparison with the Netherlands, it is also interesting to look at the measures that these Asian countries have not taken. Schools have not closed on a large scale in all three countries. Schools in Taiwan must close if there are two confirmed corona infections. In addition, schools are encouraged to teach online as much as possible. Businesses are also still open in all three countries. In Taiwan, employers are required to allow employees to work from home for two weeks when someone tests positive. Also in South Korea, companies are encouraged to work from home as much as possible. Furthermore, in South Korea, subsidies are given to companies that voluntarily cease to provide their services temporarily. At the time of writing, we were unable to find any information on the situation in Singapore in this regard.
The 9 lessons from South Korea, Taiwan and Singapore
The measures in South Korea, Taiwan and Singapore seem to be effective in combating the spread of the coronavirus. The lessons below summarize what the Netherlands can learn from this.
1. A good roadmap by SARS & MERS
South Korea, Taiwan and Singapore were prepared for the current coronavirus by their experiences with the SARS and MERS epidemics. All three countries have learned lessons and managed to translate these into new legislation, effective education and prevention. Combined with the centralist approach and rapid implementation of measures, it makes the current corona approach of these Asian countries very effective. The threat of the COVID-19 virus and the importance of avoiding contact is also deeply ingrained in society through the traces left by SARS and MERS. Combined with effective communication campaigns, this ensures that people in South Korea, Taiwan and Singapore also adhere strictly to the measures.
2. React quickly and resolutely
It is well known that rapid response is essential to prevent further spread at an early stage. The speed with which the Taiwanese government responded to the first reports of COVID-19 in China is particularly noteworthy in this regard. All three Asian countries work with a centrally led task force or command center to quickly and proactively execute the necessary measures. Speed of action seems to be one of the main explanations for the growth of infections in Taiwan and Singapore. In South Korea, this has contributed to a relatively rapid flattening of the growth curve.
3. Border checks and identifications
Another striking aspect of the policy in Taiwan and South Korea is the early implementation of travel and border restrictions combined with the identification and tracing of infected persons. Research shows that such travel and border restrictions can delay the spread of the coronavirus by approximately 2 to 3 weeks. In particular, the border restrictions introduced in Taiwan appear for the time being to be particularly effective, partly because, as an island, it has managed to isolate its entire population. Also with regard to travel and border restrictions, early deployment of measures is essential to slow down the spread of the virus. For example, travelers in South Korea are required to monitor themselves for 14 days using a self-diagnostic app. The combination of border restrictions, tracking systems and mandatory quarantine are important measures to curb the spread of the coronavirus. In this way, Asian countries bought time to prevent further spread.
4. Large-scale and proactive testing
In particular, South Korea’s strategy is based on early and large-scale testing for the COVID-19 virus. This makes it possible to use other measures much more specifically, such as compulsory home quarantine and tracing contacts and places of residence of patients. Since the 2015 MERS outbreak, legislation has been in place in South Korea to accelerate the development and permitting of testing kits. This legislation allowed pharmaceutical companies to get new test methods approved on the market within weeks. A process that would normally take 8 to 18 months. In this way, South Korea was able to increase its testing capacity in no time. Residents can go to special drive-in testing centers where anyone can get tested for about $134.
5. Tracing and isolating on the basis of data (digital tracking techniques)
Taiwan, South Korea and Singapore are all making clever use of new technologies to track movements of confirmed COVID-19 patients. For example, credit card data, camera images and GPS data from the smartphone are combined to trace contacts and offer them free tests. In South Korea, the government has made available a corona map where people can see the locations where COVID-19 positive tested people have been in recent days. There are also SMS alerts that warn people if they are within 100 metres of an infected person. In South Korea, Taiwan and Singapore, these digital tracking technologies allow for individual-level risk mapping and sharing with its citizens. Due to the experiences with the SARS and MERS epidemics in these countries, issues concerning privacy play less of a role among the population. The ‘big brother is watching you‘ by the government seems to be accepted by the population.
6. Strict quarantine measures
In South Korea, Taiwan and Singapore, quarantine measures are in place, which are also strictly controlled by the government. For example, people in South Korea who have been in contact with infected persons are required to go into home quarantine for 14 days. In all three countries, people diagnosed with COVID-19 are also required to undergo home quarantine, which is then monitored via their mobile data and random checks as well. Violation of such quarantine measures is punishable by a substantial fine in all three countries. In addition, in South Korea and Singapore, infected patients are also placed in specially isolated hospitals where no other patients are admitted.
7. Mouth Masks
Research shows that wearing mouth masks can inhibit the spread of viruses. The use of mouth masks in daily life is more culturally accepted in Asian countries. And the widespread use of mouth masks on the streets is therefore encouraged by the government as one of the important pillars in the fight against the coronavirus.
8. Social distance
In both South Korea, Taiwan and Singapore, social distancing campaigns were introduced at the first signs of the COVID-19 outbreak. A few days later, mass gatherings were banned and fines imposed for gathering.
9. Financial incentives: the carrot and the stick
Finally, it is striking that in all three Asian countries financial incentives are used to make people comply with the corona measures. For example, in South Korea, subsidies are used to encourage people to work from home. And in all three countries there are substantial fines for violating measures.
Are we taking the lessons from Asia seriously?
If we compare the lessons from South Korea, Taiwan and Singapore with the Dutch approach, it is striking that we do not apply most of the measures from the Asian countries, see table 2. This is surprising for those measures that are not dependent on current availability such as testing and/or mouth masks. Tracing and isolating infected and/or suspect persons on the basis of data is also perfectly possible in the Dutch setting. Any resulting privacy discussion is of minor importance given the current social and economic impact of the corona crisis and current measures. An important cause of the differences in measures seems to be the lack of knowledge and experience with similar outbreaks in the Netherlands and Europe. It is therefore surprising, to say the least, that the RIVM policy documents barely refer to the studies from South Korea, Taiwan and Singapore regarding their approach to the corona crisis. Based on current insights, there is a wealth of information and experience in these countries that can be of benefit to the Netherlands and other European countries.
An important reason for the differences in measures is the lack of knowledge and experience with similar outbreaks in the Netherlands and Europe.
Table 2: Comparison of corona measures in South Korea, Taiwan, Singapore and the Netherlands
It is short-sighted to attribute the successful control of the coronavirus in South Korea, Taiwan and Singapore to the centralist or so-called collectivist nature of the people in these Asian countries. The corona approach is effective precisely because of the combination of interventions. We in the Netherlands can learn from this, especially since these countries have not used total lockdown or other totalitarian measures. The predicate ‘intelligent lockdown‘ for the current Dutch approach therefore seems misplaced. Whether the corona measures from South Korea, Taiwan and Singapore are still applicable to the Netherlands is doubtful. But there is no doubt that we need to look at it seriously and without cultural bias. The current numbers don’t lie and seem to tell us that life-saving and world-changing innovation is currently coming out of Asia.
The predicate ‘intelligent lockdown’ for the current Dutch approach therefore seems misplaced.
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