The 9 lessons from South Korea, Taiwan and Singapore in combating the corona (COVID-19) outbreak
Based on recent figures, the coronavirus seems to be successfully contained mainly in South Korea, Taiwan and Singapore. None of these countries have implemented a total lock-down,
but they have been very successful in controlling the number of coronavirus infections and deaths. Given this remarkable success, it is important to understand what these Asian countries do differently from the rest of the world. In this blog, we will outline the fundamentals of the Asian government responses to control the coronavirus outbreak. These insights are essential to learn how to tackle the coronavirus (COVID-19) outbreak or prevent a possible second outbreak in the Netherlands.
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The pandemic decoded
Before looking at the differences in confirmed corona cases and deaths, it is important to clarify 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.
Chart 1: Characteristics of the Netherlands, South Korea, Taiwan and Singapore
There are a number of things that stand out when we look at the outbreak of the coronavirus in South Korea, Taiwan, Singapore and the Netherlands. Looking at the number of confirmed cases of coronavirus infections, we see an exponential increase in the Netherlands while Singapore and Taiwan hardly show any increase, see figure 1. There has been a rapid increase in South Korea, but this seems to be stabilising. Furthermore, we see that the daily mortality rate in the Netherlands is many times higher than in South Korea, Taiwan and Singapore, see figure 2. Differences could be caused by the quality and reliability of the data used. Think, for example, of the difference in testing capacity per country. Nevertheless, these figures raise questions about the approach in these Asian countries. Why is the number of infections in Singapore and Taiwan so low? And how is it that South Korea seems to be able to control the number of infections? And why is the number of deaths in South Korea, Taiwan and Singapore so low? In order to answer these questions, we have made a detailed analysis of the policy responses taken in South Korea, Taiwan and Singapore to combat the corona outbreak.
Why is the number of deaths in South Korea, Taiwan and Singapore so low?
Figure 1: Daily confirmed COVID-19 cases (up to 06-04-2020)
Figure 2: Daily confirmed COVID-19 deaths (up to 06-04-2020)
How South Korea is tackling the corona pandemic
South Korea has based its current approach primarily on the lessons learned from the MERS outbreak in 2015. At that time, the country had too little testing capacity, which meant that necessary policy responses could not be executed specifically enough. This is the exact problem we are currently facing in the Netherlands and other European countries as well. South Korea has learned its lessons from the 2015 MERS outbreak and implemented new legislation, allowing accelerated virus test kits to be admitted to the market. As a result, South Korea currently has a large testing capacity and even is the global corona testing champion. A total of more than 286,716 corona tests have been taken since 17 March. The test capacity was also deployed at an early stage: as soon as the first COVID-19 infections in China got out. As a result, South Korea proved to be one of the few countries able to intervene at an early stage.
In addition, the new legislation also enabled the government to combine data, thereby allowing contacts and the whereabouts of patients to be traced. As a result, South Korea is now one of the few countries able to identify infected persons and their contacts in great detail. Non-infected people are alerted via SMS 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 to trace about 60% of members of the Shincheonji religious sect who refused to be tested. Figure 3 shows the main measures taken to combat the corona crisis in South Korea.
Figure 3: Overview of policy responses in South Korea
How Taiwan is tackling the corona pandemic
Taiwan is one of the few countries that seem to be able to control the COVID-19 pandemic. This is even more remarkable considering the fact that Taiwan is geographically and economically closely linked to China, where the corona pandemic started. Like South Korea, Taiwan has learned its lessons from an earlier virus outbreak; the SARS outbreak in 2003. An important explanation for Taiwan’s success is the work of the National Health Command Centre, which was established as a result of the SARS outbreak in 2003. The command centre was activated immediately at the first signs of the coronavirus. This allowed Taiwan to quickly start testing people. What is more remarkable about Taiwan’s coronavirus measures, as far as we know, is that they immediately implemented the necessary border restrictions. Travelers from high-risk areas are checked at the airport and put into self-isolation for 14 days. It should be noted that Taiwan is an island and therefore better able than other countries to control its borders. Where South Korea is world champion of corona testing, Taiwan seems to be world champion of production and use of face masks. As in other Asian countries, the cultural acceptance for using face masks in Taiwan is high. In addition, Taiwan, like South Korea, combines health data and geographical data to be able to trace suspicious cases. Partly as a result of the SARS outbreak in 2003, privacy among citizens plays less of a role here and people are happy with the measures taken by the government. On the basis of the emergency authority, the government was able to quickly roll out the tracking policy on a broad scale and identify high-risk people based on medical and travel data.
Figure 4: Overview of policy responses in Taiwan
How Singapore is tackling the corona pandemic
The SARS outbreak in 2003 also enabled Singapore to prepare for the current corona pandemic. As in South Korea and Taiwan, Singapore has learned its lessons from the SARS outbreak and introduced new legislation in order to be prepared for a pandemic. Singapore started preparations after the first reports of the coronavirus in China in December 2019. Features of the coronavirus measures in Singapore include contact detection, screening and temperatures of incoming travellers and temperatures of employees and medical staff. 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 identify all contact moments of an infected person with others. These people are traced and also tested for the corona virus. When someone tests positive for the coronavirus, it is mandatory to be home quarantined. In addition, people are monitored via their smartphone to see whether they are actually at home. Any violations are subject to hefty fines.
Figure 5: Overview of policy responses in 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. Generally speaking, schools are not closed 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. Companies are also still open in all three countries. In Taiwan, employers are required to have employees work at home for two weeks if someone has tested positive. In South Korea, companies are encouraged to work from home as much as possible as well. Furthermore, South Korea provides subsidies for companies that voluntarily temporarily discontinue their services. At the time of writing we could not find any information about the situation in Singapore in this area.
The 9 lessons from South Korea, Taiwan and Singapore
The policy responses taken in South Korea, Taiwan and Singapore appear to effectively control the spread of the coronavirus. The lessons below summarise what the Netherlands can learn from this.
1. A good roadmap because of SARS & MERS
South Korea, Taiwan and Singapore were prepared for the current coronavirus as a result of 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. The combination of a centralist approach and rapid execution of policy responses makes the current corona approach of these Asian countries very effective. The threat of the COVID-19 virus and the importance of avoiding contacts are also deeply embedded in society, following the traces left by SARS and MERS outbreaks. In combination with effective communication campaigns, this means that people in South Korea, Taiwan and Singapore strictly adhere to the policy interventions taken.
2. React quickly and decisively
It is well known that a quick reaction is essential to prevent further spread at an early stage. In this respect, the speed with which the Taiwanese government reacted to the first reports of COVID-19 in China is particularly striking. All three Asian countries work with a centrally managed task force or command centre in order to be able to implement the necessary interventions quickly and proactively. Speed of action seems to be one of the most important explanations for the growth in the number of infections in Taiwan and Singapore. In South Korea, this has contributed to a relatively rapid flattening of the growth curve.
3. Border controls and identifications
Another notable aspect of policy in Taiwan and South Korea is the early introduction of travel and border restrictions combined with the identification and tracking 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 to be particularly effective for the time being, partly because as an island it has been able to isolate virtually its entire population. In the case of travel and border restrictions, early deployment of restrictions is essential to slow down the spread of the virus. For example, travellers in South Korea are obliged to monitor themselves for 14 days using a self-diagnosis app. The combination of border restrictions, tracking systems and mandatory quarantine are important measures to inhibit the spread of the coronavirus. In this way, Asian countries have bought time to prevent further spread.
4. Large-scale 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 execute policy responses much more specifically, such as compulsory home quarantine and tracing contacts and whereabouts of patients. Since the MERS outbreak in 2015, legislation has been in place in South Korea for the accelerated development and admission of test kits. This legislation enabled pharmaceutical companies to get new test methods approved on the market within a few weeks. A process that would normally take 8 to 18 months. As a result, South Korea was able to increase test capacity quickly. Residents can visit special drive-in test centres where anyone can get themselves tested for around 134 dollars.
5. Track, trace and isolate using on data
Taiwan, South Korea and Singapore are smartly using 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 track contacts and offer these people free tests. The government has made a corona mapavailable in South Korea, where people can see the locations where people have been tested COVID-19 positive in recent days. In addition, there are SMS alerts that warn people if they are within 100 metres of an infected person. These digital tracking techniques allow South Korea, Taiwan and Singapore to identify and share the risks with their citizens on an individual level. Due to the experiences with the SARS and MERS epidemics in these countries, privacy issues play a lesser role amongst the population. The ‘big brother is watching you’ by the government seems to be accepted by the citizens.
6. Strict quarantine measures
Quarantine measures have been put in place in South Korea, Taiwan and Singapore and are also strictly enforced by the government. For example, people in South Korea who have been in contact with infected persons are obliged to go into home quarantine for 14 days. In all three countries, people who have been diagnosed with COVID-19 are also required to home quarantine, which is then monitored via their mobile data and random checks. Violation of these quarantine measures is subject to a hefty fine in all three countries. In addition, in South Korea and Singapore infected patients are housed in specially isolated hospitals where no other patients are admitted.
7. Face masks
Research shows that wearing face masks can inhibit the spread of viruses. The use of face masks in everyday life is more culturally accepted in Asian countries. And the widespread use of face masks on the streets is encouraged by the government as one of the important pillars in the fight against the coronavirus.
8. Social distance
South Korea, Taiwan and Singapore started to introduce social distancing campaigns at the first signs of the COVID-19 outbreak. A few days later mass gatherings were banned, and fines were imposed for gathering.
9. Financial incentives: The carrot and the stick
Finally, it is notable that in all three Asian countries financial incentives are being used to make people comply with the corona measures. In South Korea, for example, subsidies are used to encourage people to work from home. And in all three countries there are hefty fines for violating obligated quarantine.
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 particularly striking that we do not apply most of the policy responses from the Asian countries, see table 2. This is remarkable for the measures that do not depend on current availability such as tests and/or face masks. Tracing and isolating infected and/or suspected persons on the basis of data is also perfectly possible in the Dutch situation. In view of the current social and economic impact of the corona crisis, any resulting privacy discussion is of minor importance. An important cause of the differences in policy responses seems to be the lack of knowledge and experience with similar outbreaks in the Netherlands and Europe. It is therefore astonishing, to put it mildly, that RIVM’s policy documents hardly refer to the studies from South Korea, Taiwan and Singapore with regard to their approach to the corona outbreak. On the basis of current insights, there is a wealth of information and experience from precisely these countries, which could be of more benefit to the Netherlands and other European countries.
An important cause of the differences in policy responses seems to be the lack of knowledge and experience with similar outbreaks in the Netherlands and Europe.
Table 2: Comparison of policy responses taken in South Korea, Taiwan, Singapore and the Netherlands
It is short-sighted to attribute the successful fight against the corona outbreak in South Korea, Taiwan and Singapore to the centralist or so-called collectivist nature of these Asian countries. On the contrary, the policy responses are effective through the combination of interventions. We can learn from this in the Netherlands and Europe, especially since these countries have not deployed total lockdown or other totalitarian responses. The designation ‘Intelligent lockdown’ for the current Dutch approach therefore seems misplaced. Whether the policy responses from South Korea, Taiwan and Singapore are still applicable to the European or Dutch context are doubtful. But it is clear that we need to look at them seriously and without cultural bias. The current figures do not lie and seem to tell us that lifesaving and world-changing innovation currently originates from Asia.
The designation ‘Intelligent lockdown’ for the current Dutch approach therefore seems misplaced.
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