Abstract: While the spread of Covid-19 seems to slow down after months of global turmoil, numerous experts suspect the battle of Covid-19 has not settled yet as confirmed asymptomatic cases increasing and the pending pressure of resuming economic activities, which may expose fragile communities to the second wave of outbreak. Expecting lengthy combat to this treacherous disease, it is imperative to seek solutions keeping the balance between pandemic containment and social wellbeing. Taiwan, among a few nations, has controlled the Covid-19 outbreak and maintains a relatively stable society. This article aims to understand how Taiwan is coping with the Covid-19 global crisis and developing resilience through its social infrastructure services. By using the Covid-19 crisis management as a case study in Taiwan, this article analyses the ways of social infrastructure services, government intervention, grassroots public administration, private sector collaboration, industry flexibility, and social cohesion contributing to successful crisis management.
Keywords: Social Infrastructure Services, Crisis Management, Grassroots Public Administration, Social Innovation, Social Cohesion.
Introduction: While infections of Covid-19 are elevating exponentially in Europe and the U.S. after the outbreak of coronavirus pandemic and having over 6 million confirmed cases; Taiwan, the island of 23 million, garners global attention for its effective epidemic intervention despite its geographic proximity, economic tie, and frequent direct flights to mainland China. Based on the real-time world statistics- World meter . Taiwan has a relatively low rate of Covid-19 infection by May 20, 2020, as of 440 cases compared with the USA over 1,582,000, Spain near 280,000, and the UK approaching 250,000 cases. To tackle this global crisis, Taiwan took proactive measures from policymaking to implementation to contain community transmission and prevent the Covid-19 outspread. Seeking pertinent factors of Taiwan’s successful outbreak control in this global pandemic crisis, this article aims to identify key elements that attribute to effective containment, prevention of social panic, as well as the balance between quality of life and activity restriction.
Recognizing the Crisis and Precautious Action: Despite the diplomatic isolation and blocked outside of the World Health Organization (WHO) by China, Taiwan quickly took action to contain the spread of coronavirus at the early stage of the outbreak. Taiwan officials began to board and inspect passengers for fever or pneumonia symptoms on a direct flight from Wuhan on December 31, 2019. Right after the first confirmed case of the novel coronavirus, the border control and travel restrictions took place. The cross-sector coordination among multiple government agencies soon formed the disease battlefront in January 2020 (Two Experts from Taiwan visit Wuhan, 2020).
Such early alert and vigilant reaction to the coronavirus was due to a harsh lesson learned from the SARS epidemic in 2003. The arbitrary lockout approach in the Heping Hospital at Taipei City without appropriate measures caused 24 civilian deaths with one committed suicide within 97 citizen infections; and 7 medical staff deaths within 57 medical personnel infections (Chang, 2020). Although China was criticized for delays of reporting to the WHO on SARS, the inexperienced medicine personnel and lack of disease control specialty in the state level resulted in the high rate of casualty and marked the darkest era of Taiwan medicine history. Adopting the suggestions by 21 Centers for Disease Control and Prevention (CDC) experts from the US, the Taiwan government established the National Health Command Center (NHCC) in 2004 in response to public health emergencies (Chiang, 2020, para.18).
The skepticism with data from China (Yun, 2020) and crisis management experience learned from the last SARS epidemic (Piper, 2020) contribute to the effective measures in Taiwan in response to this global crisis. As soon as the Taiwanese health authorities recognized there were suspicious cases of a new type of virus spreading in China, the officials began to wonder whether it is SARS again (Piper, 2020). Dr. Chang-chuan Chan, dean of the College of Public Health at the National Taiwan University, considered the bitter experience from the SARS epidemic as a critical factor weighed inactions of the proactive measures. The Covid-19 testing capacity in Taiwan is also noted among other nations. Only a couple days after the release of the genetic sequence of the Covid-19 on January 11, the Testing and Vaccine Center at the Taiwan Centers for Disease Control (CDC) developed the instant diagnostic kit that is able to shorten one-day testing time to 4 hours (Chiang, 2020, para.7). Recently, the National Health Research Institutes (NHRI) announced the success of 15-minutes rapid test results for Covid-19 and prepared for mass production with diagnostic kit manufacturers . In addition to swift responses to the Covid-19 pandemic, the single-payer health care systems, sufficient medical infrastructure, and advanced technology are also crucial components helping to contain the outbreak (Yun, 2020).
Medicare-for-All, Taiwan single-payer health care system: Launched in 1995, the National Health Insurance (NHI) program, equivalent to the idea of Medicare-for-All is one of the most significant social programs ever undertaken in the history of Taiwan (Lu & Chiang, 2011). The NHI benefits are quite comprehensive: it ranges from dental care to hospital care; prescription drugs cover from Western medicine to traditional Chinese medicine; and provide various health services from preventive services to elderly home care (Wu et al, 2010). In addition to the comprehensive health care services, the low copays (range from 12-18 USD for doctor visiting), good accessibility (patients can see any doctor without a referral), nationwide research databank (open resources for research purpose, public health monitoring, and policy implementation evaluation), and up to 99% population coverage rate (Wu et al, 2010) all contribute to early infection cases diagnosis and proactive patients seeking-out measures. In this Covid-19 pandemic outbreak, Taiwan leveraged the NHI database and integrated it with the immigration and customs database to help case identification (Wang et al, 2020). During a clinic visit, doctors can more efficiently take necessary measures based on the patient’s travel history and clinical symptoms.
The health care infrastructure in Taiwan also plays an imperative role to control the situation. Negative pressure isolation rooms, which are used to contain airborne contaminants, are particularly critical in this Covid-19 crisis. In Taiwan, there are 1,100 negative pressure isolation rooms while Japan has 1870 rooms. Considering the population of two different regions, Taiwan has 40 rooms per million population compared with the counterpart in Japan with 15 rooms per million (Chiang, 2020, para.26). Meanwhile, hospitals are also seeking collaboration with professionals and industries to maximize facility capacity. In the wake of the Covid-19 pandemic, Taiwanese scientists have developed portable devices with heat exchange technology that enables them to turn regular isolation rooms into negative pressure rooms with affordable cost (Wu, 2020).
Partner for Community Development at Arizona State University, USA