Masks and medical care: Two keys to Taiwan's success in preventing COVID-19 spread

Despite being close to China, Taiwan has stopped the COVID-19 with general screening strategy and encouraging people in Taiwan to wear a mask. Taiwan reported the first COVID-19 case on January 21, 2020. About 850,000 and 400,000 of Taiwan's 23 million citizens live and work in mainland China, respectively. There were 2.71 million visitors from Mainland China in Taiwan in 2019 [1]. The narrowest point between Taiwan and mainland China is just 130 km. Taiwan is one of the areas with the highest risk of the COVID-19 pandemic, but it did not happen. Taiwan has recorded just 443 cases and 7 deaths on June 04, 2020, including 55 local cases and 352 imported cases and 36 navy crew members aboard the Panshi fast combat support ship, respectively.

In European and American countries, it is generally believed that only infected patients need to wear a mask and that wearing a mask implies an admission of disease. In Asian countries, on the other hand, it is common for people to wear masks to prevent COVID-19. The daily production capacity of face mask manufacturers in Taiwan before the outbreak was 1.88 million face masks with a maximum production capacity of 2.44 million face masks per day. To ensure sufficient domestic resources for the prevention and control of epidemics, the Government of Taiwan has imposed a ban on exports of face masks on 24 January, followed by the requisition and rationing of all domestically-produced face masks (about 4 million pieces per day) by the National Health Command Center and Central Epidemic Command Center (https://www.cdc.gov.tw/En). Starting from 6 February, each person was allowed to purchase two surgical masks (priced at NT$ 5 each, equivalent to USD 0.17 each) every seven days. Starting from 5 March, the purchase limit was increased to three masks for adults and five masks for children every seven days. To ensure an adequate supply of face masks, Thailand, South Korea, and France announced the implementation of export controls on face masks starting from 4 February, 26 February and 3 March, respectively. Germany and Russia also announced a ban on exports of face masks on 4 April. Besides, the World Health Organization (WHO) also called for all countries to boost their production of face masks on 4 April.

Taiwanese people who suspect they may have been infected with COVID-19 can go to the emergency department of the nearest hospital for relevant medical examinations (including sampling and testing for COVID-19, blood tests, and X-ray imaging test) with out-of-pocket medical expenses of less than NT$ 600 (USD 20). People with high suspicion of COVID-19 infection will be admitted to isolation wards, and those who have tested positive for COVID-19 can only be discharged home after three consecutive respiratory specimens test negative for the virus. In that case, patients will have to pay less than NT$ 3000 (USD 100) out-of-pocket for medical services. Most of the medical expenses incurred by Taiwanese people are covered by the National Health Insurance program. As of 05 May, there were a total of 443 confirmed COVID-19 cases out of 72,871 screening tests under surveillance with a positive rate of 0.61%. Of the confirmed cases, 7 patients died from the disease and 428 patients (98.2%) have been released from quarantine, while the remaining patients are still hospitalised in isolation wards.

On 1 April, Taiwan President Tsai Ing-wen announced plans to donate 10 million face masks to countries that have been severely affected by the epidemic. Taiwan is donating 2 million masks to the United States, 7 million masks to European countries, and 1 million masks to countries that have diplomatic relations with Taiwan. Taiwan is currently deliberating on epidemic prevention and control strategies, and is sharing its research outcomes with the United States, European Union (EU), and the Czech Republic. Besides, Taiwan also collaborates with Australia and the United States on the exchange of materials for the prevention and control of epidemics. President Tsai pointed out that Taiwan will definitely not stand idly by based on humanitarian considerations and will actively enhance collaborations with various countries for the prevention and control of COVID-19. Taiwan is willing to assist the international community in terms of face masks, medicines, and technologies. Currently, Taiwan is capable of producing 20 million face masks per day and will boost its production capacity to 25 million face masks per day. The purchase limit has also been revised to nine masks for adults or 10 masks for children every 14 days starting April. Now that the government has lifted a ban on the commercial sale of masks, convenience stores and supermarkets have begun to sell face masks on 3 June. At present, the number of confirmed COVID-19 cases has exceeded 6 million worldwide with countless medical personnel risking their lives to treat patients [2]. The United States and EU countries are greatly affected by the COVID-19 epidemic.

On the basis of Taiwan's invaluable experience in the prevention and control of epidemics: 1. We encourage the public to wear face masks during the epidemic while keeping the price of face masks low by controlling the manufacture and sale of face masks; 2. We ensure public access to affordable comprehensive screening tests and medical care for COVID-19. We believe that these two approaches are among the main factors contributing to the success of Taiwan in limiting the spread of COVID-19. Taiwan's experience may help European countries and the United States to contain the COVID-19 epidemic.

Declaration of competing interest

None.