The strategies for the coronavirus disease 2019 (COVID-19) in Taiwan: A different tale

Dear editor,

We read with interest the paper by De Deyn et al. ¹ discussing the early strategies of the Hong Kong Special Administrative Region (HKSAR) and Singapore in the Coronavirus Disease 2019 (COVID-19) pandemic with reference to the report by Cheng et al.² We agree that both countries contained the first wave of imported cases well by effective measures. De Deyn et al. have mentioned the key difference of the date of implementation of social-distancing measures and closures earlier (January 2020) in HKSAR and later in Singapore (April 2020). With a similar earlier strategy of not advising compulsory face mask-wearing, wearing a mask became mandatory for people while going out which is regulated by tough laws since first-time offenders would be fined in Singapore.

Taiwan, similar to Singapore and HKSAR with developed economies, a high trade-to-gross domestic product (GDP) ratio, and advanced healthcare systems, has successfully managed the ongoing pandemic so far. The first COVID −19 case was reported in Taiwan on 21 January 2020,³ two days earlier than 23 January 2020, in Singapore. The proactive and effective measures to prevent human-to-human transmission of COVID-19 as described in the recent report by Wang et al. has been implemented in Taiwan.⁴ In addition to the very early measures including border control and entry quarantine system, case identification and contact-tracing policy, and educating public, we believe that the most effective and important policy is the maintaining of physical distance and the compulsory use of face mask for the general population which may play the most important role in preventing the transmission of COVID-19. In fact, there is a growing outbreak in Singapore^{1 , 5} and HKSAR,⁶ and as of 26 July 2020, there have been 458 laboratory-confirmed patients, of the 80,449 tested people, with 7 deaths reported in Taiwan.³ It is noteworthy that there is no indigenous case (total 55) in Taiwan since 13 April 2020, with all new patients being imported cases after that date. In Taiwan, the policy of school closures has been implemented only if any COVID-19 cases of students and staff present in a single school.³ Unlike Singapore, HKSAR and most countries with universal closure of schools, Taiwan has only had two schools closed for 14 days. These applaudable experiences in effectively combating the outbreak of COVID-19 are believed to be attributed to the effective measures including continuing to implement policies of maintaining physical distance and wearing masks in Taiwan.

In countries in Asia, people are used to wearing a face mask in daily life for reasons not related to the protection of the transmission of diseases. However, people in other Continents do not accept wearing a mask except for those who may be sick or have been infected. If the preventive effects of a mask are definitely confirmed, it is not surprising that wearing a mask by a healthy individual will prevent the transmission from a sick patient. In fact, the protection of the mask from getting infected by other sick patients have been generally accepted in health-care workers. US Centers for Disease Control and Prevention has recommended all people 2 years of age and older wear a cloth face covering in public settings and when around people who don't live in your household, especially when other social distancing measures are difficult to maintain.⁷ Another important issue is the shortage of masks for all people in a country and the derived problem of elevated price and the fear of the lack of masks. Currently, surgical masks are critical supplies that should continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.⁷ Taiwan's proactive measures including resource allocation by the ban on exports of surgical masks very early (24 January 2020), increasing the production capacity of surgical mask manufacturers, and assuming powers to requisition surgical masks at fixed prices are experiences deserved notice all over the world. With more than four million COVID-19 cases reported in the US so far⁵, President Donald Trump recently has tweeted an image of himself wearing a face mask, even though not a surgical mask, and indirectly called the act "patriotic".⁸ Unlike Taiwan and Singapore making mask-wearing a legal requirement, we believe that leaders of other countries must assume the responsibility of encouraging mask-wearing.

CRediT authorship contribution statement

Chia-Yen Dai: Writing - original draft, Writing - review & editing. Ting-Hsuan Dai: . Hsin-Yun Ho: . Chi-Kung Ho: .

Declaration of Competing Interest

None.