Taiwan government’s preparedness plan
After experience with the SARS epidemic, Taiwan government began regularly promoting the concept of infection control as well as implementing policies to prevent future epidemics that emphasized preventive health education, hand hygiene and cough etiquette. Infection control was made both a formal hospital accreditation item and an item targeted in yearly onsite inspections. As part of their continuing education, all healthcare professionals must participate in training courses on infection prevention and control. A further key factor that has likely contributed to Taiwan’s low number of confirmed cases is the widespread public acceptance and adherence to infection control rules that have been enacted and promoted after 2003. Moreover, Taiwan government has actively distributed three million N95 masks and isolation gowns from its 35‐day reserve stock. This distribution began in December 2019, following the finding by a nationally convened public health expert panel that COVID‐19 posed a significant risk of human‐to‐human transmission. As of 10 June 2020, no healthcare workers in Taiwan have lost their lives to COVID‐19, and only four nurses have been infected with mild symptoms and have since been cured and discharged.
The Taiwan government classified COVID‐19 as a notifiable infectious disease on 15th January, and the Taiwan Centers for Disease Control (CDC) officially activated the Central Epidemic Command Center (CECC) on 20th January. A series of clear policies, and standard operation procedures (SOPs) were regularly announced and strictly executed to prevent nosocomial infections and community outbreaks. These SOPs target surveillance and containment, case identification, resource reallocation and quarantining. These procedures included a national public policy on face masks, which temporarily prohibited the export of masks, implemented a citizen ID‐based mask rationing system, and established a public‐access mask pre‐order eMask website (https://emask.taiwan.gov.tw/msk/index.jsp; Taiwan Centers for Disease Control 2020b). The government’s pre‐emptive measures and centralized coordination of surgical‐mask manufactures have been successful in ensuring adequate supplies of personal protective equipment (PPE) for frontline healthcare workers to date.
The CECC holds daily press conferences to directly provide to the public transparent, updated information on the pandemic and related control and response measures. Quick and effective communication and information transparency have been critical to raising public awareness and knowledge regarding the COVID‐19 outbreak. All television networks broadcast public education information on personal protection measures necessary for different occasions, covering face mask and hand washing protocols, avoiding big gathering activities and crowded venues, and other issues. Nowadays, hand sanitization and temperature monitoring using thermal imagers have become routine in all public areas. COVID‐19 testing is free to the public under Taiwan’s National Health Insurance System (NHIS) and the toll‐free number ‘1922’ is manned as a single‐window information hotline for COVID‐19 questions and assistance requests. The abovementioned policies and strategies have helped Taiwan keep community transitions exceptionally low to date, allowed infected persons to receive comprehensive care, and avoided the need to lock down any city.
The Taiwan NHIS, established in 1995, provides universal health coverage with a coverage rate of 99.9% and accessible health services to all people. The NHIS database has recently been integrated with Immigration and Customs databases, creating a platform for big data analytics that allows real‐time alerts to be generated during hospital visits based on an individual’s travel history and clinical symptoms to facilitate rapid case identification and diagnosis. The system also uses app and AI software, including QR code scanning and online reporting, to check on individual travel histories during the previous 14 days. People at higher risk levels are asked to self‐quarantine at home, with their current position tracked via their mobile phone to ensure compliance with quarantine restrictions (Wang et al. 2020). The asymptomatic nature of some cases during the early stage of infection has led the CECC to update control measures, including the announcement on 1st April of a new policy urging people to practice social distancing in public spaces by keeping a distance of at least 1 metre outdoors and 1.5 metre indoors (Taiwan Centers for Disease Control 2020, 2020c).