Taiwan and Singapore have both been held up as models in the global fight against the COVID-19 pandemic. However, as of the time of writing, Taiwan has managed to keep its total cases below 400 while Singapore’s cases have escalated to more than 2,000.
Since early March, both countries have also entered their second phase of COVID-19 transmission, with both seeing an increase in imported cases which subsided by early April.
Taiwan is flattening the curve. Chart source: Datagraver
Singapore has also entered a third phase. Since March 24, it began to see a gradual increase of another wave of domestic transmission, jumping from about four to six cases a day in early to mid-March, to 17 cases on March 24 and to as high as 284 cases on April 9 (these numbers do not include import cases, which has declined from a high of 48 cases on March 23 to as low as zero on April 10). By April 8, Singapore saw its domestic cases rise above 1,000 and to more than 1,500 in total when including imported cases; it also saw the largest increase in unlinked domestic cases in one day. On April 9, Singapore saw its largest one-day increase in cases thus far.
Taiwan, on the other hand, has only seen an average of one to two domestically transmitted cases a day since the latter half of March. Imported cases have also declined from a high of 25 cases on March 23 to as low as zero cases on April 9.
Total confirmed cases in Taiwan and Singapore from March 1 to April 10, 2020.
While domestic cases make up about 14% of Taiwan’s confirmed cases, domestic cases have now increased to make up 73% of Singapore’s cases.
At the time of writing, Singapore has seen seventh deaths. Taiwan has seen six deaths. Strangely, a man in Singapore who was confirmed with COVID-19 after his death was not included in Singapore’s death statistics as of the time of writing. Singapore’s Straits Times, which operates under the close watch of authorities and maintains a pro-government editorial line, wrote on its Facebook that the man was “confirmed to have the disease posthumously.”
In a previous article in Ketagalan Media, I compared and analyzed the COVID-19 strategies both countries used in their first-phase fight of the pandemic. In this article, I look at their responses in the second phase. In particular, while Taiwan has seen its number of cases increase from 41 on March 1 to 382 on April 9, Singapore’s situation has gotten worse over the last three weeks, and it has seen its number of cases jumped by 20 times from 106 to 2,108. Though the number of cases in Singapore is still low as compared to many other advanced countries, I explore the strategic missteps the Singapore government made in its second-phase response which led to an explosion in numbers in the community.
Nonetheless, both Taiwan and Singapore have adopted some interesting targeted social distancing measures, which are worth studying, for countries which could still be in the initial-phase of the pandemic, or which are looking at returning to normalcy after a lockdown. Having said that, after two weeks of implementing its social distancing measures, Singapore finally had to undergo a lockdown due to the escalating number of domestic cases. The Singapore government however chooses to characterize its lockdown as a “circuit breaker,” but in this article, I will refer to the lockdown as what it is: a lockdown.
Singapore is also increasingly adopting draconian measures to control its population.
As of the time of writing, Taiwan continues to see only one or two domestic cases (and zero on some days) and does not see a need to undergo lockdown—yet.
Imported cases in Taiwan and Singapore have declined since border closures were implemented in mid-March
Taiwan closed its borders to visitors on March 19 and to transiting passengers on March 24, while Singapore closed its borders to both visitors and transiting passengers on March 23. Singapore also began testing visitors and returning residents with COVID-19 symptoms from March 4 while Taiwan only started doing so on March 15, though retrospective testing was also conducted on visitors and returnees going back to March 3.
New daily imported cases in Taiwan and Singapore from March 3 to April 10, 2020.
Taiwan closed its borders to visitors on March 19 and to transiting passengers on March 24, while Singapore closed its borders to both visitors and transiting passengers on March 23. Singapore also began testing visitors and returning residents with COVID-19 symptoms from March 4 while Taiwan only started doing so on March 15, though testing was then conducted on visitors and returnees going back to March 3.
When Taiwan saw a spike in the number of confirmed COVID-19 import cases on March 18, from ten the day before to 21, it immediately announced that it was closing its borders starting March 19. In doing so, Taiwan saw its number of import cases rise to a peak five days later—to 23 cases—which then started to decline. The number of daily arrivals into Taiwan has since dropped from about 37,000 a day in January and 39,000 in February to only about 7,000 a day in March. On March 19 and 20, after the travel ban came into effect, Taiwan saw only 6,511 and 5,607 arrivals. This dropped further to 2,130 on April 1, 2,163 on April 2 and 1,423 on April 3.
Singapore’s border closure came four days after Taiwan’s and was somewhat delayed—it saw its imported cases grow from nine cases daily from March 13 to 15 to 33 cases on March 18, and then 39 on March 21, before it decided to announce border closures on March 22, for implementation on March 23. On March 23 itself, Singapore saw imported cases peak at 48 cases, and then declined thereafter.
By March 31, the number of returnees to Singapore has gone down to about 1,500 a day, and from the United States and United Kingdom where Singapore has seen the largest number of imported cases, returnees have dropped to 300 from 1,500 a week before.
Total imported cases in Taiwan and Singapore from March 1 to April 10, 2020.
The border closures in both Taiwan and Singapore have thus helped to suppress the number of cases from importation, but the domestic cases paint a different picture. Taiwan’s continued low number of domestic cases could be attributed to a semi-lockdown it implemented early on in early-February—school reopening was postponed—while the refusal of the Singapore government to implement a lockdown early on could explain why it has continued to see a rising number of COVID-19 infections—by April 1, the number of total confirmed cases (domestic and local) in Singapore hit 1,000 and on April 5, Singapore saw new cases cross the 100 mark in a day for the first time. By April 10, domestic cases have risen to more than 1,500 and total cases have passed 2,000 cases.
Interesting social distancing measures implemented in Singapore—but a tad too late
Singapore has some interesting social distancing policies, but this has to be juxtaposed against the rising number of domestic infections and the timing of these policies, as well as the poor social infrastructure and poor decision making which has resulted in new cases escalating over the last three weeks.
New daily domestic and imported cases in Singapore from March 10 to April 10, 2020.
Prior to Singapore undergoing its so-called “circuit breaker” lockdown, its government had resisted doing so, even as confirmed domestic cases kept rising. Dale Fisher, chair of Infection Control at Singapore’s National University Hospital, wrote in The Conversation: “In Singapore, we want life to go on as normal. We want businesses, churches, restaurants and schools to stay open. This is what success looks like. Everything goes forward with modifications as needed, and you keep doing this until there’s a vaccine or a treatment.”
But Singapore took wanting to “look successful” too far. You simply cannot beat a virus by being so proud and over-confident.
From March 13, Singapore started to implement targeted social distancing initiatives to try to break the chain of transmission. At that time, it had seen four domestic COVID-19 cases for three consecutive days—the authorities decided at that time to announce advisories that ticketed cultural, sports and entertainment events with 250 participants or more should be canceled or postponed, or otherwise reduced in size. Advisories were also issued for public venues to limit visitors and to seat diners one meter apart from one another, as well as for employers to implement tele-commuting and stagger work hours. However, these were only advisories.
By March 20, Singapore had seen domestic cases jump to 14 cases on March 18 and 10 cases on March 20. It then decided to introduce another set of targeted “safe-distancing measures,” whereby operators of public venues such as retail stores or food and beverages (F&B) outlets should keep patrons one meter apart, such as by putting floor markers a meter apart for “queue management” and marking out seats in F&B establishments which diners should not sit on. However, these were still only advisories.
Moreover, while Singapore’s government started issuing advisories on social distancing, questions were raised on the inconsistencies—public transportation, such as the MRT and buses, were still crowded and there were no social distancing guidelines developed for public transportation, which has resulted in a massive gap in efforts to reduce the community transmission of the coronavirus. Nonetheless, after the March 20 advisory was issued, Moovit data showed that public transit usage which had already fallen by 15.5% by March 19 as compared with January 15, fell by another 24.6 percentage points by April 8. After the lockdown was announced, The Straits Times reported that public transport ridership fell even further by 50% since the start of the pandemic.
On March 24, Singapore then saw its domestic cases jump again to 17 cases, from six the day before. However, the government still decided against a lockdown—although it did announce that it would close bars and entertainment venues starting from March 26. Other public venues such as retail malls, museums and attractions could remain open if they could ensure that there were no more than one person per 16 square meters of usable space. Tuition and enrichment centers, as well as faith-based activities were suspended and events such as conferences or exhibitions had to be cancelled or postponed. In addition, gatherings were also limited to 10 persons or fewer. Questions arose as to why only certain venues were closed while others were kept open—parents questioned why schools were kept open even as tuition and enrichment centers were closed, for example. There were also calls to implement a wider lockdown, but to no avail.
On March 26, the government finally legislated that non-compliance of these “safe-distancing” measures would be an offense under the Infectious Diseases Act, which could net penalties of up to S$10,000 (US$7,078) or six months’ imprisonment or both. This was a day after Singapore reached another high of 35 domestic cases on March 25. Still, there was no lockdown.
But Singapore had another COVID-19 crisis on its hands. COVID-19 infections were starting to spread in a few of its educational institutions. A cluster related to the Dover Court International School saw its first case on March 13. It has since grown to 11 cases by April 10. On March 24, Singapore started seeing another new cluster of infections at a kindergarten – the PAP Community Foundation (PCF) Sparkletots centre in Fengshan, which reported two cases on March 24 but has since grown to 27 cases. These were among the two largest clusters of new COVID-19 infections in March alone.
Singapore’s confusing school suspension policy and the consequent cluster infections in schools
What was strange, however, was how Singapore’s authorities decided to respond after confirmed cases were identified in the schools. When the first case was confirmed at the Sparkletots center, the center was only closed for one day for disinfection and was supposed to resume operations the next day—this was decided on the basis that the teacher who was infected had been on leave for two days before being diagnosed positive with COVID-19 and was also “feeling well” the day before her leave. The Early Childhood Development Agency (ECDA) only decided to close the school for two weeks after several more staff reported feeling unwell. A day after the decision was made to close the center, another 13 staff at the school were then diagnosed as positive. Four family members of one staff were also confirmed with COVID-19. The center principal also started developing symptoms on March 17 and attended a course with staff from other pre-schools the same evening, and weirdly, the PCF would still only close its other centers for four days instead of two weeks, the ECDA informed. On April 6, another Sparkletots center, the Bedok Reservoir-Punggol center in Hougang, also saw one confirmed case. It was also uncovered from contact tracing that the Fengshan Sparkletots center cluster likely broke out after its principal was infected by a family member who had traveled to Malaysia, who then subsequently infected the other teachers during a staff meeting.
Indeed, on the Singapore Ministry of Education (MOE) website, it said that if a confirmed case is found in a school, classes would only be suspended for a day to “facilitate thorough cleaning and disinfecting of the premises”. However, this goes against the logic of the disease progression of COVID-19 where the incubation period is known to be as long as 14 days. Suspending schools therefore does little to stop the transmission if other staff or students who could potentially be infected return to school and become nodes of transmission. In fact, by March 13 when clusters of infections were forming in Singapore’s educational institutions, it was already known that COVID-19 can be transmitted via asymptomatic infections, and the Singapore government’s relaxed attitude toward school closures was therefore a cause for concern. A new study by researchers in Singapore of 243 COVID-19 cases from the middle of January to mid-March found that 10% of new infections are asymptomatic. However, Iceland which to date has conducted the most number of tests per million population, found 50% of its cases to be asymptomatic.
Indeed, parents had already been calling for school closures for weeks. As early as February 7, Singapore Education Minister Ong Ye Kung objected to suspending schools, on the basis that, “this is a drastic move that will disrupt life for many families, and it is also not realistic to expect older children to stay home the whole time school is closed”. Ong later added on March 22 that, “if we close schools, many will not stay home, but may run around in the community and mingle with a lot more people, exposing themselves to more risk.” But this was when the Dover Court International School was already seeing a cluster infection. Even when the government announced on March 24 that tuition and enrichment centers will be closed, it still refused to close schools, on the claim that, “in school, we have arranged things such that students pretty much mingle only with their classmates, [and] so if there is a confirmed case in school, we are able to contact trace very quickly and control the risk of virus spread by quarantining the class.” But by then, the cluster infection had started developing at the PCF Sparkletots center from March 24, and even so, the Singapore government only decided to move towards a one-day per week home based learning from April 1. It was only on April 3—just two days after—that Ong finally said that, “it is the right time” to close schools, after Singapore decided to undergo a lockdown. By then, the two cluster infections at Dover Court International School and the PCF Sparkletots center had seen a total of 38 COVID-19 cases. At the time of writing, another pre-school, the Little Gems Preschool, has also seen a cluster of at least three confirmed case formed.
On April 5, the police arrested a public servant under the Official Secrets Act, for taking a screenshot on her computer of an April 3 media statement that “full home-based learning” (a.k.a. school closures) would be implemented, and her husband as well for sharing the screenshot, before the media statement was released officially. During these times, it is questionable whether it is necessary to make an example out of individuals, just so the Singapore government could maintain secrecy in its strategy.
Singapore finally implements a lockdown after social distancing measures came too late
By April 3, when Singapore saw a new-high of 56 cases of domestic infections at that time, the government decided to announce a lockdown (its “circuit breaker”) will be implemented from April 7 to May 4. Singapore prime minister Lee Hsien Loong gave his third COVID-19 speech then, where he said: “Looking at the trend, I am worried that unless we take further steps, things will gradually get worse, or another big cluster may push things over the edge.”
Lee said that both workplaces and schools will close, except for “essential services and key economic sectors”, and that “gatherings should be confined to your household … this is like a circuit breaker,” Lee said.
He avoided using the term “lockdown,” even though international media reported it as such, and even locals were calling it so. Funnily, Lee also talked about how the move to the one-day a week home-based learning “has gone smoothly,” even though it had only been two days since it started, before full school closures were announced.
Total domestic and imported cases in Singapore from March 20 to April 10, 2020.
Lee also said that the lockdown was finally being implemented as a “decisive move” to “preempt escalating infections.” However, considering that it had been 12 days since domestic infections started rising above 15 cases a day, to several peaks of 35 cases on March 25, 54 cases on April 1 and 56 cases on April 3, the perception on the ground is that Singapore’s decision for a lockdown has not been a decisive one—calls for lockdown in some quarters had gone on for a few weeks. In fact, now that cases have even increased to 284 domestic cases in one day on April 9 itself (a total of 287 when including import cases), the lockdown seems long overdue rather than preemptive.
On the day Singapore saw the largest increase in the number of confirmed cases by 287 cases to 1,910 cases, it finally started implementing social distancing on MRT trains and buses and their respective stations and interchanges, by marking out spaces and seats commuters should avoid, as well as installing thermal scanners at selected MRT stations which would disallow commuters from entering if they have a fever. Sports stadiums were also closed because “people [were still] coming in groups to exercise in the stadiums,” National Development Minister Wong said. He added that people who want to exercise should instead do it on their own or with a family member in the same household, and to do so in their own neighborhood. Wong also said that the government will review the need to prohibit people from leaving their neighborhood, as well as control entry into parks. While Singapore is only implementing these measures a day before it saw its total confirmed cases spike to more than 2,000 cases, with new cases rising by nearly 300, Taiwan has implemented such measures earlier, while caseload is still at one or two a day.
Even though the number of daily new cases Singapore is seeing is still low relative to some other European countries or the United States, but compared with the sub-10 number of daily cases Singapore was seeing prior to March, the escalation to 287 cases in a day on April 9 has created disconcert.
There are other perspectives. There is the sense that Singapore has been calibrating and re-calibrating its approach in order to continue to function without a lockdown, in view of the costs that a lockdown might cost—or rather, to maintain appearances and look “successful”. The phased-in measures introduced on a roughly weekly basis—on March 13, 20, 24 and finally the lockdown on April 3—could be seen as a way to ease people into an eventual lockdown. However, from only four domestic cases on March 13 to 56 cases on April 3—or an increase by 14 times—the more than three weeks it took to eventually implement a lockdown is being interpreted as indecisiveness and ineffectiveness on the government’s part. The use of a more clinical term, “circuit breaker”, to characterize the lockdown, could also be construed as an attempt to allay people’s fears and reduce panic, by hopefully inducing a more clinical response from people towards the lockdown. However, people in Singapore are already calling it a lockdown and queues had once again formed at the supermarkets after the announcement of the “circuit breaker”. The “circuit breaker” is also being mocked by Singaporeans, one of which is how its abbreviation, “CB,” is also a euphemism for “cunt” in the Hokkien dialect.
In fact, Singaporeans were criticized as being “idiots,” “stupid,” an “embarrassment”, a “disgrace” and “suckers” by no less than Trade and Industry Minister Chan Chun Sing, when some people went into a bout of panic buying in early February after Singapore raised its Disease Outbreak Response System Condition (Dorscon) alert level to the second-highest Orange level. When Singapore’s neighbor Malaysia announced that it would enter into a lockdown on March 18, Chan also took pains to assure Singaporeans that Singapore has “many other [food] source countries which we have identified over the years and are able to activate them quickly when the need calls for it.” Chan later said on a talk show on March 26: “We’ve been able to have other [food] sources … make up for what’s been disrupted on the Malaysian side. So, by and large, I think the impact on the local markets hasn’t been significant.”
However, just a few days later on March 31, Chan then said that, due to the “dynamic global situation where there is news about a country or city putting up tighter controls every other day, Singaporeans must be mentally prepared for food prices to go up due to the constant disruptions in supply.” Online, internet users mocked Chan for the seeming about face, and some thanked their lucky stars for having panic-bought goods.
Nevertheless, the pandemic has finally forced the Singapore government to re-evaluate its self-sufficiency, and it has decided to spend S$30 million (US$21.2 million) to call for proposals in order to ramp up domestic food production to 30% of Singapore’s nutritional needs from the current less than 10%, with a target of 20% fruits and vegetables and 10% proteins. Plans are also being drawn up to convert car park rooftops in public housing estates into urban farms.
On the day the lockdown began, Singapore also passed a new law to ban all social gatherings in not only public spaces but private spaces as well—people would not be allowed to meet with other people not living together with them. “This enables us to better regulate events and gatherings, including those that take place on private properties,” Health Minister Gan Kim Yong said. Under the new law, the minister would also be able to “restrict individuals’ movements and interactions at their place of residence or any specified place, as well as their use of common areas such as void decks.” As activist Jolovan Wham pointed out, “it’s going to be illegal to gather at your own home!” The law would also allow for the “requisition of land, property or services needed to ramp up our health care capacity and public health capabilities.” Non-compliance will result in a fine of up to S$10,000 (US$7,078) and imprisonment of up to six months, or both, with repeat offenders fined up to S$20,000 (US$14,155) and jailed up to 12 months, or both.
While Singapore has chosen not to call its lockdown a “lockdown,” it would seem that the Singapore government has chosen to take even harsher measures to restrict the movements of its residents than other countries which are on lockdown. Moreover, while people can still “exercise outdoors in a park,” they are not allowed to “gather,” but what if a person sees a friend at the park? Should he or she pretend to ignore the friend? Would they be fined or jailed for acknowledging each other? Moreover, some sporting activities are also not allowed because “they might attract like-minded participants, resulting in the congregation of people from different households.” In fact, the police arrested a man who wanted to eat at a void deck even though he wasn’t part of any gathering. Another worry is that the government might actually use this new law against opposition politicians during the election which the government might want to call soon (no one knows exactly when it will be held except the government), so as to disqualify them from running in the election.
In the first two days of Singapore’s CB lockdown, the government has already issued 10,000 warnings to keep their distance from one another, otherwise they would be fined S$300 (US$212) for their second offense and charged in court for their third. Deputy Prime Minister Heng Swee Keat took to his Facebook to complain that some people are still “blatantly disregarding the measures,” while Environment and Water Resources Masagos Zulkifli said that “some are even uncooperative, insisting on dining in at eating places, not maintaining a safe distance when queuing in markets, and gathering in parks to eat or exercise together.” Prime Minister Lee Hsien Loong also said that there are “still far too many public gatherings”, and that people “must comply with the stay home measures very strictly.”
All these makes you question the logical thinking of the Singapore government which says that people are still able to head out, but should yet “comply” with staying at home “strictly”, yet they do not want to simply implement a lockdown, but insists on a “circuit breaker” which in its current form is clearly a half-baked measure. As a result, because the government refuses to “lockdown” Singapore, this is sending the wrong signals to people who therefore act in contradictory ways only because the government is itself inconsistent. Thus, due to not wanting to enact a “lockdown.” the government therefore has to resort to laws and penalties to force people to stay at home while trying to create some semblance that “life goes on”—but even at a time of crisis, they are still more concerned about playing charades than taking necessary steps.
With these new measures, it is clear Singapore is now under a full lockdown—all except for the government calling it one. During these times, the ruling People’s Action Party (PAP) still cares about “face,” a friend remarked to me.
Singapore’s lack of preparedness starts to show during this COVID-19 pandemic
But Singapore is a small country, and it has been drilled into Singaporeans the perilous nature of Singapore’s survival. In that sense, Singaporeans would have been prepared for such uncertain times.
The criticism, therefore, could be levied against the PAP government for being too arrogant that it had not seen the need to implement a lockdown earlier on in spite of the steadily increasing number of domestic COVID-19 cases, and that Singapore had not sought to strengthen its relations with its neighbors enough, resulting in fears of their unwillingness to help Singapore in these times of need.
New daily domestic cases in Taiwan and Singapore from March 3 to April 10, 2020.
In fact, just last year, former opposition leader Low Thia Khiang from the The Worker’s Party also warned: “We need to change the perception by our neighbors of Singapore as an arrogant nation that likes to compare itself favorably to other developing countries.” He added: “Oftentimes, the perceived condescension is due precisely to our success as a business hub and a global city adopting the most advanced technologies. Success breeds envy among neighbors, and this envy can turn toxic if our neighbors come to believe that our success is due to our taking advantage of their weaknesses.” An Indonesian diplomat had last year also expressed frustration over Singapore’s unwillingness to go onboard with Indonesia’s plan to adopt a common Indo-Pacific vision among the Association of Southeast Asian Nations (ASEAN).
Moreover, in spite of having implemented a lockdown, the Singapore government has still refused to increase its alert to the highest Dorscon red. Health Minister Gan Kim Yong, who is co-chair of the country’s multi-ministry task force to fight COVID-19, said on April 4: “Under Dorscon red, we would have to expect to see many uncontrollable outbreaks and widespread community transmission, and it would be very difficult to continue to do contact tracing, containment and quarantine. We would have to rely purely on safe distancing.” However, Singapore is currently not at that stage, he added. Just a few days before this, on March 26, Communications and Information Minister S. Iswaran also said that rumors that “the government is going to go into a lockdown mode” and declare Dorscon red is “false information.” However, the government did eventually announce a lockdown on April 3, albeit not by using that term. Moreover, according to government guidelines, Dorscon red is implemented when there are “major disruptions,” such as “school closures [and] work from home orders.” Nevertheless, Minister for National Development Lawrence Wong who is the other co-chair of the multi-ministry task force, said that the government did not want to use the term “lockdown” because it preferred to “focus on the specific measures.” He added that people are not being stopped from going out if they “really need” to go to work if they are in essential services, “or to get food, groceries or even to exercise,” but warned against “gathering outside.” There is a bit of mixed messaging here, and while the Singapore government did come out with a clear list of services that are considered essential and would still function under the lockdown, the scope of essential services has been criticized by internet users for being considerably broad, and might not be sufficient to cut transmission in the community. People were also initially prohibited from dining-in at F&B outlets, but realizing days after that hawkers at food centers need to eat too, the government announced that hawkers can only eat at the table “immediately in front of their stalls but should do so alone.” Depending on whether domestic infections could be reduced after this lockdown, more stringent lockdown measures might need to be implemented in the coming days or weeks. The Singapore government might also need to dispense with pretense and raise the alert to Dorscon red.
I had written in the previous comparison between Singapore and Taiwan’s COVID-19 responses that Singapore has adopted a strong health systems and testing strategy which had allowed it to contain the coronavirus, at least up until early March. However, Singapore’s several missteps in not implementing a lockdown early enough and not having seemingly planned ahead for its food security has exposed its lack of preparedness in dealing with a crisis such as this pandemic. While Singapore’s health system was prepared at the initial stage to handle COVID-19 and its decision-makers had even wanted to be the “first off the blocks” after the global economy recovers from the coronavirus (this was what Chan Chun Sing said), the Singapore government seems to have faltered over the last few weeks as it resisted a lockdown while trying to maintain a semblance of business-as-usual to “look successful”, before finally being forced into a lockdown (schools were closed just two days after the implementation of the one-day a week home-based learning), as it realizes its confidence could no longer supersede the natural progression of the disease. If anything, this virus has taught Singapore’s leaders a lesson in humility—or rather, it should have, if they would allow it.
In the end, Singapore had to undergo a lockdown because the social distancing policies were implemented too late. If they had been implemented by February, these social distancing measures might have been able to help keep the numbers down. Of course, it’s easy to say this with the benefit of hindsight. Honestly, no one knows which way the virus would go. Still, the arbitrary school suspension policy which was out of sync with the disease progression of COVID-19 also resulted in a gap to Singapore’s efforts to contain the coronavirus, thereby allowing the virus to spread. Many observers had thought that Singapore had it under control even as late as early-March, though by mid-March, the rising confirmed COVID-19 cases have led to increased calls by locals to implement a lockdown or at least the closure of schools, and the government’s unwillingness to do so is therefore a fault. As such, while Singapore’s targeted social distancing measures are interesting, the lesson to take away is that the timing of implementation needs to be right, and their implementation cannot be unscientific (schools should have been closed for 14 days), if these measures are to work. Singapore had a chance at using such measures to continue on a business-as-usual basis without a lockdown, but it did them too late, and it cut corners.
Singapore’s poor social infrastructure is exacerbating the impact of COVID-19
But COVID-19 is also exposing the flaws in Singapore’s social system. By April, Singapore saw some of its largest clusters of infections form in five migrant worker dormitories—S11 Dormitory @ Punggol, Westlite Toh Guan, Sungei Tengah Lodge, the Toh Guan Dormitory at Toh Guan Road East and Tampines Dormitory, which as of the time of writing had 303cases, 69 cases, 56 cases, 55 cases and 49 cases, respectively. Singapore’s dormitories are notorious for housing migrant workers in cramp and decrepit living conditions, and workers are known to be paid as low as US$400 or US$13 a day for 10 to 12-hour work days. A Straits Times article reported that the dormitories the workers live in are “infested with cockroaches and toilets are overflowing,” with workers not having any “social distancing measures to keep them apart.”
What is even more concerning is that up to 75,000 migrant workers (50,000 workers are housed in the first four dorms while Tampines Dormitory can house up to 25,000 workers) in these five dormitories would have to be quarantined in their dilapidated conditions for 14 days due to the outbreak. However, as Bangladeshi construction worker Shahadat Hossain, who lives in the Punggol dormitory, told Reuters, it would not be possible to “control the infection as [they] live in such a crowded place.” This therefore makes “social distancing […] useless,” migrant rights group Transient Workers Count Too (TWC2) vice president Alex Au pointed out. Singapore’s Ambassador-at-Large Tommy Koh added that, “the dormitories were like a time bomb waiting to explode” and that “Singapore should treat this as a wake up call to treat our indispensable foreign workers like a first world country should and not in the disgraceful way in which they are treated now.” But as Amnesty International puts it, the “lockdown” of the migrant workers is simply “a recipe for disaster.” The government, however, claimed on Friday that the cleanliness and sanitation of these dormitories have “vastly improved” in just after five days.
Note, however, that other than the 75,000 migrant workers being quarantined, there are about 200,000 others being held under lockdown in 43 dormitories due to the country’s circuit breaker, who are being packed into rooms of 12 to 20 men in double-decker beds, which means the numbers are going to keep piling up—though as of April 9, 5,000 workers have been moved into military camps and vacant public housing flats. The Changi Exhibition Center and offshore floating lodgings which can take 500 workers have also been identified as possible temporary housing. The government has started to “aggressively” test the workers to separate the “healthy” workers from those “infected or suspected”, where the “healthy essential” workers will be transferred away from the quarantined dormitories. Singapore’s long-term neglect and abuse of its migrant workers has thus become a massive fissure in its COVID-19 strategy, and it takes a pandemic for them to finally be able to have (some form) of proper housing. At the time of writing, there were 552 migrant workers who have been infected in ten dormitories across the island state, as well as 46 cases linked to two construction sites and 21 cases linked to a shipyard.
Singapore’s appalling treatment of its migrant workers is also reflected in a Facebook post one of its parliamentarians and former minister Yaacob Ibrahim made when he pointed to how the coronavirus managed to “empty the space” beside an MRT station of “foreign domestic workers” who had “caused some inconvenience to [his] residents”. He apologized after internet users criticized him for being insensitive. In his apology, he said: “We have never shooed them away.” In describing the measures being taken to reduce transmission within the dormitories, National Development Minister Lawrence Wong also distinct the migrant workers as a separate “category” from “our own community” of residents in Singapore.
Not only that, in its resistance to closing schools, Singapore prime minister Lee Hsien Loong also defended its decision by saying that “children from lower-income families would bear the heavier burden of the tighter restrictions”. While Singapore does not have an official poverty line, estimates by Singapore’s academics have put its relative poverty between 20% and 35% in 2015, and 26% in 2017. As such, if schools could not be closed due to the burden on lower-income families, it says something about the lack of income support and protection for the poorest members in Singapore—which is quite a significant number, since a poverty rate above 20% would put Singapore as the advanced country with the highest poverty rate. A week after the one-day a week home-based learning was announced, SG Bono, a group of volunteers providing IT support for low-income families, announced that it had received an “overwhelming” 1,200 requests for donated laptops from families who could not afford to buy computers and laptops. The Singapore government has also adopted some draconian measures to try to curb the coronavirus, such as by denying Singapore residents access to the national health financing system MediShield Life if they go overseas and become infected with COVID-19. Work passes have also been revoked and passports canceled for breaking COVID-19 regulations.
Early implementation of social distancing measures in Taiwan, even as cases remain low
Taiwan only started introducing social distancing guidelines at the end of March, in part because it has thus far only seen an average of one or two domestic COVID-19 cases a day. On March 25, even as Taiwan saw zero new confirmed cases on that day, the Central Epidemic Command Center (CECC) coordinating Taiwan’s COVID-19 pandemic response announced recommendations that indoor events which would be attended by more than 100 people should be suspended, while outdoor gatherings of more than 500 people should do so too.
Risk assessment guidelines were also introduced for event organizers to assess their risks of holding large-scale public gatherings: (1) on whether there is the ability for participants to gain information beforehand, (2) whether there is “air ventilation and replacement”, (3) where distance can be kept between participants, (4) whether participants would remain in fixed positions, (5) the duration of the event, as well as (6) whether there are hand hygiene facilities and surgical masks available. Gatherings should be canceled or postponed if they are deemed to be of a high-risk nature based on this assessment.
Total domestic and imported cases in Taiwan from March 20 to April 10, 2020.
On March 31, the CECC then released recommendations that “people in Taiwan [should] stay at least one meter apart outdoors and 1.5 meters apart indoors.” Health Minister Chen Shih-chung 陳時中, who chairs the CECC, added that if people are “unable to maintain a safe distance,” that they are “advised to wear a surgical mask.” People were therefore advised to wear masks on the MRT, as well as metropolitan rail networks and high-speed rails because of the difficulty to “maintain a safe distance.” Students in the same classroom were however not required to wear masks because they are “not random strangers.” Chen pointed out then that these guidelines were only “recommendations” and did not carry any penalty at that time, and that the government will evaluate “how well people follow [these] social distancing guidelines” before penalties are imposed for “severe violations.”
On April 1 (there were zero new domestic cases on this day as well), the CECC detailed further advisories—other than keeping a distance of 1 to 1.5 meters under what is called the first phase of the social distancing measures, people were also advised to “avoid going to events where they could come into close contact with others, such as exhibitions, sporting competitions, and concerts, as well as entertainment venues not essential to their livelihood”. In addition, proprietors of venues where people cannot be kept at least 1.5 meters apart should also suspend their operations. Restaurant owners could, however, consider installing divider boards to separate their customers. Vendors and service providers who have to come into direct contact with customers have also been required to wear surgical masks. It was later announced that no more free food samples are allowed too. Interestingly, the CECC also said: “If all people gathering in a certain place wear face masks in the proper manner, these social distancing recommendations may be ignored.” The CECC will soon be introducing guidelines for flexible working hours.
On April 9, when Taiwan announced only one confirmed (domestic) case, it also decided to close the nightclubs, after one hostess at a Taipei nightclub was diagnosed with COVID-19 and was found to have come into contact with 50 people—which might result in another cluster infection and spike in Taiwan’s cases. In Taichung City, failure to comply can result in individuals and establishments being fined NT$3,000 to NT$15,000 (US$100 to US$500) under the Communicable Disease Control Act. In comparison, Singapore only decided to close its nightclubs when confirmed cases hit 17 a day. The following day, while Taiwan saw only two new cases, it announced a series of crowd management measures, including limits on room occupancy for hotels to not more than 60%, and for night markets, traditional markets and shopping areas to have only one entry point for better crowd control. Temples are to also implement visitor control and to not provide food and drink at events.
In the second phase, the CECC said that these rules would be made mandatory, and all non-essential activities will be prohibited, such as entertainment; while only essential activities, such as “medical care, official duties, and work” could continue if the social distancing [measures] of 1.5 meters indoors and 1 meter outdoors” are observed. The second phase has yet to be implemented.
On April 1, in view of Taiwan’s Tomb Sweeping Day where many Taiwanese are expected to travel domestically during this long holiday from April 2 to 5, Minister of Transportation and Communications Lin Chia-lung 林佳龍 also announced that masks will be required on all trains and inter-city buses, and “all 12 high speed railway stations, 239 Taiwan Railways Administration stations, 1,298 post offices, as well as airports, ports, freeway service areas and bus transfer stations will check passengers’ temperatures.” From April 4, meal boxes will also no longer be sold on Taiwan’s trains and high-speed rail, and eating will only be permitted for “health reasons.” Lin explained that these measures were implemented to extend Taiwan’s efforts to “battle the COVID-19 contagion from air to land transport.” However, the transport ministry was also criticized for announcing the mask policy too late—only a day before the holiday began—as many commuters were unaware of the new rules.
As people switched from public transport to private transport, sales of private vehicles have also increased in Taiwan. Sales of cars increased by 36.3% in March compared to February, while Taiwanese electric scooter manufacturer also saw a 300% increase of their Gogoro 2 and Gogoro 3 series in February, as compared to January. Among East Asian industrialized countries, Taipei has seen the third largest drop in public transit ridership according to Moovit data, of 53.1% by April 8, as compared to January 15. Tokyo saw the largest drop of 87.2%, while Singapore saw a drop of 40.1%. Seoul and Hong Kong saw declines of 46.1% and 54.6%, respectively. According to the Economist Intelligence Unit (EIU), Singapore is known as being the “most expensive place in the world to buy and run a car,” which would explain the relatively lack of drop in public transportation ridership at that time.
On April 3, the CECC also announced penalties on users of public transport who do not wear masks—they could face fines of between NT$3,000 and NT$15,000. Taxi drivers are also allowed to refuse passengers who do not wear masks. Chen explained that masks are being used as an enforcement measure in places such as public transportation where social distancing cannot be properly implemented. He added: “If we spot someone not wearing a mask, we will ask them to put one on and if they refuse to do so, we will fine them in accordance to the Communicable Disease Control Act.” While Taiwan is rationing face mask purchase, passengers can still buy them at nearby convenience stores or drug stores in order to get on the train, and two-thirds of passengers without masks have done so since the program started. The Taipei city government has gone one step further by banning all people without masks on public transport as well as from government facilities and offices, such as public libraries and museums, and conducting temperature checks at their entrances. People and vendors at public markets in two of Taiwan’s largest cities, Taipei and New Taipei, will also be required to wear masks and have their temperatures taken, otherwise which vendors in New Taipei will be fined between NT$30,000 and NT$60,000 (US$1,000 to US$2,000) in accordance with the Act Governing Food Safety and Sanitation.
Chen also explained that these social distancing measures are being implemented early as a “preventative measure to contain COVID-19, even though Taiwan has not yet reached a lockdown level as has been the case in many other cities around the world”.
“It will be too late if we implement social distancing after a lockdown has been announced,” he added.
On April 4, due to the increased number of visitors over the Tomb Sweeping Day and news reports of people not wearing masks in major tourists spots, the CECC also made use of Taiwan’s Public Warning System (PWS) to send alerts to people at 11 tourist spots, such as the Alishan National Scenery Area and the Dongdamen Tourist Night Market in Hualien. The alert read: “When visiting crowded places during the long break, remember to keep a distance of at least 1.5 meters when indoors and 1 meter when outdoors, or wear a face mask and wash your hands frequently. Consult a doctor right away if you are not feeling well. Call 1922 if you have any questions.”
The alert that was sent was a “national-level” alert, signifying “immediate threat from disaster or danger,” and was also previously used by the CECC to alert people to places in Taiwan where passengers from the ill-fated Diamond Princess cruise ship had visited in January, when it docked in Taiwan’s waters off the Port of Keelung. To date, a total of 712 people who were onboard the Diamond Princess have been tested positive for COVID-19. The PWS had been developed to warn residents in Taiwan of “attacks from the air, land or sea, as well as natural and other man-made disasters,” where sirens will be sounded or messages sent to smartphones in the event of imminent threats. On the Sunday night of April 5, right after the long holiday ended, Taiwan also conducted a large-scale disinfection project of 863 major tourist spots, including 205 transportation hubs and 250 business areas. Chen, the health minister, added that people who visited crowded areas such as these should practice 14 days of self-health management, including strict social distancing and the strict wearing of masks as well as avoid going to school or work, and to report to a doctor if they show symptoms. Employers should also not punish employees who “ask for sick leave if their recent travel history could have put them at risk and are experiencing symptoms of COVID-19,” he said.
Having said that, Lin, the transport minister, reported that “visitors to the 13 national scenic areas and 25 amusement parks supervised by the Tourism Bureau were down 50 percent compared with the same period last year.” He also reminded that, “people can enjoy their holiday outdoors and feel just as relaxed [as long as] they adhere to disease-prevention policies, including observing social distancing, wearing masks, visiting less-crowded areas and avoiding peak travel time.” Nonetheless, the government said April 8 that restrictions will be placed on amusement parks, to 50% of their capacity. Outdoor scenic areas can also restrict capacity to 50% based on the availability of their parking lots, while scenic areas that can hold more than 100 visitors should consider setting daily limits and “ask people to make reservations in advance.” In Taoyuan, the government has set up live cameras at eight tourist spots to help potential visitors gauge the crowd level before they decide whether to venture to these places.
There are social concerns in Taiwan too –legislator Hung Sun-han 洪申翰 pointed out that individuals who are homeless also pose as a loophole in Taiwan’s COVID-19 response, in part because “they might also be physically weaker due to spending long periods of time outdoors” thereby increasing their susceptibility to the coronavirus, and also because many of them gather at the Taipei Main Station which can create another vulnerability for them, due to it being a transportation hub.
Ministry of Education data also revealed that 15% to 28% of students in Taiwan’s cities and counties do not have Internet access, which would result in difficulties accessing e-learning resources.
Compared to Singapore’s social distancing measures, however, Taiwan’s measures can be said to be more “preemptive”,in that the measures are being implemented even as Taiwan is only seeing one to two cases of new COVID-19 cases every day. What is particularly worrying, however, is that the long holiday in early April might result in spikes and new clusters to Taiwan’s coronavirus cases. The number of domestic cases Taiwan would see in the next two to three weeks would therefore determine the efficacy of Taiwan’s social distancing measures.
National Taiwan University College of Public Health (NTUCPH) dean Chan Chang-chuan 詹長權 also recommended that in view of the concern that such long holidays pose to disease prevention, the next long weekend break in early May should be postponed. Taiwan Premier Su Tseng-chang 蘇貞昌 has said however that the government has no plans to cancel the holiday, “as long as people remain self-disciplined,” though there was still one month to the holiday, so things might still change. Still, Su advised people to relax at home during the break instead. In addition, Chan is also recommending that the government extend social distancing to 2 meters in indoor areas and long-term care facilities, as well as to also implement social distancing on public transportation and outdoor areas, of a meter.
Clear and science-based school closures and guidelines in Taiwan
Taiwan has not yet seen a need to undergo a lockdown at the current point, but what tends to be forgotten is that at the start of the pandemic in Taiwan, it has already implemented a semi-lockdown via the schools which has arguably helped to contain the spread of the coronavirus in Taiwan. In an interview with Bloomberg, Singapore Education Minister Ong Ye Kung claimed that, “Taiwan in fact kept their schools open,” but this is not true as schools in Taiwan did shut for two weeks.
Taiwan saw its first confirmed COVID-19 case on January 21, and by February 2, Taiwan had 10 confirmed cases. Taiwan made the decision at that point to postpone the reopening of primary and secondary schools by two weeks, from February 11 to February 25. Contrary to the Singapore government, Taiwan’s CECC concluded that, “clusters of respiratory illness are more likely to occur at school campuses and that it’s difficult to control the disease outbreak if imported cases take place at school campuses,” and the decision to postpone the opening of schools was made as a “preventive measure to actively prevent cluster infection at schools.”
Compare this with Singapore’s Education Minister Ong Ye Kung who had said on February 7, that “schools may actually be one of the safest places for our students”. Ong also said that, “there [is no] evidence to show that the young are vectors or spreaders of the virus, [and that] the reverse appears to be the case, where the young get infected by adults at home”—apparently on the advice of Dale Fisher, who is quoted at the start of this article, as wanting “schools to stay open [because] this is what success [in fighting COVID-19] looks like.” Dale Fisher is also chair of the WHO Global Outbreak Alert and Response Network, and WHO has given some very questionable advice, such as praising China’s government for its non-transparent approach towards managing COVID-19 and its advisory that mask use is not required to prevent the spread of the coronavirus, and even claiming that there was no human-to-human transmission in January, even as Taiwan had warned WHO of the possibility at the end of December last year.
Whether or not the decision to postpone school reopening has helped to suppress the infections in Taiwan requires further study, but it should be noted that while the number of cases in Taiwan has grown from 10 cases on February 2 to 382 cases at the time of writing, Singapore’s cases have increased from 18 to 2,108. In a review of 19 papers, Kings College London post-doctoral researcher Samantha Brooks and her co-authors found that “school closure can be effective to reduce social interaction and, thus, the spread of infection, though “families need to be motivated to engage in collective action through clear information sharing as well as practical and financial support”—which Taiwan did as well.
In order to allow parents to stay at home to take care of their children, Taiwan’s government also created a “disease prevention childcare leave” whereby parents with children under the age of 12 could take two weeks of break, and their employers were not allowed to mark the employee as absent or force him/her to take personal leave, otherwise which employers would face a fine of up to NT$1 million (US$33,271). However, a gap in this measure is that employers got to decide if their employees should still be paid a salary during the leave period, though the government later set aside NT$24 million (US$798,509) to help companies who assist with the child care plans of employees.
In comparison, instead of closing schools and creating a new child care leave for parents, Singapore instead kept them open claiming it to be a “support for working parents,” its education minister Ong said. He added: “Closure of schools will disrupt many lives, especially parents who are both working, with no domestic help, and have limited childcare options.” The example from Taiwan shows that it is possible to be flexible in such an instance to provide alternate arrangements, yet Singapore’s refusal to do so has had consequences.
Just before schools in Taiwan reopened on February 25, the Environmental Protection Administration (EPA) also announced that all schools would be disinfected. The Ministry of Education (MOE) also issued preemptive guidelines where classes with one student or teacher confirmed with the coronavirus would have to be suspended for two weeks, while the whole school would have to close if two or more students or teachers are confirmed. Townships or districts where one-third of the schools saw confirmed cases would also need to shut down. Several universities and schools, such as National Chengchi University and National Tsing Hua University, have since undergone such measures when confirmed cases were found, and have been able to limit the spread of the coronavirus. Taiwan’s preparedness shows here. Again, this is compared with Singapore’s school suspension of only one day for disinfection.
While Taiwan has still not yet seen a need for a full lockdown, its science-based measures and guidelines developed in accordance with the disease progression of COVID-19 has therefore bought time for Taiwan to fight the disease more successfully than Singapore. Taiwan’s acknowledgement of schools as potential vectors of transmission in comparison to Singapore’s denial also allowed schools in Taiwan to be shut in order to cut off the transmission route. Moreover, Taiwan’s government also recognized the need to provide support for parents who would need to take care of children, as opposed to Singapore’s government which decided against doing so and therefore kept schools open in a bid to prevent having to stop work.
Yale University Sterling Professor of Social and Natural Science Nicholas Christakis pointed to evidence as showing that both proactive and reactive school closures (which both Taiwan did) can be effective to slow down the spread of the coronavirus as these could help reduce infections. He explained that proactive school closures “have been shown to be one of the most powerful nonpharmaceutical interventions” because “the children, the little vectors, [are] removed from circulation” and parents are effectively required to stay at home, thus “reduc[ing] the mixing of adults;” and reactive school closures “for a moderately transmissible pathogen reduces the cumulative infection rate by about 25% and delay the peak of the epidemic [in that region] by about 2 weeks.” Taiwan had implemented proactive school closures by postponing the reopening of schools by two weeks, and reactive school closures by introducing guidelines for school closures in the event of confirmed cases being identified in the schools.
In other words, Taiwan’s willingness to face up to the need for clear and strong measures against Singapore’s halfhearted attempts has allowed Taiwan to stay in a better position, at least for now. With Singapore’s lockdown, its students have now become one of the 90% or so in the world facing school closures according to UNESCO’s data, while Taiwan continues to be among the less than 10% of students in countries not facing closures. However, UNESCO’s data has inaccurately included Taiwan as part of China, in which schools are still largely closed. The United Nations, like WHO, is doing the world a disservice by not properly recognizing Taiwan’s success in combating COVID-19.
Taiwan’s face mask use is validated, Singapore reverses its position against face masks
Another gap in Singapore’s approach is its lack of production capability of surgical masks, as compared with Taiwan’s early planning to increase its production capacity to meet local needs.
Taiwan’s Asia University vice president Wu Tsung-neng 吳聰能 explained that Taiwan does not yet need to undergo a lockdown because current mask supplies meet demand, and there is no (or rather, little) community transmission. Therefore, the Singapore government initial insistence that mask use is not necessary unless a person is unwell could have been a major loophole in Singapore’s COVID-19 strategy. As such, on the day the prime minister announced the lockdown, he also announced that the government is also “rethinking” their advice on face masks, based on “scientific advice and guidelines from the World Health Organization (WHO).” WHO had initially advised that mask use is “not required, as no evidence is available on its usefulness to protect non-sick persons,” and even claimed that masks are being worn in some countries due to “local cultural habits.” Singapore had even in early February said that mask use is only necessary if someone has a fever, cough or runny nose, or are recovering from an illness.
However, the Singapore government has finally on April 3 decided that it would “no longer discourage people from wearing masks” because “wearing a mask may help to protect others, in case you have the virus but do not know it”, due to “evidence that an infected person can show no symptoms, and yet still pass on the virus to others.” In fact, a search on Google at the time of writing shows up many articles pointing out how WHO had been “wrong” in advising against mask use. Dr Leung Chi-chiu, chairman of the advisory committee on communicable diseases at the Hong Kong Medical Association, explained to the South China Morning Post: “Transmission from asymptomatic infected individuals has been documented for Covid-19, and viral load is particularly high at the early stage of the disease. Masking, as a public health intervention, will probably intercept the transmission link.”
Similar findings were identified among Taiwanese patients, according to Taiwanese epidemiologist Chang Shang-chun 張上淳, who said that some confirmed cases “were found to carry high traces of the coronavirus at the onset of symptoms, with viral concentrations starting to drop after a week”, which therefore “suggests that asymptomatic patients can be extremely infectious”. Moreover, the use of masks can also reduce the chance of an infected person spreading the virus to another person by 50%, infectious diseases expert Leong Hoe Nam also said.
However, due to the lack of surgical masks for the public, the Singapore government is instead providing reusable cloth masks to its residents. These masks can be purchased locally at health care and beauty stores, but it nonetheless is an additional protective measure. As of April 9, 3.52 million masks have been collected by the 1.3 million households in Singapore. Even though cloth masks do not offer the same protection as surgical masks, Richard Peltier, assistant professor of environmental health sciences at the University of Massachusetts-Amherst, told PolitiFact that thick cloth masks are still the most effective alternative in the event of surgical mask shortages because “many layers of densely woven fabric […] allows for lots of voids in the layers where particles can be trapped.” A council member of The Institution of Engineers Singapore (IES) Dr. Teo Tee Hui, also said that, the reusable masks would “provide between 50 and 60 per cent of filtration efficiency.”
Nonetheless, even as Singapore does not have the mask production capability as Taiwan, Singaporean gaming hardware company Razer announced on April 1 that it will be setting up automated face mask production lines to produce “a couple of million certified masks” a month within 30 days. This compares with about 400 million in a month in Taiwan. Another Singaporean company Mdesign Solutions also announced that it has invented a reusable mask, the Gill Mask, which uses only one-sixth the filter material of a standard surgical mask. Trade and Industry Minister Chan Chun Sing also mentioned just April 6 that Singapore is trying to build up its capacity to produce face masks but refused to share details, because “at this point in time, it will not be appropriate for us to talk about this capacity, because [they were] working with partners to secure the materials, the lines.”
From masks to food, Singapore looks sorely unprepared for the pandemic.
In Taiwan, after first pumping in NT$200 million (US$6.7 million) on January 31 to assemble 60 production lines to produce surgical masks, and another NT$90 million (US$3 million) on March 5 to set up another 32 lines, Taiwan has since March 13 been able to produce 13 million masks a day up from only 1.88 million in January, and will be able to increase it to 15 million by this Sunday (April 12), which apparently is able to meet the domestic demand of 9 million a day, though this is accounting for the rationing.
I have written about the strategy Taiwan devised to produce and ration its face masks, thereby ensuring that from having to ration the purchase of two to three pieces of masks per adult a week, Taiwan’s residents will from 9 April be able to purchase nine masks per two weeks. Several other articles have also detailed how Taiwan was able to work with a “national team” of 140 people from 29 enterprises to build up its mask production capacity to become the second largest mask producer by early March. After Taiwan set up an online system to allow people to purchase masks in March, the system has undergone two reiterations, which would soon allow people to perform such transactions more efficiently at online kiosks located at major hypermarkets, in addition to the current pharmacies and health centers, as well as at home by plugging in their National Health Insurance card to the network. Taiwan’s Digital Minister Audrey Tang 唐鳳 is instrumental in the setting up of this digital system.
In addition to surgical masks, the government in February 6 requisitioned 2.1 million N95 masks from February 17 to March 17 from local companies, and has decided to requisition 3 million of such masks every month from April 8 onwards. The move is seen as a pre-emptive move as there is currently no shortage since medical workers only use 30,000 to 40,000 of N95 masks every day, or about 1.2 million a month, but Taiwan’s CDC felt the need to safeguard supplies. There are currently four companies in Taiwan which produce a combined 100,000 to 105,000 N95 masks each day, and which will increase by another 20,000 by end-March. (Fun fact: did you know the inventor of the “electrostatic charging technology used to produce the filter media of […] N95 masks” is actually Dr. Peter P. Tsai 蔡秉燚, a Taiwan-born scientist?)
Arguably, the recognition by Taiwan’s government of the importance of mask use, and its proactive efforts to increase production as well as ration mask use has allowed Taiwanese and its residents to become part of an effective strategy to contain the spread of COVID-19 within the community. Mask wearing has become so normalized now in Taiwan that people pretty much go about their daily lives as normal, but with masks on. Nonetheless, Chen, the CECC head and health minister, has also taken to reminding people not to waste their masks but to use them “economically,” and has also recommended that people sterilize their masks by putting them in a rice cooker without water for three minutes.
Taiwan’s constant refining of its COVID-19 testing criteria to enhance its ability to catch infections
Although Singapore’s COVID-19 cases have risen to 5.5 times that of Taiwan’s, the lockdown in Singapore could still be able to help cut the transmission and help slow down the transmission. Singapore has already closed off its borders and its strong COVID-19 testing regime should theoretically enable it to catch new infections with greater speed than other countries. A study also previously showed that Singapore’s “strong epidemiological surveillance and contact-tracing capacity” were superior to other countries in detecting the coronavirus. The study did not include Taiwan, however.
It is likely that the Singapore government decided on a lockdown after evaluating on their current measures, and realizing that while its targeted social distancing measures are novel, there might be a more urgent need to cut the community off one another if the virus is to be better contained—by implementing a lockdown and adding on (cloth) masks as a protective barrier.
This is something Taiwan has also recognized—Taiwan’s current COVID-19 strategy relies on social distancing guidelines to keep people apart in order to cut off community transmission, and where not possible, to use face masks as a barrier to protect against COVID-19 infection.
New daily domestic and imported cases in Taiwan from March 10 to April 10, 2020.
In addition, in order to eliminate the coronavirus from the community as far as possible, this would therefore also require a strong testing regime that can identify infected cases as quickly as possible, so as to cut off this route of transmission.
As such, Taiwan has been revising its COVID-19 testing guidelines continuously, to more effectively identify people infected with the coronavirus. On March 25, the CECC decided to expand testing to medical and health care workers who work in hospitals, health care institutes and nursing homes, and who have developed fever or respiratory symptoms, in order to “prevent possible cluster infections in the nation’s health care system.” On April 1, the government decided again to expand the testing criteria to those with “fever, acute respiratory infection, or a lack of smell or taste,” those with “clinical, radiological or pathological diagnosis of pneumonia,” as well as people “suspected of having community-acquired pneumonia, but has no history of recent overseas travel.” In addition, other than waiting for individuals on quarantine to develop symptoms, doctors are also required to test individuals who have had “close contact with an infected person, including caring for them, spending time with them or being exposed to their bodily fluids,” as well as individuals who had been in close contact with infected patients infected who were part of a cluster.
These new testing guidelines were developed after Taiwan began to see new confirmed cases from asymptomatic individuals as well as individuals who have lost their smell and taste. CECC convenor Chang Shan-chwen 張上淳 pointed out that the lack of smell and taste among infected individuals returning from Europe and the United States was not seen among symptoms in earlier cases from China, which suggests that this could be “associated with a mutated coronavirus strain in Europe”. In addition, on April 4, the CECC also announced that because there was an increasing number of people who were tested positive for COVID-19 after they ended their 14-day home isolation or quarantine, they would be given another seven days of self-health management, during which time they should “minimize time spent in public, wear a surgical mask and practice common hygiene to avoid infecting others”, in case they would be tested positive subsequently. They are also required to test their temperature twice a day and report suspected symptoms to the authorities. Due to diarrhea being an increasingly common symptom of COVID-19 (19% of confirmed cases from April 1 to 3 presented with diarrhea), people who experience diarrhea would also be tested. “People who visited overcrowded tourist spots during the four-day Tomb Sweeping holiday” would also be considered at high and will be tested as well. Another high-risk group identified and tested were flight crew and passengers on a flight returning from New York where 10 confirmed cases were found. Deputy Minister of Health and Welfare Hsueh Jui-yuan 薛瑞元, who is in charge of the CECC’s medical response division, said that the continued expansion of testing criteria is part of its “enhanced community-based surveillance” strategy.
Even as Taiwan continues to refine its testing criteria, National Taiwan University College of Public Health (NTUCPH) dean Chan Chang-chuan 詹長權 is still calling for the testing criteria to be further broadened, such as for “vulnerable groups such as patients with serious disease in hospital or senior citizens in nursing homes”, as well as people whose jobs put them at higher risk of coming into contact with many people, including drivers, delivery service operators and convenience store workers. This was similarly echoed by Vice President Chen Chien-jen 陳建仁, an epidemiologist by training.
With the revelation by the CECC’s Chang Shan-chwen that younger cases seemed to present with milder symptoms than adults, infectious disease specialists from China Medical University Hospital (CMUH) and Linkou Chang Gung Memorial Hospital, Wang Jen-hsien 王任賢 and Huang Yhu-chering 黃玉成 are also calling for all children under quarantine to be tested. Taiwan is currently conducting about 1,500 COVID-19 tests a day, though it has reached the capacity to be able to do 3,800 tests a day which can be analyzed at 34 testing facilities.
In addition, there are also several developments in the area of test kits, treatment and vaccines for COVID-19. Taiwan’s National Health Research Institutes (NHRI) announced on April 2 that it has developed a rapid test kit which could test people for SARS-CoV-2, the virus that causes COVID-19, and give results in 10 to 15 minutes. NHRI unveiled the prototype test kit in a meeting with 22 manufacturers to discuss trial production, and NHRI President Liang Kung-yee 梁賡義 said the test kit could be available within the next three months, after Taiwan’s Food and Drug Administration developed a scheme which allows the time for clinical trials and mass production to be shortened. Taiwanese-Danish company BluSense Diagnostics has also developed a test kit which can give results as quickly as 12 minutes. A clinical trial of 15 cases in Denmark’s second-largest hospital, the Hvidovre Hospital, found an accuracy rate of 90%. It aims to be certified by the European Union next month and be available for use in Taiwan by June.
The Chang Gung Memorial Hospital, together with Academia Sinica, the National Defense Medical Center’s Graduate Institute of Medical Sciences and the University of Oxford, have also managed to “isolate 22 new strains of SARS-CoV-2 and complete the full genome sequencing of the virus,” as well as identified 25 strains of antibodies which can be used to “prevent the virus from replicating itself in the human body,” that can be developed for the treatment and higher-sensitive testing for COVID-19. Taiwanese company Senhwa Biosciences is also collaborating with the U.S. National Institutes of Health (NIH) to evaluate the efficacy of a drug it developed to treat cancer, Silmitasertib, but which has also been found to suppress the growth of COVID-19. A vaccine developed by the NHRI injected into mice also allowed them to produce antibodies, giving hope that the promising results could enable clinical trials to begin by the end of this year.
In Singapore, Biolidics, a Singapore-based company has also developed a rapid test kit that can produce results in 10 minutes with a 95% accuracy, and has also “ obtained provisional authorisation from the Health Sciences Authority for the test kits to be used in Singapore,” though Asia Pacific Society of Clinical Microbiology and Infection president Dr. Paul Tambyah cautioned that in a study by Chinese researchers using serological test kits (similar to Biolidics’ and NHRI’s kits), only 50% to 80% of infections were detected among people treated for 10 days, and thus while such kits are useful for finding linkages between clusters, they might be less useful for “acute diagnosis.”
These testing criteria Taiwan added on in March is in addition to the other testing criteria Taiwan has previously developed, such as the testing of all patients reporting with severe respiratory symptoms but had tested negative for influenza. Notably, while Taiwan decided only on April 1 to test all patients with pneumonia, Singapore had decided as early as late-January to do so. However, Singapore has not publicly announced new testing criteria in recent weeks. Singapore is also now conducting about 2,800 to 2,900 tests a day for the last month or so. Nonetheless, by April 6, Singapore has conducted 7,000 tests per million people as compared to 1,845 per million people in Taiwan.
There is therefore still a big question of whether Taiwan is conducting enough tests. At the time of writing, Taiwan has conducted 43,886 tests, which compares with the 338,449 tests Australia has done—a country with a similar population as Taiwan. Having said that, the positive rate of the tests Taiwan has conducted is only 8.7 per 1,000 tests conducted, as compared to 18.4 per 1,000 in Australia. Vice President Chen explained that what this shows is that, “the lower the rate of positive tests, the broader the coverage of tests of potentially infected people.” If so, even with the fewer number of tests conducted in Taiwan, this suggests that Taiwan’s testing regime has been relatively more effective at catching out people who are positive with COVID-19. It is not possible to know this for sure unless large scale testing is conducted on the whole population, but if this is indeed the case, it could suggest that Taiwan’s early intervention and testing implemented since the end of last year could have indeed helped it to contain the coronavirus to a manageable level that does not require taxing its resources.
Having said that, Taiwan’s positive rate has been increasing, though it should be noted that more than 86% of Taiwan’s confirmed cases are due to importation. On the other hand, it does give rise to concerns as to whether enough domestic testing is being conducted. Moreover, it is known anecdotally that hospitals have been known to still reject testing people with symptoms but have no contact history, or because they do not want to overload their existing capacity. Nonetheless, if there is widespread COVID-19 community transmission in Taiwan, it is likely that many of Taiwan’s hospitals will be overwhelmed with patients with pneumonia and severe unexplained respiratory infections. However, this is not the case as of now.
In the end, however, NTUCPH’s dean Chan Chang-chuan said that efforts need to be found to “find a way to get along with the virus peacefully, because it cannot be eradicated”. Indeed, Chan pointed to how students can still go to school in Taiwan as of now because the reopening of schools had been postponed in February which helped slow the transmission of COVID-19. However, “non-pharmaceutical intervention” such as social distancing and “physical barriers” such as face masks are still essential to guard against COVID-19 before medications or vaccines are developed to combat this coronavirus, though Chan added that “non-essential activities such as recreation” should also be suspended. Chan even joked that just like bubble milk tea, Taiwan could “change the world” with face masks, especially with more people in Europe putting on masks in crowded venues today. As Chan predicted that the COVID-19 pandemic would stretch into summer, it might even be necessary for people to be given “test certificates” to travel to other countries.
But will The health care systems in Taiwan and Singapore hold?: Too few health care workers for their populations
As both countries start reaching the maximum capacity of their isolation negative pressure wards and critical beds, their overall health care capacity is beginning to take the spotlight.
Taiwan has 1,100 negative-pressure isolation wards for its 382 confirmed cases to date, of which 91 have recovered. As of April 3, 417 of the wards were still available. Including other COVID-19 designated wards, there are 2,713 beds, of which 1,597 beds or 59% of them are still available, and the total capacity can be increased to 20,985 beds “if a widespread local outbreak occurs,” Deputy Minister of Health and Welfare Hsueh Jui-yuan said. Taiwan also has 9,932 respirators, with 1,300 still available, but the capacity will be increased to about 2,200. There are also “163 hospitals capable of performing tests on suspected cases, 143 responsive and isolation hospitals designated for admitting patients with mild symptoms, and 52 regional hospitals and medical centers that can take in patients with severe symptoms,” Hsueh added. Centralized quarantine facilities will also be expanded from 1,553 rooms at 13 quarantine centers to more than 3,000. The current rooms have been “requisitioned from dormitories, training centers, and military bases”. In addition, Taiwan has also developed a four-phased strategy to “expand capacity for hospitalizing COVID-19 patients”: during the first phase, all COVID-19 patients would be admitted to negative-pressure isolation wards or single rooms. In subsequent phases, exclusive COVID-19 departments will be set up within designated COVID-19 hospitals which will then suspend the admissions of non-COVID-19 patients, who will be redirected to other hospitals.
Singapore has 330 such beds which it says can be increased to 500 if necessary. However, this is in comparison to the 2,108 cases Singapore has seen thus far, of which 875 are still hospitalized with 32 in critical condition. Another 734 who are “clinically well but still test positive for COVID-19 are isolated and cared for at Concord International Hospital, Mount Elizabeth Hospital, Gleneagles Hospital and the Community Isolation Facility at D’Resort NTUC”, as well as another one at the Singapore Expo and MAX Atria convention center, the latter two of which have capacities for 500 patients and 480 patients, respectively. Due to the increasing number of COVID-19 cases, Singapore has decided that not all patients would require hospitalization. Health Minister Gan Kim Yong said that because “about 80 per cent of cases are mild or moderate, with many hospitalized cases experiencing mild symptoms similar to the flu, they only require limited medical care, and what we need really are isolation facilities to prevent them from infecting others until they are free of the virus.” Patients have as such been sent to private hospitals and community care facilities that have been set up to do so. Critical hospital resources, Gan said, would therefore be focused on treating the seriously ill, and to minimize the number of fatalities.
On April 8, when Singapore saw its second-largest one day increase in confirmed cases as of the time of writing, Straits Times reported that the three private hospitals had received more patient transfers than usual as “the bid to free up capacity at public hospitals has become more urgent”. In addition, the transfer of patients from the public to private hospitals is being made “on an almost daily basis” now as compared to a week before. From April 9 when Singapore saw its cases spiked to the highest at the time of writing, other than the public and private hospitals where COVID-19 tests can be conducted, testing was also extended to all of the 20 polyclinics, with at least 65 general practitioner clinics which can do so as well.
However, what is worrying is the number of critical care beds Singapore has—according to a new paper published in January 2020, Singapore has only an estimated 671 critical care beds, or only 11.4 beds for every 100,000 population. This compares with the estimated 6,701 critical care beds in Taiwan, or 28.5 per 100,000 population. However, when it comes to the number of physicians and nurses per 1,000 population, both Singapore and Taiwan are in an unhealthy position. Singapore has only 2.3 physicians per 1,000 population and 7.2 nurses and midwives per 1,000 population, while Taiwan only has 2.3 physicians per 1,000 population and 6.8 nurses and midwives per 1,000 population. This places both countries as having one of the least number of health care workers per population, which suggests that their health care workers are being overworked, which is especially concerning given the heavy stresses and workload during this COVID-19 pandemic.
Singapore therefore faces both the shortage of health care workers and critical beds to cope with the rising number of infections, while in Taiwan, the concern among health care workers is that there are not enough health care workers to operate the number of critical beds available. Both countries need to step up on this front.
Political and economic considerations impaired Singapore’s COVID-19 response; responsive and proactive measures in Taiwan prevented lockdown
In the second phase of the pandemic in Taiwan and Singapore (as well as Singapore’s third phase of community transmission), it is clear that Taiwan has a more responsive and proactive strategy.
Total domestic cases in Taiwan and Singapore from March 1 to April 10, 2020.
While Taiwan is slow in some aspects—it only started testing all pneumonia cases for COVID-19 two months after Singapore started doing so, and it started testing visitors and returning residents entering the country about 10 days behind Singapore (though it also conducted retrospective testing on those who had already arrived)—Taiwan was quicker on its feet in terms of enacting social distancing measures (advisories were issued even as Taiwan was only seeing one to two cases a day), and it has been revising its testing criteria in order to catch more cases.
Taiwan’s social distancing measures are also more complete than Singapore—while Singapore’s measures created a loophole in its public transportation system, Taiwan mandated the wearing of masks on public transport with corresponding penalties; and while Singapore only required a one-day suspension of schools when confirmed cases are seen, Taiwan demanded 14-day shutdowns. (Singapore only finally decided to do so after major cluster infections occurred in its educational institutions.)
Taiwan’s militant use of face masks and its fine-tuned and science-based COVID-19 strategies could therefore help to explain how it has managed to keep the number of new domestic coronavirus cases to only one or two a day. Singapore’s strategy which is riddled with inconsistencies could therefore go some way towards contributing to its increasing number of new cases, from looking like it was plateauing to about 100 cases at the end of February to hitting 1,000 cases by April 1, and to 2,108 at the time of writing (April 10)—or a doubling within just nine days.
The effectiveness of Taiwan’s strategy in maintaining a business-as-usual scenario can also be seen in how travel for work and other social activities has remained largely unchanged between the first week of January and March 29, according to Google’s Community Mobility Report. In comparison, Singapore has seen travel to workplaces decrease by 15% as compared to the baseline since the middle of March when Singapore started seeing a spike in community cases and social distancing measures were announced, and travel for retail and recreation has also seen a 28% decline. This data is prior to Singapore implementing its lockdown.
However, now that Singapore has decided to undergo a lockdown—albeit a partial one, since the essential services that are still operating come in a long list—and with its decision to rollback against the use of face masks, there is the possibility that community transmission could be cut off. However, whether Singapore’s revised strategy would work would depend on whether the lockdown would be thorough enough and whether the cloth masks that the Singapore government is distributing would act as an adequate barrier, otherwise which Singapore might need to implement a more effective lockdown, if cases do continue to rise unabated for the next two weeks. Chan Chun Sing said that Singapore’s “circuit breaker” measures could still be extended if the coronavirus is not reined in.
For Taiwan, the long weekend that just passed could result in a spike of new infections, and its broader testing criteria could also bring about more cases, after which a decision might be made for Taiwan’s authorities to implement a lockdown if widespread community cases are found in the next two weeks. NTUCPH vice dean Chen Hsiu-hsi 陳秀熙 pointed out, however, that “as long as the public properly follows current disease control measures, including home quarantine, an increase in infections will be unlikely.” According to NTUCPH analysis, if Taiwan’s upcoming domestic cases after the long break do not cross 20 a week, it is unlikely to lead to widespread community infections. In contrast, in the first seven days of March, Singapore already saw 31 confirmed domestic cases in a week for a population three times smaller, but the first social distancing measures were only announced on March 13. Chen added that even if small clusters were to be reported, widespread community infection can still be curbed if social distancing is practiced and face masks are worn. NTUCPH has also developed nifty models using the basic reproduction number and local positive testing rate to look at the various lockdown models Taiwan could adopt in the event of widespread community transmission, in order to slow down the spread. The basic reproduction number, or R0 reflects the number of people an infected person can pass on the disease to on average, within a community with no immunity, and current estimates put it at 2.9 globally, which is where Europe and the United States are currently at. Taiwan’s current R0 is 0.3, with NTUCPH researchers say is still “within a controllable range.” According to the researchers, an R0 higher than 1.5 would represent community transmission where “a lockdown should be considered” while one that is higher than 2.0 signifies a full-scale outbreak. Indeed, if new confirmed cases continue to remain low in Taiwan, it would be a testament to the effectiveness of Taiwan’s mask and testing strategy, as well as to how Taiwan had very early on arrested the spread of the virus by instituting measures as early as December 31 last year when the Wuhan authorities first admitted to the presence of a new coronavirus.
Singapore initially had a very sound strategy focused around its health and testing system. However, what failed and created a gap in its strategy isn’t the loophole in its health system – yet, but its politics. Dale Fisher revealed the thinking behind the decision making in Singapore when he pointed out how Singapore wanted “life to go on as normal” because “this is what success looks like”. Even Chan Chun Sing had boasted that Singapore wanted to be “the first one off the blocks” when the economy rebounds after the coronavirus. Just a month ago, National Development Minister Lawrence Wong even said that if COVID-19 becomes a global pandemic, “there is no basis for putting border controls unless we shut ourselves from the world, which we don’t want to”. But by the middle of the month, Singapore had to change its tune, and Wong had to also make an about turn. By March 18, when Singapore saw a jump of domestic infections from six to 14, from a day before, Wong said: “We cannot afford to take further risks if the number of imported cases continue to rise.” Singapore closed its borders shortly after.
The problem therefore was that while Singapore made the wise decision initially to focus its resources on the health and testing system to curb the spread of COVID-19, it clearly became overconfident and started placing its bets in the wrong basket. The Singapore prime minister’s brother Lee Hsien Yang said it succinctly when he said: “The question needs to be asked: has the government been too reactive and doing too little, just to avoid alarming the people or limit the economic damage? To what degree have its actions been blinkered by its desire to hold an early GE?” The GE is Singapore’s next general election which is to be held by April 2021, and the ruling party has shown itself to be eager to hold the election in the midst of the pandemic—the belief on the ground is that the ruling party has made the assessment that its handling of the coronavirus could enable it to win big, and it therefore wanted to push through with the election, in spite of calls by the opposition to postpone the election and focus on managing the pandemic. The Singapore prime minister also alluded to how the election is necessary so that the government could have the “strongest mandate to see it through the crisis.”
However, this is a misnomer since the ruling PAP government has already won a 69.9% mandate in 2015, and 93% of the seats in parliament, and there is simply no need to hold the election. Instead, as Lee Hsien Yang said, “the ruling party is spending precious time and mental energy on electoral arrangements while new clusters of infection are popping up.” On April 3, as Singapore announced a lockdown, the Singapore government still sneaked in a bill to enable it to take “contingency plans” to hold a “safe election.” When asked on Bloomberg how the Singapore government can still justify holding an election during the COVID-19 pandemic, Education Minister Ong Ye Kung claimed that “democracy still has to go on”, and the “election campaign plus voting [can still be done] in a safe way,” if the virus can be kept controlled.
Notwithstanding that the Singapore has not been able to get the virus in control over the last three weeks, the claim of “democracy” is fallacious. In fact, not only does the ruling PAP party disregard democracy, it is still finding time during this pandemic to persecute its critics—independent journalist Terry Xu from The Online Citizen had the police search his home without a warrant and had his computers confiscated on March 13 for alleged contempt of court, while activist Jolovan Wham had his guilty verdict for criticizing the judiciary upheld in the high court on March 16 and was admitted into prison on March 31 for seven days. Two youth climate activists aged 18 and 20 were also summoned for questioning by the police for separately holding up protest signs, and had their phones and laptops seized—the police even dug through trash to retrieve one of the signs. Upon Wham’s release, he revealed that due to COVID-19, new inmates have been quarantined in their cells at Changi Prison, and are not even allowed the yard time of one hour. Wham added that the “dismal” conditions of the cells can only fit four people “without much room left to move around” and inmates have to sleep on “thin straw mat[s …] on the hard floor” in rooms with no fans and poor air circulation.
In addition, while Singapore’s courts said that it will only hear essential and urgent matters during the lockdown, appeals under the Protection from Online Falsehoods and Manipulation Act are considered essential and urgent as well—some of the first few victims of this law have been opposition parties politicians accused on a spurious basis. Lee Hsien Yang said as much when he said that, “the current leadership seems to have misplaced priorities and are also seemingly deaf to grim realities.”
The problem? It is apparent that its initial strong health and testing system made Singapore too over-confident that it thought the coronavirus was a flu it can take on and beat—its prime minister Lee Hsien Loong said in his first COVID-19 speech on February 8 that “the new virus is much closer to influenza than SARS.” But its Education Minister Ong Ye Kung finally admitted on April 7 that COVID-19 does “not behave like influenza.” Singapore wanted to take advantage of managing COVID-19 well (then) to boost its economic reputation and win the election, but it clearly made a wrong calculation. COVID-19 is not the flu and Singapore’s unwillingness to lockdown because it wanted its economy to function business-as-usual finally pushed Singapore’s total cases above 1,000. It does not help that Singapore denied the usefulness of masks, only to backtrack on it too late in the game; nor does it help that Singapore implemented social distancing measures too late and its existing social infrastructure is simply not built to cope with pandemic outbreaks (migrant workers are being housed in poor conditions while the prime minister has even acknowledged low-income Singaporeans will be particularly hit; social distancing measures could also not be implemented on Singapore’s overcrowded MRT trains prior to the lockdown). Still, National Development Minister Lawrence Wong who co-chairs Singapore’s COVID-19 inter-ministerial task force was obstinate in refusing to acknowledge Singapore’s mistakes: “If we had put in place all the measures that we’re talking about now much earlier, we may very well still be in the same situation today.” In the end, Singapore’s political and economic decisions compromised its COVID-19 response, and this is a dear lesson for other countries to learn as well—to not allow our successes to get into our heads, and to set our priorities straight. A pandemic is also not the time to keep up with appearances, or as Lee Hsien Yang said, for the ruling party in Singapore to “couch its incremental measures in euphemisms, such as “circuit breaker” and “home-based learning.” Simply, Singapore failed because its risk assessment had been too focused on the monetary aspects and neglects the multidimensional perspectives of risk—which should include the physical, social and cultural infrastructure and institutions. You can run a business on money, but you cannot fight an epidemic with money alone.
In a previous article for Ketagalan Media, I even said that Singapore’s strategy which “is geared towards an economic focus [had at least] ensur[ed] an effective health system” because its decision-makers wanted to “protect their investments”, but I was wrong. What I did not foresee is that it is also precisely this focus on their business interests that has compromised their COVID-19 strategy, and prevented them from adopting social distancing and lockdown measures early enough, and in not investing adequately in the social infrastructure to cope with such sudden shocks to the system—and in even wanting to hold elections in the midst of the pandemic to secure their business interests and power that has blindsided their decision-making. This is perhaps a lesson to Singaporeans as to how society will become dysfunctional when you surrender your power to people who do not have your direct interests at heart.
Taiwan performs the best in terms of total confirmed COVID-19 cases per 1 million people, when comparing with other countries at a similar stage of transmission.
Chart Source: Our World in Data
There are currently 4 billion people in the world under lockdown due to COVID-19, and Taiwan remains “one of only a handful of countries in the world that still allows people to maintain a normal life and daily activities, thanks to the joint efforts of the people [in Taiwan],” Taiwan Premier Su Tseng-chang said. Singapore is one of those which has undergone lockdown, from April 7.
While I had felt that Taiwan should have similarly boasted about its efforts as Singapore did, Taiwan’s slow and steady approach has instead won it praises from other countries. Having been able to produce enough masks for domestic use, Taiwan will be donating at least 17 million masks as of the time of writing to the United States, Europe, countries in Southeast Asia under the government’s New Southbound Policy, as well as to the Latin American and Caribbean countries and its diplomatic allies, resulting in gratitude from these countries, and even from European Commission President Ursula von der Leyen, who thanked “Taiwan for its donation of 5.6 million masks to help fight the #coronavirus.”
Taiwan has also been sharing its expertise in managing COVID-19 as well as working with other countries to develop testing kits and vaccines for the coronavirus. It is important to note that Taiwan has been able to achieve all these in spite of being blocked from participating in the World Health Organization due to political pressure from China, and thereby not receiving timely information on the coronavirus.
What this episode has shown is that Taiwan is a valuable partner in global cooperation and countries need to be able to support Taiwan towards achieving an equal status on the international stage, so that it could continue to share its experience, but more importantly, play its role as a “responsible member of the international community, [because] Taiwan is ready, willing and able to contribute to strengthening global epidemic prevention,” as President Tsai Ing-wen 蔡英文 has said. For countries looking to adopt social distancing measures as they ease their lockdowns, Taiwan is where they should turn to and study. And as Taiwanese officials often say, #TaiwanCanHelp and #TaiwanIsHelping.
(Cover photo via Taiwan Presidential Office on Flickr, CC BY 2.0)
