How Singapore, Taiwan and Hong Kong contained the virus

15.03.2020 TOI 

Covid-19 is spreading unabated across Europe and the US, but some of the outbreaks in Asia have either been brought under control or been avoided at larger scales entirely. Singapore, Taiwan and Hong Kong are examples of the latter.

In a New York Times opinion piece, epidemiologist Benjamin J Cowling and graduate student in epidemiology Wey Wen Lim, both from the University of Hong Kong explained how these countries contained the virus.

None of these regions has had to employ particularly drastic or draconian measures, like China did, to control the outbreak but have managed to contain the spread nevertheless. China’s methods, though hailed as effective, were criticised for impinging on individual rights.

Hong Kong, Singapore and Taiwan are more instructive examples for other democracies attempting to control Covid-19.

As of March 14, Hong Kong reported 140 cases and 4 deaths, Singapore 200 cases and no deaths, and Taiwan 53 cases and one death. The containment in these countries is particularly noteworthy as they are popular destinations from mainland China for the Lunar New Year, during which the virus was spread across the Asia Pacific region by travellers.

Since the first cases were identified — all originating in China — local governments sprung into action. A combination of travel restrictions, quarantines, social distancing and heightened hygiene were implemented in each country. All three countries have relatively small populations, the largest being Taiwan at 23.6 million, and are geographically rather isolated — Taiwan and Singapore are islands and Hong Kong shares a narrow border with China. These factors aided in controlling the outbreak.

Singapore was the first country to cancel all flights from Wuhan and begin isolating ill travelers immediately after China announced the outbreak. Three university hostels were converted into quarantine facilities and people were compensated for any workdays lost.

Officials then began aggressively tracing all contacts of known infected people, using data from transport companies, hotels and CCTV footage.

Though large gatherings have been suspended, schools and offices have remained open to limit the outbreak’s social and economic costs. However, all students and employees undergo daily health checks and temperature screenings.

Taiwan employed similar measures but didn’t ban all flights from affected regions. Instead, it screened passengers on the planes after landing. It later halted flights from Wuhan and other parts of China after its first imported case.

Taiwan also used home quarantines more extensively than others despite availability of quarantining at state facilities. Disobeying quarantine orders also drew a penalty of up to Rs 25 lakh. Mass gatherings and religious services were banned and all schools’ Lunar New Year holidays were extended until February 25.

Just over half of Taiwan’s cases came from local transmissions, a much lower figure than many other affected countries, which illustrates the success of Taiwan’s containment measures.

Hong Kong followed a different approach, in part due to its physical border with China — about 3 lakh people cross it daily. Hong Kong’s strategy focused on limiting local transmission rather than preventing infected people from entering.

After the first case was declared in Wuhan, Hong Kong expanded its existing temperature screening facilities at entry points and asked local clinics to report any patient showing symptoms and with a travel history from Wuhan. Travel restrictions were only placed five days after Hong Kong’s first case was reported. After February 5, all those crossing the border from China were placed under mandatory 14-day quarantines.Vacant, newly constructed public housing buildings were converted into quarantine facilities. More than 24,700 are still in quarantine.

Hong Kong’s social distancing measure were extensive — large-scale events were cancelled, schools were closed until April, and civil servants have been asked to work from home for a month.

Though containing the disease in these countries often came with a social and economic cost, their methods proved effective in stemming the spread of the virus without severely curtailing personal freedoms. With no clear end to the outbreak in sight, other democracies should look to these regions as examples.

FEVER CLINICS HELPED IN CHINA

In an interview with MSNBC, Donald McNeil, an NYT science and health reporter, talked about China’s approach to containing the epidemic.

The focus in China, McNeil said, was to identify all the people displaying symptoms. Despite the lockdown, China did not encourage home quarantines. The objective was to limit spread through family clusters. This was done by checking people’s temperatures at entrances of residential areas or public spaces. If a person was found with a fever, they were sent to fever clinics, which are separate sections of hospitals. Here, people are checked for other symptoms, and are asked to undergo a white blood cell count and a flu test. If these tests don’t clear the person, they undergo an expedited CT scan. A positive result for the scan is followed by a PCR test, which is a nasal swab. People with suspected or mild cases were taken to isolation camps. Only severe cases were hospitalised. This system broke the chain of transmission and prevented overburdening of hospitals.