Taiwan; No lockdown, No mandatory masks, 23M population & 7 deaths - A country that got it right

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Agatha Farmer

There are analysts and countries on both sides of the lockdown argument. We have compiled a list of countries that did not subscribe to a full lockdown strategy and why some have been more successful than others at containing the spread of Covid-19. Taiwan neighbours China and has been the world success story without a lockdown and a with a recommendation for healthy people not to wear masks. More on Taiwan's handling of the virus below. Several analysts have claimed that lockdowns have saved lives although admitting that data is insufficient to know how much of the reduction came from voluntary social distancing. Other epidemiologists have said that generalized lockdowns were enacted without reliable supporting data.

It is accepted that the response to the pandemic has resulted in unprecedented expansion of government power. Advocates of small government worry that the state will be reluctant to give up that power once the crisis is over, as has often been the case historically. Due to the perceived severity of such measures and the increase in government power, there has been much controversy surrounding lockdowns as a concept, with epidemiologists being divided on the issue, with notable proponents for lockdowns including Imperial College London's Neil Ferguson and Cambridge's Rajiv Chowdhury, and those against lockdowns including Mainz's Sucharit Bhakdi and Sweden's state epidemiologist: Anders Tegnell.

Countries like South Korea and Taiwan, which relied on contact tracing by cellphones, have far fewer cases and deaths. Among the ones not following this strategy are, most notably, Sweden (the only European country with Belarus not to do so). Measures in Sweden included the closing of universities and high schools and asking older and at-risk residents to avoid social contact, while keeping restaurants, primary schools and kindergartens open. More on Sweden below.

Here is a list of countries without lockdowns.

Iceland: As of July 25 the total number of cases registered was 1,847, of which 1,823 had recovered and 10 deaths had occurred. With a total population of 366,130 as of March 31 the infection rate is 1 case per 203 inhabitants, which was one of the highest in the world throughout March and April, though this is attributed to more tests having been carried out per capita in Iceland than any other country; these include a screening of the general population run by Icelandic biotech company deCODE genetics to determine the true spread of the virus in the community.

Belarus: In July the country had a total of 67,132 confirmed cases including 60,425 recoveries and 534 deaths. More than 1,013,000 COVID-19 tests have been conducted in Belarus as of date. The country's population is 9.485 million.

Japan: The virus was first confirmed to have spread to Japan in January 2020. The country has seen over 29,684 confirmed cases, 21,567 recovered and 996 deaths with a population of 126.5 million.

Japan’s death rate per capita from coronavirus is one of the lowest in the developed world. Scientists have asked themselves what it is about Japan’s response to the coronavirus that has enabled such a low death rate. The government response, a milder strain of the virus, social effect caused by community immunity, cultural habits such as bowing etiquette or wearing face masks, hand washing with sanitizing equipment, a protective genetic trait, and a relative immunity conferred by the mandatory BCG tuberculosis vaccine have all been proposed as possible explanations.

The Japanese government confirmed its first outbreak of COVID-19 in the country on January 16 in a resident of Kanagawa Prefecture who had returned from Wuhan, China. This was followed by a second outbreak that was introduced by travelling passengers and returnees from Europe and the United States between 11 March and 23 March. According to the National Institute of Infectious Diseases (Japan)  the majority of viruses spreading in Japan derive from the European type while those of the Wuhan type have been disappearing since March.

The Japanese government adopted various measures to prevent and mitigate the outbreak. On 30 January, Prime Minister Shinzo Abe established the Japan anti-coronavirus national task force  to oversee the government's response to the pandemic. On February 27, he requested the temporary closure of all Japanese elementary, junior high, and high schools until early April. On April 7, Abe proclaimed a one-month state of emergency for Tokyo and the prefectures of Kanagawa, Saitama, Chiba, Osaka, Hyogo, and Fukuoka. On April 16, the declaration was extended to the rest of the country for an indefinite period.

On May 14, Japan released the registry to relieve the nationwide state of emergency COVID-19 in 39 of Japan's 47 prefectures or 54% of Japan's population, but it still applied in Tokyo, Osaka, Kyoto, Hyogo, Hokkaido, Chiba, Kanagawa, and Saitama.

On May 21, Japan ended the state of emergency in Osaka, Kyoto, and Hyogo prefectures.

On May 25, Japan ended the state of emergency in all of Japan.

South Korea: Total number of cases as of July is 14,175 , recovered 12,905 with a total of 299 deaths. South Korea's population is 51.64 million. On 20 January the first case in South Korea was announced. On February 21 according to the Centers for Disease Control and Prevention Korea, a sudden jump in cases occurred and was mostly attributed to "Patient 31" who participated in a gathering at a church in Daegu. Amidst the fears of further contamination, mass gatherings in the affected cities were cancelled and a few hundred soldiers in Daegu were placed in isolation.On February 4 in order to help prevent the spread of COVID-19, South Korea began denying entry to foreigners traveling from Hubei Province.

By April 9 South Korea had about 10,423 cases and 204 deaths, with over 494,711 people having been tested, a case fatality rate of 1.95%, which is lower than the WHO's global case fatality rate of 4.34%.

South Korea introduced what was considered one of the largest and best-organised epidemic control programs in the world, along with Taiwan, and Vietnam. Different measures have been taken to screen the mass population for the virus, and isolate any infected people as well as trace and quarantine those who contacted them, without further lockdown. The rapid and extensive tests taken by South Korea have been judged successful in limiting the spread of the outbreak, without using the drastic measure of quarantining entire cities.

Sweden: began testing for the virus on January 31 when a woman returning from Wuhan tested positive. As of July 25  there have been 78,997 confirmed cases and 5,697 confirmed deaths related to COVID-19 in Sweden. As of this date the per capita death rate from confirmed COVID-19 in Sweden (564 deaths per 100,000 population) is 25% higher than in the United States and 5-12x higher than in other Scandinavian countries such as Denmark and Norway. Similar to other European countries, close to half of those who died had been living at nursing homes. Sweden's population is 10.13 million.

On February 26, following outbreaks in Italy and in Iran, multiple travel-related clusters appeared in Sweden. Community transmission was confirmed on March 9 in the Stockholm region. Since then, individuals in every county have tested positive for COVID-19. It's believed that the virus could have reached Sweden as early as December 2019, when several individuals sought care for respiratory illness in Falun after contact with an individual with recent travel history to Wuhan.

Sweden has not imposed a lockdown and kept large parts of its society open. The Swedish Constitution legally protects the freedom of movement for the people, thus preventing a lockdown in peace time. The Swedish public is expected to follow a series of non-voluntary recommendations from the government agency responsible for this area, in this case the Public Health Agency of Sweden (Folkhälsomyndigheten). The Swedish Constitution prohibits ministerial rule – politicians overruling the advice from its agencies is extremely unusual in Sweden – and mandates that the relevant government body, in this case an expert agency – the Public Health Agency – must initiate all actions to prevent the virus in accordance with Swedish law, rendering state epidemiologist Anders Tegnell a central figure in the crisis. Having an expert agency almost completely in control of the country's COVID-19 response without the involvement of politicians set Sweden apart from other countries.

Following agency advice, the government has passed legislation limiting freedom of assembly by temporarily banning gatherings of over 50 individuals, banning people from visiting nursing homes, and physically closing secondary schools and universities. Primary schools have remained open, in part to avoid healthcare workers staying home with their children.

The Public Health Agency issued recommendations to: if possible, work from home; avoid unnecessary travel within the country; engage in social distancing; and for people above 70 to stay at home, as much as possible.

The pandemic had put the Swedish healthcare system under severe strain. Initially, Swedish hospitals and other facilities reported a shortage of personal protective equipment. At the start of the pandemic, concerns were made that Swedish hospitals wouldn't have enough capacity to treat all who could become ill with the disease, especially in regard to those needing intensive care. Swedish hospitals were eventually able to double the number of intensive care beds in a few weeks, and the maximum capacity was never exceeded.

In June, the Swedish central bank Sveriges Riksbank forecasted a fall of 10%. This was mainly due to the Swedish economy being heavily reliant on exports (which attributes to around half of the Swedish GDP) with the shrinking global economy being predicted to decrease international demand of Swedish goods and services. The Economy were also affected by problems with global supply lines, which had forced some of the biggest manufacturing companies in Sweden.

Sweden concluded that a large majority (93%) of the deaths belonged to at least one risk group, with chronic cardiovascular disease being the most prevalent (53%), followed by diabetes (26%), chronic respiratory disease (18%) and chronic renal failure (16%). As of early May, the age among those who had died with confirmed COVID-19 disease was 82, and the majority (54%) of those who had died with the disease were men.

Taiwan: As of July 27, there are 462 confirmed cases in Taiwan, including seven deaths. Among the confirmed cases is a Taiwanese man in his 50s who was fined $300,000 for failure to report his symptoms and attempting to conceal his subsequent activities, leading to a potential contamination incident at a ballroom in Kaohsiung. As of July 15 440 people have recovered from COVID-19 in Taiwan. Taiwan's population is 23.78 million.

On 31 December 2019, Taiwan Centers for Disease Control (CDC) implemented inspection measures for inbound flights from Wuhan, China in response to reports of an unidentified outbreak. The passengers of all such flights were inspected by health officials before disembarking. Taiwan's Central News Agency reported that Luo Yi-jun, deputy director for Taiwan's Centers for Disease Control, had been reading in the early hours of New Year's Eve when a thread about an unknown disease causing pneumonia in Wuhan caught his attention. He saw a post including screenshots from a group chat with Li Wenliang. He immediately emailed colleagues and put the country on alert. Wenliang was a Chinese ophthalmologist who worked at Wuhan Central Hospital and sounded the alarm on Covid, he died from the virus on Feb. 7. On 30 December 2019, Wuhan CDC issued emergency warnings to local hospitals about a number of mysterious pneumonia cases discovered in the city in the previous week.

Taiwan's medical mask recommendation - In early February 2020 the Executive Yuan adopted the recommendations of professors Huang Li-min and Chang Shang-chwen of the National Taiwan University Medical School, advocating that healthy people do not need to wear masks in open spaces. On 8 February, Chen Shih-chung, commander of the Central Epidemic Prevention Center, further said there was no need to wear a mask on public transportation. This caused a storm of protest, concentrating on the point that public transportation such as buses and MRT carriages are confined spaces, and viruses are transmitted more easily there than in open spaces. (Mask-wearing has a tradition of social acceptance in East Asia – regardless of scientific debates over the effectiveness of masks in impeding the transmission of viruses.)

Amid Taiwan's success of preventing mass lockdown that could have devastated the economy, International Monetary Fund (IMF) forecasted Taiwan's 2020 annual gross domestic product (GDP) with a decline of 4%, lower than 6% average decline of most developed economies. Private analysts predict a contraction of just 1.2% of the GDP while the government remains optimistic of a growth of 1.92%.

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