THURSDAy, MARCH 19 , 2020. THE WASHINGTON POST eZ sU A
the coronavirus outbreak
This time, though, and without
needing to be told much, Hong
Kong residents took matters into
their own hands. The city’s finan-
cial district was reduced to a ghost
town in early february as compa-
nies closed offices. Bakeries
known for hour-long weekendpandemic potential.
more than 260,000 people in
South Korea have been tested for
the virus, the highest per capita
anywhere, with testing and treat-
ment fees covered by the govern-
ment and drive-through centers
capturing global attention. on a
visit to the Korea Centers for Dis-
ease Control and Prevention on
Wednesday, President moon Jae-
in called the expansion in testing
“a great achievement that is ac-
knowledged around the world.”
Singapore, too, benefited from
its own capabilities to test, as did
Hong Kong and Japan. All devel-
oped their own diagnostic tests
when the covid-19 genome se-
quence was published.
“Singapore, through SArS,
learned it the very hard way, that
we have to develop these c apabili-
ties at the word go,” said mount
Elizabeth Hospital’s L eong. “once
you are in control of your own
fate, you can decide what way to
go.”Few cases in Hong Kong
rocked by eight months of pro-
tests, Hong Kong’s embattled
leadership began responding to
the outbreak from a position of
weakness and was criticized for
not moving fast enough to close
schools and borders.
outside mainland China, the
territory had been the biggest
casualty of the Communist Party’s
coverup of the SArS outbreak,
with some 300 deaths and little
clarity on what was unfolding
until it was too late.lines were abandoned.
Parties, weddings and family
gatherings were canceled — with-
out any government order. Al-
most everyone rushed to p rocure
masks; a recent study e stimated
that 74 percent to 98 percent of
residents wore them when leav-
ing their homes. Voluntary social
distancing was hailed as a key
reason for the lower rate of infec-
tions.
“Hong Kong is a population
which takes the idea of quaran-
tine, masks and social distancing
very seriously,” said Keiji fukuda,
director of the University of Hong
Kong School of Public Health and
former assistant director general
for health security at the WHo.Big Brother l ooks after you
from electronic wristbands to
smartphone trackers, Asian juris-
dictions have pulled out all the
stops to ensure that suspected
patients comply with quarantine
and isolation orders, monitoring
that is backed by laws that were
tightened post-SArS.
Singapore used its fBI equiva-
lent, the Criminal Investigation
Department, to effectively inter-
rogate every confirmed case with
stunning granularity — even us-
ing patients’ digital wallets to
trace their footsteps. Those
caught lying face fines and jail
time.
The city-state has been lauded
as the gold standard for identify-ing cases, with a study by Har-
vard’s Center for Communicable
Disease Dynamics finding that
Singapore was 2.5 times more
likely to detect infected people
than the global average, because
of “very strong epidemiological
surveillance and contact-tracing
capacity.”
In S outh Korea, information on
the movements of infected people
before they were tested is collect-
ed and relayed over smartphones,
creating a real-time map of areas
to avoid. Ta iwan tracks infected
people’s whereabouts via smart-
phones: Stray too far from home
and you receive a message; ignore
it and the police will pay a visit.
In Hong Kong, everyone sub-
ject to a compulsory quarantine
must activate real-time location-
sharing on their phone or wear an
electronic wristband.
These measures have been
backed by local populations that
lived through previous epidemics
and have largely shed concerns
about privacy and tracking.
All these places have stopped
short of a Wuhan-style lockdown.
matthew Kavanagh, director of
the Global Health Policy and Gov-
ernance Initiative at Georgetown
University, said Americans
should not f ocus “ only on the kind
of high-profile displays of state
power that have made headlines
from China” b ut also look at coun-
tries such as South Korea that are
“balancing Democratic openness
with rapid, concerted public-
health action.”
Experts agree, though, that
Western governments must be
prepared to limit their citizens’
movements, mandate isolation
for positive cases and track con-
tacts regardless of privacy con-
cerns.
“This is the process it will take
to save thousands of American
and European lives, billions of
dollars of the economy, your own
businesses,” said fisher, the Sin-
gapore university professor. “oth-
erwise, it is just carnage.”
[email protected]
[email protected]Denyer reported from tokyo. min Joo
Kim in seoul contributed to this
report.the databases of its National
Health Insurance Administration
and National Immigration Agen-
cy, allowing it to track everyone
who had been in Wuhan in the
recent past and alert doctors to
patients’ travel histories.
Now, Taiwan is hoping to keep
its infection numbers down and
has asked residents not to travel
abroad after its biggest s ingle-day
jump of cases — 23 — on Wednes-
day. I t is also barring most noncit-
izens from entering.South Korea’s testing blitz
China has won plaudits from
the WHo for its massive mobiliza-
tion of medical resources to test
and treat people suffering from
the coronavirus, but it failed to
learn from its coverup of SArS.
Chinese authorities initially si-
lenced doctors who tried to raise
the alarm about the seriousness o f
the coronavirus outbreak, deny-
ing the rest of the world precious
early days to assess the risks.
South Korea, meanwhile, has
become the poster child for test-
ing. Its success is rooted in a
previous failure: The limited
availability of test kits was seen as
having aggravated the 2015 mErS
outbreak, when the country suf-
fered the second-highest caseload
after Saudi Arabia.
Whereas the United States and
Japan keep testing tightly con-
trolled by a central authority,
South Korea opened the process
to the private sector, introducing
a path to grant “emergency usage
approval” t o tests for pathogens ofmented similar steps.
Asian economies have close
links with mainland China and
were among the first hit by the
novel coronavirus. Ye t, with 100
cases in Ta iwan, 181 in Hong Kong
and 266 in Singapore, their infec-
tion rates are dramatically lower
than the West’s. Spain has record-
ed more than 11,000 cases; New
York state — whose population is
similar to Ta iwan’s — has m ore
than 2,300 cases.
China learned some lessons
from SArS but failed to grasp the
danger of covering up an out-
break, while South Korea learned
plenty after grappling with mid-
dle East respiratory syndrome, or
mErS, in 2015. Both countries
struggled with big outbreaks of
the coronavirus this year but ap-
pear to have brought them under
control, thanks to stringent and
sometimes unprecedented mea-
sures within their borders.
Experts are urging countries
including the United States,
france and Spain to use time
bought by newly enforced social-
distancing measures, lockdowns
and quarantines to reset and
work out their strategies before it
is too late. These Western nations,
they say, were simply not ready.
“So many countries have sat
there, wondering what will hap-
pen,” said Dale fisher, a professor
in infectious diseases at the Na-
tional University of Singapore
who also chairs the World Health
organization’s Global outbreak
Alert and response Network and
was part of the WHo’s mission to
China in february. “It is extreme-
ly disappointing, as a member of
the mission, that we couldn’t
make it clear t o the world that this
was coming.”
taiwan’s quick action
After getting off the mark early,
countries and territories around
China ramped up border restric-
tions as the scale of the epidemic
became clear.
Ta iwan, unencumbered by po-
litical obligations to China — the
self-governing island has a tense
relationship with Beijing, which
views Ta iwan as its territory —
had the structure in place to cope.
A year after SArS, Ta iwan estab-
lished a National Health Com-
mand Center that brought togeth-
er all levels and branches of gov-
ernment, preparing for the possi-
bility of another disease outbreak.
Its interventions over the past two
months have been decisive in
keeping Ta iwan ahead of the
curve, said C. Jason Wang, direc-
tor of the Center for Policy, out-
comes and Prevention at S tanford
University.
“They didn’t hesitate, they
didn’t want to die,” Wang said.
“The mortality rate was so high
[during SArS] and they didn’t
know how bad this one was going
to be. Nobody thought it was like
the flu.”
As early as Jan. 5, Ta iwan was
tracing people who had been in
Wuhan in the previous 14 days.
Those with symptoms of respira-
tory infections were quarantined.
In subsequent weeks, authori-
ties used data and technology to
identify and track cases, commu-
nicated effectively to reassure the
public, offered relief to businesses
and allocated medical resources
where they were needed most —
rationing face masks and dramat-
ically increasing their production.
on Jan. 27, Ta iwan combined
contAinment from A
China’s neighbors relied on lessons learned from SARS
Containment strategies
Although coronavirus cases continued to increase in the following countries, the measures taken may have contributed to a more linear increase in infections
rather than the exponential rise seen in countries without such strategies.05010015020024005010015002,4,6,8,Mandatory
quarantinesCancelled events with
more than 250 people
Ban on large-
scale eventsInternational
travel restrictionWidespread testingMandatory
quarantine
School
closuresSchool
closuresWidespread testingSource: Johns Hopkins University THE WASHINGTON POSTSouth Korea Hong Kong SingaporeJan. 22 Feb. 1 Feb. 15 March 1 March 16 Jan. 22 Feb. 1 Feb. 15 March 1 March 16 Jan. 23 Feb. 1 Feb. 15 March 1 March 16PHOtOs By ROsLAN RAHmAN/AgeNCe FRANCe-PResse/getty ImAges
military and police personnel patrol a terminal at Singapore changi Airport on Jan. 30. that day, 92
Singaporeans were flown home from Wuhan, china, where the novel coronavirus was first detected.travelers at the Singapore airport are thermally scanned for elevated body temperatures, an indication
of fever that would trigger a closer inspection for possible infection with the novel coronavirus.
“It is extremely disappointing, as a member of the [WHO mission to China],
that we couldn’t make it clear to the world that this was coming.”
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