What Other Countries’ Pandemic Responses Can Teach Us
This is Part 2 in a series of articles on the United States COVID-19 public health response. Click here to see the other parts.
This article can also be found in my “Policy Opinions” section.
It’s no secret that the US had a “less than stellar” response to COVID-19. The government dragged its feet in gathering supplies and enacting the necessary provisions. When the government did begin to act, the response was inefficient and disorganized.
However, other — more successful — countries offer valuable lessons on how to prevent a disease from spreading and how to avoid an economic shutdown.
So let’s see how it’s done.
I should note that just because these countries are doing great now, that doesn’t mean they could see a spike in cases in the future if they cease to be careful too early. But for right now, these are success stories — namely, South Korea, Taiwan, and (to an extent) Japan.
South Korea — A Lesson in Efficiency
South Korea’s Statistics
The first success story on our list is South Korea. Impressively, South Korea avoided a lockdown or economic shutdown — they only closed schools and imposed curfews in a few cities.
South Korea has flattened the curve, with only 30–40 new cases a day this past month — pretty small compared to their maximum daily cases, which was over 1000.
Why is South Korea doing well?
Rapid test development and administration
First, South Korea rapidly developed tests by compelling 4 companies immediately to manufacture tests using a WHO-approved template. The US CDC, however, made tests from scratch, eating valuable time. South Korea also set up drive-through and walk-through testing facilities right away.
South Korea also ramped up testing quickly. In February alone, it conducted over 80,000 tests compared to America’s 1000. By March 17, over 270000 tests were conducted. To be clear, South Korea slowed down testing after March, so the US caught up to and surpassed South Korea. However, South Korea’s proactive start helped them isolate infected individuals quickly and not have to test as much later. The US didn’t ramp up testing numbers until March, giving the virus time to rip through the American population.
Furthermore, positive individuals were quarantined and treated by special units. The testing and treatment sites were also separate from regular hospital sites to prevent the virus from spreading. This is opposed to the US, where there are instances of patients being kept in nursing homes, for example.
Communication and Monitoring
What sets South Korea apart is its communication with local authorities and the public. This was accomplished through several apps and websites.
- The national government constantly updated public websites to track cases and who’s been tested to keep local governments in the loop.
- Free phone-apps provided notifications of spikes in cases near the user’s area and updates on the availability of personal protective equipment. Some apps give people the safest routes to work.
- Coronavirus 119 — A telemedicine app. The user inputs their symptoms, they get diagnosed, and they’re connected to a doctor to be screened. Telemedicine is normally outlawed in South Korea, but it’s allowed in limited form (people should only use it to get a physical visit) during this emergency.
This is impressive — the communication between the national government and the people and local authorities shows sophistication and efficiency.
Now here’s a measure that may seem questionable: the government also tracked people’s movements and who’s sick. An app notified users if they were near an area in which infected people had been present. This was done through the COVID-19 Smart Management System, which collected data from the Credit Finance Association, the National Police Agency, credit card companies, and phone companies to track people’s movements.
Anyway, the point is that South Korea communicated with citizens and local authorities to keep the wheels turning.
Poor Communication in the US
The US government didn’t communicate as efficiently, causing a haphazard response. For example, state governors reportedly struggled to acquire supplies from the federal government. States had to buy supplies themselves, and due to shortages, states have had to bid against each other. States have since experienced trouble in providing hospitals and patients with the necessary supplies, causing the pandemic to get worse in the US.
Another example is that the White House and the CDC provided conflicting timelines for when a vaccine would be ready and when the economy could open. Not to mention the constant flip-flopping on the CDC’s part about the effectiveness of masks, which only serves to confuse the public.
A Note on Civil Liberties
I mentioned that South Korea is tracking people’s movements. You may think “well that’s invasive.” To be clear, only epidemic investigators in Korea’s CDC see this information, which is supposed to be purged after the epidemic ends.
This measure helped social distancing efforts and is strictly a heavily regulated emergency power. However, such powers would be scorned in the US. The government spying on people conflicts with the 4th Amendment (No unreasonable search & seizure). Arguably, these actions are okay in a pandemic, but this type of power could be abused. I personally think that Constitutional rights are non-negotiable, but that’s beside the point.
Well…actually…the US does spy on people. The National Security Agency collects people’s metadata from their cellphones, along with other enhanced — and warrantless — surveillance, which we shouldn’t tolerate. I discuss balancing civil liberties during a pandemic in more detail below:
Japan: A Lesson in Testing
The weird thing is that Japan’s government dragged its feet on the COVID-19 response. It was not very proactive. Yet Japan flattened its curve, partially attributed to Japanese people generally being healthy and that Japanese people don’t touch each other as much (e.g. people don’t shake hands) in general. It’s simply a part of the culture. That’s just a theory, however.
However, Japan properly employed “cluster testing.” They found positive cases, then tested everyone with whom those people associated. This allowed Japan to detect new cases quickly without having to perform lots of tests (see left). Japan’s daily cases peaked at 743. Since May 10, they haven’t had more than 100 daily cases. So testing seems to have helped
On the other hand, the US tested inefficiently. Due to the test shortage, the CDC initially prioritized testing sick people. This seems logical, but if you only test people who already exhibit symptoms, then you’re not actively finding new cases. Japan’s testing model finds new cases before people become sick, allowing them to isolate and quarantine people who could spread the virus.
The flaw in the US model can be seen in the “test-positivity-rate” — the rate at which people test positive, or the ratio of positive tests to total tests.
Regardless, the US isn’t testing enough
While the US recently ramped up testing — 264,000 daily tests as of May 6 — experts say it’s not enough. The Harvard Institute of Global Health recommended 917,450 tests a day if we want a cluster model like Japan.
The other option is to randomly test the population for an accurate sample. Nobel-prize economist Paul Romer called for 20–35 million tests a day. The cluster model is clearly more efficient. Either way, we’re not testing enough.
Taiwan: A Lesson in Proactiveness
Some might say that Taiwan’s cases — 443 confirmed, only 3 digits — are suspiciously low. That’s not to imply that Taiwan is intentionally deflating their count, but maybe Taiwan isn’t testing enough people to get an accurate picture. Maybe Taiwan is doing as poorly as — if not worse than — the US.
However, let’s look at another metric: unemployment. US unemployment hit 16% in May (usually hovering around 12–14%). Taiwan, however, peaked at 4.4% — not fantastic, but within the “acceptable” range. Low unemployment means that more people in Taiwan are still working, implying that fewer businesses had to shut down. It seems that Taiwan wasn’t hurt as badly by COVID-19, supporting the idea that Taiwan’s response was successful.
While Taiwan didn’t conduct as many tests per capita as the US, their response worked for them — likely because Taiwan also used trace testing.
Taiwan’s Response
Taiwan was one of the first countries to receive COVID-19. However, it immediately took precautions towards preventing a disaster scenario.
On January 30, Taiwan compelled domestic manufacturers to produce 4 million masks a day and banned them from exporting masks until February 23. Banning exports was bad for other countries, but good for Taiwan.
Taiwan’s response began on December 31st, 2019 when China reported pneumonia cases to the WHO. Taiwan began monitoring Chinese travelers. After a week, they focused on Wuhan. Taiwan actually tried sending a response team to China (the US also attempted this), but China told them to piss off. Taiwanese officials reportedly sensed something fishy, so they continued monitoring travel from China. By January 26th, they banned flights to and from Wuhan (they were the first country to do that).
Because Taiwan was affected severely by the 2003 SARS (Severe Acute Respiratory Syndrome) outbreak, they equipped airports with temperature monitors in 2004. That paid off this year. Furthermore, travelers could report their travel and health history so that the government could determine who was at risk for infection. Sick people would be sent home (the government would ensure that they stay home by checking their movements via cellphone — another example of questionable government power). Also, the government periodically retested people who originally tested negative.
Taiwan monitored the virus early to keep the outbreak at bay.
How does America measure up?
While Taiwan quickly stockpiled supplies and began testing, the US waited until late March to ramp up testing and invoke the Defense Production Act (to mandate that private companies manufacture supplies). Thus, the US fell behind in testing and supply distribution and has since been playing catch up.
As a result, the US has had shortages in ventilators, masks, swabs, personal protective equipment (PPE), and other supplies.
Let’s start with masks. The Trump administration didn’t do bulk orders of N95 masks until March. The Department of Human Health Services requested $2 billion to buy masks in early February. They only got $500 million in March with which they announced they’d buy $500 million in masks over the next 18 months. The government should have enabled the HHS to do this earlier.
The HHS initially ordered $4.8 million of N95s. On March 21, it announced that $173 million in N95s would come in by April 30. Finally, on April 2, President Trump invoked the Defense Production Act for the company “3M” — Trump compelled the company to produce more N95s.
The fact that the Trump administration didn’t stockpile masks in January (or even February) was a problem that lead to hospitals being deprived of masks for a while. A March 16 survey of 8200 nurses by National Nurses United found that only 55% of nurses had access to masks. By March 16, the country had entered a national emergency, so those masks were crucial.
Now, let’s look at ventilators. In March, the Strategic National Stockpile had only 16,600 ventilators — not enough to make a dent in the demand for ventilators. According to the Johns Hopkins Center for Health Security, the country may eventually have over 700,000 patients who need ventilators. New York City alone needed 15,000 more ventilators at the time. The result was that many cities and states were deprived of ventilators.
To be fair, the government has since acquired a surplus in ventilators. But that happened in May after many hospitals suffered through ventilator shortages.
There was also a shortage of swabs in March, such as in the UCSF Health group, a San Francisco hospital system. These hospitals were concerned that their swabs would only support testing for less than a week (at the time). See, swabs are used to test for COVID-19 as they’re inserted up the nose to collect a sample. So… you kind of need them… a lot.
Travel Bans: Taiwan versus America
I mentioned Taiwan’s early travel bans and screenings, another area where they beat the US. The US banned travel to China on January 31 — not too bad compared to Taiwan’s China-ban on January 26. However, Taiwan began monitoring all international travel on February 11. The US waited until February 24–29 to ban travel with South Korea, Italy, and Iran, and the US waited until March 11 to ban travel to Europe. The delay in travel restrictions may have allowed infected individuals to slip through the cracks.
Wrapping Up
Let’s go over all the important data in the below table:
The US case rate (1st row) was higher than other countries’ rates, and America’s death rate (2nd row) was higher than those of South Korea and Taiwan. America could have done better. Furthermore, America’s unemployment rate (3rd row) reached a level more than triple that of the other countries — the US economy was hurt the most out of these countries.
The 4th row shows why the US has struggled. Early on, the US conducted fewer tests than South Korea (per capita). Why am I only showing data up until March 15? Well, testing is critical early in an outbreak. America’s window of opportunity was during February, but it didn’t increase tests until March 15. In the 6th row, I give the dates for when each government released an approved test for hospitals to use. America didn’t approve a test until the end of February, while Taiwan and South Korea were ready to go in early February. Because they had a 1-month head start, South Korea and Taiwan could reduce testing later. The US later expanded testing, but it was too late.
However, Taiwan and Japan have had low testing numbers, yet they’ve flattened their curves. The 5th row shows Taiwan’s low “test positivity rate,” which implies an efficient testing model. Even Japan’s test-positivity-rate — though higher than that of Taiwan — is considerably lower than the US rate.
Finally, the US was slow in ramping up the production of necessary supplies like masks. The 7th row shows the dates when each government required companies to produce supplies. While Taiwan and South Korea were both manufacturing supplies by mid-February, the US didn’t start until mid-March.
While these countries aren’t home free yet, they provide great examples for what the US could have done to prevent the disease from tearing through the American public. They put into perspective how much better we could be doing and that we shouldn’t excuse a mediocre response.
When politicians tell you they’re doing a tremendous job, find examples to prove them wrong (because — of course — politicians aren’t always right), and remember to Stay Cynical.
