…what Germany could learn from Taiwan

Rhein-Neckar/Mannheim/Taipeh, April 30, 2020. (First published in German on April 24, 2020) Klaus Bardenhagen has been working as a journalist in Taiwan since 2009 and writes articles for various media outlets. The correspondent captured his experiences on-site in Taipeh for the RNB – the result is an exceedingly informative and fascinating text, but one that is also unsettling. Taiwan has approximately the same population as Baden-Wuerttemberg and Bavaria combined. Both federal states, as Germany’s “Südschiene”, have been affected at a higher rate by infections and death than other German states to the north. The island of Taiwan off the coast of China has less SARS-CoV-2 infected people than the city of Mannheim. How is that possible?

Submitted by Klaus Bardenhagen, Taipeh

Translated by Catriona Gibbs, Fort Belvoir (VA, USA)

Schools, restaurants, and stores are open. Everyone can buy sufficient amounts of protective face masks and social distancing on the streets is unnecessary. Because there are only a few coronavirus cases the chain of infection was broken early on.
This sounds like a pipe dream in Germany a few months down the road but for me, and more than 23 million people in Taiwan, it is just everyday reality.

And this has been the case since the beginning of the crisis. Without shutdown or social distancing, we currently register 427 cases and 6 deaths. (Link to current numbers: https//www.cdc.gov.tw/En) (Editor’s note: Mannheim (population of 315.000) has a total of 428 cases as of April 23, 2020.)

I’ve lived in Taiwan for more than 10 years. Like basically all Germans here, I do not even want to return home at the moment. Hardly any other country has brought the Corona virus under control better than this democratic insular state off the southern coast of China, which, in terms of land mass, is slightly larger than Baden-Wuerttemberg. The fact that the rest of the world has only slowly realized this, and that Taiwan stays excluded from the WHO, is due to China’s claim to power.

Early Warning

Initially the epidemic was as far from my mind as anyone else’s in Taiwan or Germany – with the exception of the experts, whose job it was.

On December 31st the country was in the middle of an election campaign, with the presidential and parliamentary elections coming up less than two weeks later. At about 3 in the morning a doctor from the Centers for Disease Control, basically Taiwans Robert-Koch-Institute, stumbled across a message in a chatroom and alerted his superiors.

The subject was illnesses in the Chinese city of Wuhan, documented through messages by doctor Li Wenliang, who as a whistleblower was initially silenced and later died from complications of the virus. That same day not only did China report the cases to the WHO, but Taiwan began monitoring all people entering the country from Wuhan. Health inspection personnel boarded planes and checked passengers for fever and other symptoms of the still unnamed illness that would later be known as COVID-19.

Taiwan was forewarned and prepared because of a different epidemic, which Europe was spared from for the most part: In 2003 the SARS virus spread across East Asia, also originating in China. A tourist brought it to Taiwan. Even then they were left to their own devices without a WHO membership, Taiwan only registered 73 deaths.

The Taiwanese grew accustomed to protective face masks to prevent infection, the authorities had advance warning and were developing detailed plans for the next pandemic. These now just needed to be taken out of the drawer.

On January 20th Taiwan activated its Central Epidemic Command Center and it was immediately clear that the decisions made there were binding for all other agencies. That federal states or even hundreds of public health departments of the administrative districts each decide for themselves what the best health measures would be or who would need to self-quarantine, is unthinkable here.
As Taiwan registered the first infected patient – she had entered the country from Wuhan – I was as yet unaware what alarming proportions the illness would reach. The Chinese New Year was just around the corner, most people had other things on their minds.
On the 23rd I was already at my in-laws’ and was looking forward to the feast the next night when the announcement was made: the Chinese government was closing off the Wuhan metropolis, shortly thereafter further cities in Hubei province, a total of 50 million people. At last the world realized: This was serious.

Germany was soon awoken to the seriousness of the situation. On January 27th Bavaria reported the first infected person at an automotive supplier plant. This first cluster of infections was contained easily. But in the next couple of weeks, or so I believe, a deceptive confidence spread across Germany.

Carnival, National Soccer League, skiing vacations, and vacations in Italy – on February 25th the first infections in Baden-Wuerttemberg (Göppingen) and Nordrhein-Westfalen (Heinsberg) were reported. We are all aware of how things have progressed in Germany since then. Containing the virus was out of the question at that point, the number of infections rose quickly to four, five, and six figures. Many Taiwanese who generally value Germany for its planning and farsightedness, were very surprised.

Four-week timeframe

That Taiwan finds themselves in a much better position today is more than likely due to the decisions made between the end of January and end of February. Taiwan used those four weeks to resolutely contain the virus.

How the German authorities chose to secure the country against the pandemic during this timeframe, you should judge for yourself locally.

Even on February 12th the RKI at any rate assessed the risk for the health of the population as minor, on February 24th the minister of the Federal Ministry of Health, Spahn, said that Germany was “optimally prepared.” (https://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus.html)

Since the end of January we had been experiencing how the authorities in Taiwan decided on measure after measure. As a result, school holidays in February were extended by two weeks. Since then kindergartens, schools, and universities have been operating under normal conditions. The most significant measures were probably travel restrictions, home quarantine, and mask supply.
Because the regulations were so effective – compare again the infection trajectories (https://twitter.com/taiwanreporter/status/1252786825959108609) – the population readily supported it.

And yet the Taiwanese aren’t particularly obedient to authority. Demonstrating their dissatisfaction with one or the other policy is a daily occurrence here. Those who disappoint their constituents are quickly voted out of office. The administration earned its current confidence by transparent communication. The Minister of Health and Welfare as the Commander of the Central Epidemic Command Center steps in front of the cameras daily and explains every new case, every new directive.

Of course, it was easier for Taiwan than Germany to control entry – because it is an island but also because the EU with its Schengen Area is a specialized situation. On January 26th Taiwan didn’t just stop all flights from Wuhan but also all tour groups from China – despite the fact that the mainland tourists usually pose the most important visitor group.

Since February 6th Chinese citizens in general are no longer allowed to enter – no matter the country of origin. European countries were classified by Taiwan with increasing alert levels, until on March 18th they closed their borders to virtually all foreigners – On the same day, the travel ban in the EU went into effect.

Home Quarantine

Probably the most important component of Taiwan’s epidemic control, and a vast difference to Germany, was: Those who came into contact with an infected person or who had traveled from one of the high risk areas, was, as of January 14th, required to be under home quarantine – no matter if they had symptoms or not. The same is true for any Taiwanese citizen who currently travels into the country. Germany didn’t introduce a compulsory home quarantine order for travelers entering the country until April 10th, when the number of infections had already risen to more than 100,000 – and it is monitored less severely than in Taiwan.

Instead of 100,000 positive cases, we have approximately that number people sitting at home in home quarantine or who had already come out of it. Those who leave their homes or assigned hotel rooms, and be it only to smoke a cigarette in the stairwell, pay significant fines – up to 30,000€ if they act especially irresponsibly and take drives across the country or go to nightclubs. Mind you, we are talking about people who are symptom free and more than likely not infected with the virus – everyone who has been tested positive is treated at clinics anyway. With Taiwan’s manageable case numbers, it is unnecessary and unthinkable to leave an active COVID-19 patient at home.

Monitoring by Location-Tracking

Home quarantine is monitored by unannounced control calls and especially by cell phone location tracking – a thoroughly invasive breach into one’s privacy, that the telecommunication companies have allowed on the basis of the local disease control policies.
They constantly monitor the location of people in home quarantine by tracking which cell tower their signal is currently locked into. If someone turns off their phone or leaves the cell tower location nearest their home, the system immediately triggers an alarm. If the situation cannot be resolved, someone will come knocking on their door. Despite the occasional false alarm, the system has work so reliably that public authorities have to date been able to avoid using personal GPS devices or special monitoring apps.

Even a Bluetooth tracking app that has been announced for use in Germany to retroactively track people who have come into close contact with infected persons, is unnecessary considering Taiwan’s currently low number of positive cases.

Mobile phone tracking of everyone in home quarantine, an electronic ankle monitor per se, would surely spark massive protests in Germany. The sensitivity for protection of data privacy is certainly less developed in Taiwan, for most the benefits – a normal life for all – far outweigh the price of temporarily limited liberties.

But the people of Taiwan all trust in their government to not use this tool after the end of the crisis. As incentive to get through the 14 days, at the end of the home quarantine, a federal payment of 30 Euro per day beckons, in thanks for not violating the orders during that time.

The use of masks in Taiwan was never questioned

Wearing simple surgery masks in everyday life has been widespread in Taiwan for a long time for a number of reasons. Since SARS at the latest they have generally been deemed as an effective means to protect oneself against infection. Those who have a cold, generally wear one out of respect for others. Some are concerned about air pollution, just want to hide a blemish, or want to distance themselves on public transportation.

That in Germany the effectiveness of these masks has been disputed for so long because there is no absolute proof, confounded many of the Taiwanese I know. Now that masks are becoming mandatory, they feel validated.

When the epidemic in China became known, everyone immediately started panic buying so that the government banned the export of masks and not even two weeks later started rationing the dispensing of mask. Parallel to this, corporations and the government, in a joint effort, increased the production capacity. China no longer delivered, and the originally not even three million masks that Taiwan produced per day was no longer enough to fill their personal needs. This meant that the amount was initially limited to two masks per person and week and later limited to three. This was recorded via the health insurance card that every citizen has. Administration official shared tips on how to sterilize and reuse the masks. (https://twitter.com/audreyt/status/1245381627804450816)

Masks cost 15 cents in Taiwan

Suddenly I saw long lines in front of pharmacies, often up to an hour before the daily mask dispensing began. A few customers would lose their patience and become irritable, but the concept was quickly accepted. In the meantime, the daily production has risen to 15 million so that everyone can now by 9 masks per 14 days, for 15 cents apiece. In addition, an online ordering system now ensures shorter lines in front of the pharmacies.

Mask donations for Germany

When their own supply was secured, President Tsai Ing-wen announced a few weeks ago that Taiwan would donate masks to other countries. A real help but also a clever PR move because Taiwan, under pressure from China, is excluded from all UN organizations, to include the WHO, and is therefore rarely in the international spotlight.

The Taiwanese relish positive headlines all the more – and they have every right to be proud of their reaction against the virus. But there is that one entity that wants to prevent any international recognition Taiwan may receive: the government of the People’s Republic of China.

On Maundy Thursday a supply of 10 million masks, of which 1 million had been earmarked for Germany, arrived in Frankfurt. Several Taiwanese friendly delegates and the representative of Taiwan in Germany were there, but the press coverage about the donation was restrained – especially compared to the supply of 8 million masks from China two days earlier in Munich where Prime Minister Söder and the Minister of Transportation Scheuer had been waiting on the runway.

An official appointment to transfer the masks a few days later could not go ahead as scheduled due to alleged safety concerns. And then government representatives squirmed in response to the question, if they were not going to thank Taiwan for their gift: Government spokesperson Seibert and the spokesperson for the Foreign Office, Adebahr, obviously had a difficult time even saying the word “Taiwan.” (https://www.youtube.com/watch?v=QALfB04bjio)

“We are doing the right thing”

When this video started circulating, many Taiwanese reacted with indignation and disappointment. How afraid was the German federal government of China exactly, some asked? Others, can the Germans give us the masks back? But many reacted like President Tsai, who advised: We are simply doing the right thing, when we make our contribution to the international community.” (https://de.rti.org.tw/news/view/id/2002319) Gratitude does not need to be given publicly.

The immediate criticism of the embarrassing situation seems to have made an impact: On April 23rd Spahn, the German Minister of Health, wrote an official letter to his Taiwanese colleague Chen. Two weeks after the delivery, but nonetheless – and he emphasized that the experiences they had gained in Taiwan in the fight against the pandemic, were found to be very useful. (https://www.facebook.com/DeutschesInstTaipei/photos/a.631285737002301/1937314606399401)

Learning from Taiwan

So, what is it that Germany could still learn from Taiwan in the current situation, apart from not questioning the use of masks at least in certain situations like public transportation?

It is too late for necessary preparation and timely reactions, for this pandemic at any rate. Transparent decisions and well substantiated injunctions are something the federal and local governments have well in hand, from what I can see from a distance. Where they need some work, in my opinion, is the consistent enforcement of home quarantine to include people who have been in contact with the virus and other suspected cases, which, after an easing of the social distancing order will tend to become even more important. With which tools this will be regulated and how basic rights and data protection will be upheld, that remains to be seen.

The biggest advantage that I have experienced because of Taiwan’s reaction is a fundamental question of attitude. The Taiwanese are in no way a collectivist culture and are not as subservient to authority as popular Asian stereotypes would have you believe.

But they are accustomed to crises, be it SARS, periodic natural disasters, or the threat to their civil liberties by China. And most of them understand that in situations like these the insight into the necessity of certain measures ensures that the greater good will be best served – and subsequently each individual.

When I follow the debates in Germany from Taiwan, I often get the impression that many people have entirely different priorities there. That is up to them, but then everyone must live with the consequences.

About the author: Klaus Bardenhagen comes from northern Germany and has lived in Taiwan since 2009. He writes as a journalist for various media in Germany. Furthermore, he shares his impressions on Facebook (http://facebook.com/taiwanreporter) and Twitter (http://twitter.com/taiwanreporter). Previously he was a television reporter for NDR and a news editor for ZDF.