COVID-19 Day 34: An Asian Guide to Living with Coronavirus


Liberty Square Taipei, Taiwan

In a contentious press conference, President Trump discussed reopening the country amid the continuing COVID-19 pandemic. Criticism of his statements aside, the individual states, and not the President, will have the primary responsibility of implementing the scope and timing of reopening, just as they were responsible for stay-at-home orders, PPE supplies, public health and medical care resources. Our country will have to reopen before damage to our food supply, jobs, and economy exceed the damage from the virus itself.

Just as it was useful to look at Asian countries as examples of how to respond to COVID-19, it’s useful to look at successful ones for examples for reopening our country. South Korea and Taiwan are often cited as COVID-19 success stories. They have kept new cases and deaths low despite having cities that are more densely populated than New York City.

As of this writing here is how our COVID-19 stats compare.

US (overall) population 328.2 million
1840 cases per million people
78 deaths per million people

South Korea population 51.6 million
206 cases per million people
4 deaths per million people

Taiwan population 23.8 million
17 cases per million people
0.3 deaths per million people!

And just for comparison, our two largest states which are just slightly smaller than either Asian countries.

California population 39.5 million
651 cases per million people
20 deaths per million people

New York population 19.5 million
10,354 cases per million people
552 death per million people

It should be noted that both Asian countries are geographically and politically isolated from their neighbors. South Korea is on a peninsula, connected to mainland Asia but its border is the infamous DMZ with North Korea, one of the most heavily policed and fortified borders in the world. Taiwan is an island nation separated from the rest of Asia by a hundred miles of ocean. Both countries had a high volume of visitors flying from mainland China, and the rest of Asia, especially during the Asian New Year.

Both countries had been hard hit by the 2003 SARS pandemic and had prepared for another outbreak. They quickly instituted travel restrictions, testing, quarantines, and surveillance of suspected COVID-19. Unlike the US, neither Taiwan or South Korea down business or forced their general population into lockdown at home. In that respect, they provide a strong example of how to live with COVID-19.

There are other Asian countries with exemplary COVID-19 results but I leave out Hong Kong and Singapore because those are city-states with small populations (below 9M). I also left out Japan as it has anomalous case and death numbers, possibly due to limited testing of its population.

The US is dramatically different in many ways from either of those Asian countries. Our population is over 5x bigger, spread over a landmass over 10x larger. Our states (save for Alaska and Hawaii) are all geographically connected with no physical borders. Our food supply and economy is highly reliant on free inter-state trade and travel. Our population is ethnically and culturally diverse and in many ways more tolerant of lawlessness and non-complaint behavior.

Short of communist-style, police-state surveillance, interstate border restrictions would be largely symbolic except on major highways. Case in point, ICE (Immigration and Customs Enforcement) and state law enforcement have never been successful in restricting illegal border crossing into the US, so it’s hard to imagine we would be more successful with our legal population.

As we enter our post-lockdown phase some have dubbed “The Dance”,  our focus shifts from containment to vigilance. We have to quickly identify and quash fresh outbreaks brought from other parts of the country and the world. What can we glean from Taiwan and South Korea to guide us moving forward? 

First, air travel would have to be restricted and scrutinized, including thermally testing travelers (and possibly rapid PCR testing). Arrival quarantines should be required for both domestic and international travel because airports, and traveling inside aircraft, pose high risks for cross-contamination. This would drastically increase the cost of air travel but would be essential in reducing fresh virus outbreaks.

Second, broader medical testing of the general population would be required to quickly identify new outbreaks before they get out of hand. This includes thermal checkpoints in mass-transit, public buildings, and private businesses. This would allow the rapid identificaiton of suspected carriers and the tracking of individuals they may have come in contact with. This would be a serious shift in our norms of privacy and civil liberties. 

Third, while the general population could resume work and education, we would have to continue sheltering of high-risk populations including the elderly and those with pre-existing medical conditions. This is particularly difficult because the US population has a high obesity rate, and obesity has been found to be a primary indicator of COVID-19 hospitalization and death. We would have to take a hard look at the ethics and costs of forcing obese citizens to stay home.

Finally, we would have to normalize the enforce mask wearing for the general public in public and private spaces including jobs, schools, stores, restaurants, entertainment and mass transit. This along with hand-washing and sanitizing of commonly touched surfaces. We would also have to refrain from hand-shakes and other physical greeting rituals. The upshot of these personal hygiene measures is that this will reduce the spread of the flu and other contagions.

All of these measures have thus far served Taiwan and South Korea well, but reimportation of the virus from outside their borders remains ongoing concern. A few new cases have cropped up but have been successfully contained. More concerning are rare reports of reinfection of individuals who were previously recovered. All the more reason for continued vigilance. 

All this is to say, that “Asian-Style” COVID-19 strategies will be a daunting challenge to implement here. As we return to a “new normal” we’re going to have to modify our ways of living to protect ourselves and our vulnerable until a vaccine becomes available or we achieve herd immunity. This will be months or possibly years from now.

There are no easy answers, only painful choices. But the sooner we get to work on it, the sooner we get back to work.




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