What We Can Learn from Taiwan’s COVID-19 Response

The Midstory Team chats with Dr. Shao-Hsuan Hsia, the director of the Division of Pediatric Respiratory Therapy and the Chief of the Pediatric Intensive Care Unit at Chang Gung Memorial Hospital in Taipei, about Taiwan's response to the pandemic, social responsibilities and the state of public health in Taiwan.

Browse by topic or read the transcript of our interview below.

Topics covered:
[0:35] The situation of businesses and schools in Taiwan during the pandemic 
[4:06] Taiwan government’s policies against the pandemic, a learning form the 2003 SARS pandemic 
[6:57] Changes to public modes of transportation and cancellations of public gatherings
[9:58] The state of public health: Social responsibility and high compliance to mask-wearing
[12:05] Dr. Hsia’s medical background
[13:43] Hospital protocol for handling different kinds of potential COVID-19 cases
[17:51] Current levels of operations in Taiwan hospitals and availability of PPE and supplies
[19:43] Taiwan being a leader in its response to COVID-19
[21:42] Words of encouragement in this time of crisis

Logan Sander: Welcome to another episode of the Midpoint. Today, I’m so pleased to introduce our next guest who is joining us from across the globe in Taiwan. Dr. Shao-Hsuan Hsia, the Director of the Division of Pediatric Respiratory Therapy and the Chief of the Pediatric Intensive Care Unit at Chang Gung Memorial Hospital in Taipei. He’s got years of medical and administrative experience and has witnessed Taiwan’s coronavirus response from the frontlines. Thank you so much for being with us today, Dr. Hsia. 

Dr. Shao-Hsuan Hsia: Thank you.

LS: Wonderful, why don’t you talk to us a little bit about what the current situation in Taiwan is. Are things open? Are businesses, schools, are they running? 

SH: Yes, I think the answer is yes or no. Actually, we are open. People go to their work as usual. Students go to school and people will go to some tourist sites on holidays. I think it’s open, however, few people can go to other countries. Fewer people go to some popular indoor places such as movie theaters, apartment stores and malls. People need to wear masks and take temperatures before entering their workplace. And the government asked people not to hold meetings or parties of more than 100 people. For us, medical students cannot enter the hospital, so all the classes related to clinicals we have to use online internet video to teach or to learn. So partially, it’s not open. 

LS: So, you mentioned how some schools are responding. That some things are closed, but I know that, for example, elementary schools, or even middle schools and high schools are still running. As you probably know, in the United States, everything is shut down. How are those places staying open? What kinds of protocol are they using to keep things functioning during this time? 

SH: Okay. First of all, students just coming back from other countries are asked to keep at home for 14 days. And after the 14 days, they can go to school. They need to wear masks before entering the school and teachers will take temperatures at the door of the school to check if anyone has a fever. The schools, they don’t allow the air-conditioning, all of the windows need to be open. And yes, if any one student has a fever, the whole class will be shut down. If two students in the school have fevers, or are suspected cases, the whole school will be shut down. But, fortunately it hasn’t happened. 

LS: Yeah, and you mentioned that it really hasn’t gotten to that point yet. Taiwan’s numbers right now for COVID-19 are remarkably low. At the last count that I saw there had only been seven deaths and there were under 500 cases since the beginning of the outbreak, which is just incredible. How did the government administration respond so swiftly, and what has that leadership looked like so far? 

SH: First of all, we had a very bad experience in the 2003 SARS pandemic. So actually both the government and the people learned from it. And people are more willing to follow the policies of the government and the government has collected many experts to organize a team to manage these things. The government, first of all, controlled all of the materials for medical use. They prohibit mask export and also the PPE so this could assure that hospital staff would have sufficient PPE. And then, first from Wuhan, then the whole China, we prohibited people from China and the other countries with this disease to come back to Taiwan. Some, only few of them can come back and they need to be quarantined and stay at home at least 14 days to be assured that they don’t have the disease. The government will ask people not to go to crowded places and wear masks and wash hands and disinfect with alcohols, such things. I think people had a bad experience in 2003 SARS so we are very, very willing to follow the rules. 

LS: Yeah, and I think that’s something that here in the U.S. we weren’t hit as hard back in 2003 with SARS, we weren’t hit as hard with MERS, we haven’t had this kind of experience of an extreme pandemic. And in some ways, that’s really been a loss for the U.S., because we maybe weren’t as prepared or have had the experience to know how to deal with it. And U.S. citizens are so new to this kind of experience but it’s pretty incredible to see how swift Taiwan has been in tackling it. One other thing that’s really interesting is, I know that, especially, for example, Taipei is such a huge city that’s cramped in close quarters; a ton of people ride the subway, use public transit. It’s very much an urban city with a high volume of people that are close together. How has the population managed there in terms of public health and safety whether that increased signage, or how they’re dealing with public transit or any of those things? 

SH: For public transport, I think in the beginning only a few people would use the MRT, the subway. So, you can see my pictures in the rush hour. In the morning, only a few people were in the car. I think they just switched to riding bicycles, riding motorcycles or driving them to go to work. The other thing, many social activities are cancelled. For example, the conference of pediatrics in April. It was scheduled in April and we just cancelled it. There are not so many people using public transport. People are asked to wear masks before entering the MRT and we have alcohols in the entrance. We can use them to disinfect our hands. Some buses, long trip buses, just have transparent curtains in every single seat to keep the safety of travelers. 

LS: That’s pretty incredible. I’m sure you’ve heard about the protests in the U.S. A lot of people maybe not willing to follow some of the restrictions, or still attending a lot of social activity, are not wanting to wear masks, not following social distancing. Do you see any of that in Taiwan? How do Taiwanese people see these kinds of restrictions? I know you mentioned SARS, so of course, there’s been experience before, but are you seeing anyone who’s not willing to follow those guidelines? 

SH: Yes, it is reported some people are arguing not to wear masks and quarreling with the officers, but almost 95 percent or more than 95 percent of people are willing to wear masks. In my experience, when I go to the international airport to do quarantine there, there is a young man who was taken to the quarantine station. He looks very healthy, so I ask him what’s wrong with him. He said he had only a mild cough and diarrhea for several days, so he declared this and staff brought him to the station. If he didn’t say, nobody will know he had such symptoms because it’s very mild, but I think he knew that this is to protect himself and to protect others so he is willing to declare that he has such mild symptoms.

LS: That’s maybe really what it’s about, is thinking about what overall the good of public health, those others around us. I know that even wearing a mask, it’s not just for protecting yourself, but actually mainly for protecting those people around you in the case that you may be carrying. Because it’s really scary that this virus, you may not even know that you have it. You may be asymptomatic. You may not have severe symptoms, but it absolutely could affect those around you. I’d like to pivot maybe to some of your experience, maybe you could talk about your background a little bit. I know that you work in a main huge hospital and that you have experience both in pediatrics, but in administration as well and dealing with hospital policy and management. Could you talk a little bit about your own background? 

SH: Yes, I’m a pediatrician, a pediatric intensivist. I work in the pediatric intensive care unit, which has 26 beds. Most of the patients are from one month old to 18 years old, they have very critical diseases such as respiratory failure, shock or other critical disease. This is my background. 

LS: How have you seen hospital protocol change, or what kind of measures are being implemented in the hospitals as we’re facing the spread of COVID-19? 

SH: First of all, the hospital, previously we had about 10 entrances, and most of them were shut down. We have only two or three entrances now. And people entering the hospital, no matter if he is a patient or visitors, they have to be quarantined. They have to take their temperatures and ask the history of so-called TOCC: Travel, Occupation, Contact and Clusters. If he has a fever or other suspected symptoms, he is asked to go to the quarantine station. Outside the ER is an outdoor quarantine station, so there are steps to do tests for the patients. If the patient is suspected to be a COVID-19 patient, if he needs admission to the hospital, he will be located in a special area called the “Yellow Area.” If the patient is confirmed to be COVID-19, or he has pneumonia of unknown origin, he will be kept in the “Red Area” ward. In all the areas of Yellow or Red, the medical staff will be fully equipped with PPE from head to toe to take care of them. We have special protocols for patients with respiratory symptoms. We stopped so-called nebulization therapy for them, because the aerosols may have the possibility to bring the virus to spread, so we stopped the nebulization therapy. And we decreased the use of non-invasive ventilators, and we minimized work of suction sputum and we have a special protocol for the intubation protocol for the respiratory failure patients. We use a video laryngoscope to intubate these patients, to keep away their mouths and noses from the doctors. In every case of intubation, we ask the anesthesiologist to back up. They have endoscopy; If the intubation fails, they will come in at once to do the endoscopic intubation. This isn’t very different. 

LS: It seems like there’s just a huge amount of care and caution, especially on the end of the health care workers. Here in the U.S. especially recently there’s been a lot of conversation around how much our health care workers are putting their lives at risk. And it is an incredible sacrifice, not just here, but everywhere. But, one thing that we’re facing here in the U.S. and you mentioned PPE, but we have shortages of masks, of gloves. Our health care workers, our doctors, nurses, other workers are reusing their masks and their PPE. They’re going in there every day and putting their lives at risk. There are also shortages of other medical supplies, or respirators or even shortages of staff members themselves. Are you seeing that in Taiwan at all or are you still functioning pretty normally?

SH: I think we function very normally. First of all, almost all the hospitals stopped, cancelled the routine surgery in every hospital. So there was more manpower, there were more ventilators, we had more PPE to use in other fields. The government will provide all the medical staff one mask per day, surgical masks. And we have sufficient PPE to use in the hospital. 

LS: Obviously, Taiwan has been now a kind of, in some ways, a global leader in its response to the pandemic. This small island country that so many people may not have even heard about, suddenly has skyrocketed to be a leader globally. How are Taiwanese people responding to that, and what do you think that means for Taiwan’s participation in global conversations? Of course, there’s been conversation about the WHO and leadership and Taiwan’s role moving forward, do you have any thoughts on that? 

SH: Yes, I think we are proud of it. We have been doing very well in coping with the disease and we also think that we should have an opportunity to share our experience in what we have been doing for this disease and we can share our experience to other countries. We are very willing to share. I think we also should have the chance to be a member of the WHO and to get some important information from it, not from other countries. So we have 23 million people here. We shouldn’t be in an orphan or something, we should have the right to be a member of it. 

LS: Yeah, and I think there’s so much that we can learn. Specifically, I think in the U.S. as well, both from the administration and how the government has handled the crisis, but also how the population has responded. How citizens have banded together to protect the public health, to protect one another, to be willing to maybe be limited for a little while for the sake of that brighter future. I do have one last question on that, which is if you had advice for some Americans facing this crisis today, or our population. As you know, the U.S. is now the epicenter of the crisis. We’re facing thousands of deaths and now just reached, we’re now over a million cases. So we’re seeing, really, a deep crisis here and a lot of division, a lot of different opinions. What kind of advice would you want to give to Americans looking at this crisis today? 

SH: I want to tell all the U.S. people that it is not a disease that cannot be prevented. Look at us. In Taiwan, we can do it, so you can do it, too. Just wear masks, wash hands and declare any trouble, such as fever or respiratory symptoms. Just do the things to protect yourself and other people. 

LS: That’s great advice. Thank you Dr. Hsia, and I want to thank you again for sitting down with us today. It’s really a privilege to hear your experiences, what you’ve gone through and your observations on the world situation. Thank you so much. 

SH: Thank you, thank you. 

LS: Thank you all again for watching this week’s episode of the Midpoint. It was great to hear from Dr. Hsia about Taiwan’s response to COVID-19 and how they’ve kept their numbers so astonishingly low. We have so much to learn from these experiences and it’s certainly humbling during life-and-death situations such as COVID-19. If you enjoyed this episode, like, comment and share. And please consider subscribing to our weekly email newsletter, and the link is in the description below. As always, stay safe, stay healthy and stay human.


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