The Topsy-Turvy End of Zero COVID in Taiwan

For more than two years, Taiwan was one of the only places on earth that aimed to keep the novel coronavirus outside its borders altogether. The National Health Command Center, a special agency formed in 2004 after the SARS outbreak, first stopped travellers from Wuhan in January, 2020—two months before the World Health Organization declared a global pandemic. As an island with only twenty-three million inhabitants, Taiwan was able to close its borders to nonresidents in March, 2020. After that, international travellers were subjected to long quarantines that made it almost impossible for the virus to spread. For much of the pandemic, anyone who tested positive was isolated in the hospital, and their close contacts were told to quarantine.

These precautions seemed to pay off. In 2020, when much of the world was under lockdown, Taiwan went eight months without a single domestic transmission of COVID, the world’s longest virus-free streak. The so-called Zero COVID model—also adopted by China, Australia, and New Zealand—drastically reduced infections and allowed many daily activities to continue. This was what experts meant when they first talked about flattening the curve; Taiwan’s official COVID-19 death toll remained in the single digits through the end of 2020.

The United States, where I grew up, is not an island, and many of its more than three hundred and thirty million people opposed the kinds of pandemic restrictions that made Zero COVID possible. Contact tracing was difficult to implement; early lockdowns gave way to piecemeal restrictions that aimed to reduce the intensity of surges, not prevent them. While most Taiwanese people supported the Zero COVID policy, American protesters challenged mask mandates and sowed doubt about the effectiveness of vaccines. The coronavirus ultimately infected much of the country and killed more than a million people.

When I first moved to Taipei, in the fall of 2020, I was required to quarantine at home for fourteen days; a case officer called me daily to ask for my temperature. I was then warned to stay away from large crowds for seven days or face a fine. After that, the pandemic largely receded from my daily life. There were minor inconveniences—at the entrance of millions of businesses, for example, people had to scan a QR code with their phone, which would send a pre-written text message to a government contact-tracing database. But, compared with the U.S., Taiwan was an alternate reality in which businesses stayed open and crowds continued to gather. I frolicked at music festivals, shoulder to shoulder with strangers, while my friends and family in the States remained enviously sheltered in place.

In May, 2021, when the Delta variant of the coronavirus caused a surge in infections, Taiwan went into its first soft lockdown. Although people could still leave their residences to buy groceries or to pick up takeout, they were prohibited from gathering in groups. At the time, Taiwan had one of the lowest inoculation rates in the industrialized world, in part because of supply issues; some blamed China for blocking access to vaccines. Still, the daily case count peaked at under six hundred cases. By the time that the more contagious Omicron variant started to spread, last month, eighty per cent of Taiwan had received two shots. More than ninety-nine per cent of recent COVID cases have been asymptomatic or mild, according to the government’s Central Epidemic Command Center.

Taiwan’s Zero COVID strategy was finally upended on April 7th, when, in the face of an Omicron surge, Chen Shih-chung, Taiwan’s health minister, announced that the island was entering a transitional phase that would end in living with the virus. “We will not stop our journey towards opening up,” he told a parliamentary session. “The main goal now is harm mitigation.” When Chen spoke, Taiwan had reported an astonishingly low number of COVID cases—just tens of thousands since the pandemic began. (In contrast, the Netherlands, which has a smaller population, was approaching its eight millionth case.) But last Thursday Taiwan reported more than ninety thousand cases in a single day, and officials have estimated that 3.5 million people, or about fifteen per cent of the population, could be infected.

In a society with barely any firsthand experience of the virus—until a couple of months ago, I didn’t know a single person who had got COVID in Taiwan—the end of Zero COVID has caused a kind of culture shock. Strikingly, an April poll found that nearly half of Taiwanese adults wanted to keep Zero COVID restrictions in place; a roughly equal number supported a policy of “coexisting with the coronavirus.” “It feels like COVID is getting closer and closer,” a friend told me last week; the next day, her mother tested positive. In what feels like a weird reversal, people in the States have been reading about the surges in Taiwan and messaging me, asking if I’m doing O.K.

Last month, Emily Y. Wu, a podcast producer in Taipei, tested positive for the coronavirus at home. When she shared the news with family and friends, in April, 2022, her phone blew up with messages urging her to get a more reliable PCR test, which was mandatory at the time. COVID cases were still a novelty in Taiwan. “People didn’t believe it was actually COVID until you’ve had your PCR,” Wu told me recently. She was tired and symptomatic, but to make sure she wouldn’t infect others she put on a mask and rode to the hospital by bicycle. “I wasn’t ready for all the social pressure and stigma,” she said. “I just wanted to sleep.”

Residents are still struggling to shake off the mind-set that made Taiwan so successful at containing the coronavirus. On the last evening of April, Huang Teng-wei noticed that his six-month-old son, who had just come out of the bath, had flushed cheeks and warm skin. He thought that the infant might be overheated from a hike they had taken, but out of an abundance of caution he took his temperature: a hundred and two degrees Fahrenheit. Next, a rapid COVID test. Two red lines appeared. Panicked, he and his wife rushed to the hospital with their son swaddled in a pink blanket. He waited in line with about two dozen people, who were hushed with uncertainty and huddled under an awning to escape the rain. By the time a doctor could see them, it was 3 A.M. There wasn’t much to be done; they were sent home.

Huang compared the first days of quarantine to a war. He and his wife watched their son like hawks and researched infant-mortality data from other countries, which indicated that their baby would very likely recover on his own. Eventually, the fever subsided. In the next few days, when the rest of the family tested positive, including Huang’s unvaccinated young daughter, they knew to wait it out, rather than rush to the hospital again. In retrospect, Huang told me on the phone, from quarantine, they could have worried less. Residents of Taiwan are used to going to the doctor if they get a high fever, he said; a trip to the emergency room costs about ten dollars. “Taiwan’s medical care is just too good.”

In Taiwan, upticks in cases are as tangible as shifts in the weather. Loose masks are upgraded immediately with tighter-fitting ones, and the physical spaces between strangers grow. Not long ago, in my gynecologist’s waiting room, women nervously arranged themselves with at least two empty seats between each other. Although the Omicron variant rarely causes serious illness in fully vaccinated people, malls and restaurants that were packed with crowds only a month ago have thinned out. An educator in Taipei told me that parents have been polarized into two groups: those who think it’s no big deal and those who remain deathly afraid of the virus.

“They don’t have to be this scared,” Shawn Chiu, a pediatrician in Douliu, a small city in western Taiwan, told me. In early May, Chiu said, hundreds of people were lining up for rapid-test kits every day, and most had not been exposed to COVID or developed symptoms. The vaccination rate is higher than in many Western countries, Chiu pointed out, and even his younger, unvaccinated COVID patients tend to have mild symptoms. “People’s impression of the virus is stuck in the Alpha and Delta era,” Chiu said, referring to earlier variants. “Our perspective of the disease is outdated.”

In a society where pandemic mandates are taken very seriously, rapid updates to our public-health guidelines have been confusing at times. “It’s a bit messy,” Chiu said. Some rules, such as the hospital-quarantine mandate, were first created when most of Taiwan was unvaccinated, he said. People are now being told to quarantine at home. One mother told me that she was quarantined at home for twenty days: ten because she was caring for her four-year-old son, whose classmate came down with COVID, and another ten after her son ended up testing positive. Now, the recommended time is three days following an exposure or seven days following a positive test if the patient shows mild or no symptoms.

The Zero COVID model was never designed to last forever. Australia and New Zealand eased their restrictions last year. Hong Kong loosened its restrictions in March; its COVID death rate rose to one of the highest in the world, in part because its over-all high vaccination rates were low among the elderly. China and Taiwan were the last societies to maintain a strict Zero COVID policy, and their paths finally diverged in April, as China clamped down and Taiwan began to open up.

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