Indian Council of World Affairs

Introduction

Countries across the world are in a combative mode fighting the novel coronavirus pandemic (COVID-19). On March 11, the World Health Organization (WHO) declared the epidemic, which began in December 2019 in the Hubei province of China and spread across the worldin a matter of three months, as a global pandemic.[1] As of March 31, the virus has affected more than eight lakh people, killing more than forty thousand.

Though it is very early to evaluate the impact ofthe epidemic given that it is still active and implications are multifaceted, preliminary observations based on the rate of infection and fatality suggests that the effect has varied across different countries. To a large extent, the varied impact of the epidemic is a function of the response strategies different countries have adopted. The response measures of Japan, South Korea and Taiwan apart from China,have received much attention in the international media. It is no small feat that despite their proximity and close interactions with China, Japan and Taiwan have managed to keep the epidemic under control. While South Koreahad an outbreak, it has managed to bring it under control and appears to have flattened the infection curve.Evaluating the COVID-19 situation in Japan, South Korea and Taiwan, this paper maps their responses.

Japan

Japan confirmed its first case of infection on January 16,the first country outside China to report COVID-19disease. Despite its early exposure, Japan had very few cases of infection until mid-February, and most of these caseswere linked to people who had travelled to Wuhan. Though local infections were reported since mid-February, the rate of growth of the infection remained linear. For the last two weeks starting from mid-March, there has been a slight increase in the number of cases linked to cluster infection in cities like Tokyo and Osaka. As of March 31, Japan had 1953 cases of COVID-19, out of which 59 have been reported dead,while 424 have recovered.[2]Thus far, Japan has been successful in keeping the infection curve flat. However, with more and more cases being reportedfrom megacities like Tokyo, there have been concerns about whether Japan has really escaped the exponential growth stage or it is yet to come.[3]

Fig 1. COVID-19 Situation in Japan[4]

 
Fig 2. Japan: Daily Cases of COVID-19 infection [5]

In responding to the emerging COVID-19 situation, on January 30, Tokyo established the 'Novel Coronavirus Response Headquarters" task force working closely with the Prime Minister Office to coordinate the government strategy. As the first measure, on February 1, Tokyo barred visitors from Hubei province from entering the country. Later, the travel ban was expanded to include passengers travelling from all parts of China and South Korea on March 9 and most European countries, the UK and the United States on March 30.

Following the increase in number of local infections in mid-February, Japan had its priority shifted from containment to prevention and treatment, focusing on newly emerging clusters. In this regard on February 25, the government startedseveral initiatives under the framework of "Basic Policies for Novel Coronavirus Disease Control".[6] Under its recommendation, the focus has been to give medical care to severely ill patients to avoid burdening the health infrastructure and extensive contact tracing to identify and isolate clusters of infection. It also recommended people with mild symptoms to stay at home to limit the spread of the virus.  Despite the recent spike in the number of infections since the mid-March, there appears to be no significant change in Japan's approach.[7]

Unlike South Korea, which has been focusing on extensive testing as its core strategy of fighting the epidemic, Japan adopted a minimal test regime employing strict criteria. Initially, Japan conducted testing only for those patients who are severely ill. Under growing public pressure, of late Japan relaxed its testing regime to do more tests; however, in terms of the number of tests performed, it remains very low compared to other countries.[8] As of March 31, Japan so far conducted 32,497 tests compared to 410,564 in South Korea.  Japan has a testing capacity of 7,500 tests per day; however, currently, it is employing only 15 per cent of that capacity.[9] Critics argue that the actual cases of infection in Japan would be much more than what is reported if it were to test more.[10]

To promote social distancing, the government requested to suspend large community gathering and operation of schools. However, the Japanese approach to social distancing is different from strict closure or complete lockdown that has been practised in many countries. Restrictions imposed by the government remain voluntary. Furthermore, Japan does not have a legal framework that the government can invoke to enforce lockdown or restrict peoples’ mobility. Though Prime Minister Shinzo Abe has proposed a new law that will allow him to declare a state of emergency, the administration is yet to act on it.  In this regard, on March 27, Abe, during his address to the nation, said that Japan "at this point..don't need to declare a state of emergency...but .. still facing a critical moment."[11]

To ease the pressure on the economy caused by the COVID-19 situation, Prime Minister Abe on March 27 announced that his administration is preparing the “boldest-ever" stimulus package even larger than the 56.8 trillion yen ($526 billion) package put together in the aftermaths of the 2008 financial crisis.[12] Japan also postponed the Olympics, whichwas scheduledlater this year in July.

South Korea

South Korean (hereafter Korea) response to the COVID-19 has gained much international attention, as it was the second country after China that managed to flatten the curve of new infection after a major outbreak. What is noteworthy is that Korea could stem the tide without employing draconian measure such as massive shutdown and tightened travel restrictions.[13]

During four weeks following the first confirmed case on January 20, Korea reported only 30 cases, all being imported cases, mostly Korean nationals with travel history of visiting Wuhan. However, Korea reported a sudden spike in infections in the third week of February. Between February 20 and March 15, there were 8000 new infections. More than sixty per cent of the new cases were linked to a cluster outbreak among the members of a secret cult church called Shincheonji in the city of Degu.  Peaking at more than a thousand new cases on March 1 alone, Korea, with a population of 51 million had appeared to be heading towards a disaster. But in one week the number of daily cases were brought down to half, and by March 15, daily infections were brought under 100. Though Korea was successful in pre-empting community infection, it is too early to suggest that Korea has won the fight against the virus. So far (as of March 28) Korea reported 9,583 cases of infection, 153 death and 5033 recoveries, leaving 4398 active cases of infection.[14] The fatality rate in Korea so far has been low recorded at 1.33 per cent in comparison to the global rate of 4.34 per cent.[15]

 
Fig 3. COVID-19 Situation in South Korea[16]

A key feature of Korea's response strategy has been its extensive testing regime. As of March 28, Korea tested nearly 400000 people, about one test per 250 people, among the highest testing rates in the world.[17] Massive testing allowed Korea to identify and manage cluster infections, while reducing the fatality rate by treating people at the earliest.

The Korean approach to extensive testing was product of its earlier experience with MERS (Middle East Respiratory Syndrome) outbreak of 2015, which infected 186 people leaving 36 dead. The lack of testing capacity in the face MERS outbreak forced Korea to advance its biotechnology capabilities. Immediately after virus outbreakwas reported in China, Korean government officials were closely working with private biotechnology companies, who carried outlarge-scale production of test kits. By the end of January, Korea had scaled up its production to 100,000 kits per day.[18] Korea also made the test free of cost to everyone and came up with innovative approaches that include around 50 drive-through testing locations, as well as mobile facilities and door-to-door visits. More than the efficiency, the drive-in test centres lowered the risk of virus infection.[19]

The application of high-tech tracking and surveillance system has been another vital feature of the Korean strategy. Once a case of infection is confirmed, information alerts are sent out to everyone in the locality. Also, the tracking system enables the health official to track down people at high risk, namely, those who might have come in contact with the infected person using extensive CCTV records, credit card and mobile data. The level of details shared on the government website goes to the extent of identifying the seat used by a patient at a movie theatre.[20]

Unlike many countries, Korea did not implement a strict international travel ban. Wuhan was only place from which Korea restricted travel entry. However, it implemented additional screening procedures at all ports of international entry from very early. Passengers from high-risk areas were asked to install a special application in their smartphone and were instructed to update their daily health status.[21] The Korean government has announced special economic packages to support affected industries like aviation, small and medium enterprisesand low-income families to ease the pressure caused by the pandemic.[22]

Taiwan

Despite its proximity to China, Taiwan has managed to keep itself out a major COVID-19 outbreak. Taiwan so far has reported 322 confirmed cases (as of March 30), three deaths and 35 cases of recovery.[23] After reporting its first case on January 20, Taipei successfully pre-empted the infection from becoming an outbreak. Most of the confirmed cases of COVID-19 in Taiwan were imported cases, mostly Taiwanese returning from abroad. There are only very few cases that are locally acquired, indicating the absence of any cluster or community infection.

 
Fig 4. Taiwan: Total COVID-19 Infection (Source: Taiwan CDC)

Taiwan's response to the COVID-19 situation has been built on lessons learnt from its experience of the SARS outbreak in 2003 and its vigilance of developments in China. Following the SARS epidemic, Taiwan established the National Health Command Centre (NHCC), as part of its disaster management system to act as an operational control centre in situations of a national health emergency. Recognising the urgency of the situation, Taiwan activated the Central Epidemic Command Centre (ECC) of the NHCC on January 20 with health minister as the commander. Subsequently, ECC tookseveral proactive measures including “border control, case identification, quarantine of suspicious cases, resource allocation, reassurance and education of the public while fighting misinformation, negotiation with other countries and regions, formulation of policies toward schools and childcare, and relief to businesses”.[24]

 
Fig 5. COVID- 19 Situation in Taiwan (Source: Taiwan CDC)

A significant factor that helped Taiwan to keep the infection under control was its early response. When China notified unknown cases of pneumonia to WHO on December 31, Taiwanese health officials began screening flights arriving from Wuhan for passengers with flu-like symptoms on the same day. Eventually, Taipei banned all flights from Wuhan on January 23 and all flights from China on February 4. Such travel bans wereincrementally updated for different countries as the epidemic spread around the world. ByMarch 19, Taiwan had barred the entry of all foreign nationals.[25]

Since January 28, Taiwan has also leveraged on the use of technology and big data analysis for the identification and surveillance of infected patients and people who are at risk by integrating the databases of the national health system and immigration. People who are at high risk because of their travel history are being subjectedto live monitoring through their mobile phone.[26] Giving access of these databases to hospitals, clinics and pharmacies, the Taiwanese government further strengthened its surveillance system.

In increasing its ability to fight the epidemic by ensuring the availability of essential medical items like masks and sanitizers, Taiwanese government banned the export, set the prices and used government and military resources to increase the production capacity of medical supplies.  

Conclusion

Compared to Europe and America, Japan, South Korea and Taiwan, so far appeared to have the COVID-19 situation under control. Also, their fight against the epidemic, unlike many others has been effective without them having to adopt stringent measures like lockdown or strict restriction on the movement of people. Their approaches have also been different on many accounts. Taiwan's response has been predicated on its early recognition of the crisis and ability to put together a proactive system in place using lessons drawn from its previous experience with SARS outbreak and leveraging its technological capability. Like Taiwan, the Korean response was also built on its previous experience and ability to leverage its advanced technological capability in IT and biotechnology to find innovative solutions in situations of a national health emergency. Both in Korea and Taiwan, there appeared to be massive public support for government initiative indicating a high level of state-society trust, particularly on the use of extensive surveillance and monitoring. In its approach, Japan appeared to be more conservative and slow in responding to the COVID-19 situation. However, so far, the limited impact of COVID-19 on Japan suggests that it's strong culture of public and personal hygiene, and advanced health system appears to be working in its fight against containing the COVID-19 epidemic.

*****

*Dr. Jojin V. John, Research Fellow, Indian Council of World Affairs.
Disclaimer: The views expressed are that of the Researcher and not of the Council.

Endnotes

[1]"WHO Director-General's opening remarks at the media briefing on COVID-19", WHO, March 11, 2020, https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020, Accessed on March 30, 2020

"WHO Director-General's opening remarks at the media briefing on COVID-19", WHO, March 11, 2020, https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020, Accessed on March 30, 2020.

[2] "Coronavirus COVID-19 Global Cases by The Center for Systems Science and Engineering (CSSE) at JHU, https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6, Accessed on March 31, 2020.This figure excludes the 700 infected cases from the Diamond Princess, a cruise ship that was quarantined at the Yokohoma port.

[3] "Japan, spared mass outbreak so far, now sees national crisis after Tokyo surge", Japan Today, March 27, 2020, https://japantoday.com/category/national/Japan-spared-mass-outbreak-so-far-now-sees-national-crisis-after-Tokyo-surge, Accessed on March 31, 2020.

[4] "Coronavirus Disease (COVID-19) Situation Report in Japan", https://toyokeizai.net/sp/visual/tko/covid19/en.html Accessed onMarch 31, 2020.

[5] "Coronavirus Disease (COVID-19) Situation Report in Japan", https://toyokeizai.net/sp/visual/tko/covid19/en.html Accessed on March 31, 2020.

[6] "Basic Policies for Novel Coronavirus Disease Control", Ministry of Health, Labour  and Welfare, Japan, February 25, 2020, https://www.mhlw.go.jp/content/10200000/000603610.pdf Accessed onMarch 27, 2020.

[7]“New Coronavirus Infectious Disease Control Headquarters (21st meeting)”, Office of the Prime Minister, Japan, https://www.kantei.go.jp/jp/98_abe/actions/202003/20corona.html Accessed onMarch 31, 2020.

[8] "Coronavirus: Why Japan tested so few people", Nikkei Asia Review, March 19, 2020, https://asia.nikkei.com/Spotlight/Coronavirus/Coronavirus-Why-Japan-tested-so-few-people Accessed onMarch 30, 2020.

[9] Esteban Ortiz-Ospina and Joe Hasell "How many tests for COVID-19 are being performed around the world?", March 20, 2020, https://ourworldindata.org/covid-testing Accessed onMarch 28, 2020.

[10]Op.cit "Coronavirus: Why Japan tested so few people", Nikkei Asia Review.

[11]" Japan 'On The Brink' But Government Resists Declaring Coronavirus State Of Emergency", March 30, 2020 https://www.npr.org/sections/coronavirus-live-updates/2020/03/30/823800576/japan-on-the-brink-but-government-resists-declaring-coronavirus-state-of-emergen Accessed onMarch 31, 2020.

[12] "Japan's ruling party asks for ¥60 trillion stimulus to aid virus-hit economy", Japan Times, March 31, 2020, https://www.japantimes.co.jp/news/2020/03/31/business/economy-business/60-trillion-stimulus/#.XoOylogzbIU Accessed onMarch 31, 2020.

[13] "How South Korea Flattened the Curve", New York Times, March 23, 2020, https://www.nytimes.com/2020/03/23/world/asia/coronavirus-south-korea-flatten-curve.html Accessed onMarch 31, 2020.

[14] "Coronavirus Disease-19, Republic of Korea", Ministry of Health and Welfare, ncov.mohw.go.kr/en/ Accessed onMarch 31, 2020.

[15] "COVID-19 Realtime Dashboard", https://web.archive.org/web/20200324053131/https://coronaboard.kr/en/ Accessed onMarch 31, 2020.

[16] "2020 coronavirus cases in South Korea", https://commons.wikimedia.org/wiki/File:2020_coronavirus_cases_in_South_Korea.svg Accessed onMarch 31, 2020.

[17] "Korea Centers for Disease Control and Prevention", https://www.cdc.go.kr/board/board.es?mid=a20501000000&bid=0015 Accessed onMarch 31, 2020.

[18] "How South Korea Scaled Coronavirus Testing While the U.S. Fell Dangerously Behind", Propublica, March 15, 2020, https://www.propublica.org/article/how-south-korea-scaled-coronavirus-testing-while-the-us-fell-dangerously-behind Accessed onMarch 27, 2020.

[19]Ibid

[20] "How South Korea Flattened the Curve", New York Times, March 23, 2020 https://www.nytimes.com/2020/03/23/world/asia/coronavirus-south-korea-flatten-curve.html Accessed onMarch 28, 2020.

[21] Korean Centre for Disease Control, https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030 Accessed onMarch 31, 2020.

[22] "Update COVID-19 in South Korea", https://korea.ahk.de/fileadmin/AHK_Korea/Navigation_menu/News/COVID19/Update_COVID-19_03_18.pdf Accessed onMarch 31, 2020.

[23] Taiwan Centre for Disease Control, https://www.cdc.gov.tw/En Accessed onMarch 31, 2020.

[24]Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA. Published online March 03, 2020. doi:10.1001/jama.2020.3151, March 28, 2020.

[25] "Coronavirus disease (COVID-19) outbreak: Important Update Related to Taiwan, MOFA, ROC, "https://www.mofa.gov.tw/en/theme.aspx?n=635352E3900FFF8E&s=8A33013523400F35&sms=BCDE19B435833080 Accessed onMarch 31, 2020.

[26] "Big Data Helps Taiwan Fight Coronavirus", IEEE Spectrum, March 12, 2020, https://spectrum.ieee.org/the-human-os/biomedical/devices/big-data-helps-taiwan-fight-coronavirus Accessed onMarch 31, 2020.