Taiwan moves away from COVID-zero as cases climb

Foreign Affairs

While Beijing continues to impose strict lockdown measures in an attempt to maintain its COVID-zero policy, Taiwan is beginning to shift toward living with the virus.

A woman receives a COVID-19 vaccine booster in Taipei before lunar new year 2022. Photo by Ann Wang, Reuters

As China and Hong Kong impose their strictest epidemic prevention measures since 2020 in an attempt to control escalating COVID case numbers, officials in Taiwan say they are moving toward a “new Taiwan model” of living with the virus.  

In the past month, much of the world — including China — has seen a sharp uptick in COVID cases as countries struggle to keep the highly transmissible Omicron variant from spreading. On Tuesday, Taiwan reported 551 domestically-transmitted cases of COVID-19, its highest single-day count in 2022. President Tsai Ing-Wen (蔡英文 Cài Yīngwén), after being in close contact with a positive case, is self-isolating for several days despite a negative test. Over 200 schools have closed after positive cases were reported and more than 30,000 people across the country are in quarantine, according to local reports.

But there’s little fear or panic in Taipei, as most residents continue to travel domestically, work in person and attend restaurants, bars, and large gatherings. It’s a far different picture from last summer’s outbreak that resulted in a “Level 3” epidemic alert that heavily limited those activities.

Officials say the current strategy is one of slow reopening — e.g., reducing quarantine after entry from 14 to 10 days and allowing business travelers back in — while minimizing the likelihood of disaster. “COVID-zero is impossible to maintain,” Taiwan’s Health and Welfare Minister Chen Shih-chung (陳時中 Chén Shízhōng) said Thursday.

High vaccination rates give confidence

Clare, a 25-year-old nurse from Taipei, told SupChina that she and many other Taiwanese feel more relaxed during this wave because of Taiwan’s track record of controlling the virus, and because of the increased vaccination rate: about 78% of the population have had two doses, a stark contrast to the vaccination rate at the start of last year’s outbreak — just 1%.

“We trust our government’s effort in preventing the expansion of COVID cases,” she said. “The conditions of most of the patients are not as critical as before. I mean, now it’s like the flu we face every year.”

Taiwan’s high vaccination rate is one of three major factors behind the government’s confidence in coexisting with the virus, said Chunhuei Chi (紀駿輝 Jì Jùnhuī), a professor at Oregon State University’s Global Health program and a policy advisor to Taiwan’s National Health Insurance Administration. It’s because of that high vaccination rate — and more effective vaccines — that Taiwan likely won’t see death or hospitalization rates on par with Hong Kong, Chi says. As of Tuesday, 99.7 percent of cases this year were mild, with only 15 cases deemed “moderate to severe,” according to official statistics.

Taiwan also “is a little bit behind the schedule of getting the Omicron variant,” Chi said. “So Taiwan has the benefit and advantage of learning from Europe and North America about their experience with Omicron.”

Chi also pointed to recent studies that have shown a combination of vaccination and natural immunity — meaning recovery after being sick with COVID-19 — leads to the strongest protection from the virus. “The idea is to let healthy people get exposed to Omicron to acquire stronger immunity. Of course, it’s not about intentionally letting people get infected,” he said.

Can Taiwan handle a COVID surge?

Health and Welfare Minister Chen Shih-chung said on Tuesday that cases are expected to reach 1,000 per day by the end of April, and will peak in a month or two. 

To relieve the expected burden on the healthcare system, the government recently adjusted its quarantine rules to allow positive cases aged 65 and under with mild or no symptoms to quarantine at home, and is working to make more rapid test kits and antiviral drugs available.

Chief physician of New Taipei City’s Far Eastern General Hospital, Dr. Liao Chun-Hsing (廖俊星 Liào Jùnxíng), remains worried about the trajectory of the outbreak. 

“The spare rooms are limited, I will say the truth. We have very limited rooms. But the turnover is quite rapid,” he said. “I mean, compared to last year, [when] there was no space for COVID-positive cases.” But an increase to more than 1,000 or 2,000 new cases per day, he said, could pressure the system.

People over the age of 75 are Taiwan’s biggest concern, experts say, particularly after seeing how Omicron has impacted Hong Kong’s under-vaccinated elderly population. Misinformation and initial hesitation about the vaccines’ potential side effects, as well as accessibility issues, contributed to the low rate among Taiwan’s elderly.

Despite pleas from some parents, Taiwan has not yet approved vaccination for children between the ages of 5 and 11 based on “insufficient information” to determine whether they should be vaccinated. Among people 75 and older, only 71 percent have had two shots. About 52 percent of the overall population has had a booster shot.

The government ramped up its vaccination campaigns with a focus on the elderly by sending medical teams directly into communities and offering vouchers of $500 NTD ($17). It’s part of Taiwan’s strategy to “buy time” before continuing to open borders, said Wei J. Chen (陳為堅 Chén Wèijiān), director of the Center for Neuropathic Research at Taiwan’s National Health Research Institutes.

“We would like to open but also avoid heavy mortality in our elderly population. So if opening leads to an extremely high infection rate, I think [the government] will readjust,” Chen said. “But I think [current] numbers are pretty manageable.”

Chiao Feng, a 45-year-old property manager in New Taipei City, said she hasn’t gotten her booster shot because she doesn’t think it’s necessary. Taiwan is still relatively safe compared to other parts of the world, she said. Her son, who is eight years old, is not yet eligible for a shot.

“I think if most people are fully vaccinated, even with two doses, that’s enough, I suppose. Most younger people are vaccinated. But I think we are more concerned about the elderly people,” she said.