Health·Analysis

Is Taiwan's impressive response to COVID-19 possible in Canada?

Taiwan has limited the outbreak of COVID-19 using big data and other emergency measures despite its close proximity to mainland China.

As Canada struggles to flatten the curve, Taiwan has so far avoided a big curve

People wait in long lines to buy face masks outside a pharmacy in Taipei, Taiwan. The government enacted legislation to prevent price gouging for masks and banned their export to prevent shortages. (Ann Wang/Reuters)

Taiwan is credited with sharply limiting the spread of coronavirus on the island by pairing and analyzing the electronic health and travel records of its residents, along with enacting other emergency measures.

But privacy experts say legal protections would prevent similar big data use in Canada.

When adjusted for population size, Taiwan has about 70 per cent fewer cases than Canada, despite being just 130 kilometres from China, where the outbreak began, and having thousands of daily visitors from the mainland — 2.7 million in total in 2019 alone. 

Both Canada and Taiwan reported their first presumptive cases of coronavirus within days of each other in January, but by March they had diverged sharply in the number of infections reported.

As Canada struggles to flatten the curve — or slow the spread of the virus — Taiwan has prevented a curve.

(CBC)

Dr. Jason Wang, director of the centre for policy, outcomes and prevention in Stanford University's school of medicine, said Taiwanese authorities were "vigilant."

"They acted swiftly and they brought in measures to contain the spread of the virus," said Wang, who frequently teaches in Taiwan.

Wang co-authored "Response to COVID-19 in Taiwan: Big Data Analytics, New Technology and Testing," which was published in the journal JAMA. In that analysis, he noted that the island has been on alert for epidemics since the SARS outbreak in 2003.

According to his analysis, Taiwanese officials began boarding flights from Wuhan, the initial epicentre of the outbreak, as early as Dec. 31, 2019, shortly after China disclosed its first cases of the novel coronavirus. Eventually, certain flights were banned and visas for visitors to Taiwan were cancelled.

Triaging with text messaging

The government has since barred all foreign travellers from entering the island.

Taiwan also created a health questionnaire that passengers accessed by scanning a QR code with their phones while still on planes as they were arriving.

Depending on their health status, they were sent a text message providing them with a health declaration pass to fast-track through immigration. Anyone at a higher risk of infection was urged to go into self-isolation at home and tracked via their cellphone to make sure they stayed there. False reporting of health information became a fineable offence.

"So this way they could triage a large number of passengers very quickly without lining up in the airport, which in itself is a risk," Wang said.

After activating its central epidemic command centre on Jan. 20, the Taiwanese government integrated its health insurance database with its immigration database to create a real-time super data source that became central to identifying people most at risk of infection. 

The database is accessible by health professionals and certain government officials in Taiwan and includes a patient's travel history and personal information. Health officials regularly use text messaging to communicate with patients and follow up in person. 

Dr. Iris Gorfinkel, a Toronto physician and researcher, has long advocated for electronic medical records accessible to doctors and their patients.

But she said Taiwan's use of big data to respond to the coronavirus outbreak wouldn't be possible under Canada's current privacy legislation.

Dr. Jason Wang, director of the centre for policy, outcomes and prevention at Stanford University's medical school, said Taiwanese authorities 'acted swiftly and they brought in measures to contain the spread of the virus.' (Damian Marhefka/Stanford University)

"I think that in the Canadian context, it would be viewed as rather dystopian," she said.

In Canada, health and travel records are also siloed under provincial or territorial and federal jurisdictions respectively.

Brenda McPhail, director of privacy and technology at the Canadian Civil Liberties Association, said that's "a good thing."

However, she said that if there was public appetite in Canada for big data use during times of a health crisis, "there should be an expiration date."

She said even though "it may actually be helpful in mitigating risk," there would have to be legal protections in place to ensure "extreme" data collection doesn't continue indefinitely because "we've been habituated to the idea that it's OK to collect more than we normally would about individual behaviour or movements."

Despite being so close to the epicenter of the outbreak in China, with a combination of swift public health measures and big data, Taiwan is reporting fewer than 80 COVID-19 cases. 2:01

Wang also noted the extraordinary lengths with which Taiwan went to secure personal protective equipment for health-care workers and residents.

The government not only banned the export of protective masks, but it also made price gouging illegal and the military eventually assisted in increasing mask production to ensure everyone who needed one would have access.

Nobody wants to get quarantined, but at least you're treated like a person, not a virus.- Dr. Jason Wang

Gorfinkel, who's also a family physician, said she was "actually kind of admiring that because my struggle with not having masks in my office has been an ongoing one for the past month."

While Taiwan's response to the coronavirus is aggressive, Wang found the government was careful to not tread on people's dignity and rights, even when fines were introduced for breaking isolation orders or spreading misinformation about COVID-19.

People in Taiwan expect a high level of liberty and score highest on personal freedom in Asia, after Japan, according to the U.S.-based human rights watchdog Freedom House. Taiwan is not a member of the United Nations so its human rights record is not evaluated by the body.

Some Taiwanese patients in isolation are also given supplies such as hand wipes, forehead thermometers and food during home visits from workers who check on their welfare. 

Wang said that "makes it more tolerable. I mean, nobody wants to get quarantined, but at least you're treated like a person, not a virus."

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