How to beat coronavirus: Heed Asia's lessons from epidemics past

When authorities in Wuhan announced on December 31 that they had detected a cluster of viral pneumonia in the Chinese city, with 27 cases linked to a seafood market, they said the disease was preventable and controllable, with "no obvious signs of human-to-human transmission."

But in wealthy places on China's periphery - Hong Kong, South Korea and other nations - a rapid response swung into action.

One reason was that they learned from the past.

"We were the Sars countries," said Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Hospital in Singapore who contracted severe acute respiratory syndrome during the 2002-03 outbreak. "We were all burned very badly with Sars, but actually it turned out to be a blessing for us."

Political will, dedicated resources, sophisticated tracking and a responsible population have kept coronavirus infections and deaths in Taiwan, Hong Kong and Singapore relatively low. South Korea, with more deaths, has led the way in widespread testing.

This offers lessons for the United States and Europe as they grapple with thousands of new cases and sometimes confused responses to the crisis.

Just hours after China's disclosure of the first Wuhan cases, Hong Kong's Centre for Health Protection warned local doctors to obtain travel and exposure history from patients presenting with fever and acute respiratory symptoms, and to isolate them.

In Taiwan, officials boarded planes arriving from Wuhan and assessed passengers for symptoms before allowing anyone to disembark. Within days, Singapore, South Korea and other Asian states implemented similar steps.

Asian economies have close links with mainland China, and were among the first hit by the novel coronavirus.

Yet with 100 cases in Taiwan, 181 in Hong Kong and 266 in Singapore, their infection rates are dramatically lower than in Western countries. Spain has recorded more than 11,000 cases; New York state - whose population is similar to Taiwan's - has risen to more than 2300.

China learned some lessons from Sars but failed to learn the danger of covering up an outbreak, while South Korea learned plenty after grappling with Middle East respiratory syndrome, or Mers, in 2015. Both countries struggled with big outbreaks of Covid-19 this year but appear to have the virus under control thanks to stringent and sometimes unprecedented measures.

Experts are now urging countries like the US, France, Spain and others to use time bought by newly enforced social distancing measures, lockdowns and quarantines to reset and work out their strategies before it is too late. These Western nations, they say, were simply not ready.

"So many countries have sat there, wondering what will happen," said Dale Fisher, a professor in infectious diseases at the National University of Singapore who also chairs the World Health Organisation's Global Outbreak Alert and Response Network and was part of the organisation's mission to China in February. "It is extremely disappointing, as a member of the mission, that we couldn't make it clear to the world that this was coming."

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After getting off the mark early, countries and territories around China ramped up border restrictions as the scale of the epidemic became clear.

Taiwan, unencumbered by political obligations to mainland China - the self-governing island has a tense relationship with Beijing, which views Taiwan as its territory - had the structure in place to cope.

A year after Sars, Taiwan established a National Health Command Centre that brought together all levels and branches of government, preparing for the possibility of a repeat. Its interventions over the past two months have been decisive in keeping Taiwan ahead of the curve, said Jason Wang, director of the Centre for Policy, Outcomes and Prevention at Stanford University.

"They didn't hesitate, they didn't want to die," Wang said. "The mortality rate was so high [during Sars] and they didn't know how bad this one was going to be. Nobody thought it was like the flu."

As early as January 5, Taiwan was tracing people who had been in Wuhan in the past 14 days. Those with symptoms of respiratory infections were placed in quarantine.

In subsequent weeks, authorities used data and technology to identify and track cases, communicated effectively to reassure the public, offered relief to businesses, and allocated medical resources where they were needed most - rationing face masks and dramatically ramping up production.

On January 27, Taiwan combined its National Health Insurance and National Immigration Agency databases, allowing it to track everyone who had been in Wuhan recently, and alert doctors to patients' travel histories.

Now, Taiwan is hoping to keep its infection numbers down, and has asked residents not to travel abroad after its biggest single-day jump of cases - 23 - yesterday, and is barring most noncitizens from entering.

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China has won plaudits from the World Health Organisation for its massive mobilisation of medical resources to test and treat people suffering from the coronavirus, but failed to learn from its coverup of Sars. Chinese authorities initially silenced doctors who tried to raise the alarm about the seriousness of the coronavirus outbreak, denying the rest of the world precious early days to assess the risks.

South Korea has become the poster child for testing. Its success is rooted in a previous failure: The limited availability of test kits was seen as having aggravated the 2015 Mers outbreak, when South Korea suffered the second-highest caseload after Saudi Arabia.

Whereas the US and Japan keep testing tightly controlled by a central authority, South Korea opened the process to the private sector, introducing a path to grant "emergency usage approval" to authorise test kits for pathogens of pandemic potential.

More than 260,000 people in South Korea have been tested for the virus, the highest per capita anywhere, with testing and treatment fees covered by the Government and drive-through centres capturing global attention. On a visit to the Korea Centres for Disease Control and Prevention, President Moon Jae In called the expansion in testing "a great achievement that is acknowledged around the world."

Singapore, too, benefited from its own capabilities to test, as did Hong Kong and Japan. All developed their own diagnostic tests when the Covid-19 genome sequence was first published.

"Singapore, through Sars, learned it the very hard way, that we have to develop these capabilities at the word go," said Leong. "Once you are in control of your own fate, you can decide what way to go."

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Rocked by eight months of protests, Hong Kong's embattled leaders began responding to the outbreak from a position of weakness, and were criticised for not moving fast enough to close schools and borders.

Outside mainland China, the territory had been the biggest casualty of the Communist Party's coverup of the Sars outbreak, with some 300 deaths and little clarity on what was unfolding until it was too late.

This time, though, and without needing to be told much, Hong Kong residents took matters into their own hands. The city's financial district was reduced to a ghost town in early February as companies shut offices. Bakeries known for hour-long weekend lines were abandoned.

Parties, weddings, and family gatherings were cancelled - without any government order. Almost everyone rushed to procure masks; a recent study estimated between 74 per cent and 98 per cent of residents wore them when leaving their homes, and celebrated voluntary social distancing as a key reason for the lower number rate of infections.

"Hong Kong is a population which takes the idea of quarantine, masks and social distancing very seriously," said Keiji Fukuda, director of the University of Hong Kong School of Public Health and former assistant director-general for health security at the WHO.

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From electronic wrist bands to smartphone trackers, Asian jurisdictions have pulled out all the stops to ensure suspected patients comply with quarantine and isolation orders, backed by laws that were tightened post-Sars.

Singapore used its FBI equivalent, the Criminal Investigation Department, to effectively interrogate every confirmed case with stunning granularity - even using patients' digital wallets to trace their footsteps. Those caught lying face fines and jail time.

The city-state has been lauded as the gold standard for identifying cases, with a study by Harvard's Centre for Communicable Disease Dynamics finding it was 2.5 times more likely to detect infected people than the global average, because of "very strong epidemiological surveillance and contact-tracing capacity."

In South Korea, information on the movements of infected people before they were tested is collected and relayed over smartphones, creating a real-time map of where to avoid. Taiwan tracks infected people's whereabouts via smartphones: Stray too far from home and they receive a message; ignore it and the police will pay a visit.

In Hong Kong, everyone subject to a compulsory quarantine must activate real-time location-sharing on their phone or wear an electronic wristband.

These measures have been backed by local populations who lived through previous epidemics and largely shed concerns about privacy and tracking.

All these places have stopped short of a Wuhan-style lockdown.

Matthew Kavanagh, director of the Global Health Policy and Governance Initiative at Georgetown University, said Americans should not focus "only on the kind of high-profile displays of state power that have made headlines from China" but on countries such as South Korea that are "balancing democratic openness with rapid, concerted public-health action."

Experts agree, though, that Western governments must be prepared to limit their citizens' movements, mandate isolation for positive cases and track contacts regardless of privacy concerns.

"This is the process it will take to save thousands of American and European lives, billions of dollars of the economy, your own businesses," said Fisher. "Otherwise, it is just carnage."