Taiwan, Japan, Sweden and Greece; a tale of four countries.

Early in 2020, the world started taking notice that a novel coronavirus disease, was spreading in the Chinese city of Wuhan.  It was later named, SARS-CoV-2 and the disease Covid-19.  As of today, there are slightly more than 6 million confirmed cases around the world and the global death toll has surpassed 370,000.   

Taiwan is an island nation of 24 million that sits just 70 miles from China.  More than four-hundred thousands of its citizens work in China and more than 2 million Chinese visit Taiwan every year thus a massive outbreak of the disease named Covid-19 seemed all but inevitablefor Taiwan would be one of the hardest hit countries.  Yet despite the odds, Taiwan has recorded only 441 cases of the disease as of today, with only 7 patients dying.  

So how did Taiwan manage to have so few cases and so few deaths from the disease.  First and most important Taiwan enacted prevention measures early.  On Dec. 31, the day the Wuhan authorities announced that there were several patients with an unidentified type of pneumonia, Taiwan activated stricter control measures with testing of incoming travellers with fever and questioned suspected travellers about their contact history.

On Jan 20, Taiwan activated its Central Epidemic Command Center (CECC), which rolled out more than 124 measures such as banning all exports of surgical masks and providing all its citizens with two free masks.  On Jan 26 it banned travel to and from Wuhan.  According to a March 3 article published in JAMA, the CECC rolled out measures that included border control, case identification, quarantine for all travelers from regions hard hit by the disease, and postponing the reopening of schools following the winter break.  The center also served as the source of information for the public, with daily press conferences that provided the population with reliable and easy to understand information about the outbreak.  It was thanks to these measures that Taiwan experienced one of the smallest fatality rates in the world of only 0.3 deaths per million.

Japan went its own way, limiting tests to only the most severe cases.

Japan — the grayest country in the world and a popular tourist destination with large, crowded cities — has one of the lowest mortality rates from Covid-19. Τhe government never forced businesses to close and the medical system did not get overwhelmed. 

Japan focused on quickly containing small outbreaks through contact tracing. It has focused on lessening people’s anxiety and stressing the basic science of prevention: wash your hands, wear a mask, keep your distance from others.

A public education campaign urged people to avoid the “Three C’s” which are closed spaces with poor ventilation, crowded places and close contact.

Last week, Prime Minister Abe declared Japan’s battle against the outbreak a success, taking the country off its “lockdown lite” that lasted only a month and a half.  Japan experienced one of the smallest fatality rates in the world of only 7 deaths per million.

As the virus spread across Europe, many Greeks feared that Greece would be hit as bad asItaly and Spain.  On Feb. 27, a day after the country’s first Covid-19 case was diagnosed the government canceled the annual carnival and all sporting events and on March 11, it closed down schools and universities. Two days later all travelers from abroad had to go through a two-week mandatory quarantine.  It also closed down cafes, restaurants, libraries and museums.  Attendance of mass in churches was also forbidden even during Holy week and Easter. 

Everyone in the country during the 2 ½ months lockdown had to request permission by sending an SMS each time we were to leave our homes, to go to supermarkets, doctors’ offices, pharmacies to visit and help our elderly relatives, to go for a walk or risk a fine.

(Picture of an empty Monastiraki square in Athens with view of the Acropolis in the background.)  

The government established a council of experts who issued information and advice on a daily basis.  It was the willingness of most Greeks to comply with experts’ suggestions that brought about an outstanding result of only 2,915 confirmed cases and 175 deaths as of today.  Greece similarly to Japan tested for the virus less than 1 percent of the population. As of today, 15,903 tests per million were performed mostly on people admitted to hospitals with symptoms and those who have been in contact with confirmed cases. Spot tests on travelers coming into the country from abroad were performed as well.  For comparison purposes Germany and Austria countries that also had very good results performed 47,194 and 47,477 tests per million of inhabitants respectively.  

As of this week, the number of cases and more important the number of deaths per million comparing to other European countries point to a Greek success story.  So, what was Greece’s good result due to?  First, as Taiwan, Greece enacted its plan, a strict lockdown, earlier than most European countries.  Second, the population of 11 million Greeks lives in a mainland which is mountainous, the size of which is 50,000 square miles, and which is surrounded by two seas the Aegean (82,000 square miles) and the Ionian sea (65,000 square miles) with more than a thousand islands,  thus the country is sparsely populated as its physical characteristics make contact between villages and small towns difficult, which after all was forbidden during the lockdown.  Third, most of the Greeks accepted the enacted recommendations of social distancing and adhered to its principles.   Greece experienced one of the smallest fatality rates in Europe of only 18 deaths per million.

(Picture of a deserted beach in Porto Rafti, Greece)

Sweden's controversial plan to deal with the coronavirus allowed for people to go outside, visit restaurants, bars  and shops as long as they kept distant from each other.  Sweden closed high schools and universities and did not allow gatherings of more than 50 people.  Although not everyone in Sweden is happy with this approach, the majority of the people were satisfied.

Anders Tegnell, who advocated this approach, estimated that 40% of the people in Stockholm will be immune by the end of June which will give the country a big advantage, as most of the countries will experience a “big second wave” later this year.  As of May 20th, only 7.3% of Stockholm’s inhabitants have antibodies to Covid-19.  He also said the “lockdown strategy” has not scientific basis especially when it comes to the young and children as they do not transmit the disease.   Sweden has reported zero coronavirus deaths in the last 24 hours, for the first time since March 13.  Sweden experienced fatality rate was average in Europe with 440 deaths per million.

So, which approach should countries follow in the future when an infectious disease appears to be spreading and the danger of an epidemic is real?  Extensive testing such as performed in Singapore allows authorities to quickly determine who is infected and isolate them.  More than 90% of cases in Singapore  were mostly young, healthy men. Of those who died, 95% were more than 60 years old, while the vast majority of those infected were between the ages of 20 and 59. 

Taiwan’s and Greece’s success stories suggest that an early detection of a pandemic and enactment of measures for its control minimize the number of cases, flattens the curve and deaths.  

The “lockdown light’ approach of Japan also ensured a low death fatality rate.   

The open society approach with social distancing as it was practiced in Sweden has higher death toll but left the economy minimally affected.  

All four countries followed their experts’ advice and their policies did not become a source of political discord.  Unfortunately, fear and politicization of crises stigmatize governments or groups of people without helping to solve the challenge at hand therefore are ultimately unproductive.  Hopefully, in 2021 an effective vaccine will become available that will limit the prevalence of the disease.  Past pandemics such as the 1918-1919 Spanish flu, still have lessons we all can learn and benefit from as most viral pandemics have similarities therefore similar measures such social distancing, wearing masks when in crowded places, washing our hands often, use of hand sanitiser,  sneezing and coughing etiquette, often help in their control.  

Finally, going out for a walk and spending time in nearby park or nature reserve reduces stress and help us feel healthier and happier.  Looking at greenery and listening at nature’s sounds including total silence afforded to us in remote areas can boost our sense of well-being.   

Well, my friends this is the last post on pandemics and Covid-19.  In my opinion the pandemic will die down on its own as most epidemics do and all of us those infected or not will remember the Covid-19 epoch for the rest of our lives.

(Picture of the view and the undeveloped path  I took my daily walk that helped my mood during the lockdown)