key: cord-1055973-3in2z10q
authors: Hughes, Michael W.; Liu, Ping-Yen
title: An American's perspective living through COVID-19 in Taiwan
date: 2020-07-10
journal: J Formos Med Assoc
DOI: 10.1016/j.jfma.2020.07.011
sha: 7f82e71675ab1ea790a09da1e7f6d9ba28c7f1a9
doc_id: 1055973
cord_uid: 3in2z10q

nan

I never thought moving to Taiwan in 2012 would be a serendipitous event and did not predict it to be one of the safest places in the world during a pandemic. In October of 2012, I was recruited to Taiwan to help build a medical research center focusing on wound healing and to perform regenerative medicine research at National Cheng Kung University College of Medicine. Although the culture is different than my home of southern California, it is wonderfully beautiful. The Taiwanese culture is a major force why COVID-19 has not been as disastrous as other nations. The main reasons Taiwan is so successful are many, but three stand out to me.

"Those who cannot remember the past are condemned to repeat it." (George Santayana) The SARS outbreak in 2002 was a serious issue for China and Taiwan, but not for the west, including America. Taiwan took to heart the lessons learned from SARS and put in place specific measures to prevent a SARS-like event from reoccurring. This was evident when I arrived in 2012 at Taiwan Taouyan International Airport. As I transited from the concourse to immigration, I passed through a quarantine station monitoring all passengers' temperature using thermal imaging cameras. Any passenger who registered an abnormal body temperature was taken aside and questioned on their health and travel history. I thought this interesting because the USA does not have this system in place. These stations helped detect potential cases and prevent the spread of COVID-19.

Taiwan is an island, and could be called "An Island of Masks." In 2012, I observed a large percentage of Taiwanese wearing masks in public. I came to learn that wearing a mask in public reduces transmission of virus from the wearer. This culture is very prevalent throughout Taiwanese society and is considered to be polite or good mannered. To go into public with an illness and not wear a mask is considered rude. Furthermore, the mask price is relatively low and is free under specific conditions. The American culture is very different and most Americans would not think to wear a mask to prevent others from being infected. The Taiwanese mask wearing culture was significant in preventing the spread of COVID-19. 1 Finally, the difference in societal philosophy of the east versus the west played an important role in the spread of COVID-19. In the east, societal conformity is the norm. This conformity is complex and its role in society can be traced back to multiple teachings including but not limited to Taoism, Confucianism, and Buddhism. If an authority, for example the government or the police, orders a directive for society's protection, most Taiwanese will perform this directive to help. However, in the west, the philosophy is to ask questions about the directive before Americans decide to act. These philosophical differences have strengths and weaknesses. In the case of the COVID-19 outbreak, precious time was saved in Taiwan by this societal philosophy, but time was lost in America by questioning the lethality of COVID-19 or if mask wearing was effective for reduction of virus transmission.

Although each of these issues individually contributed to the Taiwanese and American situations for COVID-19, there was a synergistic effect too. These behaviors amalgamated to either; create a safe haven in Taiwan, or the world's highest number of infections in America (June 16, 2020). My hope is for Taiwan to stay safe and for America to learn from this history, look to medical scientists for knowledge to protect citizens, and prosper in the future.

Respiratory virus shedding in exhaled breath and efficacy of face masks

The authors have no conflicts of interest relevant to this article.