24 MARCH 2020 / ASIA’S SECOND WAVE
[NEWS]
SEAN RAMESWARAM (host): I’m Sean Rameswaram and this is a coronavirus update from Today, Explained for Tuesday, March 24, 2020.
SCORING - IN THE BASEMENT
SEAN: We’re now approaching 400,000 confirmed cases of Covid-19 around the world in something like 194 countries and territories.
The Olympics have officially been postponed until 2021. This will only be the fourth time the games have been cancelled or postponed following the three times prior during the two World Wars.
A World Health Organization spokesperson says the United States has the potential to become the next center of the crisis with almost 50,000 confirmed cases, and many, many more believed to be unreported.
On Monday, Covid-19 deaths in the United States surpassed 100 in a single day for the first time. The United States Surgeon General, Dr. Jerome Adams, said, “This week, it’s going to get bad.”
Meanwhile, President Trump can’t wait to get back to business as usual. His new refrain appears to be “The cure cannot be worse than the problem.” He says he’s not looking at months of the country being shutdown and has been calling for businesses to reopen sooner than expected and for people to get back to work. He proposed Easter, which is just a few weeks away.
Might not be a great idea in New York City where the White House’s coronavirus response coordinator, Dr. Deborah L. Birx, said the “attack rate,” which is the percentage of the population infected with the virus, was nearly one in 1,000 in New York City. That’s five times higher than in other parts of the country. And more cases per capita than Italy.
Public health types are warning the rest of the country to take note of New York’s situation. Thomas R. Frieden who used to run the CDC and New York City’s health department told the New York Times, “The question now is whether the rest of the U.S. will learn from New York and avoid the situation that it is facing and is likely to get worse in the coming days and weeks.”
Meanwhile in India, Prime Minister Narendra Modi ordered a complete lockdown for the entire country. He said "many families will be destroyed forever" if the country didn't take control of its coronavirus outbreak in the next three weeks. That’s a country of 1.3 billion people, by the way.
If you’ve got questions, we’ll try to get answers. Today Explained at vox dot com is the email address. The show is at today underscore explained on Twitter and I’m at rameswaram. We also now have a phone number. Call us and leave a message at (202) 688-5944.
SCORING OUT - IN THE BASEMENT
[INTRO]
[THEME]
SEAN: Remember back in January when it was just China dealing with this? Then things got bad in Iran and Italy. Things got bad in South Korea. But they managed to flatten the curve. And now the United States looks like the next major coronavirus crisis.
It feels like it sorta fully made its way around the world. But along the way, there were a few key spots that managed to outmaneuver Covid-19. Places you’d think would have been hit hard. Places like Taiwan and Hong Kong and Singapore that have close ties to China, but death tolls in the single digits.
I asked Liza Lin how that happened. She covers Asia for the Wall Street Journal from Singapore.
LIZA LIN (Reporter, Wall Street Journal): Taiwan, Singapore and Hong Kong come with a bit of a history. All three of these countries had gone through a different coronavirus 17 years ago, that coronavirus is broadly known as SARS.
<CLIP> CNA: The current Wuhan virus episode is reviving memories of the severe acute respiratory syndrome or the SARS crisis in 2003.
LIZA: And the coronavirus SARS hit all three countries pretty hard. In fact, if you tally up the death rate, Singapore, Hong Kong and Taiwan, you probably get about close to half of the total number of deaths from SARS during that period. So, you know, once you know this history, you subsequently also understand why the countries reacted the way they did. And with such speed as well.
SCORING IN - CORNER PIECE
LIZA: We had news of the coronavirus kinda filter out somewhere close to the end of December. And then Singapore, Taiwan and Hong Kong start to respond probably in the middle of January. Singapore and Taiwan in the early stages didn't do social distancing. So they kept offices open. Schools went on as normal. Early February, end of January, Singapore decided to close its borders to China. And that at that point was a pretty controversial move, just simply because it was one of the first few countries to do it. In fact, was the third country to do it after North Korea and Russia. And so that came as a little bit of a surprise. I would say maybe five or six days later, Taiwan followed suit.
<CLIP> CBC: Taiwan's response to Covid-19 credits the island's health officials for taking action early. Boarding flights and screening for sick passengers. Passengers now fill out health questionnaires on their phones while at the gate.
LIZA: They closed their borders to Chinese travelers.
<CLIP> CBC: Taiwan also tied together electronic patient files to immigration records, following up with those at risk based on their travel history. Texting them to self isolate if needed and checking up in person, threatening fines if orders are ignored.
LIZA: Singapore and Taiwan have followed a more similar trajectory in the way they handle the virus outbreak. They also set a very, very detailed contact tracing. When an infectious disease occurs you want to put a stop, or corral the disease as early as possible. And for that, you need to find out who's carrying the disease, who might be carrying the disease. And this is where contact tracing comes in. You want to trace who are these people who might be carrying the disease and who are the confirmed cases and then retrace their steps in the last two weeks before they found out they had the disease. Who did they meet? Where did they go? Which were the places they hung out? And finally, they set up a cross-department task force, one in Taiwan, one in Singapore, they basically acted as a conductor to an orchestra. So Taiwan and Singapore put in place a task force. So they got everyone together in one place and they're making decisions together collectively and they're putting it out quickly. Hong Kong pursued a different approach. Hong Kong closed schools. Civil servants in Hong Kong were asked to work from home. And if you understand the dynamic in Hong Kong, the private companies typically take the cue from civil servants and how the Hong Kong government handles its workforce. So many private companies got their employees to work from home as well. So this part of social distancing was very effective for Hong Kong in its early stages.
SCORING OUT
SEAN: Okay, so Singapore, Taiwan, and Hong Kong take a mix of measures, including closing borders, contact tracing, setting up task forces, and social distancing. How does that affect how many Covid-19 cases they see?
LIZA: Yeah, at the start it was hugely successful. I have to single out Taiwan here. I mean, by the middle of February, they were going like six days without any cases. Singapore took a little bit longer, but by the end of February, there was a day where we were announcing no new cases. Hong Kong as well, people were starting to kind of loosen up a little bit, going out, having dinners, maybe have someone over...a close friend or something.
SEAN: Which is to say that they managed to sort of contain the virus. People felt confident?
LIZA: Definitely. I wasn't physically in Taiwan or Hong Kong. But I can tell you for Singapore, you know, people, in the early stages, there were definitely more people wearing masks. There is, like, panic buying of hand sanitizer, disinfectants and stuff. By the time end of February rolled around, people were definitely more relaxed. You could feel like visibly no one was eyeing each other with suspicion whenever you were coughing. But that said, you know, that the Singapore government was really good with risk communication. They said upfront, if you were sick, stay at home. So I think towards the end of February, you weren't even hearing anyone sneeze. Our cough on the subway, which is kind of very reassuring.
SEAN: Can the rest of the world learn something from Singapore? From Taiwan and Hong Kong?
LIZA: Online, I'm seeing a lot of people say Singapore, Hong Kong and Taiwan are small cities. You know, their experience can’t be replicated in the West, in much bigger countries like in the United States, for example. But I feel that's kind of misplaced. People think Singapore, Hong Kong and Taiwan were so successful because the populations are small. People feel like the population has a high trust in the government and was blindly following. I mean, I personally feel that small populations are great for disease monitoring and surveillance but I feel like the small populations had nothing to do with the fact that the countries responded really quickly, the fact that the countries were very prepared for this infectious disease.
SEAN: And how does that compare to what you’re seeing in the west?
LIZA: I personally feel like the biggest difference is in the population and how they're reacting to these new measures.
SCORING IN - THIS IS NOT A DREAM
<CLIP> AL JAZEERA REPORTER: People themselves are dreading any return to the dark days of SARS.
SPEAKER 1: We are in a crowded city. It will be terrifying if it comes here.
SPEAKER 2: I hope it’s not like SARS again. If it is, I will stay away from the crowds.
SPEAKER 3: If it happens, I'll wear a mask and do more work from home.
LIZA: Because after SARS, these three countries, which were very badly hit during SARS, they beefed up their health care system. They added more quarantine facilities, for example, they knew the importance of using personal protective equipment, masks, gloves on health care workers. In Taiwan—actually, very admirable—they repurposed factories to make masks so there wouldn't be a masks shortage. They kept the prices of masks down. So there is a cap on the price of some of the masks. In Singapore, it was pretty similar. What the government here did was to give every household four masks. So, you know, just to kind of calm the paranoia, calm the panic buying. In Hong Kong, Singapore and Taiwan, people listened to the government. Not because they wanted to listen to the government. If you've been following what's happening in Hong Kong and the last one year, you know that the people there don't blindly listen to the government, but they were afraid. In Singapore, there were 33 people who died from SARS in 2003. In Hong Kong, 300. So I feel people were scared and they stayed home and that had nothing to do with the government. This had everything to do with going to SARS.
SEAN: After the break, Liza will explain the risks of a second wave in places that already feel like this crisis is behind them. It’s Today, Explained.
SCORING OUT
[MIDROLL]
SEAN: OK, so Liza, Hong Kong, Singapore, Taiwan, they manage this crisis comparatively very well. Are they in the clear now or are they still at risk? Can people just run around the parks and give each other hugs and kisses? Or is there still major concern about this, this outbreak spreading?
LIZA: They're not in the clear yet. In fact, we've been seeing over the last one week or so, Singapore and Hong Kong and Taiwan actually hit new highs in terms of the number of daily new recorded cases.
SEAN: And so you're saying it's like as you're saying, this is like a second wave?
LIZA: Yes, I would call that a second wave.
SCORING IN - A SONG TO BRING BACK THE SUN
<CLIP> DW NEWS: Well, fears are growing in Hong Kong of a second wave of Coronavirus. The territory had been successful in containing the first outbreak, but new cases have spiked in recent days. The Territory reported a record jump in coronavirus cases as thousands returned home from overseas.
LIZA: A lot of the world is currently going under lockdown and it's almost like an antiglobalization of some sort. You know, everyone who has gone overseas for work is kind of looking to come back home. And it's the same for, like, Singapore, Hong Kong and Taiwan. In the case of Singapore, in the last one week or so, the country has recalled a large number of student students who have gone overseas on exchange, for example. So we're seeing a lot of these people return home and they have been coming home from places hard hit by the coronavirus: from the U.K., from Germany, from the US. So we're actually seeing the number of cases go up. But it's not because of local transmission. It's not one person walking in the middle of the central business district in Singapore spreading to other people. It's more of these travelers or these citizens coming back home and they're bringing the virus home.
SEAN: So in these second waves, in these three regions, how many cases have we seen so far?
LIZA: Yes, I would say the second wave probably began last Monday. And you have been seeing new highs, new daily highs in all three places from there. So right now, I think we have Singapore standing just above 500 cases, in Hong Kong above 300. And in Taiwan, we're at about 200 cases. It doesn't sound like a lot. When you see the number of cases in the U.S. and the West. But, you know, it was a big jump from like the beginning of March.
SCORING OUT - A SONG TO BRING THE SUN BACK
SEAN: OK, so you established that Taiwan, Singapore and Hong Kong were able to do really effective containment of Covid-19 the first time around. Are they are they having really good luck the second time around, too?
LIZA: Well, the second time around, the results we've yet to see the successful fulness or the effectiveness of the strategy just simply because people are still returning. But at least what the governments in these three places are doing is they're acting to close their borders even further than it was before. Originally, it was shut to China, parts of Korea, parts of Europe that were hard hit by the virus. But now in all three places, no foreigner is allowed to enter in the airports, which, you know, in the case of Singapore, Hong Kong, are big transit airports and are not taking transit passengers either. And any resident or citizen returning to a country has to be quarantined for two weeks. So I would say we don't know how this new wave is going to end, but the three governments are putting in measures to make sure the virus is contained.
SEAN: The United States is really struggling with social distancing. People just don’t get it. In Canada the Prime Minister is threatening to involve law enforcement. How are they enforcing it over there?
LIZA: It's hard to put a broad brush stroke and talk about all three countries together. I would say the the governments in all three regions are definitely taking steps to just make sure quarantines being enforced and they're doing it through a variety of ways. One is just digital surveillance. For example, in Hong Kong, they issued these wristbands that you have to wear if you come back to the country and you're serving our quarantine notice. And the wristbands basically flag to the government that if you left that area of quarantine, it sends a notice to health authorities who then come and check that you're where you're supposed to be. In Singapore What's really quite interesting that they rolled out recently is an app, the name it TraceTogether. The idea about this app is everyone downloads the app and using a Bluetooth signal. If you come into contact with someone within like a certain radius, maybe two meters, if you come within two meters of me and we hang out for half an hour, our phones store, the fact that we have had that interaction.
SEAN: Creepy.
LIZA: And should should the person meeting come down with the virus, then authorities go into that person's phone, they check the app to figure out who is he, who he or she's been in contact with, and then use that for contact tracing. So in a way, it's digital contact tracing instead of interviewing someone to figure out who he or she has been hanging out with, they look at the phone, they look at digital data to do it instead. What the government says is data or story, that information or other information is stored on your phone. I think they are quite conscious of the fact that people do value their privacy. And they mentioned that users can opt out of the app. But even even despite them saying all this, I still feel a bit skeptical because the whole idea sounds like you're signing up, you're signing yourself up to be surveilled.
SEAN: Yeah. I’m with you. How are Hong Kong, Taiwan, and Singapore’s less wealthy neighbors faring right now?
LIZA: So now we're actually seeing other countries in the region, like for Southeast Asia, for example, they're getting their first wave. So while Singapore, Hong Kong and Taiwan are going into the second wave, we're seeing Thailand, for example, Philippines, Indonesia. Now they're going to their first wave. It's also a matter of test kits. In the early days, these countries probably were not testing as much as they should be. Whereas Singapore, Hong Kong and Taiwan were pretty rapid about testing and testing frequencies. So now we're actually seeing the other countries in the region starting to discover that maybe they had Covid patients walking around within the population even before this month. In the case of Malaysia, which put in movement restrictions earlier this month, we're seeing about 100 new cases daily. So they've been hit pretty hard. Close 1600 cases at this point. Next worst hit is Thailand. Thailand has more than 700 cases. And Indonesia, and Indonesia is a nation of 270 million people. That's a huge country and they don't have enough test kits. So right now they have reported about 700 cases. But in reality that's probably also because they haven't been testing enough.
SEAN: If they don’t have the tests, or the apps, or the surveillance infrastructure, can they still take something away from Hong Kong or Singapore or Taiwan?
LIZA: So I would say that if there's any takeaway from this second wave, I would say Hong Kong, Singapore and Taiwan’s experience probably shows to the rest of the world that the virus is something you have to deal with in the long term.
SCORING IN - CORNER PIECE
LIZA: It's not going to be like a short haul thing. You know, a one month, one off thing where you have to stay at home or wash your hands or just practice better hygiene. I think what the region, the region of Hong Kong is showing is that this is definitely something that's going to be with us for a while. And we can't let down our guard because once we let down our guard, then the virus just comes back again.
SEAN: Liza Lin is a reporter for the Wall Street Journal. She usually writes about tech, but lately, like most of us, she’s been doing a lot of reporting on the coronavirus. I’m Sean Rameswaram. This is Today, Explained.
SCORING OUT - CORNER PIECE