Since she learned of the coronavirus outbreak, Amy Ho’s daily routine has gotten a bit more complicated. Coming home now involves sanitizing her shoes, washing her hands with soap and water, taking off her medical mask and changing her clothes.
The Hong Kong resident ventures outside only by necessity. She walks to and from work. Goes to the grocery store once a week. That’s it. Her teenage daughter has only left their apartment twice since the end of January.
“It’s annoying, sure. But our health is the most important thing,” she says.
Over Easter, the family looked forward to vacationing in the U.K. and Italy. But with the virus raging, they canceled.
Her precautions may sound drastic, but they’re hardly unique in a city that was among the first to be swept up in the global coronavirus crisis.
That Hong Kong has become a lodestar for its ability to seemingly keep the disease at bay, for now at least, is no accident: it’s desperate to avoid repeating the nightmare of a 2003 epidemic. Globally, SARS or severe acute respiratory syndrome, infected over 8,000 and killed 774, including 299 in Hong Kong.
Though SARS devastated many Asian metropolises, in its wake, some doubled down on preparing for the next crisis.
“Somewhat perversely, we can look at SARS as the dress rehearsal,” says Jeremy Lim, co-director of the Leadership Institute for Global Health Transformation at the National University of Singapore. “The experience was raw, and very, very visceral. And on the back of [it], better systems were put in place.”
Singapore, Hong Kong and Taiwan have been hailed for using those hard-won lessons to combat the new coronavirus—officially COVID-19 and a relative of SARS.
It’s still too early for anywhere to declare victory just yet. But against the odds, these enclaves have succeeded at keeping their virus numbers low, despite their links to China. Perhaps governments in North America and Europe, which are now bearing the brunt of the pandemic, can emulate their best practices, and turn the tide on an infection spreading rapidly through the global population.
For Singapore, Taiwan and Hong Kong, the story could easily have been one of catastrophe. The novel coronavirus emerged just in time for Lunar New Year, when millions travel across the region in the world’s largest annual human migration. All three territories are closely interconnected with mainland China, with direct flights to Wuhan, the outbreak’s epicenter.
Yet even as the virus continues its seemingly inexorable spread—ticking upward of 132,500 cases Friday—recoveries in Singapore, Taiwan and Hong Kong are starting to outpace, or catch up with, active cases.
Key to their success so far has been the decision to respond aggressively from the outset.
In Taiwan, an island of 23 million, arrivals from Wuhan were subject to health screenings before human-to-human transmission of the virus was confirmed on Jan. 20.
By Feb. 1, Taiwan, Hong Kong and Singapore had all proactively implemented travel restrictions on passengers coming from the mainland, contravening the World Health Organization’s [WHO] insistence that travel bans were not necessary. The precautions came at a significant economic cost to these international hubs, which all rely on mainland China as their biggest trading partner and source of tourists.
The three destinations were also well prepared, making rapid response possible.
Following SARS in 2003, Taiwan established a central command center for epidemics. By Jan. 20, it was coordinating the government’s response to the coronavirus. It quickly compiled a list of 124 “action items,” including border controls, school and work policies, public communication plans and resource assessments of hospitals, according to an article in the Journal of the American Medical Association.
“If you assume that containing an epidemic is like running a 100-meter dash, Taiwan had a head start because it was prepared,” says C. Jason Wang, director of Stanford University’s Center for Policy, Outcomes and Prevention, and one of the article’s authors.
Taiwan, just 81 miles from mainland China, was expected to have among the highest number of imported cases, he adds. But it has now tallied just 50 cases—fewer than Slovenia.
“Epidemic preparedness starts years before an outbreak,” Emanuele Capobianco, director of health and care at the International Federation of Red Cross and Red Crescent Societies, tells TIME. “If [the] number of beds or doctors were cut over the years, for example, it will be very difficult to compensate in a short period of time.”
He adds: “It is hoped that countries with strong health systems will eventually be able to manage this outbreak also, thanks to the lessons from Asia.”
Taiwan’s rapid mobilization contrasts starkly with South Korea and Japan, which are also proximate to China and enjoy advanced healthcare systems. They have faced criticism for their initially sluggish responses and the ensuing explosion of cases.
Rigorous detection and strict quarantine
When the virus began crossing China’s borders in January, Singapore appeared fated for a large-scale outbreak. The tiny city-state was the third country to report cases of COVID-19, and by mid-February, had recorded over 80 infections, the highest outside the Chinese mainland.