Speed, decisiveness, cooperation: how a tiny Taiwan village overcame Delta

The work day in Fangshan starts before dawn and finishes at midday, when fishers or farmers of mango and onion sit together in the shade, sharing a bucket of cooked prawns and bottles of Taiwan beer.

The hometown of Taiwan’s president, Fangshan’s borders encompass a long stretch of coast and four villages home to around 5,500 people, sandwiched between mountains and oceans. Quiet and picturesque, it’s left off most tourist trails, which instead focus on Kenting national park to the south.

But over the past few months something remarkable has happened here. The community, one of the poorest in Taiwan’s poorest province, has beaten the Delta variant.

How it did so offers very simple lessons for other countries struggling to suppress an outbreak.

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An unexpected visitor

In June, midway through Taiwan’s worst Covid outbreak of the pandemic with thousands of cases of the Alpha strain, authorities in the southern county of Pingtung detected a rush of cases in Fangshan, none of which appeared connected.

Fangshan had much in its favour – a low-density rural population with an outdoor lifestyle, and high community compliance. But it also had a lot against it. Fangshan’s health system is listed as “insufficiently resourced”, 20% of the population is over 65, and there were no protocols in place for being Delta ground zero. Almost nobody was vaccinated.

What followed was surprising in that it was nothing extraordinary. But it worked, and the outbreak was over in 19 days. The cluster would stop at 17, with one fatality.

The first patient identified was 63-year-old Chang Feng-nan, one of his village’s three or four taxi drivers. Other early cases included a 56-year-old woman and her eight-year-old grandson, both recently returned from Peru and quarantining at home.

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At least three had some travel history, so the area’s director of health, Shy Cherng-Guei, requested genomic sequencing.

Two days later the results came back: Delta.

“I was definitely in shock,” recalls the county’s political leader, magistrate Pan Men-An. “Pingtung was the first. All the preventative measures were for Alpha. We had no reference point, or anyone we could ask.”

Delta spreads quickly. A total 667 people were quarantined or hospitalised as cases or close contacts. Chang’s contacts alone – identified through a notebook he kept of his daily interactions – numbered around 100 and included passengers, friends and family, and their friends and family.

Chang is believed to have caught the virus from a passenger he drove to hospital, who caught it from their partner who caught while taking out the garbage and having a fleeting chat with the boy next door, who had been to Peru. A couple in Fangliao, 50km away, are suspected to have caught in when they sat in the same hospital waiting room as the pair who’d been to Peru. The 72-year-old wife died on 21 July.

‘We felt like soldiers’

Pingtung’s response had some simple key elements: speed, decisiveness, and overwhelming community cooperation with restrictions and contact tracing. Shy says a local response with central government resources was key, as it limited bureaucratic delays. But the people’s cooperation and existing pandemic hygiene (masks and handwashing) “gave us a lot of time to react”.

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Before the genomic test results were back magistrate Pan announced a three-day soft lockdown of Fonggang and Shanyu villages over the community loudspeaker, and boxes of food and daily necessities were delivered to each household. Authorities established a command centre and Pan, Shy and senior health officials spoke nightly to discuss and enact new measures. “We felt like soldiers being assigned missions,” says Lu Meng-lun, who led the command centre.

Hengchun ancient city gate (South Gate), The city wall which is the best preserved in Taiwan
Hengchun ancient city gate (South Gate), The city wall which is the best preserved in Taiwan

More than 14,000 people were tested, some reportedly lining up for kilometres. The central government redirected 1,200 vaccines doses for all adults who had tested negative. Three days were spent disinfecting the villages.

“People were scared,” says Tai Feng-chin, Fangshan health clinic’s head nurse, who led contact tracing investigations. “People in the villages kept calling the centre to ask how it was going, what they needed to do, how to prevent the virus,” she says. Tai kept taking phone calls from home, estimating it peaked at 2-300 a day.

A sense of anger

At a Buddhist temple overlooking Fonggang, village warden Lin Jung-ji says he’s proud of the community for looking after each other, but there should have been more government support. “I wish there were more resources and subsidies to those affected by the virus or who lost revenue,” he says. The outbreak and lockdown coincided with the crucial annual harvest of mangoes, devastating many local farmers.

Officials and leaders have been quick to praise for the people coming together for the greater good, but questions of formal financial compensation are often waved away.

In Shanyu, taxi driver Chang is at home, furious. He’s still suffering some lingering effects from Covid, and an empty bedroom serves as a constant reminder that his elderly mother is still sick. He says he hasn’t received a single follow-up call since he was discharged two months ago and was turned down for financial help for his mother’s care.

He feels aggrieved after helping investigators – often in the middle of the night – while he was sick himself, only to now be “abandoned”. He can’t make any money either because people are too scared to get in his taxi.

Many in Fangshan blame the government Central Epidemic Command Centre (CECC) for the outbreak by allowing home quarantine for residents like the people returning from Peru. Taiwan bars most non-citizens from entering and puts most people in hotel quarantine, but eligible residents were allowed to isolate at home.

“The CECC owes the people here a big apology,” says the head of Fonggangs’s development association, Huang Lung-sien, angrily.

The CECC has since reversed the policy, requiring all arrivals to isolate in hotels. It has also adopted other measures used in Pingtung, including second tests of quarantined cases before discharge, and expanded testing.

Way back in March 2020, Dr Michael Ryan, the outspoken executive director of the WHO’s emergencies program, warned the world that the greatest error countries could make was to hesitate.

“Be fast, have no regrets. You must be the first mover. The virus will always get you if you don’t move quickly.”

Taiwan’s first brush with Delta is unlikely to be its only one. At the time of publishing authorities were quarantining students at a northern school and their families as close contacts of a suspected Delta case – the child of a pilot.

Pingtung’s response was not perfect but it worked better than most.

“I didn’t think the transmission could be curbed so rapidly,” says director-general Shy. “Transmission of Delta in the outside world has been terrifying. When we contained the virus it felt like I was dreaming.”

Additional reporting by Chi Hui Lin

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