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The Right Response to Pandemic: How Taiwan Has Gone Five Days with Zero Coronavirus Cases

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Screenshot of homepage PPT Boards. The newspaper reads, “Thank you for your contribution to the effort to combat the coronavirus pandemic.”

April 30, 2020 – On the last day of 2019, “No More Pipe,” a user on PPT Boards, Taiwan’s version of Reddit, reposted a message by a Dr. Li Wenliang that warned about a respiratory disease spreading in Wuhan, China.

At around the same time, Luo Yi-jun, was unable to sleep. The deputy director for Taiwan’s Centers for Disease Control got out of bed and logged into PPT boards to surf trending posts.

He launched Taiwan’s first health inspections the following day, the start of a new decade and the beginning of a new normal.

Dr. Li has now died from the mysterious “respiratory disease” amidst the now-scorned approach that the Chinese government took to the novel coronavirus.

But partly because of Dr. Li, Taiwan has been hailed as one of a handful of success stories for how it has effectively halted the spread of coronavirus within its borders, with the country now celebrating its fifth day of zero confirmed cases.

The keys to Taiwan’s response have been rather inconspicuous to everyone except its citizens. That is, until H.E. Audrey Tang, Taiwan’s Digital Minister, detailed the different aspects that gave rise to its success in a webinar hosted Wednesday by the Atlantic Council.

Unlike neighboring China, Taiwan took an approach of ‘humor over rumor’

Even beyond taking early action (perhaps the earliest public action of any nation), there’s a lot that went right in Taiwan’s response to the pandemic.

Taiwan has been here before. The 2003 outbreak of SARS ravaged the island nation, infecting 668 people and claiming the lives of 181. In addition to being the Asian country in which SARS spread the fastest, Taiwan also endured the humiliation of having a strategy of “barricading an entire hospital” backfire.

Many needlessly died, and some argued that the government violated constitutional rights in the process. Since then, Taiwan has upped its disease detection capabilities and been on high alert.

Taiwan has opted for the soft power approach

Taiwan has also used creative means in countering misinformation about the virus. In February, Taiwan’s health ministry introduced citizens to its cartoon “spokesdog,” a Shiba Inu named Zongchai who helped counter coronavirus rumors and promote safe habits.

The Zongchai strategy “went absolutely viral” according to Tang, dwarfing the original rumors about a toilet paper shortage (the government successfully traced back the conception of the rumor to a toilet paper reseller).

This “humor over rumor” strategy contrasts sharply with Taiwan’s rival across the Formosa Strait. There, the Chinese government has relied on Maoist-era messaging and populist propaganda that taps into a sense of national duty. Slogans from different parts of the country vary include “to visit each other is to kill each other,” and “to get together is to commit suicide.”

But Taiwan has also taken a few hardline measures

The Taiwanese government has also embraced a form of communication that aims to build trust with the public. Since January 20, 2020, President Tsai Ing-wen has hosted an “ask-me-anything” style press conference that does not adjourn until all press questions have been addressed and answered.

“We emphasize opening our mind to new and novel ideas,” Tang said, saying that government officials and the public have worked as a “collective intelligence system,” where transparency and the exchange of ideas are key.

The government’s embrace of creative solutions doesn’t end there. Tang related how when a young boy complained at one of these conferences of being teased for wearing a pink mask to school, government officials posted pictures of themselves wearing pink masks to work on social media to prevent a snowball effect of mask abstentions.

Of course, Taiwan also achieved success by taking some hardline measures.

Taiwan’s version of the Centers for Disease Control early on decided that “everywhere else on earth is on high risk” and banned all incoming flights in the early stages of response, according to Tang.

Later, all incoming travelers to Taiwan had to be assessed and ranked according to threat level.

All high-risk incomers were sent to centralized quarantines run by the government. Low-risk incomers were sentenced to self-quarantine in their houses, where a “digital fence” was created to notify authorities and neighbors whether that person had left a designated quarantine area.

Communitarian culture played a strong role in holding individual’s accountable, as the population demanded to play the role of “co-detective” and report neighbors suspected of breaking quarantine protocol. Tang called community enforcement in general “really effective” in helping contain the disease.

Digital Minister Audrey Tang

Face masks, geography and projections that Taiwan would be ‘second worst-hit’

Taiwanese citizens early on were limited to buying two face masks a week to ensure that the nation would not run out, which was tracked and enforced by a national health insurance that covers “99.9 percent” of the people, according to Tang.

In addition, open source maps partly run by civil hackers, or “civil engineers” as Tang called them, collaborate to publish the supply level of masks at every pharmacy in the country every three minutes.

Tang admitted that geography played a huge role in Taiwan’s successful response. There’s no way for a wanderer “to accidentally stumble on Taiwan,” Tang admitted, referencing Taiwan’s island geography.

However, she did not let that detract from Taiwan’s efforts. For effect, she said: “81. That’s how many miles Taiwan is from mainland China,” the ground zero and long-time epicenter of the COVID-19 disease caused by the novel coronavirus.

In fact, Tang referenced an early Johns Hopkins study predicting that Taiwan would become the second worst-hit country in terms of coronavirus cases, behind China.

That was wrong.

No contact tracing app – but an app to donate masks to the rest of the world

Even though Taiwan never launched any contact tracing apps, it has used a different app to mitigate the spread of COVID-19— for other countries.

A new government-sponsored app allows citizens of Taiwan with extra masks to donate them to other nations. Including other governmental efforts, Taiwan has donated “tens of millions” of masks.

“Currently Taiwan feels calm” due to how well it has responded, Tang said. Now it is “in a stage where people are feeling generous.”

Photo of Kaoshiung’s 85 Building celebrating “ZERO” cases for three straight days

 

David Jelke was a Reporter for Broadband Breakfast. He graduated from Dartmouth College with a degree in neuroscience. Growing up in Miami, he learned to speak Spanish during a study abroad semester in Peru. He is now teaching himself French on his iPhone.

Health

Senate Subcommittee Hears Broadband Affordability, Regulatory Flex Key to Reducing Hospital Burdens

Health providers testified before a Senate subcommittee that Congress should be open to all forms of telehealth.

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WASHINGTON, October 7, 2021 – A Senate subcommittee heard Thursday that affordability is the greatest barrier to broadband adoption and that lawmakers should exercise regulatory flexibility when it comes to the forms of telehealth to help reduce inessential hospital visits.

Covid-19 often brings about extreme shortness of breath, the severity of which is best assessed by a doctor, Deanna Larson, president of Avel eCARE, told the Senate Subcommittee on Communications, Media, and Broadband, which convened a hearing on the state of telehealth and removing barriers to access and improving patient outcomes.

Patients with affordable, high speed internet access can be monitored at home by doctors so that they don’t enter an emergency room or take up a hospital bed prematurely, she said.

Larson urged Congress to extend or make permanent their regulatory flexibility toward telehealth especially as it relates to being neutral on the kinds of telemedicine, such as phone-only care, asynchronous care, and remote patient monitoring. An economic benefit of which would be keeping medical commerce local, she said. Patients wouldn’t be required as often to move to a higher level of care out of town.

Physicians would have 24-hour access to the patient through video calls, monitoring patients in a way which significantly lightens the burdens of the healthcare system, added Larson. With telehealth, doctors can advise patients on exactly when and if they need to go to an emergency room.

Steps to improve telehealth

The committee also heard testimony from Sterling Ransone Jr., president of the American Academy of Family Physicians. Ransone, a strong proponent of telehealth, has found that the digital divide touches rural, tribal and urban communities alike and proposed a series of steps Congress could take to increase public health through broadband policy, including investing in universal affordable broadband service, digital literacy services, end-user devices, audio-only telehealth and data collection in the determinants and outcomes of telehealth as it relates to key factors such as race, gender, ethnicity and language.

Defining broadband as a social determinant of health, Ransone highlighted that affordability is possibly the greatest barrier to broadband adoption and that affordability and access disproportionately affect rural communities.

Sanjeev Arora, founder of Project ECHO and distinguished professor of medicine at the University of New Mexico, agreed: “expanding access to high-quality, high-speed broadband connectivity is critical. It’s a prerequisite for the success of any telehealth model in rural communities and urban underserved areas.”

Telehealth isn’t just vital and broadly popular, it is cost saving. Federal Communications Commissioner Brendan Carr, who also appeared before the subcommittee, shared an estimate that widespread telehealth availability could save the health care system $305 billion a year.

Carr, in an effort to reduce inessential hospital visits and decrease the risk of spreading Covid-19, endorsed the CONNECT for Health Act, the RUSH Act of 2021, the Telehealth Modernization Act, and the Protecting Rural Telehealth Access Act, which in combination would remove geographic restrictions to telehealth services, foster use of telehealth in skilled nursing facilities, grant the Secretary of Health and Human Services greater ability to reduce telehealth restrictions and more.

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Expert Opinion

Craig Settles: Libraries, Barbershops and Salons Tackle TeleHealthcare Gap

Craig Settles describes the important role that community institutions have played in promoting connectivity during the COVID-19 pandemic.

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Photo of Urban Kutz Barbershops owner Waverly Willis getting his blood pressure checked used with permission

Today, Senator Ed Markey, D-Mass., Senator Chris Van Hollen,D-Maryland, and Representative Grace Meng, D-N.Y., led 40 members of Congress to introduce the Securing Universal Communications Connectivity to Ensure Students Succeed (SUCCESS) Act. The bill would extend the Emergency Connectivity Fund by five years and provide $8 billion a year to schools and libraries for student connectivity off-campus.

Barbershops and hair salons are long-time anchor institutions in African-American communities that have shown promise for advancing telehealth. Their partnering with libraries (a broadband anchor institution), and the Biden Administration’s enlisting of 1,000 shops and salons to help combat COVID-19, telehealth and public health in these communities could go into overdrive.

Missing their July 4 COVID-19 vaccination goals, the Biden Administration raised money to transform the shops into mini-medical centers. This success is motivating shop owners to do more. As one of the targets for $7 billion in broadband funds, libraries are idea partners that can provide broadband services, digital content, and digital and health literacy shops’ customers. 

Mike Brown manages a barbershop in Hyattsville, Maryland, and participated in the vaccination program. Brown and others owners talks with their customer about how the vaccines have been proven to work. “I use my platform to advocate for truth and dispel myths,” said Mr. Brown in an Wall Street Journal article, who has also held a vaccination clinic in his shop. “I’ve gotten about 60% of my clients to get vaccinated.”

The program has opened shop owners’ eyes to the power they have to make a difference in the healthcare of their communities. It’s a logical transition from the vaccination program to hypertension screening. Urban Kutz Barbershops in Cleveland have been screening customers for 12 years, recently with telehealth assistance from the famed Cleveland Clinic’s. 

Owner Waverley Willis says “Barbers and hairdressers are part-time marriage counselors, psychiatrists, spiritual advisers, and expert listeners. So many customers listen to our medical advice.” He has made a noticeable impact on many of his customers’ healthy eating habits as well.

Think differently about broadband, public health and telehealth

On July 1, the Federal Communications Commission began a 45-day Emergency Connectivity Fund of $7.1 billion in broadband and digital technology funding to support libraries and schools. By August 13, libraries interested in grants from the program must present a proposal on how they plan to spend money for libraries laptops, hotspots, Internet services, and other resources to advance education and remote learning. 

A generous interpretation of “education“ enables libraries to serve any patrons with broadband. If libraries are situated in areas in which there are no ISP services, they can request money from ECF to build their own broadband infrastructure for unserved patrons. Unlike traditional E-rate proposals, ECF doesn’t require a competitive bid for services, meaning libraries can present a quote from the first vender they contact.

Libraries partnering with shops and healthcare organization could give shops laptops, telehealth software, and portable hotspots to provide hypertension screening and other healthcare services that are suited to their customers’ needs up to three years. Shop owners often don’t have computing devices or Internet access in their shops. Telehealth devices such as portable digital blood pressure monitors and digital scales will have to be provided separately and possibly through funds from another government agency such as Health & Human Services.

For hypertension screening, for example, shops can take customers’ blood pressures digitally. The healthcare provider takes that data through telehealth and recommends treatment when necessary or advisable. The partner likely would have established rates for their healthcare services. Shops can then decide on additional telehealth services they want to provide.

The shops could work with libraries to develop health information and interactive Web content to reduce hypertension and other medical issues through healthier living, plus the libraries can provide telehealth services beyond what the shops can do.  

Libraries and shops can also designate customers who need a laptop, hotspots and telehealth software for chronic illnesses such as severe hypertension, diabetes, heart disease, mental health treatments, and so forth. However, these devices in this scenario would need to be given out for longer periods then just a couple of weeks. For occasional medical appointments, libraries can loan out laptops and hotspots for limited times such as two or three weeks. Libraries are good at delivering digital training and literacy programs.

Why barbershops, hair salons and libraries? 

Facilitating telehealth and healthcare does have an educational element for barbershop and hair salon customers as well as for general library patrons. These health services and information help both groups of people learn more about their own health, enables them to react effectively to medical issues, and be more proactive in taking care of their health.  

The ability for shops and salons to reach and impact African-American communities is legendary. “This type of barbershop health initiative has been shown to be effective,” said Cameron Webb, a senior White House health equity adviser on the coronavirus. Willis adds, “On more than one occasion, a guy’s blood pressure would be so high we would urge him to skip the haircut and go straight to the emergency room.”

The author of this opinion is municipal broadband expert and industry analyst Craig Settles.

Libraries have years of experience introducing new technology such as broadband to underserved populations. Matt McLain, Associate Director for Community Engagement at Salt Lake County Library, said, “We’ve had a pretty good amount of success reaching Hispanic populations at their markets. We have Asian markets out here too. And our health initiatives are quite important with the church leadership in these communities.”

The healthcare and broadband gaps are real and they are deadly! So many elements of the COVID pandemic reiterates the deadliness of those gaps. According to the Centers for Disease Control, of the data collected as of June 14 nearly two-thirds of people who got at least one dose of the vaccine were White. Only 9% were African-Americans. 14 million urban household cannot get any broadband, without which you cannot get telehealth, and 75% are Black or other people of color. 

There may never be as many federal broadband and health-related grant programs as we are seeing now. Partnership potential between libraries and haircare shops are many. Will public health practitioners and advocates, broadband builders, and community leaders step up?

Craig Settles conducts needs analyses with community stakeholders who want broadband networks to improve economic development, healthcare, education and local government. He hosts the radio talk show Gigabit Nation, and is Director of Communities United for Broadband, a national grass roots effort to assist communities launching their networks. He recently created a guide to help librarians uncover patrons’ healthcare needs, create community health milestones and effectively market telehealth. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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Health

Institutions Must Continue Riding Telehealth Growth Momentum for Post-Pandemic Care

Governments and health providers have an opportunity to carry the momentum of 2020 for telehealth’s future.

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Anthem President Gail Boudreaux

July 15, 2021 — The average healthcare organization completed two years’ worth of digital transformation during the first two months of the pandemic, according to IDC Health Insights data. This is only the beginning of telehealth advancement, and governments and health providers should continue to push for further development even after the pandemic slows, the Western Governor’s Association said in a virtual event last month.

The WGA launched its Western Prosperity Roundtable to work on policies such as telehealth and other technologies that have the potential to connect unserved and underserved communities.

While telehealth technologies have been gaining traction for some time, the past year led to a tremendous increase in usage. David Pryor, regional vice president and medical director for Anthem Inc., said that 2020 saw 80 times more utilization of telehealth than the year prior.

With the help of innovation, health centers were able to pivot from in-person care to digital. Digital kiosks have been implemented in states such as California to help improve specialty care and decrease language barriers. These kiosks give patients access to cameras put them in touch with healthcare professionals for important services including mental health.

Empirical experiences

In one experience that Pryor shared from a frontline women’s health clinic in California, a deaf patient came in for an exam and the clinic was able to utilize the video feature with a sign language interpreter on the digital kiosk. “The patient started to cry because she [had] never had such a caring visit,” Pryor said.

Technology advancement has created opportunities for those that previously were overlooked, including rural communities that were forced to commute long distances to receive healthcare and urban centers that lacked options.

The WGA aimed for the panel to push state legislators to continue increasing healthcare access for their constituents through digitalization.

Some states have established their ongoing commitment to telehealth already. In a statement released in August 2020, the Governors of Colorado, Nevada, Oregon and Washington shared their goals to support telehealth services for residents of their states. “Telehealth is here to stay.” they wrote. “We will have individual state-driven approaches to implementing telehealth policies, but our work will be guided by seven overarching principles: access, confidentiality, equity, standard of care, stewardship, patient choice, and payment/reimbursement.”

Over the course of the pandemic, Congress has created and helped fund several programs, many of which focus on telehealth, programs to help accelerate broadband deployment across the country in efforts to connect minority communities, Tribal lands, and other qualifying households.

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