Lessons From Taiwan for In-Person Higher Education During COVID-19 Pandemic

By Lisa Rappaport

July 29, 2020

(Reuters Health) - Strict guidelines implemented for reopening colleges and universities in Taiwan during the COVID-19 pandemic offer a roadmap that can be applied elsewhere to help return students to campus safely, a group of doctors writes in the Annals of Internal Medicine.

The paper details steps taken in Taiwan, one of the few countries where in-person education is happening somewhat normally amid the global COVID-19 pandemic, to promote the safety of students, faculty and staff on campus. While some aspects of government and education in Taiwan are much different than in the U.S. and other countries with less centralized governments, there are still best practices from Taiwan that can offer a roadmap for other nations to follow, said Mark Wrighton, professor and chancellor emeritus at Washington University in St. Louis, who coauthored an accompanying editorial.

"The central government structure and aggressive implementation of policy rewarded Taiwan," Wrighton said by email.

"Of course, the U.S. and Taiwan have very different governments and different cultures," Wrighton added. "However, colleges and universities everywhere operate similarly."

With a population of about 24 million people, Taiwan acted promptly and aggressively to limit the spread of COVID-19 cases and has had a very small number of cases and deaths, Wrighton said.

General guidelines issued in Taiwan required the creation of a task force at each university; screening based on travel history, occupation, contacts, and clusters of people various individuals on campus might come in contact with; policies for quarantines when needed; general hygiene practices including mandatory masks indoors; rules for sanitation and ventilation; regulations for school assemblies and large gatherings; policies for reporting any suspected cases; and clear rules for closing schools and arranging make-up classes when needed to respond to any cases in the school community.

In addition, Taiwan policies clearly detailed that a class should stop meeting in person if one student or staff member in the class tested positive for COVID-19, according to the policies detailed in the paper. Universities and colleges had to close for 14 days if they had two or more confirmed cases.

There were just seven confirmed cases at six universities in Taiwan as of June 18, senior author Dr. Shan-Chwen Chang of the College of Medicine and Hospital at National Taiwan University in Taipei and colleagues write in their article.

One university closed temporarily and adopted virtual classes until it could reopen following 14 days of contact tracing and quarantine of any contacts identified.

In addition, the Taiwanese government had strict border control policies in place early in the pandemic, with health checks on flights from Wuhan, China, starting on December 31, 2019, according to the paper.

Then, Taiwan integrated travel history records from immigration to national health records on January 27, 2020, to enable providers at the point of care to pinpoint when they had patients coming from COVID-19 hotspots.

That month, Taiwan also requisitioned masks for central distribution, followed soon after by a mask quota system at pharmacies to allow residents to pick up masks using national insurance cards.

Masks became mandatory on April 1, 2020, and national alerts also stressed the importance of wearing masks and observing social distancing.

Universities and colleges still faced unique challenges in Taiwan due to large student populations coming from China where the virus was widespread. Many Chinese students returned home for the Lunar New Year holidays in late January then returned to campuses in Taiwan, and Taiwan delayed resuming classes by two weeks to facilitate a safe return to campuses.

Dr. Chang did not respond to requests for comment.

As schools ready for the new academic year in the U.S., the experience in Taiwan shows that a safe return is possible with a disciplined and consistent approach, Wrighton said.

"All members of the academic community must embrace daily self-screening and cease any engagement if there are signs of being infected," Wrighton said.

"Everyone must be socially distanced by at least six feet and if possible more; everyone must properly wear masks; everyone must regularly wash hands; and all must be mindful of in-person engagement with those outside the academic bubble; and indeed visitors to campuses should be limited to only those who would be essential to operations of the school," Wrighton added. "And every school must have an action plan to respond to even a single individual who becomes infected."

SOURCE: https://bit.ly/316x2nV and https://bit.ly/2P38Lt0 Annals of Internal Medicine, online July 2, 2020.