Last Wednesday marked the 12th day in a row in which the number of COVID-19 cases in Taiwan was lower than the number the previous week on the same day. The figure for that day was over 19,000 reported cases.
People are now accepting this figure, somewhere between 15,000 and 20,000, as background noise, and the government is contemplating reducing the mask mandate. It appears that we are about to normalize the cost of COVID.
LONG COVID
Photo: Bloomberg
It’s sobering to calculate: at 19,000 cases a day, every 60 days Taiwan experiences over 1.1 million cases, with all the attendant costs. A meta-analysis of studies of long COVID in the Journal of the American Medical Association found that 6.2 percent of COVID suffers will develop at least one of the three major clusters of long COVID symptoms.
Of those, according to that study, in roughly 15 percent, or 1 percent of all COVID cases, symptoms will persist for a year or longer. That means that every 60 days Taiwan will be generating 10,000 cases of long COVID of a year’s duration, which in many cases renders victims unable to work. That’s 60,000 such cases annually.
In a study of US cases, 15 percent of COVID victims developed long COVID (persisting two months after the initial infection), with unvaccinated individuals suffering disproportionately. Recall that low vaccination rates among the elderly in Taiwan remain an issue. In another study of over 3,000 long COVID suffers from 56 countries, the majority reported that symptoms lingered for more than 35 weeks.
Photo: Reuters
Of course, those are majority experiences. The outliers are simply insane. Ed Yong in an article for The Atlantic described a case of brain fog that lasted a terrifying 900 days. The victim once worked in AI, “but now ‘runs into a mental wall’ when faced with tasks as simple as filling out forms.”
QUACKERY
It is conventional to calculate the economic losses from deaths, caring for COVID cases, treating long COVID cases and lost work hours. Less obvious to many who have thought about this will be the diversion of investment to socially frivolous purposes, such as “alternative” medicines and their attendant “treatment” infrastructure.
Photo: AFP
In the first half of the last century there was an extensive sanitorium movement for tuberculosis, which did nothing to cure the disease, but planted sanitoria in all sorts of countryside in the belief that clean dry air was good for the disease. Tuberculosis was the most famous rationale for sanitorium building, but they were also built for a variety of other “ailments,” including “hysteria,” fatigue and masturbation.
It is easy to see how that might play out with long COVID, especially in a society that has a widely accepted existing formal system of traditional Chinese medicine as an alternative to scientific medicine. I look forward to the late-night cable TV and radio ads in rapid-fire Taiwanese extolling the virtues of patent medicines for long COVID issues. This will receive impetus from the common experience of long COVID sufferers: doctors don’t listen to them. Multiply that by the short, peremptory doctor visits that characterize Taiwan’s health system.
SOCIAL COSTS
As with other long-term diseases, long COVID will also generate a host of social costs. Sufferers will put off marriage and children, and lose not just work time (and their jobs) but also learning and promotion opportunities. In Africa this is a common problem with diseases like malaria, which has easily measurable effects on worker productivity.
In children it will harm school performance. “Brain fog” is reported in many cases of long COVID, nearly 70 percent, with up to 78 percent reporting inability to concentrate, according to one study. The school system here runs on rote memorization, after all.
In Sweden, where the virus was essentially permitted to run rampant, an insurance company survey found that 32 percent of the 18-24 age bracket reported brain fog, affecting their social, work and school lives.
That’s what living with COVID means. That’s what happens when it becomes normalized. Around every four years, at the current pace, we will generate enough cases to infect everyone in Taiwan. Many of those will be reinfections, of course. It goes without saying that studies show reinfections worsen both the chance of getting long COVID and its destructive effects.
Nor does anyone really know what the long term effects of the disease are. It is still too new.
The national health insurance system allocates hospital beds and other medical resources on a geographical basis, with a strict number of beds for a given population. This means that the system has few slack resources, an impediment that has slowed the development of a robust medical tourism system here. COVID cases and long COVID will further strain the system, a strain that will become constant over time.
An excellent 2020 piece by Jane Rickards in AmCham’s TOPICS magazine described some of the trends in hospital administration and health care in Taiwan. Typically, the national health insurance covers 56 percent of health care costs, while the remaining 44 percent (read: future long COVID costs) comes from the patient’s pocket. The elderly constitute 15 percent of the insured population, but almost 40 percent of medical expenses.
One of the experts consulted for the piece noted that Taiwan lags behind South Korea and Japan in care for chronic diseases. With Taiwanese averaging 15 visits a year to local clinics and hospitals, the piece says, Taiwan’s system is geared for quantity, not quality of care, and long-term diseases that require patient monitoring and management, such as diabetes, are less well served by the system. Long COVID is a long-term disease.
The death numbers bounce around, last week falling between roughly 35 and 65 a day. At 40 deaths a day, Taiwan will experience 1,200 a year, comparable to the 1,648 people who lost their lives in scooter-related accidents in the first 10 months of last year. It could well be more.
We have decided, in our weariness with travel restrictions and mask orders, to declare that we are done with COVID, to accept all the lost lives and lost years of work and individual growth as the cost of doing business.
After all, that always happens to other people, right?
Notes from Central Taiwan is a column written by long-term resident Michael Turton, who provides incisive commentary informed by three decades of living in and writing about his adoptive country. The views expressed here are his own.
If one asks Taiwanese why house prices are so high or why the nation is so built up or why certain policies cannot be carried out, one common answer is that “Taiwan is too small.” This is actually true, though not in the way people think. The National Property Administration (NPA), responsible for tracking and managing the government’s real estate assets, maintains statistics on how much land the government owns. As of the end of last year, land for official use constituted 293,655 hectares, for public use 1,732,513 hectares, for non-public use 216,972 hectares and for state enterprises 34 hectares, yielding
The March/April volume of Foreign Affairs, long a purveyor of pro-China pablum, offered up another irksome Beijing-speak on the issues and solutions for the problems vexing the People’s Republic of China (PRC) and the US: “America and China at the Edge of Ruin: A Last Chance to Step Back From the Brink” rang the provocative title, by David M. Lampton and Wang Jisi (王緝思). If one ever wants to describe what went wrong with US-PRC relations, the career of Wang Jisi is a good place to start. Wang has extensive experience in the US and the West. He was a visiting
The small platform at Duoliang Train Station in Taitung County’s Taimali Township (太麻里) served villagers from 1992 to 2006, but was eventually shut down due to lack of use. Just 10 years later, the abandoned train station had become widely known as the most beautiful station in Taiwan, and visitors were so frequent that the village had to start restricting traffic. Nowadays, Duoliang Village (多良) is known as a bit of a tourist trap, with a mandatory, albeit modest, admission fee of NT$10 giving access to a crowded lane of vendors with a mediocre view of the ocean and the trains
One of the challenges with the sheer availability of food in today’s world is that lots of us end up spending many of our waking hours eating. Whether it’s full meals, snacks or desserts, scientists have found that it’s not uncommon for us to be mindlessly grazing at some point during all of our 16 or so waking hours. The problem? As soon as this food hits the bloodstream in the form of glucose, it initiates the release of the hormone insulin. This in turn activates a switch present in every one of our cells, which is responsible for driving cell
RSS