Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Sunday, February 19, 2023

Blood Sugar Hex Magic

                       Untitled


Yes, it's a punny title, but I won't change it. 

It felt like magic when I began losing weight without trying. Several months out from COVID recovery, I'd changed exactly one habit: I was drinking an average of two liters of water per day. Before COVID I had a small water bottle for going out; by the time I'd sipped it dry I could usually find a place ot refill it. Now, I could down that thing in three gulps, and was instead bringing a full liter everywhere I went. I'd have to refill that as well. I assumed that my wholesome new drinking habit was the driver of the weight loss. 

I had to have pants taken in and shirts re-tailored. I bought a belt. Even my shoes fit a little looser. From July to November, I lost a dress size. By January, it was a size and a half. As of now, it might be two.

I won't lie: it felt great. I didn't have any other issues or symptoms, so I just kept on assuming it was all that water. It's no secret that I'm -- what are we calling it these days? Curvy? -- and it was thrilling to be dropping pounds. Who wouldn't want that, especially with very little effort? 

Most cultures these days seem to be weight-conscious. People will say it's about health but it's really not. It's straight-up "NO FATTIES" judgmentalism. If you're fat and healthy that's still insufficient. If you're thin and sick, you should handle that, but it's ultimately better than being fat. There are people who will argue with the idea that this is totally fucked up, and that's fucked up too. 

Taiwan is no different. Taiwanese society's obsession with weight isn't even unique: you'll find pills and horrible diets and people -- mostly women -- taking on unhealthy habits and getting surgery in every other Asian country and many, if not most, places beyond. Although the country of my birth is somewhat fatter on average, all of these things exist there too. If you needed any evidence that none of it works, there it is: the United States has the juice cleanses, the disgusting powders, the gross teas and the weird contraptions too, and Americans aren't getting any thinner. 

The main difference I've found is that Taiwanese standards for being thin are far stricter: you have to be a stick to even fit into the clothing sizes available. Large-size stores exist, but they don't work for me as I'm too tall for the hemlines and the cuts don't take curves into account.

People (usually women) who are average or even slender have told me that they're regularly called fat. One told me a guy walked away because he believed he should be able to wrap his hands around her waist and have his fingers touch, which is some eating-disorder level bullshit.  I've heard far too many people commenting on weight as though it's a moral failing in an infuriatingly matter-of-fact way, and include people who are simply not fat in that definition (not that it would be any more acceptable if they didn't). 

If you're a foreign woman, it's unlikely that you'll meet these size standards. Even thin Western women I know have said they feel like giants here. Trust me, it's even harder when you're a Big Foreign Sasquatch. In addition to local messaging, there's a big community of misogynist Western dudes who have the "no fatties!" mindset. Fortunately, they mostly ignore expat women they deem overweight. They don't seem to realize they're handing us a gift.

It's to the point that seeing a doctor can be an exercise in stress, when medical professionals ought to focus on treatment. It felt like being cursed, or hexed: presenting for care, being told to lose weight and possibly receiving substandard care from a doctor who assumed weight loss was the only possible treatment, feeling like trash about it, and avoiding seeking further care. People say being overweight can lead to lower life expectancy, but I wonder if seeking medical treatment less often, and receiving insufficient treatment when one does, might lead to medical conditions spinning out of control that didn't need to be life-threatening in the first place.

Although I don't really want to speak Mandarin when there's a contraption that looks like a wine key stuck up my vagina, I quit one English-speaking OB-GYN and sought out another, because her only suggestion for treating my cystic ovaries was to lose weight. Of course, the cystic ovaries probably contribute to the weight in the first place. 

When I got COVID, I asked for Paxlovid as I was feeling weird in the general heart area, which is generally not considered to be a good thing. I have a family history of heart problems (though as far as I know, I'm fine), but that wasn't enough. The telemedicine doctor said it didn't qualify. So I said "oh, but I'm fat!" and got the drugs: having a likely predisposition to vascular issues was insufficient, but weight was. The doctor also said that heart problems were associated with obesity, and I didn't have it in me to reply my family members with heart issues were not fat, with no exceptions. 

I don't want to single out Taiwan, though. Fat people are treated like crap by society and medical professionals around the world. A doctor in the US whom I saw because I tested positive for tuberculosis exposure (I never developed the disease) exhorted me to lose weight, in college, when I wasn't fat. The main difference is that in the US people will talk about "fatties" (or "fat chicks", because this is mostly aimed at women) in derogatory ways to no-one in particular. In Taiwan they'll be more straightforward about it, but are more likely to say it to your face. 

In Taiwan, my tailor and one doctor congratulated me on my weight loss. Foreign friends said I should get checked out as my water consumption was atypical, others didn't see a concern: drinking that much of a calorie-free substance is a common weight-loss tactic!

Here's the truly unhealthy part: I didn't want this to be a problem. Of course no one does, but specifically I was quite happy to continue slimming down. A tiny voice in the back of my head kept prodding me -- you know they're right. Water or not, my rate of weight loss wasn't normal or healthy. And yet, as much work as I've done to simply love myself and focus on being a person rather than a number on a scale, I wanted to keep losing it. Going to the gym hadn't worked. Eating better never worked either. Why not take this gift being handed to me?

It gets worse: walking around in my slimmer body, I didn't just feel better about myself, I felt healthy. After all, losing weight is healthy, right? Slimmer people are healthier, no?

This was in fact extremely dangerous. I was not healthy. But when society tells you that dropping a size or two is good for you, it's extremely hard to break away and say no, something's wrong.

I visited the US recently, and it took an old college friend to really hammer it home: I needed to see a doctor. Excessive water consumption and unexplained weight loss were the most common symptoms of high blood sugar and diabetes. Even then, thinking back on years in Taiwan being matter-of-factly told I was fat, with insane diets and life-consuming exercise regimes suggested as a "cure", I secretly hoped that I would be able to "keep" the weight loss.

And yes, I did find the anti-fat messaging in Taiwan more damaging. That could just be me: it's easy to ignore Internet chuds in the US screeching about "fat chicks", usually with some assumption that said fat chicks would be single forever. Who cares? I'm not single!

It's harder to not let oneself be affected by a straight-up proclamation that you are fat and that is bad. The advertising affected me more too. It's harmful enough that the US has re-vamped all its weight-loss marketing as "wellness" or "health" (I'm sorry but nasty drinks and no food are not healthy, period). In Taiwan, well, you are fat and that is bad.

For someone who's worked hard to break free of mindsets like these, it really shows how deeply this societal messaging runs, and how damaging it can be. I came very close to not seeking care because I thought of weight loss as an unequivocal good! 

I should have known better. You know who else lost a lot of weight because she was sick? My mother, just before the cancer came back. She's no longer with us.

I did make an appointment with an endocrinologist after returning to Taiwan. You know what it took to do that? A friend treating my new body as a warning sign rather than something to be congratulated. I should not have needed that hard a push. I also massively cut down my sugar intake and reduced my carbohydrate intake, although it's hard to sustain that with no clear diagnosis. It was especially hard as my first week doing this was in Mexico, where the chocolate and the churros are delicious. 

You know what? Even then, I fretted about it the day before and morning of, simply because I wasn't in a good mental place to be told yet again that I am fat and that is bad, with the implied message that I'm a moral failure, or lazy, or a bad person because I am fat, which is what I suspect a lot of people truly believe. 

Nobody should have to feel that way when doing something as normal as going to the doctor. Everybody, in every country, should feel empowered to present for care without judgment. 

This story has no ending, as I'm still waiting for my blood sugar results. I can't imagine I'll be told I'm fine. 

There is one happy conclusion, however: unlike so many doctors before her, the endocrinologist didn't say a word about my weight. I told her I'd had COVID about six months ago, and the symptoms began immediately after. I'd had my blood sugar checked before I got sick, and there was no issue. She pointed out that there is some evidence that COVID can actually cause diabetes in rare cases, so I was right to be spooked. She asked me if I had a family history of diabetes, which I do.

She did not exhort me to exercise or eat less. That's a good thing. There is no overweight person in the world who is unaware of it, who hasn't already been told this, who doesn't know. It's never new information. It's not helpful. 

She did her job: ordered the necessary blood tests and told me how to fast and eat before each one. We'll discuss the results next week. 

I only wish every other doctor in my life had approached it that way.

If I had to offer any general advice, it would be the same for Taiwan as for the US: stop. Just stop. Leave people alone. You don't know their lives, you don't know their health, and the "I'm just concerned about your health" concern trolling is actively harmful -- but you knew that. Treat health issues as health issues in and of themselves, and don't tie moral rectitude or assumptions about health to weight. Every single thing you want to say, everyone already knows, and it does not help. Listen to Maintenance Phase and just...stop. 

Monday, July 25, 2022

In quarantine, who can hear you scream?

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My teeth are like these chairs


My teeth and I have a somewhat adversarial relationship. I just want teeth that work and don't disintegrate. If they stayed in my mouth and met that most basic criteria, they could be brushed twice a day with a sustainable toothbrush and fancy Italian toothpaste that gives one's breath a whiff of sweet jasmine. 

Sadly, it was not meant to be. I don't like my teeth, mostly because they don't like me. The devils just won't stop acting up. They develop problems at the worst possible times: in Singapore on vacation, while I have COVID, in the middle of proficiency test examining.

So, I just wanted to write a little about my experience in quarantine -- specifically, what happens if you develop a bit of a dental drama at a time when no one can help you.


It seems I've developed a severe toothache. This tooth has bothered me for awhile; I actually need an implant, but the dentist says to keep on keepin' on until there's no alternative. Implants are expensive and the procedure takes awhile to complete. That, and every time I think about a screw going into my jawbone I squirm and tear up and he sees it. I know it's not supposed to hurt, but tell my lizard brain that. 

This round of tooth pain is so unbearable that I am afraid to take more painkillers, as I've already reached the 24-hour hard limit. Ice helps but only briefly. I have numbing gel and clove oil and they do not work. I can barely eat and I'm sleeping poorly.

Knowing that they will let you out of quarantine for medical emergencies, I called 1922. They gave me the city government phone number, which I called this morning. 

The city government worker who answered said that the whole "emergency quarantine leave" thing is only for the actual emergency room. If there's one thing I know from my dental troubles, it's that emergency rooms do not include dental care unless you've been in, say, a major car accident and your face is messed up in a very urgent way. 

"Nobody's going to be able to treat you," she said, not unsympathetically. "The best they'll do is give you more pain medication."

You mean the pain medication I am quite literally in danger of overdosing on, which still doesn't work? 

Yep.

Even though I tested myself this morning and at the 10-minute mark stated by the testing procedures, it came up negative? (After another 15 minutes a faint T-line appeared; perhaps I am not as COVID-free as I'd thought when the timer went off). 

Yep.

I understood the minute she said permission to leave was only for emergency room services. Like in the US, the health system acts as though your teeth are somehow not part of your body -- any other pain might be an emergency but nobody will help you with your teeth. Taiwan's health insurance covers fillings and root canals, but not crowns or implants. Teeth, apparently, don't matter and tooth pain doesn't really count. 

I couldn't really be angry about this. Upset, unhappy and in pain? Sure. But "angry" isn't fair: if you were still under a government-mandated quarantine anywhere in the world, would a dentist see you? I mean, that's the kind of doctor you breathe on the most!

The only real differences between Taiwan and the US in this regard seem to be that Taiwan enforces quarantine a lot more strictly, and in Taiwan you can actually call someone to ask what your options are. If you're lucky, you might even get help in English -- I no longer need this, but there was a time when I did. I feel for newcomers who are now in the same position. I feel even more for the majority of foreigners whose native language isn't English, who may have even more difficulty accessing information and help. 

An American friend said it seemed unfair: if I wanted treatment it should be my right to break quarantine and seek it. I understand that perspective, but the Taiwanese perspective that I could cause the dentist to fall ill and potentially create an outbreak in a medical office made sense. Taiwan wasn't going to let me die of a brain infection, but I would potentially have to endure some pain for a few days longer than I'd like. 

I did not want that pain, but I understood the general principle. I'd also learned that naproxen, or a combination of ibuprofen and acetaminophen, were more effective than either ibuprofen or acetaminophen alone, that sucking on whole cloves worked better than the oil, and that if I iced it for longer I could calm the pain somewhat. It wouldn't be fun but it would be survivable. 

I made an appointment at a hospital for Wednesday morning, the minute I am out of quarantine. No private clinic would see me until 14 days after a positive test. I could make it until Wednesday, but not the week after. 

And then...a miracle. 

When I reported to Ren'ai Hospital that my tooth pain was severe enough that I wanted to see a specialist and could not easily wait, I thought the phone number they gave me was a dead end unless I actually developed sepsis. 

But no! A hospital staffer unexpectedly called me today to say they'd gotten a report of my situation and asked if I wanted to go to the emergency room. I said I would be willing to, but if a dentist wouldn't see me, what would be the point? 

So she looked around and found a dentist willing to do online consultation. It's not perfect -- dentistry really requires a better examination of one's teeth than a phone can provide -- but it's someone, willing to do something. She even added me on her own Line to help me set up the consultation with the dentist.

That all worked out (though the process was a little confusing). I still haven't figured out how to get pharmacies to deliver to my home, so a friend came by, picked up my NHI card and some money, ran it up to the dentist, got my drugs and ran them back, all without coming face-to-face with anyone in the House of Plague.

I don't know if it would have rolled out differently if I'd been anything other than a white woman. Would a local have gotten such help? (Would they have needed it, knowing the language and having better connections than I ever could?) How about a foreigner who wasn't obviously Western? I have no way of knowing, I can only relate the experience I had. 

Perhaps I was helped because I happened to go through Ren'ai Hospital, and someone there happened to take my issue seriously enough to step in. Would I have gotten care if I'd reported another way? I have no way of knowing. 

Honestly, this was better than anything I could have pulled off in the US (without lying about my COVID status there). I understand worry about putting your health in the hands of a big government system -- what if they prohibit the path that's best for you? Yet, I can't say that's what happened. Yes, Taiwan can force you to stay in quarantine and the US can't. But would anyone in the US have thought to call me up and get me what I need like that? Doubt it. I'd have been on my own.

This isn't to say I prefer all-powerful, paternalistic or authoritarian governments. I don't. I would not have gotten what I needed in most such governments. Could you imagine things working out this way in China? I can't. 

Rather, I prefer governments that at least make an effort, even two years into a pandemic. I know that's hard to do in larger countries like the US, but the US also has more resources. They could try to meet residents' needs while having stronger policies to fight COVID. They just...don't. Maybe it's a cultural thing -- I feel like in the US the service you'd get would be very much dependent on your ZIP code. But from here, it looks like giving up.

My experience didn't deliver a perfect solution, but now I have what I need to make it to an appointment. I'm still in pain but I hope it will start subsiding. I feel pressure in my tooth from swelling or (not to get too gross about it) pus. But I got necessary drugs, and I won't be putting any doctors at risk.

Sunday, July 24, 2022

What to do if you get COVID as a foreigner in Taiwan

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I don't have a relevant cover photo, so enjoy this pretty tile from Portugal.


Other than having "I've finally bagged me the 'rona!" stuck in my head for the past few days, I've been thinking about how to help other foreigners in Taiwan with the whole process of it all, once you've tested positive.

It's not particularly straightforward, even if your Mandarin is pretty strong, and most of the guidance online is inadequate. "Find a clinic or hospital near you for a telehealth appointment!" is not useful if you feel terrible and are not up to searching online to find one. "You can get medication delivered to your home!" is similarly unhelpful without clear directions as to how, especially if you're not feeling well and don't have the energy to figure it out on your own. 1922 varies depending on who's available to talk to you at any given time: one friend got immediate help, the other got asked her name and phone number in Mandarin and was told someone would call her (fine if your Mandarin is okay, not great if you don't speak it.) 

So, I thought I'd do my best to write a guide. This is specifically aimed at people whose Mandarin is worse than mine, who don't have, say, a local significant other to help. Mine's not perfect, but it exists -- if yours is better, you probably don't need my help! 


Before you test

I strongly recommend, before you even feel sick, to have a plan in place. I didn't -- unwisely kept putting it off as non-urgent -- and had to figure all this out while sick. Learn from my mistake! What sort of plan? Well, you'll want to: 

1.) Download the EUCare app and register, if you have National Health Insurance (you can't use it if you don't). The registration is offered in English, and it doesn't obligate you to make an appointment. You'll need to verify your phone number and possibly e-mail.

Be sure to enjoy the "Congratulations, you are now part of us!" message you get when your registration is successful! I had a little trouble registering, but when I swiped the app closed then re-opened it, it worked.

2.) Figure out where you'll do your telemedicine appointment in advance (which may or may not be through EUCare). If you plan to use the Taipei City Hospital system and don't have anyone to pay the registration fee for you, then you may want to download a relevant app such as Taipei Pass in advance, as they have to review your account before you can use it. 

3.) Have a plan in place for paying the registration fee and picking up any medicine -- this can be done through online payment and home delivery, or having a trusted person be able to take your health insurance card to the hospital or clinic and pick it up for you. I strongly recommend discussing/agreeing in advance with those close to you regarding who will help whom if you suddenly can't leave the house. Even if you have a partner, they may get sick too. It is so much easier to have someone you can call at the ready to go pick up what you need.

4.) Keep a supply of painkillers, cough medicine and diarrhea medicine at home (just trust me on that last one). Some of those flu drink packets don't hurt, either. I also recommend having some citrus or sour candy or lemon drink mix on hand if you think you might be taking Paxlovid. 

Other items my friends or I have felt useful to already have at home:

Extra pet food, if you have pets (have a plan if you have a dog who needs to go out); extra garbage bags; sufficient toilet paper; lip balm, toothpaste and lotion; seasonings to make your food appetizing; and a stash of something you like that's not perishable so you don't need to immediately order grocery delivery -- for me that's frozen dumplings but it can be anything you can survive on for a day or two. 

5.) Figure out in advance if you qualify for Paxlovid (here's an FDA guide from the US and another guide regarding what Paxlovid is and who should take it). In Taiwan, I don't know every regulation, but chronic issues such as asthma or high BI qualify you, among others. There are also risk factors (such as liver or kidney issues and certain contraindicated drugs). I'm not a doctor; if you think you qualify, be ready to ask at your appointment. They may not ask you; you'll need to bring it up. 

Not everyone needs Paxlovid, so don't ask for doses you don't actually need. I qualified and received it, Brendan didn't, and he's doing fine. If you do need it, however, be prepared.

6.) Have some idea how you will get food delivery, especially if you have, say, a fobbed elevator and delivery people cannot get to your door. This may mean talking to your doorperson, making arrangements with friends or stocking up in advance on non-perishables.


Testing positive

You no longer need a PCR confirmation; an at-home rapid test is sufficient. You will need your health insurance card, positive test result, and a pen/marker

Now you'll need a confirmation appointment. You can do this in person, but you can't take public transportation, so if you don't have a vehicle (or are too sick to drive) and there's no one to take you, you'll have to walk. 

I strongly recommend that you do this online instead. 

Using EUCare

You can do so through the EUCare app. I'll link to some other resources after the screenshots below.

Once you register, there is a button for making an online appointment -- it's the "Rapid Test Positive Confirmation" button with the bell. 



They only have one clinic (located in Tainan) that does confirmations all day, so if you can't find anything near you, select "Tainan": 


The other options to the right are, in order: Taipei City, New Taipei, Taoyuan, Taichung, Tainan, Yilan, Hualien and Taitung. 

I don't know why it doesn't include every county, but this is an online confirmation, so it doesn't really matter. 

If you've selected Tainan because it's the only one open, choose Chimei, the first option:





I can't promise you'll only be given this option, so if there are several, choose this one: 






Choose a doctor and time (this is just one option, from what was available when a friend tested positive):






You may be asked to upload a picture of your health insurance card and positive result, and you may also be asked if there's anything else the doctor should know. You can type this in English. 

If the system acts up, just close the app and try again. It's a little buggy but it usually works at least on the second try. If you choose an option other than Tainan Chimei, and can't read what the choices are, I recommend getting Google's Translate app, which allows you to upload photos, including screenshots, to tell you what they say. 

If you don't get those options when you register, contact them via Line (the Help icon at the bottom -- make sure you have Line installed as it will take you over there.)  

Or just sign out and in again: pink button to sign out, yellow to get back in, and the circled option once you do that.





You can also use the Help function other issues with the app, and if you tell them in the beginning you prefer English they'll do their best (I didn't use EUCare but a friend did, and this is what he told me.) When you add their Line you'll get a bunch of messages -- these just tell you that the Help service is for using the EUCare platform, not actual medical attention, a rapid test confirmation or a COVID taxi, and that it's illegal to insult or abuse them or send pornography. 

You'll get a notification when it's time to join. Just open the app and press the button.

The doctor you get should be able to speak English (most doctors in Taiwan do, even if service or support staff do not). If you have any concerns such as picking up medicine you can ask at this time. Have your address ready -- if your confirmation appointment is not close to you, they can send any medicine to a nearby pharmacy.

According to another friend this can get difficult if you don't speak Mandarin -- if you don't, it's best to have someone who does on hand to help you. You'll have to choose the pharmacy and then have someone pick it up for you, or call to have it delivered. 

However, there doesn't appear to be a charge to use EUCare -- at least, my friend wasn't asked for any money.



Taipei City Hospital (for Taipei residents)

If you live in Taipei City, you can make an appointment through the city hospital system. This is what I used. The page tells you about how to do this -- I checked it in Translate mode for you all, and I can confirm it's pretty readable. You'll need the same items as above: National Health Insurance card (if you have one -- if you don't, have a photo ID ready), positive test and a marker. Click on one of the options in green: 



The options, in order are:

Chunghsiao/Zhongxiao (near MRT Houshanpi)
Ren'ai (at Ren'ai-Da'an intersection, near Zhongxiao Fuxing)
Chunghsing/Zhongxing (near Dihua Street)
Heping (near Longshan Temple)
Women's and Children's (on Nanhai Road near Freedom Square)

Choose whatever is most convenient for you and -- hopefully -- the person you have lined up to pick up your medicine and pay your fee. Actually inputting the information is not very hard: 



Choose a date (usually the same day or next day). 上午 is the morning clinic, 下午 is afternoon. It asks for your full name, date of birth, ARC number, phone number and address as well as a captcha. I put in my address in Mandarin, so I don't know if it will accept English. If you're worried about this, have your address in Mandarin ready to copy and paste. These are just examples of choices if you click "Ren'ai".

Click the blue button at the bottom to get your number. Then add the relevant Line ID and change your account display name.

You'll also need a method of payment for the NT50 registration fee if nobody can go to the relevant hospital for you. You'll need to download one of the the relevant apps such as Taipei Pass or the city hospital app (the latter in Chinese, for you to copy and paste: 臺北市立聯合醫院行動掛號). 

Taipei Pass takes awhile to activate as they have to review your registration. The city hospital app is only in Mandarin, and even though I can read everything on it, I can't figure out how to register. So, I strongly recommend you have an agreement with someone in advance. 

I used Ren'ai. I was asked to add the relevant Line ID and change my display name to my name and appointment number (an example is given on the information page.) They sent a message a few minutes before with a link, which I clicked on. A button appeared to enter the conference room and I did. The appointment was efficient, professional and in English. I didn't see that they actually used Line at all!

My husband was asked to add a different Line account when he tested positive (yes, we are a COVID House now) -- mine was tpechra9, his was tpechra8. His appointment actually was through Line, so just stay by your phone and wait for a notification. Have a picture of your ID/NHI card and positive test ready. I was asked to show mine -- all the appointments are recorded -- but he was asked for a photo upload. 

There are specific pickup windows for medicine, which is handled outside the main hospital. Ask your doctor which window your pickup buddy will need. If you need it delivered, ask at this time. I am not sure how to actually do this, as we had someone pick it up for us both times (Brendan did mine, and a friend did Brendan's). 

If you think you qualify for Paxlovid, be sure to proactively ask about it. It does not cost extra.


Local Clinics

You can also confirm your positive result through a local clinic. However, when I attempted to find one, I found that feeling like absolute garbage did not improve my ability to find that information and make phone calls in Mandarin. Turns out, being barely able to sit upright makes it difficult to do something in a foreign language. Who would've thought!

If you do want to go this route, here is a page listing all clinics which do positive result confirmation so you don't have to root around on Google Maps, like I tried to do. Again, learn from my mistakes!

Each link will take you to a city government page with some PDF links. These are all in Chinese but they translate to English fairly well (again, I checked for you). The PDFs are what contain the actual clinic and hospital contact information; you have to call yourself. 

In Taipei, the city hospital system is certainly easier to deal with, but this may be of help if you are outside Taipei. It doesn't translate well, as the links disappear. If you don't have even a little Mandarin, I recommend you at least be able to recognize the characters for where you live if you want to use this method.

Lienchiang (Matsu) and Kinmen just list the clinics with no links -- it's up to you to look them up and call them. No, they probably don't speak English, so if that's a problem you'll want to stick with EUCare.

Keep in mind that while the doctors usually speak English, the staff often don't. If you feel comfortable calling around while you are sick, then you probably didn't need my help in the first place! However, I wanted to include this option.


After confirmation

The confirmed case form

Soon after you are a confirmed case, you'll receive a text message with a link to a form which is helpfully all in Mandarin. Unfortunately, I had not thought to write this post when I received it, so I filled it out and sent it off without taking screenshots. 

If you can read Mandarin, it won't be that hard (though the information for close contacts -- that's family and workplaces only -- can get a bit lengthy. It's not required, but if you do have close contacts who aren't aware that you're positive you do need to fill it out.) 

If you don't, my best recommendation is to take screenshots and open them in the Translate app. Some difficult sections, such as asking you your neighborhood or 里, are actually optional. I happen to know my li but not every foreigner does, and it's a pain to look up.

Soon after, you'll receive a bilingual notification of quarantine, which will tell you what day you can leave home. This should be sent to you by text, with the last six numbers of your ID as the password. The link does expire after a few days, so I suggest you download this. I had to email it to myself and open it on my desktop to do so. 


The phone calls

You should receive two phone calls on your first official day: one from your district health office and one from whoever is designated with checking on you for the national government (for me, someone from Ren'ai Hospital calls daily). At least, that's true for me -- Brendan says he didn't get a call today, but I did. 

The district health office is your friend -- if you need help with something like garbage service, tell them so. If you're unsure, take down their number. You can always call them later to ask for help, as they'll only call you once. 

Depending on where you are, the district health office may not speak English. I don't know what to tell you except to be ready for this. 

The daily call checks on your symptoms for the national database. I usually talk to them in Mandarin, and you get all types. The first one confidently spoke English before I even tried to break out my language skills. The next day, the caller offered, but seemed happy she didn't need to. The third caller was clearly terrified of talking to a foreigner at all, even though I assured her she didn't need to use English. So, you know, you get all kinds.

If you don't speak Mandarin and make it clear in the beginning that you need English, they may make sure someone who speaks it will call you daily, or transfer you. I can't promise that, but that's how these things usually shake out. 


I'm quarantined but need to see a doctor for something else!

If you get sick with some other thing while in quarantine, you can make an appointment through EUCare (go to the button that says "Specialist" and choose from the options (it will again be a list of hospitals and clinics by location in the same order as above). In Taipei your best option is Mackay (台北馬偕紀念醫院), which is second on the list if you click "臺北". Choose your preferred clinic by the photos -- for example, for persistent cough, click on the lungs. Choose the last one, Family Medicine, if you're unsure what you need.  Input your information and a photo of your NHI card, and specify what you need in the box. You can do this in English. Then book the appointment and wait for the notification. 

The only part that may be confusing is the "Unified ID" (統一編號). That's usually a term for a business ID, but it's used here. Input your regular ARC/APRC ID number. 

You can also call 1922 for help, though their ability to do much will depend on who's staffing it at that time. Some people I know have gotten excellent service, some have gotten a gruff request for a phone number in Mandarin, so someone could call them back in English. 

I personally have developed a toothache in quarantine, and will probably call 1922 about it tomorrow, so I'll update with any useful information (there is no dental icon on EUCare). 


Other advice

These are just some tips I have from being in quarantine. 

First, I cannot stress enough to prepare in advance. I had done some of the not-yet-positive things I suggested above, but not all of them. Be smarter than me. Agreeing in advance with multiple friends that you'll all help each other will especially make everything so much easier. 

Secondly, if you do get Paxlovid and develop Paxlovid Mouth, the secret to killing that awful taste long enough to eat is citrus. It could be lemonade, lemon water, sour candies, Vitamin C tablets (the kind that come in the yellow and green tube, or the Korean ones in the moon-shaped plastic dispenser work great.) It could even be Pocari Sweat, which is mildly citrusy. But you'll want something -- eat a sour candy or drink lemon water if the taste becomes unbearable or you want to eat a meal that doesn't remind you of battery acid upchuck. It kind of tastes like a bitter chemical sewage; I really cannot emphasize enough how awful it is. 

But lemon and citrus kill it! It's kind of the big secret to surviving those five days while eating somewhat normally. Stock up. 

Drink massive amounts of water. We're talking as much as you can take. Be ready to pee it all out, but just keep drinking. 

Brendan says coffee every morning helps his symptoms. I drink it too, but haven't noticed that it makes them much better. It's worth trying, however. 

Rest even if you feel okay, at least for the first few days. Use this as an excuse to do nothing. 

There is no need to test daily. You can't leave for a week anyway, so it's not worth testing until you're close to your quarantine end date. Save your tests!

If you've read this far, there's a fair chance you're sick. If not, stay healthy!


Sunday, November 21, 2021

Taiwan’s COVID response: let’s stop assuming “imperfect” is the same as “terrible”


Just a warning: I wrote this after an extremely busy work week and after taking the anxiety meds that help me sleep. If that shows in the writing style or other weirdnesses, I’ll go back and improve on the post later.


“This is probably going to be my last year in Taiwan,” someone told me recently. This was partly for personal reasons, but partly because “I’m just not very happy with Taiwan’s COVID response.” Not enough vaccines, not rolling them out fast enough, the interminable quarantine — they simply weren’t impressed. 

“It’s really shocking how the government hasn’t made any effort to import more vaccines,” said another friend, though they admitted that view mostly came from their parents and the pan-blue news they watched. 


Still other friends are upset about the lack of information about what quarantine rules apply to foreigners — do we get subsidies? Do we qualify for the 7+7 program? Is it legal to charge foreign residents more than citizens for quarantine? There’s also a lack of consideration for foreign residents who want to reunite with family members, and extremely unclear guidelines regarding how to sign up for first or second shots.


I don’t agree with the negativity of most of these takes, but they’ve come from people I respect. They pushed me to think about the ways we all decide what evidence we choose to consider when forming an opinion, especially if you’re looking to justify what you’ve already decided you want to believe. Nobody is safe from confirmation bias.


My own perspective: Taiwan’s COVID response remains fantastic, and the evidence for this is simple. It’s one of the only COVID-free countries in the world. As far as I know, the only one with a comparable population and density. Despite considerable odds — Beijing’s attempts to block vaccines from reaching Taiwan, exclusion from the WHO and proximity and connectedness with China — Taiwan has crushed each COVID surge. What other country went from an extensive outbreak to zero COVID in 7 months, without (in my view) unduly impinging on guaranteed rights and freedoms. The vaccine rollout indeed began slowly, but it’s scaled up impressively since. I meet very few Taiwanese anti-vaxxers or anti-maskers: the vast majority of those jackasses seem to be foreign residents -- with some exceptions, of course.


(If you are one of those, I want nothing to do with you. I am not interested in your “opinion.”)


I empathize with the frustration, however. I support keeping the mandatory quarantine as long as experts deem it necessary, but the fact is, it’s made it impossible for us to visit family. At the same time, I’ve watched those family members travel while I am effectively stuck in Taiwan. I don’t miss leisure travel as much as I thought I would, but I do miss my family. I accepted that I’d miss Christmas 2020 and two weddings — the last family wedding before these two was my own 11 years ago, so they mattered to me — but I never imagined I’d have to give up Christmas 2021, too. 


Of any country to get stuck in, however, I am indeed grateful that it is Taiwan, with its zero domestic cases.


I watch friends and family in the US getting boosters, while my friends in Taiwan are still getting their second shots. I wonder how long it will be before I can get an mRNA booster, especially as both of my doses are AZ. I’m grateful that I was able to get the vaccine at all, but that booster? It’ll probably be awhile. Until then, international travel is indeed a bit more dangerous for me.


Even dismissing the exaggerations and truth-twisting of Taiwanese TV news (especially pan-blue news), it’s easy to see COVID-era Taiwan two ways: 


The half-empty glass: the delay in ordering vaccines caused the delays in receiving them. The quarantine is keeping Taiwan closed off while the rest of the world opens. The vaccines many of us were able to get aren’t the best, and aren’t necessarily going to make it easier to travel in the future. Guidelines have been vague and unclear, and foreign residents have been ignored entirely, treated as though we don’t exist. The government grew complacent in learning about the latest treatments and approaches because the country was COVID-free for so long, which led to higher mortality when an outbreak did occur. A surprising number of pilots (though still a tiny minority) didn’t follow the quarantine rules tailor-made for them. Businesses, especially those which typically served tourists, have closed. Taiwan is being left behind, and it’s starting to show.


The half-full glass: dude. We’re living in a COVID-free country. How many people can say that? How can you say a response that resulted in zero COVID isn’t working or isn’t impressive? This is despite having to fight just to be recognized on the international stage. Nobody has turned the wisdom of masking or vaccinating into a major political battle, even when they criticize the government. Taiwanese are masking and vaccinating and that’s more than you can say for a lot of belligerent ultracrepidarians in the US.


Perhaps the government could have jumped on orders faster, but the fact is that Beijing’s attempted (and somewhat successful) sabotage was real, and is not Taiwan’s fault. There have been outbreaks, and we’ve crushed them. There has been confusion and poor communication, and certainly missteps as well. What country can’t say that though? What government has handled the pandemic perfectly? What government has handled it better than Taiwan’s? The only real contender is New Zealand, and I’m not even sure that case is strong. We’ve all made sacrifices, and compared to what people in other countries have lived through, they’re mostly bearable (my heart goes out to anyone still waiting to bring a spouse to Taiwan with no timeline as to when it might be possible. That’s cruel.) 


My family in the US spent upwards of a year mostly locked indoors, away from others. I’m (de facto) being asked to wait about a year longer than I’d like to make that long-desired trip to see my family.


At the end of the day, however, we are living in a COVID-free country. What more do you really need in your glass?


To come to that more positive outlook, I pushed myself to think through the glass-half-empty view of Taiwan’s COVID response. Indeed, I found a lot to criticize: their views didn’t entirely lack logic or a point. Every day I don’t book a plane ticket to the US, that becomes clear. Every day I wonder when I’ll be able to get better protection than AZ for the Delta variant, I get it. 


The lesson: every country has made mistakes. Some more than others — the US’s strategy seemed to be ¯\_(ツ)_/¯, followed by a pretty decent effort, followed by a bunch of bellicose Dr. YouTube graduates who act like they’ve swallowed not-smart drugs ruining everything. No mistake Taiwan has made was worse than that of any other government, let alone so much worse that they deserve to be singled out for a poor response.


I’ve noticed a tendency of some — especially foreigners in Taiwan who’ve had a rough day — to assume every good strategy is simply obvious and doesn’t merit any praise for the Taiwanese COVID response, but every bad strategy is an indictment of the country.


That is, if it’s not absolutely perfect, they say it’s terrible. And they call it terrible with a level of dismissiveness and frankly condescension that they would most likely not aim at any other countries. COVID cases are surging in Europe, but do you see them going after that? No — Taiwan is a disaster to them because a few mistakes were made, but Europe? “Oh that’s worrisome”. That’s it. Oh, in Rotterdam they’re rioting against masks — that’s fine. But a pilot didn’t follow the rules in Taiwan? The problem must be the rules, not the individual pilot!


This leads to polarized viewpoints where Taiwan’s excellent-but-imperfect response is viewed as either unassailably amazing, or unforgivably terrible. 


The “unassailably amazing” people are in fact willing to be assailed, if you offer good evidence. 


The “anything less than a perfect response is a disaster!” people— a standard they would be unlikely to apply to any other country — are harder to reach. It’s hard to change someone’s mind if they want to dwell in negativity.


Fortunately, the middle ground is not devoid of people. There are also reasonable voices who posit that a generally excellent response was marred by a few missteps, but that the bad odds Taiwan has faced thanks to China merit quite a bit of grace towards Taiwan. Some of those missteps, however, do need to be addressed. 


This would best describe my viewpoint. But I had to come to it from an excessively positive one, genuinely consider the negative takes and incorporate what made sense while sloughing off everything that didn’t make sense when compared against the bigger picture (that is, the response of the rest of the world). 


If I can beg everyone reading this to one thing, it’s this: reconsider. Go through your baseline opinion on Taiwan’s COVID response and examine each of your assumptions, beliefs and areas of especially strong pride, anger or defensiveness. By all means, ignore the anti-science junk which is truly not worth your time.


Then, check them against your previous opinion. If this process causes your bright & sunny views to moderate a bit, then that’s a new level of nuance. It doesn’t mean your overall perspective is not a positive one.


If it causes you to question your previous negativity, great. 


If not, that’s your right, but we’re not going to agree. 


Perhaps consider that process for any opinion. Are you dumping on Taiwan because it doesn’t meet impossible standards of perfection that you wouldn’t apply to your home country? Stop, maybe. 


Are you looking at Taiwan through rose-colored glasses that you haven’t tried to remove? Your issue is the less severe one, but there might still be something to be learned here. 

Thursday, November 11, 2021

Who should Taiwan open for?

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For not quite two years now, Taiwan's borders have been closed to most people. In on-and-off policies, students, resident visa holders, foreign blue-collar labor, businesspeople and others have been permitted to enter...or not. Tourists have been firmly shut out. As the rest of the world (wisely or not) begins to re-open and "live with COVID", there's been debate about whether Taiwan should do the same. 

Some of this discussion has been quite reasonable: allowing students, family members of citizens and residents and people who have accepted jobs are all logical policies to support. Other points have been, shall we say, less trenchant -- for example, the push to let tourists back in. 

So, let me change the tone here and just lay it out. Yes, we should let family members -- especially spouses and children -- of both citizens and residents into Taiwan. Most spouses of citizens can now do so, but family members of non-citizen residents remain barred from entry. This is wrong. Quarantine and contact tracing have been fairly successful -- I see no reason not to let students and people with jobs waiting for them in as well. A special category of visa you can petition for if your situation gives you personal reasons to go to Taiwan can also be made available: for, example, unmarried partners, siblings and other family members.

Tourists, however? No. 

There was a recent article in The Guardian about this, but I don't want to focus on it. The discussion has been going on longer than that, and the attitude is widespread enough to merit a general response rather than a targeted breakdown. 

International tourism is a little over 4% of the economy. That's not nothing. I'm not saying the hotels, restaurants and tour businesses affected aren't important. But let's be honest -- it's a thin slice of what makes Taiwan hum. Even if Taiwan were more of a tourist-dependent place like, say, Bali, I'm not sure I'd be in favor of opening up. At such a small slice of what makes Taiwan go, however? Absolutely not.

Am I personally in favor of giving up a zero-COVID life and risking an outbreak in Taiwan so we can get that 4% or so humming again? No. Why should I? Why should anyone?

I'm sorry, hotels in Kenting, but I'm not  willing to give up the more or less normal life we can now have in Taiwan so that you can get more customers. I am certainly not willing to risk my health for it! I don't think many people are, nor should they be. Your business is simply not as important to me as normalcy in daily life in Taiwan and a near-zero chance of catching COVID -- for everyone who lives here. When vaccination rates rise that can change, but we're not there yet.

Perhaps think of strategies to entice domestic customers to take all that annual leave they're not spending on international travel to stay at your hotels during the week. 

Besides, re-opening for tourism would mean doing away with the quarantine. I suppose borders could be opened but the quarantine kept in place, which would certainly deter tourists but be tolerable to those with reasons to make the trip. However, we're still at the point where it's better to actively discourage non-essential travel, and framing it that way does the opposite. Perhaps in a few months, especially if quarantine capacity could be increased, that would be a conversation worth having. But by the time that happens, we'll also have higher vaccination rates anyway.

Honestly, I'm sick of the quarantine regulations too. We all are. I would very much like to go back to the US to see my family, some of whom I have not seen in person since 2018. My grandmother is 95 years old and I worry every day that things won't get better in time for me to see her again. It's just a sad financial fact that quarantine hotel rooms for my husband and I are simply not financially feasible after a genuinely rough summer. 

But the fact is that the quarantine has helped catch imported cases, and we still need it until vaccination rates are higher. Mandatory 2-week quarantines and international tourism are simply not compatible.

Besides, opening up for tourism would guarantee an outbreak -- for this reason, the entire premise of the argument is flawed. An outbreak wouldn't exactly cause tourists to pour in, would it? It would not only depress the exact sort of inbound travel that opening up would aim to bring in, it would depress domestic tourism too. We know this because that's exactly what happened during the May outbreak. I was in Tainan recently and the B&B owner admitted that from May until the "soft lockdown" ended, allowing indoor venues to re-open, they didn't have a single guest. Now, they have some -- we weren't the only people staying there. A fresh outbreak would mean none.

What's more, the risk such a move would bring would devastate a far greater chunk of the economy than the sliver fueled by international tourism. Business that rely on local custom -- restaurants, shops, cafes, smaller hotels catering mostly to local crowds, even cram schools as much as I dislike them -- all took a hit from the May outbreak. Many closed: the hotel I liked in Taichung which seemed to mostly attract young Taiwanese weekenders on mid-range budgets, the Konica shop I'd use to print out photos for relatives, more than one cafe I liked as well as several restaurants, gone. My own income was briefly torpedoed, as was my husband's, though fortunately at different points.

They didn't close, and we didn't have to dip into savings, because there weren't international tourists. That all happened because the domestic economy was affected. Risk that again for that tiny 4%, which probably wouldn't even reach 4%? No thanks.

I don't think the CECC is being particularly wishy-washy about this, either. It's true that they haven't set clear milestones for re-opening or changing quarantine rules. It's true that they won't state clearly what vaccination percentage will be considered "sufficient". But that makes sense to me: this is literally an evolving disaster, and it's evolving because people are not smart. They hear ignorant takes about vaccines and hesitate to protect themselves and others. They make obviously logically flawed arguments about "re-opening", which brings further outbreaks.

Oh yes, and they complain that "we can't find mayonnaise" -- or something -- when supply chains are disrupted around the world and there is indeed mayonnaise to be had. I have some in my fridge. It's available. I'm certainly not interested in risking my health and life because some guy whined to The Guardian that there isn't enough mayo. Come on.

The virus mutates, it becomes more infections, and all the milestones have to change. 

I don't call an evolving response to an evolving problem wishy-washiness or lack of clarity. I call that being flexible, which is exactly the right way to be. There is some strain, but the whole world is strained. By comparison, Taiwan is not a festering hellhole due to bad policies (though there have been some, I admit). It's stayed pretty good, due to (mostly) good policies.

So yes, by all means let's push the government to consider allowing home quarantine for the vaccinated at some point in the almost-predictable future. Let's push to allow people who should have the right to be here -- family, workers, students -- to be allowed in. Certainly, let's look at further relief as necessary for the worst-affected sectors. If you're able, take some time off during the week and go use those quiet tourist facilities while they're not crowded. Give the hoteliers and tour operators a bit of domestic custom. I'm looking at some trips I can take myself, now that life in Taiwan is closer to normal again.

But no, it is not time to re-open for international tourists. It's just not. 

Wednesday, June 2, 2021

Introducing Terry Gou, China's vaccine gamepiece

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Are those claws real? Does it matter, if the purpose is the show?

I really didn't want to write about vaccines even one more time, but it feels somehow necessary. Sigh.

You've probably heard the news that Terry Gou -- Foxconn billionaire and guy who called Taiwan independence supporters "garbage" -- has applied to the Taiwan FDA to import 5 million doses of BNT. More accurately, a New Taipei-based biomedical firm is the official applicant, Gou's role is basically to write the check and talk to the press. Notably, Shanghai Fosun is not a part of this deal (perhaps there are some fees paid to waive distribution rights). 

Health Minister Chen Shih-chung has confirmed that the application is under review, but apparently the original authorization letter from BioNTech (BNT) does not seem to be included. From my understanding, that letter is essentially the proof that BNT is going to deliver what it says it will -- BNT doses imported straight from Germany.

I'll be quite interested to see how that story develops in the coming days. As it stands now, it seems clear that without that document, the planned purchase and distribution cannot go through. (If it doesn't, however, prepare to hear Gou scream about it and blame "the DPP" for the paper he doesn't have). 

One could say that Terry Gou might have been able to get around Shanghai Fosun by paying them off, and perhaps this is true. However, the government refusing to pay those fees was not the reason given for BNT's contract with the Taiwanese government falling through. Unless the Tsai government and Ministry of Health and Welfare (MOHW) are both telling some massive lies to the public, the reason was related to the use of the word "country" (and then "Taiwan") in the contract.

So, Shanghai Fosun -- whose owners certainly have close ties to the CCP -- is willing to step aside for Terry Gou, but not the Taiwanese government? Why?

Here's the best explanation I can provide: essentially, it's all politics on China's part, where they've set up a game that it will be very hard for Taiwan to win.

How does the game work?

First, China blocks the Taiwan government’s negotiations with BNT. Then China claims ”only” Shanghai Fosun has the right to sell BNT to Taiwan. Taiwan rejects this “offer” as Shanghai Fosun never applied for distribution approval in Taiwan

Then Terry Gou submits the application that Fosun couldn't be bothered to attempt. Terry says the vaccines will come straight from Germany — not through Shanghai Fosun.

Suddenly Shanghai Fosun’s inalienable “rights” to the Taiwan market no longer seem to matter. Which means they were never the reason why Taiwan's own negotiations were abruptly cut off even after a contract had been agreed upon.

This time, nobody in China, the media or the pan-blue camp claim Gou is “circumventing” Fosun or “trying to obtain independence through vaccines”, even though he is doing exactly what the Taiwanese government tried to do earlier (which, again, was completely acceptable).

China wants the DPP to look bad, so they won’t stand in the way of pro-China Terry Gou (remember just whom he called "garbage"!) obtaining these doses.

As there are some questions about this authorization letter, it is unclear to me if BNT has actually agreed to sell him the vaccines or not. There are also a few other lingering questions. If China is refusing to let Taiwan access vaccines because Taiwan insists on doing so without abrogating its sovereignty, how will China react if these BNT doses are approved in Taiwan without the Chinese government's involvement? (Remember, BNT is still not approved in China proper, only Hong Kong and Macau).

The MOHW will still have to go through quite a bit of documentation to obtain these 'donated' vaccines -- what name will they use for Taiwan? If their use of "Taiwan", "Republic of China" or "country" stops the deal dead, will China, the KMT and Gou scream "politics!" at the DPP? (Yes.) 

If the original authorization letter is required before this can go through, will Gou and the KMT still scream "politics"? (Yes.) 

It's also not clear to me if BNT is actually approved for use in Taiwan yet. If it isn't, that will have to happen. Approval for emergency use is possible, but in those cases typically the government itself assumes legal liability if any problems arise. If Gou donates the vaccines through this biomedical firm, how does the legal liability for that work? If that's the reason they are rejected, will these same parties scream "politics"? (Yes.) 

Therefore, if Gou doesn’t secure the vaccines, he can blame the DPP. This looks good for both the KMT and China.

If he does secure them, the government looks bad: incompetent, unable to get this done themselves, when the truth is China blocked their attempt to do exactly what Gou is doing now. The media will have a field day, and nobody will stop to think that these 5 million vaccines were specifically intended to embarrass the government. I say this without making a value judgment on whether we should or shouldn't import them (although I absolutely would refuse one, and I willingly took AZ). 

In either scenario, China wins. The KMT looks good. The current government looks bad. If this is a game, China is winning. Again, I say this with no value judgment on whether 5 million German-made BNT doses in Taiwan would be a good thing. Of course, if they came with no political strings, they would be. But they do come with political strings which are worth interrogating.

It also hands another victory to China: whether the vaccines actually get here or not, the CCP is sending a message. Cooperate with us. Call independence "garbage". Be pro-China. If you do, and are willing to play by our rules, we'll clear the path to life-saving vaccines for you. If you don't, then we'll put you in as many chokeholds as possible. So you'd better vote for the party we prefer, got it?

In other words, nice countr---er, province you got there, Taiwan. It'd be a shame if something happened to it.

Through it all, China pulls the levers. And perhaps this helps Gou with plans for a 2024 presidential run, a race the KMT could conceivably win despite their China stance being deeply unpopular.

So they are playing politics with vaccines, while accusing the DPP of exactly what they are doing. That's usually their strategy, to be honest. It's easy to see through once you know how it works.

(If I'm missing anything in this rundown of exactly what's going on, please feel free to comment in the spirit of sharing information. Troll comments, however, will not be accepted.)

I won't end with a fist-pump and reassurance that Taiwan will win this game. Right now, if this is Monopoly, China has too many properties. But there is some reason to hope. 

First, the government is responding with dignity, truly the only way that they can -- by not turning their noses up at these doses, and even taking Gou's calls to show they're not obstructing the process. From the Focus Taiwan link above:

In response, Health Minister Chen Shih-chung (陳時中) thanked Gou for his efforts to help Taiwan obtain vaccines during a daily press briefing, adding that the application was already under review.

Meanwhile, an official at the Ministry of Economic Affairs told CNA that Economics Minister Wang Mei-hua (王美花) had taken a call from Gou on Monday, to make sure he had the necessary information and contacts prior to completing the application.

The government, which initially expressed strong reservations about local governments and private enterprises attempting to procure COVID-19 vaccines, has lately softened its position, on the condition that it remains firmly in control of the process.


I'm no political strategist, but this is how I'd handle it. 

What I think they're really doing: the government knows this is a game, and they know vaccine procurement is no joke. They're aware Gou is highly unlikely to succeed. Better to just let him try and let the problem take care of itself, so the inevitable accusations of "blocking" him won't look credible -- because they won't be. 

Secondly, I don't claim to have data regarding how Taiwanese feel about these vaccines. However, from my students (everyday office workers -- generally just normal people, not political activists), there seems to be an understanding that this is indeed a game, and it was started not by the Tsai government, but China and the KMT. Many are filtering out news like this, choosing to only watch the 2pm CECC press conference because they're "sick of the rumors and bad reporting". Online it seems the world's gone haywire, but in the meatspace, there are still plenty of sensible people. The game hasn't turned everyone into a disinformation zombie. And China's "better vote for who we want or you'll suffer!" tactics have been backfiring since 2014.

I've also not heard anyone from this admittedly anecdotal group express any misgivings that Taiwan isn't good enough, can't manage this, or is somehow incompetent or unable to run itself as a country. Quite the opposite, in fact: they're staying home and talking about getting through this together as a country. That's good news.

Finally, this won't last forever. It can't. More vaccines will come; we'll get through this outbreak. Taiwan has proven itself a competent nation, as much as if not more so than any other developed democracy. China and the KMT are using this window of time between the outbreak occurring and vaccine availability to launch an attack, but this attack is time-limited. It will end. It's just unclear how much damage there will be.

Will Terry Gou actually procure these vaccines? Will they make it into Taiwanese arms? I honestly don't know, though I highly doubt it. It's almost irrelevant, however. To the orchestrators of this circus, the theater is all that matters.

Friday, May 28, 2021

A Taxonomy of Lies about Taiwan's Vaccine Situation

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Razor blades in candy were always an urban legend, but I wouldn't take China's candy


Trust me, nobody wants to talk about a different topic more than me, but as long as disinformation is permeating discussions about vaccine access in Taiwan, it's important to make sure reasonable clarifications are available in English. 


I want to start by saying that I understand there is a lot of fear and anxiety right now. There's an outbreak in Taiwan that, while not growing exponentially, is still growing. It is probably controllable over a period of months, but that still means several months of worry, doubt, admonitions to stay home, and yes, some deaths. Hospitals are strained. There's a global vaccine shortage in most countries, while the US is flush with doses, and other countries have struggled to obtain them. 

That's a worrying situation to be in, and I don't want to diminish it even as I repeat my message to not freak out

It also presents a window: a time when Taiwan is trying to manage its outbreak while attempting to obtain vaccines which are in short supply globally. Eventually, Taiwan will get this under control and vaccines will be available, but we're looking at a timeline of months. That gives malicious actors plenty of time to disseminate disinformation, and for those lies to fester. And some unsavory political elements are trying to use that window to sow distrust in the Taiwanese government -- specifically Tsai and the DPP -- while calling for cooperation on the surface. These same elements turn and point fingers at the Tsai government for "playing politics". 

Anxious people may believe things that give them an outlet for their stress, so I'm not writing this to belittle anyone. It's pretty normal human behavior, and not all believers in disinformation are ill-intentioned. I do believe people are glomming on to this "we want BNT" storyline because it represents a type of hope. They want vaccines and these seem available. They're not, but that doesn't mean those who misplace their hope in these vaccines are bad, or wrong, and I don't intend to imply otherwise.

Rather, I just want to create a clear record in English to prevent further misdirection.


Let's take a look at each of these false claims about Taiwan's vaccine situation in turn, and then hopefully leave the topic behind for good. 


The national government is unfairly blocking local governments from obtaining vaccines on their own

The story here is that the CECC said earlier in May that cities and municipalities could procure vaccines on their own if they wished, and people are complaining that the CECC is "now" insisting that only the national government can procure vaccines.

This is genuinely confusing, so I don't blame anyone who perhaps skimmed this news believes that this is  a course reversal or about-face meant to take power away from local governments. 

The key point, however, is that the vaccines these local governments could potentially buy, and the distributors that sell them, still need to have been approved by the central government before the purchases can take place, and the batches themselves also need to be tested. This is usually done by the central government, and then after given the all-clear, a municipality could theoretically purchase these drugs on their own.

The central government noted, however, that the procurement procedures were complex and cumbersome, and would probably be challenging for a city to pull off on their own. Imagine if, say, Nantou City approached BioNTech, which rebuffed the Taiwanese government, or called up Moderna, which sold doses to Taiwan which are coming late due to a global shortage. What leverage does Nantou City have that Taiwan doesn't? Why would those companies sell to Nantou, not Taiwan? Do they have the resources to get through the procedure in the first place?

However unlikely, in theory, I suppose it could be done. 

The issue here is that the local governments trying to "buy their own doses" now aren't talking about buying approved batches from approved distributors. They're talking about the Shanghai Fosun doses, and Shanghai Fosun has not applied for approval to distribute their product in Taiwan. Therefore, they're not approved, and municipal governments cannot buy from them.

Hence, the government is clarifying that locally-procured doses and the brokers who sell them still have to go through the same Taiwan FDA approval process as everyone else. 

This limitation also applies to Terry Gou, who says he wants to purchase ten million vaccine doses. If he can do that through an approved channel and get those doses to the government for the required batch testing, then fine. It'd prove that the government could just throw around cold, hard cash -- but fine. 

However, if he thinks he can just buy whatever from any channel he likes and get those doses in Taiwanese arms without the usual approval process, he's dreaming.

By the way, there's an update to the Terry Gou story: the game continues. It turns out manufacturers don't want to sell to these various non-government-affiliated parties.

If these municipalities truly wanted to approach approved channels to purchase more vaccines on their own, I'd be very interested to hear the whether the CECC's answer might change given recent political hassles. It would actually make sense to centralize one's vaccine strategy given the current crisis to ensure the fairest possible distribution, but I hope the CECC would make that clear.


Tsai and the DPP are trying to keep out foreign vaccines to 'protect' the market for the Taiwanese-made vaccine 

This is obviously untrue. In fact, I'll go ahead and say it's a blatant lie. 

If it were true, why has Taiwan spent the better part of a year trying to negotiate for every foreign vaccine they can get their hands on, from AstraZeneca to Moderna to BioNTech -- millions of doses in all?

If uptake on these doses has been slow, it's because there's a global vaccine shortage and massive inequities in availability (the US, for example, clearly has plenty), and ordered shipments are taking longer to fulfill. Plus, it is absolutely plausible that China has been blocking Taiwan's attempts to secure vaccines. Taiwan only implied this before; now they've come right out and said it's the case. It has nothing to do with trying to 'protect' a local product. 

If the government were trying to 'protect' the market to ensure the domestically-produced Taiwan vaccine has enough takers, first, that would entail endangering lives and a full-blown COVID health system breakdown to possibly make money later on.

The Taiwanese government isn't perfect, but I highly doubt they'd do that -- you'd have to think of them as monsters. They're imperfect, but they're not monsters. (China, on the other hand, absolutely would do that to Taiwan and the CCP is indeed run by monstrous people). 

This "insider trading on the local vaccine" accusation likely arises from the extremely confusing story of Tungyang 東洋, a Taiwanese pharmaceutical company, which had been in talks with BioNTech and possibly, Shanghai Fosun as well (though I'm unclear on this). but pulled out for unclear reasons. Some say the amount of product offered for the price made for a poor business decision. It has been reported that at that time, the drug wasn't far enough along in clinical trials for the company to feel confident in the deal, whereas others say Tungyang dithered too long. Still others say that the government wasn't adequately supporting them (one would expect the government to commit to purchasing those doses from Tungyang, once approved). 

I don't know what happened, but it seems clear that if the Taiwanese government turned its back on these BioNTech doses to protect their own profits from local vaccine sales, then they wouldn't have tried so hard to procure millions of other foreign vaccines. Whatever is going on here, it isn't that.

In fact, it sure sounds like the sort of thing people who stand to make a lot of money on the Shanghai Fosun doses would say to divert attention from their own activities. (I can't prove that, however.)



But China can't block Taiwan's access to vaccines!

Yes, they can. 

I'll talk more below about how people came to believe that the only way Taiwan can access BioNTech vaccines must be through Shanghai Fosun, the Chinese company that claims it has rights to "Greater China". 

But first, Taiwan has every right to seek another distribution channel from the manufacturer, which can accept or reject this. Taiwan has now directly stated that China intervened in Taiwan's own negotiation with BioNTech, which again, it had every right to engage in.

This wouldn't even be close to the first time China has pressured an international organization or company to change how it deals with Taiwan, from excluding Taiwan from the WHO, trying to block international aid to Taiwan after major disasters, to pressuring airlines and IELTS and other English proficiency exams to call Taiwan "Taiwan, China".

The vaccine issue is no different.

If you think China can't do the exact same thing to a vaccine distribution contract, please think again.


Shanghai Fosun has the "right" to claim distribution for BioNTech in Taiwan, and the government is trying to circumvent them

This has a veneer of truth, but is ultimately false. 

Drugs available in Taiwan need to be approved by the Taiwan FDA, and are often batch-tested as well (this is certainly the case with coronavirus vaccines). Brokers and agents -- who may have the right to produce the same drug, or sell an already-produced drug from the original manufacturer -- also require approval. 

Fosun doesn't have this approval in Taiwan itself, so its "rights" don't exist here -- it can't just barge into the market at will. It still needs that TFDA approval.

For many drugs, multiple avenues of purchase are approved in Taiwan. If you're on any long-term medication, you might have noticed that the packaging and even 'look' of the drug changes, despite the actual drug being the same. For example, my main anxiety medication is lorazepam. It's usually branded as "Silence" -- small, white pills in bubble sheets. Then my hospital changed distributors and I still got lorazepam, but they were larger, yellow pills dosed out into sealed plastic packets (I don't remember the name, but it had changed). Now they're back to the familiar Silence. Once, I was given Ativan: tiny blue pills in gold foil sheets that are half as strong, and was told I can take two. Ativan is lorazepam in a smaller dose. Why? The hospital changed suppliers, but it's all the same drug.

It's very common, and a highly competitive business.

Approval, however, remains crucial. Even if the drug is not fake, if it's sold through an unauthorized channel, the government considers it to be "counterfeit". It doesn't matter if that distributor has an agreement with a manufacturer whose drug is approved in your country; the distributor also requires approval. Any pre-approval agreements are contingent on that process being completed.

What does this mean for Shanghai Fosun? That they may have "secured the rights for Greater China" including Taiwan from BioNTech, but there is absolutely no law or regulation stopping Taiwan from seeking out an alternative method of acquisition. BioNTech could always refuse, but they always have the right to authorize another distributor that is not Fosun.

It's not even that rare, and it sure doesn't seem to be a problem for Fosun or the CCP if the buyer is pro-China billionaire Terry Gou, who once called independence supporters "garbage".

That's why they talked to Taiwan in the first place, before backing out -- after pressuring Taiwan to remove the word "country" from the contract -- under what I can only assume was some sort of pressure or (ahem) aggressive incentivization. 

In fact, what Fosun has are the rights to sell a drug called "Fubitai", which is BioNTech's drug with a Chinese name. As far as BioNTech is concerned, it has no official Chinese name for its drug, that's a name Fosun is authorized to use. Taiwan has every right to seek out the same drug, not branded as "Fubitai". Another distributor for this drug is Pfizer, and Pfizer has no agreement with Shanghai Fosun. Although BioNTech might object -- meaning perhaps the contract would be rejected or there would be a fee -- there is no law prohibiting Pfizer and Taiwan from working together. 

Even Tungyang,  the Taiwanese company which tried to secure BioNTech rights but ultimately didn't (a long convoluted story that could be its own post), was not doing anything wrong by ultimately not working with Fosun. They might have made other mistakes, but talking to BioNTech was not one of them. Companies do it all the time. The only real issue here is that the government's messaging could have been clearer.

And this isn't even getting into the timeline of when Taiwan was or wasn't specified in the "Greater China" contract with Shanghai Fosun. I'm quite aware there's a story here and have my sources, but it's become increasingly clear that it doesn't matter. 


Taiwan "rejected" Fosun's offer of vaccines

Imagine if I applied to do a PhD at Harvard, but before I could even send in my application and proposal, the Dean of my preferred school called me up to tell me personally that she intended to reject me. 

That sounds like the sort of nightmare I'd have, but in the waking world it would be preposterous.

Well, so is this myth. 

The cold hard fact is that Fosun never applied to distribute those vaccines in Taiwan. I offered one possible reason why in my last post: basically, it would require a level of submission commensurate with approval by a national government. So by making such a submission, Fosun would in essence be admitting it is dealing with a national-level government. In other words, that Taiwan is a country. 

People have been complaining that Tungyang (mentioned above) didn't seem to think this was a problem, and that the approval should be fairly easy. However, Tungyang is a Taiwanese company that would be quite familiar with the approval process and regulations. Shanghai Fosun has never applied for such approval because Chinese drugs are banned in Taiwan. In fact, I'm not sure any Chinese drug company has gone through this process in Taiwan. 

Therefore, there's probably another reason Fosun hasn't applied: these doses are said to have been produced in Germany, so in theory, a Chinese company could apply to distribute them in Taiwan. However, Fosun has said they intend to start domestic production of "Fubitai" soon. As they would be Chinese-made, Fosun would not be able to sell them here. They'd be going through all that work for a one-time shipment of vaccines. 

So what is the incentive for Fosun to go through that process for a one-off sale?

Far more likely that it was a political ploy all along to attack the Taiwanese government in the window they have open to them -- when Taiwan is facing a crisis, and vaccine uptake has been slow.

That said, I would actually understand why the government wouldn't want to deal with Fosun. They seem dodgy at best -- complaining about not having rights they never applied for -- and I wouldn't want to deal with them either. It's likely Tungyang got spooked by them too. This might be the reason why the government now insists it will only talk to manufacturers directly: perhaps it got burned in these previous negotiations.

That doesn't mean, however, that Fosun was "pre-emptively" rejected.

I don't really know the full story behind why Tungyang's deal with BioNTech fell through, but it doesn't really matter. Perhaps the government could have supported Tungyang more. Perhaps it seemed wise in the moment to decide against the deal, as the vaccine hadn't been through all clinical trials. The government's own messaging on this could be a lot clearer.

Regardless, the company kicking up a fuss now is Fosun. And yet, they don't seem to be any closer to actually applying for distribution approval. 


You can just buy vaccines at Costco in the US, so why not do that?


This one is the funniest, but fortunately doesn't seem to be widely believed. And yet, there's always someone.

KMT Chair Johnny Chiang recently tweeted out a picture of a vaccination center available at Costco in the US, and KMT city councilor (and person who perhaps needs an intervention) Wang Hong-wei 王鴻薇 posted that if vaccines were so easy to get in the US that you could just buy them at Costco, shouldn't Chen Shih-chung just head to the US and buy out the stock?

I hope that I don't need to post a lengthy explanation of why you cannot, in fact, just go buy vaccine doses in bulk at Costco, right next to the Einstein's Bagels, tubs of oregano and massive graduation cakes.

Perhaps Wang is really that ignorant, but it's more likely that she's smart enough to know how ridiculous she sounds, but doesn't think her constituents are smart enough to see it.

I don't want to put every preposterous statement by every KMTer on the party as a whole. Wang is one city councilor. However, that's hard to do that when it's not just the grunts but the caucus whip saying Chen Shih-chung should be "executed" -- a method of governance the KMT is intimately familiar with, though you'd think they would have figured out was wrong by now. It's even harder when KMTers below him echo that sentiment.

However, with the KMT calling for cooperation with the government while continuing to undermine them at all levels, I have to wonder whether they're truly striving for cooperation or they're just a bunch of backstabbing Mean Girls.



It is possible for Shanghai Fosun to distribute their doses of German-made BioNTech in Taiwan quickly, but the government is blocking them

No.

It's not even clear these particular doses could make it to Taiwan. The approval process takes months, as you can see by the lengths of time some of these contract dramas have played out. At the latest, the doses in question expire by September. There's a very good chance they'd be expired by the time they were even shipped. Plus, it seems odd that Shanghai Fosun would just have all those doses sitting in a warehouse, knowing full well they can't sell them to Taiwan without going through the proper channels. There's a fair chance what they have is the option to buy the doses, not the drugs themselves. I can't prove that, however.

And by then, Taiwan would have other options available, including AZ, Moderna and the domestic vaccine.

Changing that timeline to get the doses here quickly would require changing the law to allow Chinese drugs into the Taiwanese market, and I know very few people who aren't deep blue unificationist extremists who think that's a good idea.

In any case, the main point here is that Fosun never applied to distribute its doses in Taiwanbut is complaining that it can't distribute its doses in Taiwan! The only way around this if Fosun continues its obstinacy is for Taiwan to just...pretend it doesn't have laws and allow Fosun to operate here the way it can in Hong Kong and Macau. 

Essentially, you can have these doses but the price is your sovereignty.

In other words, if you want those German doses of BioNTech, then pressure Fosun to submit the necessary data, samples and paperwork. 

They're the ones holding it up. But even then, it's a daydream to think these doses could possibly make it to Taiwan in time.

Chen Shih-chung is not being transparent about Taiwan's attempts to obtain vaccines

It's true that sometimes the information from the CECC on what vaccines are coming, where they're coming from and when seems unclear. By June, by July, some are coming, we're awaiting the next shipment, they're on order. It would be reassuring to hear something more concrete. The disparity between the number of shipments actually received and what Taiwan says it's ordered seem huge.

However, this doesn't appear to me to be a lack of "transparency". Again, there is a global vaccine shortage. Many countries likely have similar issues: millions of doses on order, but shipments coming frustratingly late. 

I don't have as much of a window into this world as I do into pharmaceutical approval processes (which I know a surprising amount about despite not working in the field, because I've listened to dozens of presentations on just this issue). I would imagine, however, that there are a lot of harried phone calls, negotiations and favors, wheedling and requesting, cases being made, and back-and-forth in order to ensure that at least some of what's on order is received in a timeframe that can ensure the government seems to have the issue under control. 

It's very hard to put this sort of constant negotiation into palatable words for the public. Nobody really wants to see how sausages are made. Information is great, and we need as much as possible. Said in just the wrong way, however, too much information provides fodder for the KMT to call you weak, bureaucratic, slow or ineffective. They're probably just trying to maintain public trust by not raising a fuss (and everyone's blood pressure) about the actual mechanics of vaccine procurement in a time of crisis and shortage. 

One thing I do think they could do better isn't so much transparency, but messaging. The Tsai government still has one key weakness: they don't announce their victories clearly enough. This feels very cultural to me, in a particularly Taiwanese (and perhaps Japanese) way. The KMT seems to have no issue announcing successes regarding things they haven't even done all that well! Clearer messaging on how hard they are working to get all of this to happen without showing the whole sausage might help, but it has to be done carefully.

Chen Shih-chung is not trying hard enough to obtain vaccines (and is satisfied with 'second-rate' ones)

See above. Pay attention to the actual numbers involved when the CECC talks about what it's been trying to order, and how they waited quite some time to go from "implying" that China blocked their access to BioNTech to outright stating it. 

It's quite clear that this is a monumental, difficult and frustrating task. AZ came first because that's what we could get, not because Chen thinks Taiwanese don't deserve the best vaccines. The shipments are slow, again, because of a global vaccine shortage and access inequities. 

I'm not even sure Chen sleeps at this point. That's how hard he is clearly working.

The outbreak is in part due to the Tsai government being 'complacent' about vaccination drives

This is completely backwards. 

The government procured the vaccines it could, and tried to get them out to frontline workers and other priority groups. It was the lack of local transmission at the time that stymied the drive, not complacency. (The area where they made the big mistake was the shortened flight staff quarantine and not ensuring adequate security at quarantine hotels.) 

People didn't want the shots because they didn't think they needed them. 

So, rather than be complacent about that, the government opened it up to just about everyone. It's true that many people who could have simply signed up for a self-paid shot didn't because they didn't realize that nobody was going to follow up on their "reason", but at the time, it made sense to create a small barrier to ensure there wasn't a stampede for vaccines, to ensure that doses would still be available for the priority groups should they change their mind. 

Once it became clear that the local outbreak was a real problem, the government immediately changed course, and now those vaccines have been given to priority candidates. 

That is not government complacency. It's the government trying to include normal human behavior into their vaccination strategy.


A new study on Sinopharm offers evidence that it's more effective than previously thought, therefore it definitely is (and thus we should consider allowing it into Taiwan)

I don't want to spend a lot of time on this, but as the most reprehensible unificationists in the KMT are trying to use the "let the German BNT doses in!" talk as a gateway to calling for Sinopharm (and other Chinese drugs) to be allowed into Taiwan. This would essentially mean changing the law. 

Not that unificationists and malicious CCP actors see it that way. Having helped create Taiwan's vaccine problem -- and make it seem like more of a failure than it really is in the media -- they offer a "solution": use our Shanghai Fosun/BioNTech vaccines, and here are some Sinopharm ones too! Just issue a "permit". Forget that you have your own FDA and approval process. Forget that Chinese drugs are banned by law in Taiwan. Let us treat you like Hong Kong and Macau! 

It's a poison apple: take it, and watch your citizens' willingness to get vaccinated plummet and pay for it with your sovereignty. Or refuse it, and we continue to attack you for not doing "enough" to procure vaccines.

At around the same time this attack started up, a study came out showing Sinopharm may be more effective than previously thought. However, it is unclear how much protection it provides against severe symptomatic cases or how well it works for older patients. At the same time, the Seychelles, which has the most vaccinated population in the world (it helps that it's a small population), is seeing a fresh outbreak. About 60% of vaccinated individuals in Seychelles received Sinopharm; the rest received AstraZeneca. Although most cases were among the unvaccinated or those who'd only received their first dose, it's still troubling that vaccinating most of a country's citizens with Sinopharm does not appear to be enough to reach herd immunity. 

Generously, I would call this data inconclusive. That one study is fantastic. It's one study. I'd like to see some replication, especially given the situation in the Seychelles.

Now, I actually want Sinopharm to work. In so many countries, it's the only option, or one of the only ones. China, Thailand, Seychelles, half of all available doses in Hong Kong: Sinopharm. With WHO emergency approval, the number of people who will receive Sinopharm will only rise. Those people deserve to be safely vaccinated as much as anyone else. I do hope the doses they have received are effective, as any human would.

That said, I accepted AZ but would refuse Sinopharm. I personally do not trust any drugs from China, nor the government under which they are produced. 

I also do not think the law should be changed or temporarily suspended to allow Chinese vaccines (or any drugs) into Taiwan. I honestly do believe the CCP is evil enough to tamper with the supply, because China is an existential threat to Taiwan. It is in their best interest for Taiwan to suffer. 

As such, I don't even really think the Shanghai Fosun doses should be let into Taiwan. But certainly, whatever data might say about Sinopharm, Taiwan should never, ever trust the CCP or any drugs it attempts to bring into Taiwan.

I don't know the percentage of Taiwanese who'd be willing to take the Fosun-brokered BioNTech doses made in Germany if they could. There's no data. But we do know that willingness to take Chinese vaccines is very low: less than 2%. All those Chinese business executives claiming "Taiwan compatriots" want Chinese vaccines -- and not clarifying the doses in question -- are deliberately dodging this clear fact. 

In fact, if the Taiwanese government were to allow Fosun's German doses in, they'd probably have to ensure they remain separate from any supply where patients don't get to choose which vaccine they receive, as it may impact willingness to make an appointment at all. If the allowed Chinese-made vaccines in, that would cause even more of a problem. Afraid they'd be injected with a Chinese-made vaccine against their will, registrations might well plummet. If they went ahead with the procurements anyway, they'd have to be very clear about messaging: that you'll only get these shots if you specifically sign up for them

It's smart for the government to refuse to play this game.

Yes, this is political. But the threat is real, and unique to Taiwan.