Learning from the past: Taiwan's responses to COVID-19 versus SARS.

OBJECTIVES: This study evaluated the effectiveness of two major citizens' mobilized intervention strategies - facemasks and alcohol-based hand hygiene and their changes from the 2003 SARS outbreak to the 2020 COVID-19 pandemic (pdmCOVID-19). METHODS: We surveyed 2,328 Taiwanese from July 29 to August 6, 2020, assessing demographics, information sources, and practice of preventive behaviors from the 2003 SARS or 2009 pandemic influenza H1N1 (2009pdmH1N1) era to the current pdmCOVID-19 as well as post-survey intention to continue preventive practices. Logistic regression was employed to identify characteristics associated with close adherence to preventive behavior practices in 2020. RESULTS: About 70.2% of participants adhered closely to recommended preventive behavior practices. Compared with 2003SARS/2009pdmH1N1, there was a significant increase in the use of facemasks during pdmCOVID-19 (66.6% vs. 99.2% [indoors], p < 0.001) and the use of on-person alcohol-based hand sanitizer (AHS) (44.2% vs. 65.4%, p < 0.001) or 98.4% (hand sanitation at entry of buildings, p < 0.001) during the pdmCOVID-19. Multivariable logistic regression revealed four characteristics significantly associated with continuance of close adherence to recommend preventive behavior practices in 2020: being female (adjusted odds ratio [aOR], 1.72), receipt of government COVID-19-prevention information (aOR, 1.52), recruitment of the study subjects from primary care clinics (aOR, 1.43), and previous use of AHS during the 2003SARS/2009pdmH1N1 (AOR, 1.37). CONCLUSIONS: With Taiwan's concerted efforts of government leadership, healthcare providers' risk communication, and public cooperation, we rapidly brought the COVID-19 pandemic under control. We advocate the importance of high coverage of population-based preventive behaviors in population-dense areas with increasing dominant fast-spreading SARS-CoV-2 variants.