Biden’s Americore Under FBI Investigation

Posted on March 10, 2020March 10, 2020 by Denise Simon

Biden, Inc., or James Biden in deep legal trouble.

Joe Biden’s Brother Accused of Defrauding Rural Healthcare ...

FBI got a search warrant and raided the office….

The Federal Bureau of Investigation raided a health care business linked to Joe Biden’s brother in late January, seizing boxes of documents.

The raid of an Americore Health hospital represented a deepening of the legal morass surrounding James Biden’s recent venture into health care investing at a time when questions about the business dealings of Joe Biden’s relatives, and their alleged connection to the former vice president’s public service, continue to dog his presidential campaign.

In the weeks since the raid, two small medical firms that did business with James Biden have claimed in civil court proceedings to have obtained evidence that he may have fraudulently transferred funds from Americore “outside of the ordinary course of business,” and a former Americore executive has told POLITICO that James Biden had more than half a million dollars transferred to him from the firm as a personal loan that has not yet been repaid.

The purpose of the Jan. 30 raid of an Ellwood City, Pa., hospitalremains unclear, and there is no indication it was related to the actions of Biden’s younger brother, who has not been accused of criminal wrongdoing. Its owner, Americore, has faced legal problems and allegations of mismanagement that are unrelated to James Biden.

But recent filings in ongoing legal proceedings, along with new accounts provided to POLITICO by former executives of Americore and others, point to potential pitfalls for the former vice president, painting the fullest picture to date of James Biden’s health care dealings and the ways in which they allegedly related to his older brother. In 2017 and 2018, James Biden was embarking on a foray into health care investing, telling potential partners, including at Americore, that his last name could open doors and that Joe Biden was excited about the public policy implications of their business models, according to court filings and interviews with James’ former business contacts.

Tom Pritchard, a former Americore executive familiar with the business’ finances, told POLITICO that James Biden’s arrival exacerbated Americore’s financial problems. Holding out the promise of a large investment from the Middle East based on his political connections, James Biden introduced Americore’s founder to his older brother and helped land a bridge loan to Americore from a hedge fund, Pritchard said. But then, Pritchard said, James Biden received a six-figure personal loan out of Americore’s coffers while encouraging the firm to take on greater financial liabilities. The cash infusion from the Middle East never arrived, and, Pritchard says, James Biden has not paid back the loan, the terms of which are unknown.

“It was all smoke and mirrors,” Pritchard said.

Meanwhile, Americore found itself increasingly hamstrung by high-interest loans and unable to pay employees and vendors, a situation that disrupted the operations of the rural hospitals it owns.

Now, the business is in bankruptcy court, and federal authorities are circling.

David Randolph Smith, an attorney for James Biden, declined to comment.

A Biden campaign official said that Joe Biden never discussed Americore with his brother or expressed support for the business. The official said that Americore’s founder, Grant White, purchased a ticket to a September 2017 fundraiser for the Beau Biden Foundation, an event attended by Joe Biden. “If the two interacted in any way, it would have been a handshake and nothing more,” the official said.

The messy politics surrounding the business dealings of Biden’s relatives, and President Donald Trump’s efforts to exploit them, have loomed over the presidential contest for several months, damaging both camps. Trump’s failed attempts to pressure Ukraine’s government to announce an investigation of Biden and his son, Hunter, led to Trump’s impeachment. Though Trump was acquitted by the Republican-controlled Senate, polls showed that a plurality of Americans consistently supported the impeachment, which highlighted evidence that Trump abused his power for partisan political ends. At the same time, a recent POLITICO/Morning Consult poll found that 57 percent of voters believe Hunter Biden’s well-compensated position on the board of a Ukrainian energy firm amounted to a scandal, compared to 19 percent who do not.

Over the course of Biden’s run, reports have trickled out about James, a sometimes business partner of Hunter’s, who has received financial support from people with an interest in influencing Joe and been repeatedly accused of trading on Joe’s clout to advance his business ventures.

Biden has defended his son Hunter and said that his relatives’ business dealings have had no connection to his official duties. But the recent developments related to James Biden’s health care ventures demonstrate that as long as Biden remains in the campaign, the issue of his relatives’ financial dealings is likely to remain as well.

Even before the development surrounding Americore, James Biden’s venture into health care investing has been surrounded by legal allegations and claims that he invoked his brother’s clout.

Last year, two medical services firms jointly sued James Biden and his business partners in federal court in Tennessee, alleging James and his partners promised to provide a large investment from the Middle East, then pushed the firms to make expensive acquisitions, as part of a scheme to drive them out of business and steal their business models. As previously reported, those firms alleged that James Biden cited his family’s political connections and promised his older brother would promote their health care model as part of his 2020 presidential campaign.

Another health care firm sued Platinum Global Partners — a Florida corporation that lists James and his wife Sara as managers — in Palm Beach County in June. The firm, which makes an oral rinse with applications for cancer patients, alleged that Platinum reneged on an agreement to invest in it and requested that Platinum turn over documents related to the Biden Cancer Initiative, a nonprofit founded by Joe Biden to fund medical research. An executive involved in litigation against James Biden previously told POLITICO that, on a call, James said he could get the Biden Cancer Initiative to promote the oral rinse.

The Tennessee case is ongoing. The Palm Beach County case was dismissed without prejudice in November.

James Biden and his partners have denied the central allegations in both cases.

But, in interviews, former executives of Americore offered additional, similar accounts of James Biden invoking his brother’s influence and the promise of investment funds from the Middle East that never materialized in order to push their firm to grow quickly, taking on new financial liabilities.

Unlike those other firms, Americore is now in the sights of the Justice Department.

The precise nature of James Biden’s relationship to the firm — founded by White, a Canadian investment banker, in 2017— is contested.

The plaintiffs in the Tennessee case described him as a principal of Americore and entered a business card identifying him as such into evidence. James Biden has disputed that he is a principal of the firm in court proceedings, though he has not detailed the precise nature of his ties to Americore,which owns hospitals in Pennsylvania, Arkansas and Missouri.

Pritchard and the other former Americore executive, who spoke on condition of anonymity out of fear of retaliation, each said James Biden was actively involved in the company during their tenures there. “Jim was operating as a principal or Jim was portraying that,” Pritchard said. “Whether on paper he had any ownership, I’m not 100 percent sure.”

Pritchard said James Biden first became involved with Americore in 2017, offering to use his political contacts to help the firm land business and investments. “He could get us in front of the unions. He could get us in front of certain people in government. He could get us in front of the right people,” recalled Pritchard, who said he was skeptical of plans to involve James Biden in the firm.

A former employee at Pineville Community Hospital in southeastern Kentucky, which was acquired by Americore in 2017, said she got the impression that James Biden was in a top leadership role at Americore when he visited the facility and introduced himself in early 2018.

The other former Americore executive — who left the firm after less than a year over concerns about its business practices that were unrelated to James Biden — recalled that James spoke regularly of the ways in which Joe Biden’s presidential aspirations could benefit the firm, and vice versa. “His brother was very interested in rural health care and very interested in veterans’ health care, and it was something he really wanted to get behind,” the former executive recalled James Biden saying. “This would help his brother get elected if it were to take off and go.”

Both former executives recalled James Biden said he would help facilitate a multimillion-dollar investment from the Middle East.

Pritchard said the exact source of the funds was never made clear to him. “That linkage was supposed to come via Jim Biden via whatever influence he had through his brother in the Middle East,” said the other former executive, who worked for Americore in 2018.

The plaintiffs in the Tennessee case allege James Biden and his partners aimed to solicit investments from the state-owned Qatar Investment Authority and met in West Palm Beach with representatives of the Turkish conglomerate Dogan Holding. James Biden and his co-defendants denied the allegation about the Qatar Investment Authority and acknowledged meeting with Dogan.

The former executives also said that James Biden began to set up an office on the second floor of Americore’s headquarters in Fort Lauderdale, Fla. “It was like a little shrine to him and his brother and [former President Barack] Obama,” recalled Pritchard, who said he clashed with James Biden over James’ requests to be reimbursed for pricey furniture for the office.

The other former executive said that when he saw the office, several framed photos of the Biden brothers and foreign dignitaries sat on the floor, ready to be hung on the walls.

The former executives also described James Biden’s role in soliciting financing for Americore.

Pritchard said James Biden arranged a bridge loan to Americore via his business partner Michael Lewitt’s hedge fund, the Third Friday Total Return Fund.

But Pritchard said he learned that after Americore received the bridge loan, it made a six-figure loan to James Biden for his personal use.

Lewitt declined to comment, but referred to a letter he sent the Ellwood City Ledger blaming White’s alleged use of high-interest loans for Americore’s problems and vowing to restore the firm’s finances and operations.

Several Americore entities are currently in the midst of federal bankruptcy proceedings, providing a glimpse into their finances.In February, one of those entities, Americore Health LLC, filed a schedule of assets that included $650,000 due to accounts receivable. Pritchard said that figure referred to the loan repayment owed by James Biden.

Pritchard said that after James Biden received his loan payment from Americore, James reduced his involvement with the firm as its financial difficulties mounted.

“Jim needed to lay low because his brother was possibly running for president, and he didn’t need any bad press,” Pritchard recalled, saying that after James stepped back, Lewitt asked to review Americore corporate documents to ensure they did not bear James’ name.

The other former executive said that not long after he first saw the office being set up for James Biden in mid-2018, the office was emptied out.

Meanwhile, Americore’s problems have increasingly spilled into public view.

4 on Trial for Shooting Down MH17

Posted on March 9, 2020March 9, 2020 by Denise Simon

FOR THE 298 victims of Malaysian Airlines flight MH17, shot down by a Russian Army missile over Ukraine in 2014, even a hint of justice has been a long time coming. But each year, investigators and prosecutors edge the case forward. On March 9th a court in the Netherlands will commence the criminal trial of four men (three Russians and one Ukrainian) accused of playing crucial roles in the decision to fire the missile. The hearing will be held in a courtroom next to Schiphol airport in Amsterdam, from where the flight to Kuala Lumpur took off. The defendants will be absent, though at least one will be represented by lawyers, since Russia does not extradite its own nationals and the location of the Ukrainian is unknown. But the biggest absence of all will be that of the Russian government, which bears the ultimate responsibility for supplying, and probably firing the missile.

Russia says its input into MH17 crash over Ukraine ignored ...

Dutch prosecutors say their case runs to 30,000 pages of documentation. After the crash, a research unit called the Joint Investigative Team (JIT)—including investigators from the Netherlands, Australia, Belgium, Malaysia and Ukraine—spent five years meticulously establishing what had happened. The plane’s wreckage was shipped to the Netherlands and reconstructed. Ballistics experts established that it had been shot down by a Russian-made BUK anti-aircraft missile. Mobile-phone conversations intercepted by the SBU (Ukraine’s secret police) appeared to show that Russian military personnel detailed to help pro-Russian separatists in Donbass had directed the operation.

Meanwhile Bellingcat, a digital-forensics group, collected thousands of public-source records from ordinary citizens’ smartphone pictures and dashboard cameras. These showed a convoy including a BUK launcher driving from a Russian army base to the Ukrainian border in the days before MH17 was shot down, and returning just afterwards with one missile missing. The JIT later confirmed Bellingcat’s research, and recovered the spent fuselage of a BUK missile from a field in Ukraine. In 2018 the JIT’s prosecutors announced they had determined that the missile belonged to the Russian army’s 53rd Anti-aircraft Brigade.

The men now facing trial all played important roles in Donbass’s rebel militias in 2014. The most senior, Igor Girkin (also known as “Strelkov”), a Russian nationalist and former army officer, was the minister of defence of the self-proclaimed Donetsk People’s Republic. He maintains his innocence. Sergei Dubinski and Oleg Pulatov, both Russian, and Leonid Kharchenko, a Ukrainian, served in the rebels’ military-intelligence unit. They are accused of having played command roles, rather than of firing the rocket themselves. It is unclear how they will plead or even whether they will respond to the charges. The SBU’s mobile-phone recordings allegedly include two of the defendants conversing with senior Russian officials. No one believes they intended to shoot down an airliner. Rather, the theory is that they assumed the plane belonged to the Ukrainian air force and did not bother to check.

Russia denies having anything to do with the downing of MH17 or giving support to the Donbass rebels. Since the crash it has issued a stream of disinformation and (often conflicting) alternative theories of what happened. The Russian defence ministry released supposed radar data of the incident showing a second aircraft, perhaps a Ukrainian fighter. When the data were shown to have been faked, the ministry never spoke of it again. Last summer after Ukraine captured Vladimir Tsemakh, allegedly an air-defence specialist for the rebels, Russia insisted he be included in a prisoner exchange (an odd demand given that it claims never to have supported the separatists). He was sent to Russia over Dutch objections, and is now believed to be living in Donbass again.

Rebels stall as MH17 bodies left to rot source

The trial’s first days will be devoted to procedural issues, and the defendants’ absence will rob the scene of drama. But although much of the evidence is already public, Dutch prosecutors are thought to have much more unrevealed information which will come out at trial. The trial is expected to last at least for the rest of the year. Even if it results in convictions in absentia, Russia is highly unlikely to change its mind about extraditing the accused men.

Yet while the defendants may not be present, the families of those who died on Flight MH17 will be. Time has been allotted for them to make statements to the court. Russia’s strategy of obstruction and obfuscation has frustrated their demands for justice, but the trial may provide closure for some.

Lebanon is Tail-Spinning into Default

Posted on March 9, 2020March 9, 2020 by Denise Simon

BEIRUT (Reuters) – Lebanon announced it cannot meet its debt payments and halted a March 9 bond payment of $1.2 billion on Saturday, setting the heavily indebted state on course for a sovereign default as it grapples with a major financial crisis.

In a televised address to the nation, Prime Minister Hassan Diab said foreign currency reserves had hit a “critical and dangerous” level and were needed to meet basic needs. He called for “fair” negotiations with lenders to restructure the debt.

source

The default will mark a new phase in a crisis that has hammered the economy since October, slicing around 40% off the value of the local currency, denying savers free access to their deposits and fuelling unemployment and unrest.

The crisis is seen as the biggest risk to Lebanon’s stability since the end of the 1975-90 civil war.

“How can we pay creditors abroad when the Lebanese cannot get their money from their bank accounts?” Diab said. “Our debt has become greater than Lebanon can bear, and greater than the ability of the Lebanese to meet interest payments.”

The long-brewing crisis came to a head last year as capital inflows slowed and protests erupted over decades of state corruption and bad governance.

“We are paying the price for the mistakes of the past years. Must we bequeath them to our children?” Diab said.

The Lebanese had “lived a dream that was a delusion as though things were just fine, while Lebanon was drowning in more debt”, he said.

There has been no sign of a bailout from foreign states that aided Lebanon in the past. Western governments insist Beirut first enact long-delayed reforms to fight waste and corruption.

Diab was appointed in January with backing from the Iran-backed group Hezbollah and its allies. Former prime minister Saad al-Hariri, a traditional ally of the West and Gulf Arab states, stayed out of the government.

NOT PRODUCTIVE ENOUGH

Diab, a little-known academic when he became prime minister, said corruption had drained the state while also criticizing economic policies adopted since the war. Lebanon was importing 80% of its needs and was not productive enough, he said.

He took aim at a banking system that drew capital to the country with dollar interest rates five to 10 times greater than those offered abroad.

“We do not need a banking sector four times the size of our economy. We will have to come up with a plan to restructure the banking sector,” he said.

The gross public debt has reached around 170% of gross domestic product, meaning Lebanon is close to being the world’s most heavily indebted state, he added.

Citing the World Bank, Diab said more than 40% of people could soon find themselves under the poverty line. Lebanon has a population of around 6 million, including about 1 million Syrian refugees.

Lebanon has a total of some $31 billion in dollar bonds that sources told Reuters on Friday the government would seek to restructure.

A set of Lebanon’s bond holders are to step up efforts to form a creditor group in the coming days, one of the members of the group said.

“From what we understand the government wants to be reasonable and so do most creditors. They understand the country is in a difficult situation,” the member said.

Lebanon’s public debt is worth about $89.5 billion, with around 37% of that in foreign currency.

Lebanon has sought technical but not financial assistance from the IMF, though many analysts believe that the only way for the country to secure financial support would be through an IMF program.

“Watch now if bondholders can block any deal,” said Nick Eisinger, principal, fixed income emerging markets at Vanguard, which holds some Lebanese debt but has been underweight in the market for a long time.

“It’s unclear how quick they can go down the restructuring route or get a deal because they need reforms first or at the same time,” he said.

Banks began restricting cash withdrawals and transfers abroad four months ago. Diab indicated the controls could soon be standardized, saying a draft law would “regulate the relationship between the banks and their customers, for it to become more fair and just”.

Erdogan/Turkey Floods Greece with Migrants

Posted on March 9, 2020March 9, 2020 by Denise Simon

Primer: Erdogan broke his pledge to Europe on the Syrian migrant issue.

Ankara opened the door for migrants last week after 33 of its soldiers were killed in a Syrian government airstrike in Idlib, north-west Syria.

President Recep Tayyip Erdogan launched a military offensive in the north of the war-torn country late last year, aimed at creating a safe zone to accommodate the 3.6 million Syrian refugees in Turkey.

The other aim was to oust from the Syrian Democratic Forces (SDF), which it considers an extension of the Kurdistan Workers’ Party (PKK). Turkey says the PKK — which launched an armed struggle against the Turkish government in the 1980s in a bid to form an independent Kurdish state within Turkey — is a terrorist organisation.

A fire broke out at a refugee center on the Greek island of Lesbos Saturday night amid tensions with Turkey over the flow of tens of thousands of mostly Syrian migrants who’ve tried to cross into Greece by land and sea last week.

Flames engulfed the Swiss-run One Happy Family refugee center Saturday night, causing property damage but no injuries, according to Greece’s firefighting service.

The center is located outside the island’s capital Mitilini near the Kara Tepe refugee camp, where about 1,500 refugees live, Swissinfo reported. It served as a meeting place and offered school lessons, a hairdresser, a café and a library to hundreds of migrants daily.

Residents on the Greek islands of Lesbos and Chios have been protesting government plans to build new migrant detention centers amid a renewed influx of refugees, mostly coming across the sea from Turkey. Dozens of police officers were injured when demonstrations turned violent last month with protesters attacking those guarding construction sites for new centers.

After years of living on the front line of the migrant crisis, residents on Greece’s Aegean islands oppose the government building any new migrant detention centers on their islands, and, instead, want asylum seekers relocated to the mainland while they’re processed or await deportation. Existing migrant camps on the islands are already several times over capacity.

Meanwhile on the mainland, the European Union, in an effort to curb rising tensions at its borders, announced Saturday it is allocating nearly $800 million in funding for Greece to be used for establishing and keeping up “infrastructure” at the border.

The dramatic move came amid a sharply escalating crisis after Turkey opened the country’s border to Greece as part of an apparent push to make Europe offer more support in dealing with the fallout of the Syrian war. Late last month, Turkish President Recep Tayyip Erdogan’s government said it would no longer prevent migrants and refugees from crossing over to EU countries, prompting thousands to flock to the country’s land border with Greece.

The mass movement of migrants and refugees to Greece’s borders appears to be organized. Buses, cars and cabs were organized in Istanbul to ferry people to the border, while some of those who managed to cross have said they were told by Turkish authorities to go to Greece and that the border was open.

Meanwhile on the mainland, the European Union, in an effort to curb rising tensions at its borders, announced Saturday it is allocating nearly $800 million in funding for Greece to be used for establishing and keeping up “infrastructure” at the border.

The dramatic move came amid a sharply escalating crisis after Turkey opened the country’s border to Greece as part of an apparent push to make Europe offer more support in dealing with the fallout of the Syrian war. Late last month, Turkish President Recep Tayyip Erdogan’s government said it would no longer prevent migrants and refugees from crossing over to EU countries, prompting thousands to flock to the country’s land border with Greece.

source

The mass movement of migrants and refugees to Greece’s borders appears to be organized. Buses, cars and cabs were organized in Istanbul to ferry people to the border, while some of those who managed to cross have said they were told by Turkish authorities to go to Greece and that the border was open.

Greece deployed riot police and border guards to repel people trying to enter the country. The border area has seen violent confrontations between the migrants and Greek security forces, with officers in Greece firing tear gas to block the migrants and Turkish police firing tear gas back at their Greek counterparts, according to the Associated Press.

Erdogan said his decision to open the border has pushed more than 100,000 people to cross into Greece so far. That estimate is higher than those of Greek authorities, who on Wednesday said 32,000 people have attempted to cross the border. About 230 people, mostly from Afghanistan, had been arrested.

On Saturday, youths threw rocks at Greek police and tried to break down a border fence in a desperate attempt to enter Greece. At least two migrants were injured in the skirmishes.

Erdogan will travel to Brussels on Monday to talk with top EU officials about a 2016 Turkey-EU agreement, which has now collapsed, on containing the refugee flows to Europe. The two sides have accused each other of failing to respect their commitments. More here.

Taiwan More Advanced than U.S. to Deal with Coronavirus

Posted on March 9, 2020March 9, 2020 by Denise Simon

Taiwan, while in a contentious government power struggle with China, the country has a very conservative approach on economic stability and encourages entrepreneurial strengths.

(Reuters) – China is pressuring Taiwan with “provocative” air force maneuvers near the island and spreading fake news to sow discord during the coronavirus outbreak, security sources and government officials in Taiwan say.

This sets the table for why Taiwan’s master plan to thrive during the coronavirus outbreak.

Angry Taiwan blames China for UN aviation meet snub | The ...

You can be assured corporate leaders in the United States are taking notice and are hosting some top level meetings regarding research and development across the country during this anxious time in America and across the world.

Taiwan records its first coronavirus death as global toll ...

Read on for some interesting actions Taiwan has taken given how interacted the country is with China.

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Taiwan is 81 miles off the coast of mainland China and was expected to have the second highest number of cases of coronavirus disease 2019 (COVID-19) due to its proximity to and number of flights between China.¹ The country has 23 million citizens of which 850 000 reside in and 404 000 work in China.²^,3 In 2019, 2.71 million visitors from the mainland traveled to Taiwan.⁴ As such, Taiwan has been on constant alert and ready to act on epidemics arising from China ever since the severe acute respiratory syndrome (SARS) epidemic in 2003. Given the continual spread of COVID-19 around the world, understanding the action items that were implemented quickly in Taiwan and assessing the effectiveness of these actions in preventing a large-scale epidemic may be instructive for other countries.

COVID-19 occurred just before the Lunar New Year during which time millions of Chinese and Taiwanese were expected to travel for the holidays. Taiwan quickly mobilized and instituted specific approaches for case identification, containment, and resource allocation to protect the public health. Taiwan leveraged its national health insurance database and integrated it with its immigration and customs database to begin the creation of big data for analytics; it generated real-time alerts during a clinical visit based on travel history and clinical symptoms to aid case identification. It also used new technology, including QR code scanning and online reporting of travel history and health symptoms to classify travelers’ infectious risks based on flight origin and travel history in the past 14 days. Persons with low risk (no travel to level 3 alert areas) were sent a health declaration border pass via SMS (short message service) messaging to their phones for faster immigration clearance; those with higher risk (recent travel to level 3 alert areas) were quarantined at home and tracked through their mobile phone to ensure that they remained at home during the incubation period.

Moreover, Taiwan enhanced COVID-19 case finding by proactively seeking out patients with severe respiratory symptoms (based on information from the National Health Insurance [NHI] database) who had tested negative for influenza and retested them for COVID-19; 1 was found of 113 cases. The toll-free number 1922 served as a hotline for citizens to report suspicious symptoms or cases in themselves or others; as the disease progressed, this hotline has reached full capacity, so each major city was asked to create its own hotline as an alternative. It is not known how often this hotline has been used. The government addressed the issue of disease stigma and compassion for those affected by providing food, frequent health checks, and encouragement for those under quarantine. This rapid response included hundreds of action items (eTable in the Supplement).

Recognizing the Crisis

In 2004, the year after the SARS outbreak, the Taiwan government established the National Health Command Center (NHCC). The NHCC is part of a disaster management center that focuses on large-outbreak response and acts as the operational command point for direct communications among central, regional, and local authorities. The NHCC unified a central command system that includes the Central Epidemic Command Center (CECC), the Biological Pathogen Disaster Command Center, the Counter-Bioterrorism Command Center, and the Central Medical Emergency Operations Center.⁵

On December 31, 2019, when the World Health Organization was notified of pneumonia of unknown cause in Wuhan, China, Taiwanese officials began to board planes and assess passengers on direct flights from Wuhan for fever and pneumonia symptoms before passengers could deplane. As early as January 5, 2020, notification was expanded to include any individual who had traveled to Wuhan in the past 14 days and had a fever or symptoms of upper respiratory tract infection at the point of entry; suspected cases were screened for 26 viruses including SARS and Middle East respiratory syndrome (MERS). Passengers displaying symptoms of fever and coughing were quarantined at home and assessed whether medical attention at a hospital was necessary. On January 20, while sporadic cases were reported from China, the Taiwan Centers for Disease Control (CDC) officially activated the CECC for severe special infectious pneumonia under NHCC, with the minister of health and welfare as the designated commander. The CECC coordinated efforts by various ministries, including the ministries of transportation, economics, labor, and education and the Environmental Protection Administration, among others, in a comprehensive effort to counteract the emerging public health crisis.

Managing the Crisis

For the past 5 weeks (January 20-February 24), the CECC has rapidly produced and implemented a list of at least 124 action items (eTable in the Supplement) including border control from the air and sea, case identification (using new data and technology), quarantine of suspicious cases, proactive case finding, resource allocation (assessing and managing capacity), reassurance and education of the public while fighting misinformation, negotiation with other countries and regions, formulation of policies toward schools and childcare, and relief to businesses.

Border Control, Case Identification, and Containment

On January 27, the National Health Insurance Administration (NHIA) and the National Immigration Agency integrated patients’ past 14-day travel history with their NHI identification card data from the NHIA; this was accomplished in 1 day. Taiwan citizens’ household registration system and the foreigners’ entry card allowed the government to track individuals at high risk because of recent travel history in affected areas. Those identified as high risk (under home quarantine) were monitored electronically through their mobile phones. On January 30, the NHIA database was expanded to cover the past 14-day travel history for patients from China, Hong Kong, and Macau. On February 14, the Entry Quarantine System was launched, so travelers can complete the health declaration form by scanning a QR code that leads to an online form, either prior to departure from or upon arrival at a Taiwan airport. A mobile health declaration pass was then sent via SMS to phones using a local telecom operator, which allowed for faster immigration clearance for those with minimal risk. This system was created within a 72-hour period. On February 18, the government announced that all hospitals, clinics, and pharmacies in Taiwan would have access to patients’ travel histories.

Resource Allocation: Logistics and Operations

The CECC took an active role in resource allocation, including setting the price of masks and using government funds and military personnel to increase mask production. On January 20, the Taiwan CDC announced that the government had under its control a stockpile of 44 million surgical masks, 1.9 million N95 masks, and 1100 negative-pressure isolation rooms.

Communications and Politics

Reassure and Educate the Public, While Fighting Misinformation

In addition to daily press briefings by the minister of health and welfare the CECC, the vice president of Taiwan, a prominent epidemiologist, gave regular public service announcements broadcast from the office of the president and made available via the internet. These announcements included when and where to wear a mask, the importance of handwashing, and the danger of hoarding masks to prevent them from becoming unavailable to frontline health workers. The CECC also made plans to assist schools, businesses, and furloughed workers (eTable in the Supplement).

Taiwan’s Outcomes so Far (as of February 24)

Interim Outcomes

The CECC has communicated to the public in a clear and compassionate manner. Based on a poll of 1079 randomly selected people conducted by the Taiwan Public Opinion Foundation on February 17 and 18, the minister of health and welfare received approval ratings of more than 80% for his handling of the crisis, and the president and the premier received an overall approval rating of close to 70%. As of February 24, Taiwan has 30 cases of COVID-19. These cases represent the 10th-highest case number among countries affected thus far, but far fewer than the initial models predicting that Taiwan would have the second-highest importation risk.

Challenges

First, real-time public communications were mostly in Mandarin Chinese and sign language. Other than the Taiwan CDC website, there was not enough communication in different languages to non-Taiwanese citizens traveling or residing in Taiwan. Second, while its attention was focused on air travel, Taiwan permitted the docking of the Diamond Princess cruise ship and allowed passengers to disembark in Keelung, near New Taipei City, on January 31, before the ship left for Japan. The ship was subsequently found to have numerous confirmed infections onboard. This created a temporary public panic with concern about community spread. The government published the 50 locations where the cruise ship travelers may have visited and asked citizens who may have been in contact with the tour group to conduct symptom monitoring and self-quarantine if necessary. None were confirmed to have COVID-19 after 14 days had passed. Third, whether the intensive nature of these policies can be maintained until the end of the epidemic and continue to be well received by the public is unclear.

Conclusions

Taiwan’s government learned from its 2003 SARS experience and established a public health response mechanism for enabling rapid actions for the next crisis. Well-trained and experienced teams of officials were quick to recognize the crisis and activated emergency management structures to address the emerging outbreak.

In a crisis, governments often make difficult decisions under uncertainty and time constraints. These decisions must be both culturally appropriate and sensitive to the population. Through early recognition of the crisis, daily briefings to the public, and simple health messaging, the government was able to reassure the public by delivering timely, accurate, and transparent information regarding the evolving epidemic. Taiwan is an example of how a society can respond quickly to a crisis and protect the interests of its citizens.

Article Information

Corresponding Author: C. Jason Wang, MD, PhD, Stanford University, 117 Encina Commons, CHP/PCOR, Stanford, CA 94305 ([email protected]).

Published Online: March 3, 2020. doi:10.1001/jama.2020.3151

Conflict of Interest Disclosures: None reported.

References and footnotes found here in detail.