Background and Objective:
Taiwan was predicted to bear high risk of COVID-19 importation at the beginning of 2020. The author examined available evidence to explore what made Taiwan perform well in 2020, fix its breach in 2021, and overtake the other forerunners in 2022.

Methods:
Pandemic control strategies were categorized into 3 types- elimination, suppression and mitigation. Annual COVID-19 mortality rate, annual excess deaths and Google community mobility trend were used as impact indicators. Cumulative vaccination coverage rate was used to indicate preparedness, and tests per 1000 per day and stringency index in different periods were used to compare public health input.

Results:
In 2020, Taiwan applied swift and strict elimination strategy. At a population size of 23 million, there were only 802 confirmed COVID-19 cases, 7 deaths, and 253 consecutive days with 0 domestic case in 2020. In 2021, a significant breach pushed the daily incidence close to that of UK at the same period, but Taiwan maintained its elimination strategy and eventually returned to zero though it took 3 months with inadequate testing capacity and refusal to lockdown. In 2022, Taiwan cleaned up several Omicron breaches with only 3 deaths by March 31. However, it suddenly announced returning to normalcy with the “New Taiwan Model” on April 1. The daily incidence grew explosively and by November 26, its annual cumulative mortality rate has exceeded most of the other countries.

Conclusion:
By cross-sectional comparison between countries and before-after comparison of the same country, the study shows that community activities were least restricted under elimination, and mitigation was consistently associated with hundred times higher health impact but didn’t bring about normalcy in daily lives when incidence was high. Some countries managed to keep weekly excess death rate within 20% after abandoning elimination, but not Taiwan.