Oxygen in short supply, elderly patients dying at home alone, hospitals struggling to find beds for the newly infected. These scenes seen from the US to Italy to India for the past 16 months are now playing out in Taiwan — the country that was a model to the world in containing the virus. When Covid-19 was first spotted in China, Taiwan was better prepared than virtually any other country, and meticulously rolled out border control, quarantine and contact-tracing measures that had been sitting on the books ever since Sars hit in 2003. But now infectious diseases experts say health authorities have squandered the chance to learn from the experiences that other countries had while going through outbreaks. “Over the past year, our Central Epidemic Command Center did not recognise the need to prepare ahead of time,” said Su Ih-jen, a public health expert who headed Taiwan’s Centers for Disease Control at the time of the Sars epidemic. First and foremost, Taipei dropped the ball on testing. Throughout the pandemic, health minister Chen Shih-chung resisted mass screening using rapid test kits, insisting on the targeted use of polymerase chain reaction, or PCR tests — a method that yields more accurate results but takes more time. He also blocked research into the efficacy of different rapid test kits on the market and the building of stocks. That has triggered a shortage of test kits and led to vastly diverging accuracy rates in different parts of the country depending on what test kits the local authorities used. The health authorities only last week ordered a state lab to experiment with different test kits to see which were the most accurate — information that could have been easily collected from other countries in the past year. As a result, a large backlog of test samples has formed. This bars the Central Epidemic Command Center from getting a clear, real-time picture of where, how and how fast the virus is spreading — knowledge vital for fighting it. Medical experts also say that Taipei put patients with light symptoms up in the best-equipped hospital beds before the local outbreak. Hospitals were therefore not ready to rapidly take up the large numbers of severe cases arriving now. Another problem appears to be cultural, or even personal. The health minister’s stellar record in keeping the virus out for so long has earned him so much authority that other public health experts have been discouraged from challenging him. In a pun on Chen’s first name, which sounds like the Chinese word for “clock”, criticising the minister is called “going counterclockwise”. “People have realised that going counterclockwise would not end well, and that has discouraged local officials from taking the initiative,” said Su. Some of the country’s biggest strengths in containing the virus over the past year cannot come to bear here: Taiwan’s meticulous contact tracing helped stop earlier small-scale clusters, but the health authorities are now too overwhelmed by the sheer size and speed of the outbreak. Its first significant local outbreak of Covid-19 has so far caused the number of infections to rise seven-fold to 8,511 cases as of Monday and the death toll to balloon from 12 to 124 in three weeks. None of this negates the success Taiwan had in keeping the virus at bay for more than a year. Thus is the nature of a pandemic that it will test just about any health system to breaking point. Taipei now needs a different skillset. While rigour and stubbornly following procedures helped stop the virus in the first round, now speed and flexibility are vital. There are some encouraging signs: under the soft lockdown the number of new cases has started to fall in the past two days. The government has also dropped its opposition to companies conducting rapid screening of their workforces, a step that will allow much more broad-based testing. But there is a long road ahead. Su said: “I worry that we have only seen the tip of the iceberg.”